Should I Cancel Medicare?

[jr8049]

I have Medicare as my primary and GEHA (a private plan thru my former Federal employment) as secondary. I am concerned that I am being treated as a second class citizen because of Medicare being Primary. I am concerned that, when I go see my doctor, they see that I have medicare and they realize that to perform a certain procedure they will not get paid near as much as if I had private insurance which, unfortunately, will determine if I get the procedure.. I saw a quote from Dr John Noseworthy of the Mayo Clinic: "The Mayo Clinic will prioritize the care of privately insured patients over those on Medicare and Medicaid". I am considering stopping my Part B of Medicare and just have GEHA as my only insurance. I realize that I will have more expenses (deductibles and coinsurance) but better care will compensate for that. I didn't realize, until recently, that having a private health insurance plan as secondary doesn't add any benefit to the doctors or hospitals but only covers my coinsurance and deductibles. Does anyone see any red lights in this idea?

[somarco]

@jr8049 

If you cancel Part A you will forfeit your SSA benefit.

If you cancel Part B then later decide to reinstate, you will pay a late enrollment penalty.

If you pay anything at all for your GEHA coverage you are possibly paying too much.

Mayo does not accept Medicare assignment and will bill excess charges. If your GEHA plan does not cover XS charges you will be responsible for them.

[fffred]

@somarco 

Very interesting! Thank you for the information.

I was aware of the premium surcharge for any hiatus from Medicare Part B (if I remember correctly, it's 10% for each year of hiatus...although this is the "late" penalty, I wonder if it's different for a "break").

But I was unaware of the link between Medicare Part A and forfeiting one's SS retirement benefit. This is good for me personally to be aware of.

It's likely that I will be moving north to my wife's home country and would no longer need Medicare Part B. I figured that if "something" happens in the future and I returned to the US the extra 10% in Part B premium (for each year out of the system) would not break me. And I figured that I might maintain it for up to a year just to see how things go up there. But I would surely be annoyed to entirely lose our SS old age benefits.

Now I'm wondering if it is even possible to "pause" Part B. But it does seem to be possible per this SSA document https://faq.ssa.gov/en-us/Topic/article/KA-02713 and the referenced form CMS-1763.

Again, thanks for pointing to this potential issue.

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@somarco wrote: 

If you cancel Part A you will forfeit your SSA benefit.

If you cancel Part B then later decide to reinstate, you will pay a late enrollment penalty.

[somarco]

I was aware of the premium surcharge for any hiatus from Medicare Part B (if I remember correctly, it's 10% for each year of hiatus...although this is the "late" penalty, I wonder if it's different for a "break").

The CMS term for hiatus is disenroll and then later re-enroll.

The penalty will apply (10% for each 12 month block where you are without coverage). At least in theory you could drop B for 11 months and avoid the penalty. However, if you are not eligible for an SEP to re-enroll then you must wait until the GEP (General Enrollment Period) which is Jan thru Mar of each year. Your Part B would start in July of that year.

If you disenrolled in January then wanted to re-enroll for December (11 months without B) you would be "cheated" out of your plan to game the system unless you have an SEP.

If you disenroll from Part B to join an employer group plan then penalty is waived as long as you re-enroll within 8 months of losing your group plan AND you did not take COBRA.

If you "move up north" and later want to re-enroll in Part B you can do so during the GEP, wait for coverage until July of that year and pay the late penalty.

The beauty of all this is, only folks in DC could come up with such twisted rules and exceptions.

The SSA link you provided effectively says you CAN drop Part B if you complete the required form, have a psychological evaluation and submit to the SSA interrogation.

It was much easier for the Prodigal Son to leave and return to the family than it will be for you to leave and come back to Medicare Part B.

Any questions?