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Thread: BCBS and Medicare

  1. #1

    BCBS and Medicare

    MediCare over our BCBS

    Hi, I'm not sure if I'm in the correct forum to ask about MediCare . . .
    My husband was injured 2 yrs ago and we have BCBS Federal through my work. Prior to his accident we had rarely used our health insurance so, what they have provided from BCBS over these past 2 yrs we feel has been excellent.
    He has been on Soc. Sec Disablity and we were told that MediCare will automatically kick in at the 2 yr date of SS benefit.

    What I'm needing is info on how the process works when MediCare is his primary and BCBS is secondary. Will the level of care change? I have been given some pamphlets from Medicare and will be reading through them but was curious as to what to expect with the change of insurance.

    Any info or in sight is appreciated. Thank you for your time.

  2. #2
    Quote Originally Posted by PBing View Post
    MediCare over our BCBS

    Hi, I'm not sure if I'm in the correct forum to ask about MediCare . . .
    My husband was injured 2 yrs ago and we have BCBS Federal through my work. Prior to his accident we had rarely used our health insurance so, what they have provided from BCBS over these past 2 yrs we feel has been excellent.
    He has been on Soc. Sec Disablity and we were told that MediCare will automatically kick in at the 2 yr date of SS benefit.

    What I'm needing is info on how the process works when MediCare is his primary and BCBS is secondary. Will the level of care change? I have been given some pamphlets from Medicare and will be reading through them but was curious as to what to expect with the change of insurance.

    Any info or in sight is appreciated. Thank you for your time.

    I went through this a while back, though my BCBS was privately purchased preinjury, it became secondary (which was a surprise to me) when Medicare started.

    BCBS undoubtedly reimburses providers at a higher rate than Medicare, so it will be a little more difficult to find providers who accept it. Medicare has some weird rules too... for example my catheters are shipped to me through the mail, but now Medicare requires them to call me and ask me exactly how many days worth of supplies I have left before they ship the next shipment (you know, in case I decided not to piss for a few weeks for some reason). If your experience is anything like mine, then there will undoubtedly be a few long drawn out phone calls by you, arguing with BCBS agents and trying to get someone at Medicare to pick up the phone so the two of them can figure out who pays first. In my experience, pretty much anything that Medicare covers BCBS will cover as well (so if their coverage is better they might pick up some of the left over cost of medicare).

  3. #3
    Thanks for the reply. I figured it wouldn't be without lots of phone call and hassles. I was told by someone that more than likely BCBS will demand Medicare be primary. I was hoping for it to be the other way around.

    Funny about the caths, we've experienced the same thing when a pharmacy calls to refill a shot that he takes every night.

    thanks again, have a good holiday.

  4. #4
    I have Medicare & BCBS. I am very happy with the level of care. I continued to use the providers I always used at the hospital / doctors offices of my choice. Don't have to go to a different place that I don't trust. Medicare pays for some things, then any amount they don't pay for, or if they don't pay for something...BCBS generally picks it up.

    I am going for doctor's visits to see about updating my chair (probably new seating at least) - and that will happen this next week. It's unknown how the new seating will be covered (if at all) but the visits & consults should be covered, at least. Then we'll discuss specifics and see about the seating (I have Cerebral Palsy and am a part time chair user, except I've been falling/losing balance a ton more...so my case is special).

    For everything else I've needed (before I got Medicare and only had BCBS) - I absolutely loved BCBS.

    Also had a family member sustain a TBI about 6 months ago - BCBS was his primary insurance and has paid for 100% of everything he needed, including hospital care (at 3 hospitals), two ambulance rides, a few ER visits on return when he wasn't doing well, and lots of cognitive & physical therapy that has helped him make tons of positive progress. Again, can say I absolutely loved BCBS - kicked in and started paying immediately, no questions asked, "just get him the care he needs, if there's additional funding, (the insurance co) will worry about that later, the pt & pt's family doesn't have to stress themselves over it."

  5. #5
    Senior Member
    Join Date
    May 2010
    Location
    Chesapeake, VA
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    589
    If you have a federal plan, I doubt that Medicare will be primary. The rule is that if there are more that 100 participants (not enrolled but eligible), Medicare is secondary. If it is a plan for a federal employee and you were told that Medicare will be his primary, I would question that.

    We have used BCBS (when Ry was initially injured) supplemented with Medicare once he became eligible and other primary insurers (CIGNA, AETNA, and back to BCBS0. Mt husband works for federal contractors (always large group-more than 100 eligible) and we have had wonderful success. Medicare covers what the private does not. This includes co-pays (once Medicare deductible is met), co-insurance (dependent on plan). We have had HMO, PPO, IPO coverage from the primary insurers and the hardest part has been getting the providers to bill appropriately. I notify Medicare every time our primary insurance changes and they do it right. Since Ry has done significant PT over the years ( 6 years post incomplete C-2 with TBI). The additional coverage has been the reason he can do it. We are living on one income now (Ry is my job) so the co-pays can really add up. Additionally, it allowed RY to enroll for a Part D plan. This covers the portion of his drugs that insurance does not (the co-pay). As I am sure you have learned, these can really add up fast.

    It may add a bit of hassle to your life (making sure everyone knows who is primary) but it can be more than worth it, depending on your husband's current and future needs.--eak
    Elizabeth A. Kephart, PHR
    mom/caregiver to Ryan-age 21
    Incomplete C-2 with TBI since 3/09

  6. #6
    That's great to hear!! Yes, my BCBS is federal (USPS so more than 100 participants)
    Hearing that it may be possible that our out-of-pocket costs might be covered as well, takes a load of worry off of me! Also, allows Paul to have more PT. He had stopped going because of the co-pays adding up.
    My husband was self-employed and lost his business due to the accident. I was amazed at the way BCBS handled everything he needed, as well as staying in contact with me through the entire terrifying journey. I was dreading the thought of his level and ease of care changing. Knowing that if it got to be difficult process to see doctors/PT, billing/claims or added to our medical costs, he would refuse to go and just try to deal with it.

    Thank you for sharing your experiences and info. I love this site, it has been my "go to" for the past 2 yrs. It's has been my solid to have a community of people who are willing to offer their knowledge, experience and suppor, as our life had become so unsteady!

    Best to all

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