I have BlueShield Medical insurance. My copay is $15. My company takes care of it. I also have hospitalization for me and my spouse..
Total Comments: 95
Posted: Sun Aug 19, 2012 06:28 am Post Subject: disabled with medicare part a only
I am under 65 and disabled, my husband is also under 65 and I have been on his medical High deductible plan with his former employer.
He is now starting a new job they are asking if either one of us is eligible for medicare. I have never picked up part b because i always had coverage as a dependent with my husband.
can they force me to pick up part b and if so since I am disabled and under 65 they should pay 1st then medicare. if I was medicare eligible because i reached the age of 65 medicare would be primary correct?
can they deny me coverage during open enrollment if I am medicare eligible? they have more than 100 employees. The job is in Virginia. Any advice would be greatly appreciated
Posted: Sun Aug 19, 2012 06:32 am Post Subject: disabled with medicare part a only
I am under 65 and disabled, my husband is also under 65 and I have been on his medical High deductible plan with his former employer.
He is now starting a new job they are asking if either one of us is eligible for medicare. I have never picked up part b because i always had coverage as a dependent with my husband.
can they force me to pick up part b and if so since I am disabled and under 65 they should pay 1st then medicare. if I was medicare eligible because i reached the age of 65 medicare would be primary correct?
can they deny me coverage during open enrollment if I am medicare eligible? they have more than 100 employees. The job is in Virginia. Any advice would be greatly appreciated
Posted: Sun Aug 19, 2012 06:35 am Post Subject: disabled with medicare part a only
I am under 65 and disabled, my husband is also under 65 and I have been on his medical High deductible plan with his former employer.
He is now starting a new job they are asking if either one of us is eligible for medicare. I have never picked up part b because i always had coverage as a dependent with my husband.
can they force me to pick up part b and if so since I am disabled and under 65 they should pay 1st then medicare. if I was medicare eligible because i reached the age of 65 medicare would be primary correct?
can they deny me coverage during open enrollment if I am medicare eligible? they have more than 100 employees. The job is in Virginia. Any advice would be greatly appreciated
Posted: Mon Aug 20, 2012 03:04 am Post Subject:
can they force me to pick up part b and if so since I am disabled and under 65 they should pay 1st then medicare. if I was medicare eligible because i reached the age of 65 medicare would be primary correct?
Are you receiving Social Security Disability Income payments? If you are, and have been for at least 24 consecutive months, you are covered by Medicare.
If your husband's employer's health plan is "self-funded" they have the freedom to make the rules as they see fit under ERISA, as long as they do not discriminate in the few ways that ERISA prohibits.
can they deny me coverage during open enrollment if I am medicare eligible?
Yes, if they are a self-funded plan, they can require you to enroll in Medicare as your primary coverage. It probably relieves them of most claims.
Marriage is not in the list of prohibitions. They can treat you differently as a dependent than they treat your husband as an employee. They must treat you as a dependent the same way they treat all other dependents--disabled or not.
Yes, it sucks. When the politicians wrote ERISA in 1974, they created a number of (now) well-known unintended consequences. Most of them have never been corrected. Like your inability to sue an employer-sponsored health care plan in most cases, and your inability to apply more liberal state law to employer-sponsored health care plans that would otherwise have violated your rights as an insurance consumer.
Posted: Mon Aug 20, 2012 08:38 pm Post Subject: Question about response
I do not believe they are self funded (they have contracted Blue Cross/Blue Shield as their health care provider.
what is the definition of self funded plan? The plan is from the State.
If they are not self funded then even with medicare part a only they should pay as primary and cant deny me as a dependent of my husband. Please confirm . thanks for getting back so quickly
Posted: Mon Aug 20, 2012 08:38 pm Post Subject: Question about response
I do not believe they are self funded (they have contracted Blue Cross/Blue Shield as their health care provider.
what is the definition of self funded plan? The plan is from the State.
If they are not self funded then even with medicare part a only they should pay as primary and cant deny me as a dependent of my husband. Please confirm . thanks for getting back so quickly
Posted: Mon Aug 20, 2012 09:57 pm Post Subject:
A self-funded plan is one in which the employer pays the actual medical expenses instead of purchasing insurance (few self-funded plans are fully insured).
You might "think" you have BCBS as your health care provider, but in reality, you may have BCBS as the "third-party administrator". If you look at your subscriber card, you may see words to the effect that BCBS provides "administrative services only" -- which means the employer uses BCBS as a TPA to handle the benefit plan, in exchange for employees' access to the BCBS network of providers and negotiated rates, but BCBS has no actual liability for the payment of claims. The employer does. When employees incur a medical expense, the employer pays it directly through the TPA.
So what does the fine print on your BCBS subscriber card say (usually on the back side)?
If the plan is self-funded, it has wider flexibility under federal law (ERISA) when it comes to discriminating against persons who may be eligible for other coverage first, including spouses and children, and persons eligible for Medicare.
Posted: Tue Aug 21, 2012 02:28 am Post Subject:
can they force me to get part b and have medicare pay 1st? I thought it was if under 65 medicare is secondary 65 and over medicare is primary.
I guess your telling me if they are self funded they can make their own rules. I do appreciate your help
Posted: Tue Aug 21, 2012 02:47 am Post Subject:
I thought it was if under 65 medicare is secondary 65 and over medicare is primary.
Common misunderstanding.
Did you look at your subscriber card to see if it is indicative of a self-funded plan or not?
if they are self funded they can make their own rules.
Only if they do so within the guidelines of ERISA. There is some fairly wide latitude given to self-funded plans, which is why many large employers choose to go that route. But they cannot discriminate on the basis of age, gender, national origin, race, color, creed, or religion.
They can require a spouse to apply for all benefits to which he/she may be entitled (such as their own employer's group plan, or Medicare, if eligible). They can require a spouse whose birthday is earlier on the calendar to cover the children with those benefits as their primary insurance.
All of the self-funded plan details and requirements are contained in a document called the Summary Plan Document ("SPD"). Employees are provided with an abridged version of that document that provides many/most (but not all) of the major coverages and exclusions in the plan, along with specific requirements for spouses' and dependents' coverage.
What does your husband's SPD say?
Posted: Tue Aug 21, 2012 04:24 am Post Subject:
We haven't gotten our cards left. I will ask him to contact HR and ask for the Summary Plan Document. Thanks again.
Posted: Sun Aug 19, 2012 06:28 am Post Subject: disabled with medicare part a only
I am under 65 and disabled, my husband is also under 65 and I have been on his medical High deductible plan with his former employer.
He is now starting a new job they are asking if either one of us is eligible for medicare. I have never picked up part b because i always had coverage as a dependent with my husband.
can they force me to pick up part b and if so since I am disabled and under 65 they should pay 1st then medicare. if I was medicare eligible because i reached the age of 65 medicare would be primary correct?
can they deny me coverage during open enrollment if I am medicare eligible? they have more than 100 employees. The job is in Virginia. Any advice would be greatly appreciated
Posted: Sun Aug 19, 2012 06:32 am Post Subject: disabled with medicare part a only
I am under 65 and disabled, my husband is also under 65 and I have been on his medical High deductible plan with his former employer.
He is now starting a new job they are asking if either one of us is eligible for medicare. I have never picked up part b because i always had coverage as a dependent with my husband.
can they force me to pick up part b and if so since I am disabled and under 65 they should pay 1st then medicare. if I was medicare eligible because i reached the age of 65 medicare would be primary correct?
can they deny me coverage during open enrollment if I am medicare eligible? they have more than 100 employees. The job is in Virginia. Any advice would be greatly appreciated
Posted: Sun Aug 19, 2012 06:35 am Post Subject: disabled with medicare part a only
I am under 65 and disabled, my husband is also under 65 and I have been on his medical High deductible plan with his former employer.
He is now starting a new job they are asking if either one of us is eligible for medicare. I have never picked up part b because i always had coverage as a dependent with my husband.
can they force me to pick up part b and if so since I am disabled and under 65 they should pay 1st then medicare. if I was medicare eligible because i reached the age of 65 medicare would be primary correct?
can they deny me coverage during open enrollment if I am medicare eligible? they have more than 100 employees. The job is in Virginia. Any advice would be greatly appreciated
Posted: Mon Aug 20, 2012 03:04 am Post Subject:
can they force me to pick up part b and if so since I am disabled and under 65 they should pay 1st then medicare. if I was medicare eligible because i reached the age of 65 medicare would be primary correct?
Are you receiving Social Security Disability Income payments? If you are, and have been for at least 24 consecutive months, you are covered by Medicare.
If your husband's employer's health plan is "self-funded" they have the freedom to make the rules as they see fit under ERISA, as long as they do not discriminate in the few ways that ERISA prohibits.
can they deny me coverage during open enrollment if I am medicare eligible?
Yes, if they are a self-funded plan, they can require you to enroll in Medicare as your primary coverage. It probably relieves them of most claims.
Marriage is not in the list of prohibitions. They can treat you differently as a dependent than they treat your husband as an employee. They must treat you as a dependent the same way they treat all other dependents--disabled or not.
Yes, it sucks. When the politicians wrote ERISA in 1974, they created a number of (now) well-known unintended consequences. Most of them have never been corrected. Like your inability to sue an employer-sponsored health care plan in most cases, and your inability to apply more liberal state law to employer-sponsored health care plans that would otherwise have violated your rights as an insurance consumer.
Posted: Mon Aug 20, 2012 08:38 pm Post Subject: Question about response
I do not believe they are self funded (they have contracted Blue Cross/Blue Shield as their health care provider.
what is the definition of self funded plan? The plan is from the State.
If they are not self funded then even with medicare part a only they should pay as primary and cant deny me as a dependent of my husband. Please confirm . thanks for getting back so quickly
Posted: Mon Aug 20, 2012 08:38 pm Post Subject: Question about response
I do not believe they are self funded (they have contracted Blue Cross/Blue Shield as their health care provider.
what is the definition of self funded plan? The plan is from the State.
If they are not self funded then even with medicare part a only they should pay as primary and cant deny me as a dependent of my husband. Please confirm . thanks for getting back so quickly
Posted: Mon Aug 20, 2012 09:57 pm Post Subject:
A self-funded plan is one in which the employer pays the actual medical expenses instead of purchasing insurance (few self-funded plans are fully insured).
You might "think" you have BCBS as your health care provider, but in reality, you may have BCBS as the "third-party administrator". If you look at your subscriber card, you may see words to the effect that BCBS provides "administrative services only" -- which means the employer uses BCBS as a TPA to handle the benefit plan, in exchange for employees' access to the BCBS network of providers and negotiated rates, but BCBS has no actual liability for the payment of claims. The employer does. When employees incur a medical expense, the employer pays it directly through the TPA.
So what does the fine print on your BCBS subscriber card say (usually on the back side)?
If the plan is self-funded, it has wider flexibility under federal law (ERISA) when it comes to discriminating against persons who may be eligible for other coverage first, including spouses and children, and persons eligible for Medicare.
Posted: Tue Aug 21, 2012 02:28 am Post Subject:
can they force me to get part b and have medicare pay 1st? I thought it was if under 65 medicare is secondary 65 and over medicare is primary.
I guess your telling me if they are self funded they can make their own rules. I do appreciate your help
Posted: Tue Aug 21, 2012 02:47 am Post Subject:
I thought it was if under 65 medicare is secondary 65 and over medicare is primary.
Common misunderstanding.
Did you look at your subscriber card to see if it is indicative of a self-funded plan or not?
if they are self funded they can make their own rules.
Only if they do so within the guidelines of ERISA. There is some fairly wide latitude given to self-funded plans, which is why many large employers choose to go that route. But they cannot discriminate on the basis of age, gender, national origin, race, color, creed, or religion.
They can require a spouse to apply for all benefits to which he/she may be entitled (such as their own employer's group plan, or Medicare, if eligible). They can require a spouse whose birthday is earlier on the calendar to cover the children with those benefits as their primary insurance.
All of the self-funded plan details and requirements are contained in a document called the Summary Plan Document ("SPD"). Employees are provided with an abridged version of that document that provides many/most (but not all) of the major coverages and exclusions in the plan, along with specific requirements for spouses' and dependents' coverage.
What does your husband's SPD say?
Posted: Tue Aug 21, 2012 04:24 am Post Subject:
We haven't gotten our cards left. I will ask him to contact HR and ask for the Summary Plan Document. Thanks again.
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