Who Pays?

[te1271]

I am retired from UPS. My wife and I were covered under the Aetna/UPS retirement medical coverage until we turn 65. My wife signed up for Medicare and AARP Plan G. She turned 65 in September so Medicare was set to start on 9/1. On 8/30 she suffered a stroke and was hospitalized from 8/30 until 9/2. Does Aetna and Medicare split the cost since her Aetna coverage ended midnight on 8/31 and Medicare started 9/1? Or does Aetna pick up the charges until she was discharged? Since she was still on the Aetna plan on 8/30 the hospital only asked for those insurance documents and not any Medicare documents. Now Aetna is denying some of the charges from that hospitalization that were submitted after 9/1.

[navymama72]

Yes short answer.   I hope your wife is doing much better.

It is shared cost.   AETNA is denying because Medicare ALWAYS pays first then AETNA.   Call the hospital and doctors offices and provide the the Medicare information.   Problem should resolve.

I am retired VA Hospital Nurse and researched Medicare plans, my employer health plans and supplements for a year before I took Medicare.   Employer plans pick up all remaining costs deductibles- hospitals, lab work, tests like mammograms, Xrays, therapy, etc, etc, follow-up  copays including office appointments and pay whatever Medicare does not.   What I found take Medicare A & B + KEEP employer plan you like and NOT buy supplement (duplication of benefits).  Employer plan IS your supplement.    Insurance and Medicare companies avoid telling you because they are in the making $$$ business.   DO not need to take part C.   Part D is prescription and employer plan likely covers your prescriptions already.   If true, do not need Part D.   When each of you have Open Season - can always change/tweak your choices.

For last 4 years I have paid out $0.00 medical however; prescription copays you pay (exception).

Also, think like you and wife are identified TOTALLY separate (like divorced).   If wife worked should consider keep employer plan if likes it and NOT take straight Medicare only Part A & B.      What you do need to think about if wife is on YOUR plan and you die first she will lose your health plan so need to think ahead.   Hope this helps.   

Medicare and AETNA will be stubborn since switching between insurance.   Need to be diligent.  Any questions or need help welcome to email me navymama72@hotmail.com   

[te1271]

I would love to keep my employer plan but it is set up so that you get those benefits when you retire up to the month you turn 65. In my case I turned 65 last year and my wife, who was also covered under my plan, got to stay on it until she turned 65 in September. Our only option was to sign up for Medicare and purchas a suppliment. We both chose AARP/ United Health Care plan G. Aetna has told me they would pay the expences up to September first and then Medicare and my suppliment would be responsible for all costs starting September first since my Aetna coverage ended midnight August 31. Today I had the hospital submit all the bills starting September first to Medicare. I will wait and see how that is going to work out.

[somarco]

@te1271 it is customary for health insurance to include extended benefits for claims that began before termination of coverage. In other words, Aetna may choose to cover claims from 8/31 through the discharge date. You will need to look through your SPD under the section for "extended benefits" or "extended coverag".

HR may also be able to guide you. UPS should advocate on your behalf.

Had your wife not enrolled in Medicare for 9/1 Aetna would have been responsible for coverage under COBRA.

If Aetna is steadfast in their denial your option would be to ask the providers to bill separately for claims as of 12:01AM 9/1.

[te1271]

I found the answer today. I called Aetnaa and they said they cover everything up to 8/31 the last day of insurance coverage. All bills and services after that date must be submitted to Medicare and my suppliment even if it was a continuing hospitalization.