Medicare Question

[robbase]

Mom is medicare eligble next year. She still works / has health insurance through work. She still plans to work a few more years if possible.

A doctor told her that other than signing up for medicare, she doesn't need to take any action while she is still working because Medicare will serve as her primary insurance and her work insurance should pick up the rest for any medical issues.

Is this correct? is she missing out on anything if she doesn't sign up for some other insurance when she signs for medicare?

I know nothing of medicare stuff.

Thanks

[Gardening Grandma]

I've been on Medicare for just about a year now. I believe that her doctor is correct, with one caveat. Does she have drug coverage through her employer? If not, she should sign up for part D (prescription coverage). If she does not have prescription coverage and does not sign up for a plan, she could be penalized later if/when she does sign up for part D.

[Deleted]

I just checked this in a Medicare "booklet" on-line and she may still want to keep her employer's health coverage. The employer plan is primary, meaning it will pay first. Some doctors limit the number of Medicare patients they'll take because Medicare's reimbursement rates are so low. I'm still working (age 57), DH is on SS (he's 72) and all his expenses are paid by my employer's plan.

Here's the link.

www.medicare.gov/publications/pubs/pdf/02179.pdf

[robbase]

thanks all for the responses so far, I am not sure about prescription drug coverage from her work plan, I will have to find out

I appreciate your assistance

Rob Base

[Gardening Grandma]

The employer plan is primary, meaning it will pay first.
Not necessarily. There are situations even for working individuals where Medicare is primary (pays first)... Page 10 of the above pdf file has a chart that shows when Medicare is primary and when the company insurance is primary, Medicare says the chart doesn't cover all situations, so you have to check with the benefit office.

[Deleted]

Yeah, I can see that if she's with a small employer, for example, Medicare pays first.

The OP said he was going to check into prescription coverage- one thing I noticed was how high the cost of Medicare prescription drug coverage can run. In the highest income brackets, it's over $300/month. Part of the decision, in addition to the quality of both plans, should be the out-of-pocket cost for coverage. Even though there's no charge for Medicare Part A (hopsital coverage), the charges for Part B (doctor visits) and prescription coverage could well exceed what she's paying for her share of the cost of employer coverage.

[frisbee21]

If her employer has 20+ employees, the group plan pays primary and she does not need Medicare until she quits active work.

Medicare Part A (hospitalization) is free. Enrollment in Parts B (doctor, outpt) and Part D (prescription drug) can be delayed without penalty until she quits working. The cost of Part B is income-based and the cost of Part D depends on the plan she chooses. On top of all this, she should get a Medigap policy too when she quits working.

If her employer has less than 20 employees, then Medicare is primary and her employer will probably require her to be enrolled in at least Parts A & B. (Probably not Part D or Medigap until she quits working but she should really check with the benefits person at her company).

FYI, Part B is the expensive piece based on prior income -- up to just over $300/month for high incomes. Part D (drugs) cost between $30-$100/month depending on the plan and vendor. Medigap usually $120-$200/month -- these are all Wash DC estimates and vary by geo area and plan.

It's very confusing for seniors. Hope this helps.

[Deleted]

Jan 9, 2011 15:20:31 GMT -5 @frisbee21 said:

It's very confusing for seniors. Hope this helps.

That was my impression. I'm 57, computer literate, I work in the insurance business (property-casualty, not health) and I'd have a hard time making some of those decisions. No wonder seniors get confused with all the options. My favorite was the "doughnut hole" (which we call a "corridor deductible" in the business) in the prescription plans. It really caught a lot of people by surprise. What a wretched idea!