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Re: Forced to Join Medicare

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@Igotubabe wrote:

My husband is a 100% diasbled vet and I am entitled to Champva benefits. Before turning 65, Champva paid my co-pays and our Federal BCBS paid the lions share. Once I turned 65, I was forced to join Medicare A&B so that I could keep my Champva. Now Medicare is considered my primary so they get billed first even if it's something they do not cover so I have to wait on their denial before anyone can charge BCBS and Champva. We don't want to give up our BCBS as we can never get it back but I don't understand why I am forced to have Medicare as my primary when I have a great BCBS policy. Would I be better off giving up BCBS and Champva and take a medicare supplemant? As of now, everything is covered. Champva pays all my scripts, Medicare pays first for doctors and then BCBS. Trouble is we pay a lot out of pocket for BCBS. My husband gets full care from the VA and he did not pick up Medicare B so we dare not give up the BCBS. Any advice or anyone understand why Medicare has to be my primary when I have prefectly good insurance. 


Let me say 1st that since you are Medicare age and your husband is a Vet with a 100% service related disabity - then there is no more "We" in picking a health plan and in your case, health planS.  You pick yours and he should pick his to get the best coverage for the individual.

 

i am assuming that you are a RETIRED Federal worker and that is the reason things are set up as they are with all your insurance plans.  Federal benefit rules say that your Federal Health plan becomes secondary when you reach Medicare age UNLESS you are still working, then the Federal Health plan remains primary.

Everything done in government healthcare cost is done because of money.

 

Easiest solution for your coverage is to go back to your Federal job - then BCBS becomes your primary and you can hold off on Medicare until you stop working.

Your CHAMPVA would remain either way, the way it does now or in combination with BCBS like it was before you stopped working.

 

Right now, like you said, your benefits are paid in a hierarchy - Medicare, which gets the best price from providers of the plans, pays 1st, they send it on to the others and your retiree insurance pays 2nd, then onto CHAMPVA.  As long as the providers accept assignment in Medicare / CHAMPVA (same ones should accept both) and they are in your BCBS Retiree network, you should have little out of pocket cost on everything that Medicare deems medically necessary and medically necessity can always be appealed if there is a problem.  

 

Denial by Medicare of a service that is medically necessary could happen but not that much.  Anything in particular since you mentioned this happening.  Also if you register for an account under MyMedicare - you can pretty much see your claims as they are processed under Medicare whereas if you wait for the EOB, in paper format, they only mail those quarterly.

 

Yes, you do have to pay your Medicare Part B premium but you should be covered under the other (2) for any deductibles for Medicare.  CHAMPVA does have a pretty good pharmacy program if the medications are covered and you utilize Meds by Mail.  If you pick up a Medicare Part D plan which you would have to do if you dropped CHAMPVA that would mean another monthly premium to pay in addition to whatever Medicare Supplemental plan you pick.  

 

Remember also that that there is only a narrow window a little before and a little after Medicare eligibility and a few other very specific events where you can pick up a Medigap plan with guaranteed issue rights - meaning that the insurer don't consider health conditions, age, underwriting when setting your premiums depending upon federal and state rules.  Sometimes, depending upon your state rules, they can also deny you.  Just mentioning this so that you have all the bases covered when you make your decision.

 

Depending upon what coverage your BCBS gives you now and the cost of the premium compared to what your selected Medigap plan would cost you in premiums - that maybe where your decision lies and making sure you can get a Medigap plan without underwriting.

 

CHAMPVA cost you nothing and you do get benefits from it when combined with Medicare.

 

I believe the same similar cost and benefits might be your husbands case too.

A comparison of his ( I assume spousal )BCBS premium to Medicare Part B premium might be part of the decision.

 

Medicare Part B insurance helps pay for doctors' services and outpatient care. It will cover him if he has an emergency and is taken to a non-VA hospital. Without Part B, he might have to pay some of those costs himself.  He also may have the need to use medical providers outside the VA system.  However, using a provider outside of the VA could change but there are few details at present to actual do an analysis on this right now.  

 

But  if he uses the VA for all of his care and there is a great deal of difference between these premiums - it should still be a consideration.

 

What benefits do you see in this BCBS plan for you (with Medicare and CHAMPVA) and for your husband (with the VA) ?  Does the VA send claims to BCBS or is his rating such that the VA takes care of it 100% including medications; I'm guessing the later with his rating.

 

 

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MY SIGNATURE: "It’s Always something" - Roseanne Rosannadanna
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Re: Forced to Join Medicare

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Message 2 of 12

My husband is a 100% diasbled vet and I am entitled to Champva benefits. Before turning 65, Champva paid my co-pays and our Federal BCBS paid the lions share. Once I turned 65, I was forced to join Medicare A&B so that I could keep my Champva. Now Medicare is considered my primary so they get billed first even if it's something they do not cover so I have to wait on their denial before anyone can charge BCBS and Champva. We don't want to give up our BCBS as we can never get it back but I don't understand why I am forced to have Medicare as my primary when I have a great BCBS policy. Would I be better off giving up BCBS and Champva and take a medicare supplemant? As of now, everything is covered. Champva pays all my scripts, Medicare pays first for doctors and then BCBS. Trouble is we pay a lot out of pocket for BCBS. My husband gets full care from the VA and he did not pick up Medicare B so we dare not give up the BCBS. Any advice or anyone understand why Medicare has to be my primary when I have prefectly good insurance. 

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Re: Forced to Join Medicare

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Message 3 of 12

@ASTRAEA wrote:

@GailL1 wrote:

 

You will have to give more details for a precise answer.


@GailL1 - I believe I started by saying that she died back in 2005, and I didn't ask any question that needed to be answered. I just mentioned her possibly outdated experience, being able to retain private health insurance thru her former employer - The City of New York - without having to sign up for Medicare, and that she received refunds annually for not using it.


Yes, the City of New York had a Health Benefit Program - and your Aunt could have gotten a refund of her Part B premiums -

http://psc-cuny.org/clarion/january-2015/getting-refund-medicare-part-b-premiums

 

She could have opted no to get Medicare and remain with her City of NY Health Benefit program -

(See #4 at this link)

City of New York Health Benefits Program Frequently Asked Questions for Retirees

 

There are several state and I guess city special exceptions and circumstances but these are not the norm.

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MY SIGNATURE: "It’s Always something" - Roseanne Rosannadanna
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Re: Forced to Join Medicare

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Message 4 of 12

@GailL1 wrote:

 

You will have to give more details for a precise answer.


@GailL1 - I believe I started by saying that she died back in 2005, and I didn't ask any question that needed to be answered. I just mentioned her possibly outdated experience, being able to retain private health insurance thru her former employer - The City of New York - without having to sign up for Medicare, and that she received refunds annually for not using it.


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Re: Forced to Join Medicare

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Message 5 of 12

Were her working years covered under an employer that did not participate in Social Security or Medicare programs - maybe a state or federal employee?

Social Security.gov Publication - How State and Local Government Employees are Covered by Social Sec...

 

If she did pay into the Medicare program - she left benefits on the table but of course, if her retiree insurance covered everything and they paid 1st, then there was no need for Medicare to pay anything.

 

You will have to give more details for a precise answer.

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MY SIGNATURE: "It’s Always something" - Roseanne Rosannadanna
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Re: Forced to Join Medicare

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Message 6 of 12

@GailL1 - My aunt had an HMO thru her former employer, and never signed up with Medicare. She received NO coverage thru Medicare.


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Re: Forced to Join Medicare

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Message 7 of 12

@ASTRAEA

You are confusing "Employer/Employee" Insurance with Employer "Retiree" Insurance - not the same.

 

Medicare will work with employers that have both an "Employer/Employee"(still working) or a 'Retiree' (no longer working) insurance plan - the size of the employer determines who pays 1st - the Retiree plan or Medicare.

 

Medicare.gov - Which Insurance Pays 1st

 

Medicare.gov - Retiree Insurance

 

However the OP has an HSA plan at her emloyer most likely with a HDHP, she also wants to start drawing a SS benefit and continue to work and because of taxation reasons, Medicare does not work with HSA plans - you will get penalized if you do not withdraw from your HSA plan before beginning Medicare.

 

The OP may also have other employer/employee health coverage options other than an HSA depending upon her employer but those premiums maybe higher.

 

She cannot keep the HSA type plan if she:

1.  decides to get a Social Security benefit

2.  abd she is older than 65 - the Medicare eligibility age

 

 

 

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MY SIGNATURE: "It’s Always something" - Roseanne Rosannadanna
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Re: Forced to Join Medicare

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Message 8 of 12

@WebWiseWoman, @GailL1 - That wasn't always the case, or may depend on the employer. My aunt who spent her last 3 years with me had worked for the City of New York. After she moved in with me, in her late 80s, and I began helping with all her paperwork, I realized she still had private medical insurance as a retiree. In fact, she would get an annual "refund" from Medicare, for not using their coverage! She died 12 years ago, so corporate & Medicare rules may have changed since then.


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Re: Forced to Join Medicare

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Message 9 of 12

That is exactly right because HSA's do not work with Medicare- basically because of tax reasons.

 

You are being required to join in Medicare Part A because you are over the age of 65 and are going to be drawing a Social Security benefit.

 

This will explain all the tax related reasoning -

BenefitsPro 01.04.2018: Medicare and HSA eligibility: Understanding the rules

 

So, you do have an option of NOT drawing a Social Security benefit and not being required to sign up for Medicare Part A until you have stopped working and lose your employee health benefit along with your HSA.  As long as your employer does not require you to sign up for Medicare, some or all of its parts, when you turn 65 because some employer plans turn into other Health coverage when you turn 65, like a supplemental plan.  Depends on the size of your employer.

 

Kiplinger: Medicare, Social Security and Your Health Savings Account

 

However, if you are going forward with your plan of drawing a SS benefit and having to sign up for at least Medicare Part A, be sure that you talk to your company's HR Dept. about credible coverage and this coverage documentation will need to be submitted to CMS when you decide to take Medicare Part B and Part D.

 

Credible coverage has to be approved by Medicare so that when you do sign up for all the parts of Medicare, particularly the beneficiary premium payment of Parts B and Parts D, you are not assessed a premium tax penalty FOREVER.

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MY SIGNATURE: "It’s Always something" - Roseanne Rosannadanna
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Re: Forced to Join Medicare

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Message 10 of 12

Great information, Astrea (again)!

 

My Employer has a document in our portal that addresses this issue and states exactly what you wrote, so this (imho) is Employers dumping we who have worked so long, and can still work and be productive.

 

In the US, Employers can stop providing health insurance due to the availability of what has become inferior health care system Medicare...

 

#VegasStrong

 

Phil Harris, actor and showman, to John Fogerty of CCR: “If I’d known I’d live this long, I’d have taken better care of myself.”
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