by sloane9 » Wed Nov 03, 2010 10:17 pm
I recently became disabled and receive SSD payments. I was automatically enrolled in Medicare. I am also covered by my husband's employer group insurance. I have to wear custom prosthetics for both feet which have been paid for the last 20 years by the employer insurance. I was employed by the same company for 27 years. Can I keep both insurances, Medicare and the group? I am afraid Medicare won't pay for the prosthetics as they are very costly over $20K per set. What can or should I do?
Posted: Wed Nov 03, 2010 11:31 pm Post Subject:
There is nothing wrong with having both Medicare and private coverage through your group plan. Medicare and your group plan will simply be established as a "primary/secondary" payer situation.
Specifically, in most situations, if the insured person has both Medicare and Group coverage, the group plan will be the primary provider of coverage with Medicare acting as secondary, sometimes called the "excess" provider. There are some possible differences here depending on the size of the group, the age of the group insured and the medical issues at hand.
So, I see no issues with keeping both plans as long as you feel ok with the premiums and other costs that go along with having both.
InsTeacher 8)
Posted: Thu Nov 04, 2010 05:42 am Post Subject:
So, I see no issues with keeping both plans as long as you feel ok with the premiums and other costs that go along with having both.
If you have both Medicare Part A and Part B, you may also enroll in a Medicare Advantage plan if available in your area. While it will still be "secondary" to your group plan, you may discover that the MedAdvantage plan offers similar benefits (which will be better than those under "Original Medicare") at less cost, and could be more advantageous than carrying two coverages at additional cost.
The criteria for what Medicare does or does not pay is embraced by the words MEDICALLY NECESSARY. If a doctor cannot justify the need to Medicare, CMS will deny the expense.[/quote]
Posted: Thu Nov 04, 2010 06:18 am Post Subject:
Yeah Max, I've heard that the Medicare Advantage plan is not available everywhere. Is there any particular reason why in some places it's not considered such as a necessity?
Posted: Thu Nov 04, 2010 02:17 pm Post Subject:
Is there any particular reason why in some places it's not considered such as a necessity?
It's not that it isn't a necessity, Steven, but that Medicare Advantage plans are mostly HMO/PPO plans. If there aren't enough younger, healthier persons to support the HMO's normal operations, they may choose not to establish an HMO for the older folks. It's not a requirement to do so.
The ultimate goal of Obamacare is to do away with Medicare Advantage altogether, because it involves "private insurance companies" which are EVIL in the eyes of Obama and the Democrats. At least the sea change in the House of Representatives on Tuesday this week will help to stave off that plan for a while. If the Senate and the Presidency falls out of Democratic control in two years, perhaps some semblance of sanity will return to America before 1-1-2014.
Bye-bye Pelosi (although I'm sure she'll stock the bar well at taxpayer expense in these next two months)! Lucky you, this time, Senator Reid! The hand writing on the wall is now visible to all.
Posted: Thu Nov 04, 2010 02:25 pm Post Subject: as long as you feel ok with the premiums and other costs tha
I am paying $54 extra to keep both plans. So, I know the group insurance will help pay the $22k for prosthetics. It seems a small price to pay for some "insurance" hahahaha pun intended. It seems an even smaller expense to pay for some assurance.
Posted: Thu Nov 04, 2010 02:27 pm Post Subject:
That is $54 a month! Thanks for all your answers. I appreciate the replies. I am keeping both.
Posted: Thu Nov 04, 2010 03:05 pm Post Subject:
It seems a small price to pay for some "insurance" hahahaha pun intended. It seems an even smaller expense to pay for some assurance.
That's the fundamental concept of insurance -- you trade a small amount of your money for the larger promises made by the insurance company.
If your prosthetics are deemed to be "medically necessary", Medicare will also pay for them, so you may not need to spend that extra $650 per year for the "assurance" you currently have. Contact the CMS for a determination.
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