14 replies to this topic

[DannyR]

I recieved a letter a couple days ago stating that July I will be eligible for Medicare. I plan on going into the Social Security office here in town but was hoping on getting some from advice from those who have used Medicare in the past. My big problem is I already have insurance through my wifes job that pays 90/10 with a low deductible. If I were to go on Medicare that coverage would still be the same only i would be paying for medicare. One of the benefits would be my prescriptions would be paid 100% for the first $2500 but then what? I take a lot of meds and would probably use that up in the first 6 months. I have read on their site that I can decline it and pick it up later but will have to pay a penalty but it doesn't say how much only that it depends on what drugs I take and how my health is.I was wondering if anyone has done this? I'm thinking Part A is free Part B and D cost but a person really needs to have at least all 3. Funny with all the talk goung on about Social Security and Medicare how I could spend the next 11 years without Medicare but feel they are backing me into a corner with threats of penalties.They will wave those penalities if you have a plan that they callk "credible" which from my understanding has to be through a government agency Federal, State, or Local. It's a maze of legal talk and I'm no lawyer.

[airart1]

just sign up and keep both, dont turn it down or u will have to pay for it, but if u take it the first time its offered u wont have to pay a premium, or thats the way it use to work, but even at 100 bucks a month for 80% coverage, u will never beat that, and who knows if this obama care stands, it might not even be available to u if your not already on it or your wifes insurance might go non existence under his crap.......i made the mistake of turning it down and using my wifes insurance and then i wasnt eligable........

[qbounce]

I'm on my wife's insurance AND I also have Medicare, just this year. So, I can't tell you how things will pan out when her insurance caps out on certain things. I plan on calling her insurance company soon to inquire how Medicare works as a supplementary insurance to our already existing insurance.

I was told by Medicare that it depends on the insurance company you have now, and that employers insurance plan. Some plans picked up by employers are really good and cover everything including eyes and dental, while others don't.

[DannyR]

My wife has pretty good insurance. Eyes,dental,drugs she even has life insurance on me and from what they are telling us they would be a supplemental to Medicare. I am afraid that I will get caught up like airart did if I don't take it now. I realise all insurances are different. From what I am finding out I will have to do both what bothers me is I don't think I will have anynore coverage than I have right now.

[airart1]

i think it will still be to your advantage to have both, i think like they told you medicare will take up the 80 percent and private will pick up the remainder, i know thats how they do the VA, and my moms blue cross blue shield from my late fathers retirement, that once she turned 64 and got medicare, BCBS kicked in as the supplementary to pay the left overage, but if its something like dental, eyes, that medicare dont cover then her BCBS pays......i would think more is always going to be better and even if u do end up paying the 100 bucks for the medicare, u cant get any insurance that pays 80 percent for that money....shoot my private ins was 1800 a month in 1999......just me, not counting my sons was 275 a month.....

[Tetracyclone]

My understanding of the rules led me to believe I would not be penalized for delay in signing up for B and C because of good private coverage, but I took that from the written material. Your local SSI rep may be very helpful with this, and I will reexamine my own options in the light of this discussion.

The government has taken Medicare rules into Wonderland, where even lawyers cannot figure it out.

[airart1]

all i can say is if i took it when i was injured in 1990 the first time i was offered it i woulnt have had to pay the premiums, but when i finally closed the business's and got my dissability in 2000 and signed up for medicare it cost me the 94.60 premium or whatever it is, and my medicare d costs me around 30 dollars i believe, well i went to sign up for medicaide but there is no slot for us disabled unless u have gotten at least 1 ssi check, but they did pay for my medicare a-b premiums, so it was worth it........thats all i know, but i have friends now that have been dropped from medicaide in the past 2 years for no reason and they received ssi.....so since obama has been in, alot of the disabled have been dropped off of there medicaid is what i do know.....just what i can figure from what i'm told every year at my review and experience.......

[tyvin]

This is how medicare determines if medicare will be your primary insurance if there is another insurance. If the private insurance that covers you now has more than 100 people employed at wherever then you keep the private insurance as your primary and medicaid becomes the secondary. If less then 100 medicare is considered the primary and then the private secondary.

I just went through this as my medicare was approved due to the 2 year post accident thing. My private insurance is still supplied by my former work place which employs over 100 people. I found this out when the DME company tried to make the medicare primary when I let them know I had the medicare. I was told that medicare will pick up the latter 20% that is my co-pay but I've yet to see it. Also many qualifying agendas that medicare has are being adopted by the private insurance companies. For instance the qualification for the wheelchair are now what medicare is with my private insurance company. I believe this is all a reaction to what will happen when Obama care hits us (if it does); everyone is getting ready.

Things are changing quickly.

[tyvin]

Also my understanding is that part A and B are free. As far as the Rx programs; none are free when I talked with an associate. It all depends on what meds you take and then a figure is decided on; there were like 5 options. And as far as paying anything for the medicare I don't unless I use it and that would be the co-pay if it was my primary which it isn't or enrolled in one of the drug programs. There appears to be a lot of different understanding about medicare. Though it's a federal program I wonder if it's also individualized by state as far as benefits are concerned?

[DannyR]

I think probably a lot of the confusion comes from the way it is written. From what I found out this morning the part D will more than cover the cost of the premiums. Under my old insurance that I had through my job,they just cut me loose, I paid about $100 for 90 day supply plus what i have to get at the local rx...now with my wifes it will be $500 for a 90 day supply plus what I have to get at the local Rx. The difference being 3 of my prescritions do not come in Generic and are expensive. Under my old plan if I couldn't get them in generic they would pay the same percent but this plan doesn't do that.

[airart1]

really 500 bucks for 90 day supply danny, dang, i use a company called wellcare for my rx supplement and none of my drugs cost much of anything, i dont know what the drug is u are using but wow, i also use the VA and with filling out there means test my prescriptions cost 0.....and my part a and b were not free, from me turning it down, they took it out of my ssdi, but now medicaid pays the premium, i cant get medicaid but i do get my premium of 94.60 paid thru the medicaid program, didnt make sence to me, now this may come about because of the wheelchair, i dont know, didnt ask, i know 25 people on medicare and they pay this premium, it comes out of there ssdi,......even my mom pays it, it comes out of her social security, this is a fact, and medicare is the primary and her blue cross and blue shield is the secondary unless its something that medicare will not pay for.....these are facts.......i'm sure most of this information is on medicare.gov website will explain it, u also got to remember medicaid is decided by the states, so from every state they're going to be different regulations....i havent looked at my handbook in a few years that we get every year, but it used to give the cost of premiums in the first few pages....medicare is federal so the rules apply nation wide, but medicaid is state to state, maybe this is why its different for something tyvin.....oh, u were also talking about co-pays, most of the dr's dont even charge the co-pay here, if u only have medicare they usually just suck up the 20 percent......

Edited by airart1, 23 March 2011 - 06:48 PM.

[airart1]

wow, just googled medicare premiums and it looks like its all changing year to year, wonder how thats gonna affect us all.....check it out.....so i guess some of my knowledge seems to be outdated......i'm not keeping up with the times it don't seem, maybe my VA coverage affects it also, i guess i should research before posting, but these are some major changes from what i was told...i guess under obama care they're gonna squease every dime they can from our ssdi check.......

https://questions.me...-rates-for-2011

Edited by airart1, 23 March 2011 - 06:56 PM.

[DannyR]

For the maintance drugs I have to use Caremark per our insurance we have blue cross through her job and I had blue cross through my old job it's just the difference in the policies. I do take a lot of meds. Remember the old Saturday Night Live with the pharmacist who was always saying "Take A Pill"....that's how I feel sometimes.:-)

[airart1]

but danny is it still costing u 500 bucks a month for your scripts, man that is pretty high and have insurance.......

[DannyR]

That's for 3 months. I have to do mail order and they send 90 day supplies. yeah 500 a month I would have to do without. It would be about 160 a month. This is my first go round with her insurance.