by Guest » Fri Oct 19, 2012 11:28 pm
Hi,
I live in California. I was in an accident and hurt my neck at work in 1999. I was on workers compensation until 2005. During that time I was approved for SSD w/Medicare part A & B. I dropped part B in 2004 because I could not afford the payments.
In 2006 my spouse got a good job that includes Cape Blue Shield insurance, we both have the insurance. They have not asked if I was working or on disability during yearly enrollment and there was no addendum or rider for my neck injury. I have now been insured with Blue Shield 8 years. Along with illnesses, I have had steroid shots and a couple MRI’s for my neck.
This week I got a letter from blue Shield asking if I qualify for Medicare! Yikes! I have been doing a lot of reading, (I always over-think things) and I hope I am wrong, but I think it looks like maybe I will owe?? - I'm not even sure if i should answer back to them :(
Bottom line is: Can Blue Shield recover “subrogation” for my neck because I have Medicare part A and qualify for part B? :shock:
Help - Any advise will be greatly appreciated!!
I live in California. I was in an accident and hurt my neck at work in 1999. I was on workers compensation until 2005. During that time I was approved for SSD w/Medicare part A & B. I dropped part B in 2004 because I could not afford the payments.
In 2006 my spouse got a good job that includes Cape Blue Shield insurance, we both have the insurance. They have not asked if I was working or on disability during yearly enrollment and there was no addendum or rider for my neck injury. I have now been insured with Blue Shield 8 years. Along with illnesses, I have had steroid shots and a couple MRI’s for my neck.
This week I got a letter from blue Shield asking if I qualify for Medicare! Yikes! I have been doing a lot of reading, (I always over-think things) and I hope I am wrong, but I think it looks like maybe I will owe?? - I'm not even sure if i should answer back to them :(
Bottom line is: Can Blue Shield recover “subrogation” for my neck because I have Medicare part A and qualify for part B? :shock:
Help - Any advise will be greatly appreciated!!
Posted: Sat Oct 20, 2012 05:54 pm Post Subject:
Workers' Comp claims are not the responsibility of your personal health insurance, including Medicare, because they are the responsibility of your [former] employer. Blue Shield can possible go after that coverage for reimbursement. If they are asking about you being on Medicare, it is because they may be able to bill Medicare for some of your claims they have paid (but those are also time-limited, so they cannot go back more than about a year). But if you only have Medicare Part A, those claims would be limited to hospitalization only.
Certainly, when you first enrolled in your wife's group health plan, there were questions related to these things which were supposed to be answered YES. Answering NO would have been a misrepresentation. The good news is that CA law changed a couple of years ago, and once you have been covered by the same plan of insurance for more than 24 months, the coverage is incontestable. So even though it may not be 24 months since the law changed, if you've been covered by the same plan since 2006, you have nothing to worry about. Your 24 months ended in 2008.
Posted: Sun Oct 21, 2012 11:34 pm Post Subject:
Thank you very much for your reply. Does this also mean that while my wife is a full-time employee, Blue Shield cannot force me to enroll and pay into part B of medicare?
Posted: Sun Oct 21, 2012 11:37 pm Post Subject:
Thank you very much for your reply. Does this also mean that while my wife is a full-time employee, Blue Shield cannot force me to enroll and pay into part B of medicare?
Posted: Mon Oct 22, 2012 12:46 am Post Subject:
Does this also mean that while my wife is a full-time employee, Blue Shield cannot force me to enroll and pay into part B of medicare?
That depends on the type of plan your wife's employer maintains -- a fully insured plan or a self-insured plan. In a fully insured plan, you might be able to continue coverage as a dependent (it's a contractual matter between the insurance company and the employer -- your Medicare coverage could be primary or secondary). A self-insured plan under ERISA has more freedom to discriminate against dependents who have other coverage that could be their primary coverage (as Medicare would be for you).
You have to know which type of benefit plan it is. If self-insured, there will be a "Summary Plan Document" that discusses all this to a greater or lesser extent.
Posted: Sat Nov 17, 2012 09:29 am Post Subject: Blue shield w/ medicare part A
That isn't true in Minnesota, Rita. We just purchased BC/BS for medical
care and the Humana drug plan for my mother. It is coordinated by the same
insurance agent, and the Human drug plan was much better that any of those
offered in combination with the BC/BS medical plans.
Posted: Sat Nov 17, 2012 12:26 pm Post Subject:
We just purchased BC/BS for medical care and the Humana drug plan for my mother. It is coordinated by the same
insurance agent, and the Human drug plan was much better that any of those offered in combination with the BC/BS medical plans.
This is an entirely different scenario than that which was posted. It does not apply to the situation in which the OP was eligible to be covered by both an employer sponsored plan and Medicare.
If you obtained a Medicare Advantage Plan without the Prescription Drug Plan, then it would be necessary to obtain a separate Medicare Prescription Drug Plan. However, in many areas of the US, Medicare Advantage-Prescription Drug Plan combinations (called MAPD) have no added premiums. A BCBS plan plus a Humana Drug plan will cost more money.
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