Re: Medicare/ins questions

[Guest guest]

Do you have the Medicare book explaining benefits. If not, you really need one.

I know for the state (Alabama) we are in Medicare is the primary. It might very

from state to state. When I looked for a supplement for my dad I made sure to

get a plan that paid the Medicare deductables and then he was covered 100%

except for medication. The same was the case for my mother-in-law. I recommend

you go on line and check things out since you are a disability.

It is terrible to need medical care and have to worry about your coverage. I

wish the best for you.

Regina

>

> Can anyone help? I am currently on Medicare - under 65 - for disability. I

chose a supplement - Humana - for an additional cost per month (which I am not

sure I need). My hubby was recently hired and has been offered insurance. I

have been trying to crunch the numbers but it all comes out to be still so

expensive and still so confusing. When I called medicare with my questions, all

they can say is " it depends " . When I called the new insurance, their response

is the same.

>

> Questions:

> If a person is on medicare and has another insurance, will medicare be primary

or will the other insurance be primary?

>

> If a person is on medicare, do they need the supplemental insurance?

>

> When I get my Orencia infusion, I have to pay the 20% co-pay along with my

deductible. If I have a secondary insurance, will I still have to pay the

co-pay, will I still have to pay the deductible?

>

> With the new insurance, there is a $500 deductible. Having medicare and the

new insurance, do I have to be concerned about the deductible?

>

> Where does a person go for answers?

>

> Thank you all for your help and assistance.

>

[Guest guest]

Joanne,

I'm on Medicare, and I have a supplemental insurance, too. Medicare is

my primary, and it has a deductible and they pay only 80% of what they

approve, plus they don't help pay for my medications. My supplemental

helps with these additional expenses. I happen to have a deductible

with the supplemental, too, but that's because it's a continuation of

my state employees' insurance that I don't have to pay for. With a

supplement that you do pay for, they should pay more than mine does.

Your supplemental may help pay for your deductible and the Orencia

infusion, also prescriptions. It depends on the individual policy as

to how much they pay.

Sue

On Oct 5, 2009, at 4:18 PM, Joanne Dubnicka wrote:

> Can anyone help? I am currently on Medicare - under 65 - for

> disability. I chose a supplement - Humana - for an additional cost

> per month (which I am not sure I need). My hubby was recently hired

> and has been offered insurance. I have been trying to crunch the

> numbers but it all comes out to be still so expensive and still so

> confusing. When I called medicare with my questions, all they can

> say is " it depends " . When I called the new insurance, their

> response is the same.

>

> Questions:

> If a person is on medicare and has another insurance, will medicare

> be primary or will the other insurance be primary?

>

> If a person is on medicare, do they need the supplemental insurance?

>

> When I get my Orencia infusion, I have to pay the 20% co-pay along

> with my deductible. If I have a secondary insurance, will I still

> have to pay the co-pay, will I still have to pay the deductible?

>

> With the new insurance, there is a $500 deductible. Having medicare

> and the new insurance, do I have to be concerned about the deductible?

>

> Where does a person go for answers?

>

> Thank you all for your help and assistance.

>

[Guest guest]

Hi i also have medicare , my husbands insurance and blue cross supplementary

insurance. in most cases 99% if you have insurance with your work or your

husbands Medicare is Second, your husbands becomes Primary and if you feel you

need it your supplementary is Third. the supplementary is supposed to pick up

the 20 % Medicare doesn't pay for the supplementary plan is different for many

people. so for me this is how it goes I go to my hospital for an ER visit and

then they first bill my husbands insurance and the copay is 75 dollars from his

insurance then they bill Medicare and medicare will bay 80% of the 75 dollars

that is left from the first insurance then my Blue Cross sup. insurance will

cover the rest. I only keep the third insurance because i have been so ill. we

have to claim bankruptcy from the medical bills I have. so now I just make sure

i am covered. as for destructible your medicare has a deductible of 137 a year

your primary insurance would cover that medicare doesn't care who pays the 137

your are responsible for it so if you have another insurance pay that is fine

they will never know. now supplementary insurances will not cover any thing that

medicare does not cover so they will not cover the 137 or like jaw surgery is

not covered by medicare so jaw surgery would not be covered by the

supplementary. the 500 dollar deductible that you have with your husbands

insurance you guys would have to cover and for my family that is easy one trip

to the ER and that is billed and then the 500 is owed by us personally. this is

how it works for me in my state and with my insurance as i said before you

supplementary may be different but the rules with medicare are pretty much the

same for most. medicare is almost always secondary unless the insurance your

covered by is from a retired spouse this is what they have told me. i hope i did

not make this more confusing . I do not work for medicare so I am not an expert

but for myself and my parents this is how it worked. if you called medicare and

they had no answers for you call back and ask for medicare coordinator of care

people and go form there best of luck Northern Michigan

>

> Can anyone help? I am currently on Medicare - under 65 - for disability. I

chose a supplement - Humana - for an additional cost per month (which I am not

sure I need). My hubby was recently hired and has been offered insurance. I

have been trying to crunch the numbers but it all comes out to be still so

expensive and still so confusing. When I called medicare with my questions, all

they can say is " it depends " . When I called the new insurance, their response

is the same.

>

> Questions:

> If a person is on medicare and has another insurance, will medicare be primary

or will the other insurance be primary?

>

> If a person is on medicare, do they need the supplemental insurance?

>

> When I get my Orencia infusion, I have to pay the 20% co-pay along with my

deductible. If I have a secondary insurance, will I still have to pay the

co-pay, will I still have to pay the deductible?

>

> With the new insurance, there is a $500 deductible. Having medicare and the

new insurance, do I have to be concerned about the deductible?

>

> Where does a person go for answers?

>

> Thank you all for your help and assistance.

>

[Guest guest]

Regina is correct. Every State has a Medicare booklet for the insurances that

are used with Medicare.

There are three types of insurance - Supplements, Assignments and Advantage

plans.

Supplements, do what the name implies. They 'supplement' your medicare

insurance. Medicare is billed first.

Assignments are like a HMO. Medicare " assigns " the medicare insurance premium

to the Assignment Insurance. You usually have to choose a Medical Group, and

have to use their doctors. They usually have a co-pay, but some do not.

Advantage plans are like a supplement, but pay everything. They are usually

more expensive that the other plans. They usually pay everything above the 80%

that Medicare does not pay and the yearly deductable. This is the plan I have,

yes it's expensive. Even with getting it through my Employee's retirement.

Then again, I will not have to pay anything out of pocket for my surgeries.

Now for those people who have insurance through their State, it is generically

called Medicaid. Medicaid is the insurance of last resort, and is billed last.

In our cases, if you are on SSI, you will have Medicaid. After 24 months, if

you also have SSI/SSDI, you will be eligible to Medicare. Medicare gets billed

first, and most medical offices do not bother billing Medicaid at that point

because Medicare reimburses at a higher amount.

The Best Advice I can give you --

Call your doctor's office, both Primary Care and Rheumatology. Ask for the

person who does the billing (accounts receivable). That person usually will let

you know which insurance companies work best for them and YOU.

For your questions

> > If a person is on medicare, do they need the supplemental insurance?

YES, especially if you are on disability. We never know when we will need

something more than just our regularly scheduled visits and medication. An

example, I would never have though I would be having spinal surgery. The 20%

that Medicare does not pay would have done me in. I would have been responsible

for tens of thousands of dollars, it makes the deductable I pay seem like

nothing.

> >

> > When I get my Orencia infusion, I have to pay the 20% co-pay along with my

deductible. If I have a secondary insurance, will I still have to pay the

co-pay, will I still have to pay the deductible?

> >

Depends on the insurance. You have to call the insurance company or talk to the

billing office at your doctors office. If you can figure it out, check out the

insurance companies website.

> > With the new insurance, there is a $500 deductible. Having medicare and the

new insurance, do I have to be concerned about the deductible?

Maybe?

**** There are two other items to consider. If your husband's insurance is

better than medicare & supplement. You can call Medicare and ask for the premium

to be suspended, and get insurance only from your husband's insurance through

his company. OR Call the insurance company directly and ask if they have a

Medicare supplement. If they do ask for information, it can be a great way to

go.

So, you are probably confused beyond belief. Write out on a grid the pros and

cons. Or just what each insurance offers. Yes, it is very confusing.