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Thread: Medicare?

  1. #11
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    Quote Originally Posted by SCI-Nurse View Post
    You can only add Medicare B back during a Medicare "open season", so if you find you need it and don't have it, then you may have to wait months to sign up. Remember that Medicare A essentially pays only for hospitalization, not for doctors office visits, PT, OT, home care skilled nursing, etc which is covered under Medicare B only. I believe DME is also under Medicare B.

    You can find a ton of information about Medicare here: http://www.medicare.gov


    (KLD)
    I think you can also add it if you have a "qualifying" situation, ie, if your husband were to be laid off, and lost his insurance, you could pick up part B.
    T7-8 since Feb 2005

  2. #12
    Senior Member zillazangel's Avatar
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    Quote Originally Posted by sjean423 View Post
    Zilla, it is different if the group plan is the spouse's. ie If Chad were covered under a group plan where you work.

    And, it has to do with the size of the company, as mentioned above. I am also in the situation, where my insurance through my husbands plan is primary, and medicare is secondary.
    So if I covered him under my employer's plan, I could make my employer's coverage primary (my company is massive), and Medicare secondary? That would be quite advantageous potentially. Hmmmmm.
    Wife of Chad (C4/5 since 1988), mom of a great teenager

  3. #13
    Senior Member redbandit's Avatar
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    That was my situation, zilla. When my wife was working I was on her plan with Wyeth (now Pfizer) and my Medicare was secondary. It should work that way for you.

  4. #14
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    Quote Originally Posted by zillazangel View Post
    So if I covered him under my employer's plan, I could make my employer's coverage primary (my company is massive), and Medicare secondary? That would be quite advantageous potentially. Hmmmmm.
    You don't get to "choose" who is primary, there is some rubric, but a disabled spouse covered under the plan of the non disabled spouse, who works for a big company, (not sure of the headcount, it was mentioned before) ends up with medicare secondary. Altho, you would be choosing, but switching of course.

    It works out well for me, Cigna gets the bill first, does their reasonable and customary, in network agreement magic where they make money disappear, pays their part, and then it goes to medicare. After I hit the medicare deductible, they pick up a good part of what cigna doesn't. For instance, I just got a lab bill for $1.84.

    If you go that way, be prepared to tell the billing peeps, over and over that medicare is secondary. They tend to mess that up a lot. And even at the eye doctor, it has to go through cigna first, and get denied, even tho we don't have vision care.
    T7-8 since Feb 2005

  5. #15
    https://www.shiptalk.org/About/SHIPr...spx?mf=Display

    Also every state has an Number where you can call with questions like this.
    If you can't handle me at my worst, then you sure as hell don't deserve me at my best.


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  6. #16
    Super Moderator Sue Pendleton's Avatar
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    Your Part B premium now goes up based on your joint adjusted gross income on your tax returns and is adjusted yearly.

    SJean has the same type coverage I did. My husband's insurance was primary to my Medicare until just recently when he retired and now his old insurance is both of our secondaries. And it got very old telling everyone Medicare was secondary and have them bill it wrong anyway.
    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

  7. #17
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    Quote Originally Posted by Sue Pendleton View Post
    And it got very old telling everyone Medicare was secondary and have them bill it wrong anyway.
    Exactly! Over and over for one provider. And both for small offices and big hospitals.
    T7-8 since Feb 2005

  8. #18
    Super Moderator Sue Pendleton's Avatar
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    Quote Originally Posted by sjean423 View Post
    Exactly! Over and over for one provider. And both for small offices and big hospitals.
    I finally asked my doc's billing clerk if they used an outside system and they did. I called them and said if they could not manage getting their computer programs to light up the date of birth on Medicare claims then the next time they sent my bill to Medicare first I would be calling 1-800-xxx-xxxx, the Medicare Reporting Office for Fraud, Waste and Abuse. Never had another problem until they switched billing offices so I just called pre-emptively and that also worked. My doc's billing clerk had huge numbers on all the copies of my cards so she was not the problem.

    Never did figure out how to deal with Hopkins but they figured out a way to get paid twice during the last reimbursement cut by charging Medicare one bill to A for the hospital based clinics and a second to B to pay the clinic physician. That part is/was legal. But then I had to fix 2 bills each visit but only to the main hospital based outpatient clinic not to the Brady Uro Institute at another Hopkins' hospital.

    Now I just get asked if I am eligable for VA benefits on each visit to my UW hospital, clinics and centers. Obviously they scanned my social through vets who registered their service with their home state. Always wondered why that question was on my out processing papers when I ETS'd and checked on my DD214. But otherwise all my billing is through one system and my husband is now too since he hit the magic 65. Rather nice just scanning EOBs for any actual mistakes.
    Courage doesn't always roar. Sometimes courage is the quiet voice at the end of the day saying, "I will try again tomorrow."

    Disclaimer: Answers, suggestions, and/or comments do not constitute medical advice expressed or implied and are based solely on my experiences as a SCI patient. Please consult your attending physician for medical advise and treatment. In the event of a medical emergency please call 911.

  9. #19
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    One billing office got it figured out finally, after being fined for filing to late w/ medicare. The sent it to medicare first at least twice, and denied b/c medicare wasn't secondary, then FINALLY sent it to cigna (I called both times I got the medicare denial). When it finally got to medicare properly it was late, and fined. I think the doctor got involved with his billing service at this point (it was not done by his office either).
    T7-8 since Feb 2005

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