Rant: Medicare Snafu

[Talent312]

DW had her first office visit with coverage under Medicare and her Supp-Plan. At the office, she documents the switch and they take photos of her new cards. Everything's cool. Then, three weeks later we get a bill...

It says my state-employee (retiree) policy denied their claim becuz she's no longer covered by it. Well, duh. So, we call the doc's office. Their better explanation: They first submitted the claim first to Medicare who denied it, saying that my policy was primary.

We look at her Medicare account online and yeah, it says she's still covered under my policy. So, we call Medicare to straighten them out. They say: "We don't assume that someone's former policy is terminated, just 'cuz they enroll in Medicare; it's up to the enrollee to tell us." -- How about telling enrollee's that?

They'll fix it, but it will take two weeks to process thru the system -- never mind that all it should take is the click of a mouse -- and no, they won't reverse the denial. The doc will have to wait and resubmit.


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[urban5]

I had exactly the same thing occur. You would think they would indicate somewhere in the signup process that you need to alert Medicare of the change. Plus you have to contact a different division of Medicare to make the change.

 

[rapmarks]

My sister had a major problem with the that, worked til 69 and had a heart attack the day after she retired


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[vacationhopeful]

I spent the last several YEARS and MONTHS counting til I turned 65yo for Medicare. Not impressed with the transition ...esp understanding needing separate and ADDITIONAL coverage ... like for scripts, etc.

Seems you have to CANCEL your prior medical coverage .... 30+ days in advance for you OLD medical policy.

Oh well ... I simply called my "vulture" ACA medical insurance company and sent the continuing bill back with some worthy notes on it ... which I photocopied saying CANCELLED due to Medicare qualified. That insurance company and the ACA ... either or BOTH should have clearly seen that as individual paying for a medical insurance policy ... should be transitioning OVER to Medicare (not a group employee policy) at age 65. Or even sent me a nice letter ... 3 months in advance, saying ... YOU NEED TO DO, apply, PICK, and Cancel, etc.

Greed ... is the ONLY reason I can figure .....

 

[Luanne]

For some reason I think my medical insurance was automatically cancelled when I reached Medicare eligibility. It may have been because I was covered as a retiree through the company I had worked for and retired from.

 

[nightnurse613]

I am amazed. The exact same thing happened to my husband. It took several months to clear - partly because there was old bills still processing. Of course, he was covered by my employee medical and his military (Tricare) up until he turned 65 which probably contributed to the confusion. Also, found out his military changes when he turned 65, too!

 

[isisdave]

Hmm, I worked past 65, and when I retired, my company just stopped my coverage at the end of the month. I just applied to Medicare online, probably the month before, and it all worked out fine.

 

[bogey21]

My advice to all is that 6 months prior to signing up for Medicare study like heck the transition to Medicare. Things to consider are Traditional Medicare or Medicare Advantage; Medicare Plan B; Medicare Plan D; Supplemental Coverage; Cancelling Existing Coverage; etc.

 

[Sugarcubesea]

So I'm still 10 years away from 65 but I figure I better start learning now... If you are still working at age 65 are you automatically taken off of your companys insurance and placed onto medicare...

So the onus is on us to notify Medicare that their policy is now the primary.

I'm so thankful for this board... I learn something everyday from you guys, thank you so much

 

[Quiet Pine]

I went to a local insurance agent who specializes in Medicare. He represents more than 40 different insurance companies and helped me make a decision. I was familiar with Original Medicare from assisting my parents, but he had the experience to help me choose what's best for me. It's been 10 years, and I still call him every year to make sure I'm in the right plan.

 

[Luanne]

We went to our insurance agent for a tutorial on Medicare insurance. I'd gotten a letter from him prior to turning 65. We ended up not buying insurance through him (State Farm), but the information he provided on all of the options was very helpful. The best advice I got was from my sister and also a friend. If you are going to go with a Medicare supplement plan (I have F I think) find the cheapest one out there. They all have to provide the same coverage.

 

[PStreet1]

When the checks from Medicare and your supplemental insurance begin coming in, as they will eventually, use caution in how you pay the bills. I've had numerous, extensive hospitalizations, which means the bills go on for pages. Sometimes the insurance company pays the patient with a check; sometimes Medicare pays the patient with a check, and these are in addition to what Medicare/insurance has already paid the medical provider directly. Do not simply call the medical provider (unless it's for a single trip to the doctor) and pay the amount of the check you received and anything else you owe.

Instead, read the paperwork that comes with the checks and see what the date of service was and what the original charge was. When you call to pay, say you want to pay by "line item." Give them the date of service and the original charge so they can apply the money to that, particular item. Do that for each and every check you receive.

I was told to do that after I called with a total amount and told them to apply it to the bill. It turned out there was a mistake in their billing and the payment was applied to the wrong line item, which had been incorrectly coded. TWO YEARS later, I was still trying to get the bill straightened out. Finally, it was, more or less, correct, and they said to always pay by line item when a check is received so that when all insurance/Medicare checks have been received, the total left for you to pay is correct.

I've also found that paying the portion left for me to pay when I first receive a bill saying that is the final amount is a mistake. In almost 100% of the cases, if I wait until the next billing period, another payment has been made by Medicare/insurance directly to the hospital or another check has come to me. Waiting a month after they think they have the final amount to see if it really is the final amount has saved much confusion on the billing.

(Obviously, little things like doctor appointments are a different matter, and if you are lucky enough to avoid hospitalization, you won't need this advice.)

 

[Quiet Pine]

I got a Plan F High Deductible. This year's deductible is $2200, 5 times what I spend in a year on doctors. I accept it, just as I don't think homeowner's premiums are wasted when my house doesn't burn down. My premium is $37.88 a month (yearly increase as I get older.) Medicare Advantage can be cheaper, but I prefer not to be constrained by networks.

 

[Luanne]

I got a Plan F High Deductible. This year's deductible is $2200, 5 times what I spend in a year on doctors. I accept it, just as I don't think homeowner's premiums are wasted when my house doesn't burn down. My premium is $37.88 a month (yearly increase as I get older.) Medicare Advantage can be cheaper, but I prefer not to be constrained by networks.

I have Medicare Plan F also. But in addition I have a Medicare supplement plan. I don't think there is any kind of deductible involved. At least since I've been on Medicare I haven't paid anything out of pocket.

Your monthly premium sounds very low. Is that for Medicare or for a supplement? In either case I'm going to repeat myself and say it sounds very low. Between Medicare and the supplement I'm paying around $200/month and I had gotten the impression that was about average.

I just did a quick check and discovered (which I obviously didn't know) that there is a Plan F and a Plan F high deductible. I have the regular Plan F.

 

[Talent312]

I assume that relatively healthy, low-risk peep choose high-deductible plans for their lower costs which, while perfectly understandable, drives up the cost for the rest of us "sickly" peep.

What I learned from DW's billing snafu: Before using Medicare the first time...
-- Do not assume smooth sailing. Check to see what coverages Medicare lists.
-- If an old (terminated policy) is listed as still current, get them to fix it.
-- Make sure your doc knows they are not to bill the old (terminated) plan.

 

[isisdave]

So I'm still 10 years away from 65 but I figure I better start learning now... If you are still working at age 65 are you automatically taken off of your companys insurance and placed onto medicare...

So the onus is on us to notify Medicare that their policy is now the primary.

I'm so thankful for this board... I learn something everyday from you guys, thank you so much

As of now, you would probably stay on your company's plan, as long as your company employs more than 20. But check with them!

Medicare signup doesn't happen automatically unless you are already receiving SS benefits. So get in touch 3 months before 65. Nowadays you use their website; in ten years, it'll probably be something telepathic. Even if you're still working, you'd sign up for part A, which is free.

 

[vacationhopeful]

AND ... here is some important HINTs.

When you first sign up at age 65 .... sign up the MONTH before YOUR 65th birthday. If you sign up the MONTH OF YOUR 65th birthday ... it will not be effective til the beginning of the NEXT month. Almost all private plans just dump you the month of YOUR 65th birthday.
Birthday in April; sign up March. coverage starts April. And they really want you to pick you PART whatevers.
Then you have the NEXT 2 months, which you can STILL change your PART whatevers with the new plan starting the FOLLOWING month.

After that, you have to wait til the year's Open Enrollment period in the fall (Sept?) with coverage/plans starting in January.

Any additional coverages ADDED after your initial age 65 signups ... WILL have a "forever penalty" fee tacked onto your plan costs...plus a 3 month NOT COVERED period before being effective ... the signup is in September month... coverage starts January 1st.

 

[Luanne]

Even if you're still working, you'd sign up for part A, which is free.

It's my understand you have to sign up for Part A. My dh was still working and was covered under MY healthcare insurance when he turned 65. He signed up for Part A, but his secondary coverage was what he already had.

When he and I both retired (I was 62, he was 66) he signed up for Part B, and a Medicare Supplemental plan. One thing you need to be aware of is, in order to determine the amount Social Security will withhold for your Medicare Part B premium, they go by your last year's salary. So initially dh's premiums were quite high. We were able to get them lowered by going into the Social Security office, showing them that we were both retired and he was not making that salary any longer. It wasn't an issue for me when I turned 65 since I hadn't been working for several years.

 

[Sugarcubesea]

As of now, you would probably stay on your company's plan, as long as your company employs more than 20. But check with them!

Medicare signup doesn't happen automatically unless you are already receiving SS benefits. So get in touch 3 months before 65. Nowadays you use their website; in ten years, it'll probably be something telepathic. Even if you're still working, you'd sign up for part A, which is free.

Thank you, that is good info to know. I'm so hoping that I can work till 65 but nothing in life is gurenteed.

 

[Talent312]

... Medicare signup doesn't happen automatically unless you are already receiving SS benefits... Even if you're still working, you'd sign up for part A, which is free.

When DW turned 65, she signed up for Part A, but becuz she was covered under my employee plan, she held off on Part B for several years. Then I retired. To qualify her for delayed enrollment, we had to provide proof of coverage under my plan for the missing years... I started that process ~6 months before my intended retirement becuz I knew the peep I was dealing with would mess it up at least once.

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[WalnutBaron]

I'm still a few years away from Medicare, but I guess the moral of this story is to remember that when dealing with a government program, there is no such thing as customer service or a customer-oriented mentality. I have health insurance now through Kaiser Permanente here in California, and I love it. Great system, excellent care, very customer and patient-oriented. But when we make the switch to Medicare in about 6 or 7 years after I retire, we're going to need to remember to assume nothing, realize that anybody who is actually helpful in a government bureaucracy is an anomaly and not the norm, and that we're going to need to be our own advocates because no one is going to squire us through the morass of rules and procedures but ourselves.

To be honest, it's a little daunting. I'm not looking forward to it.

 

[VacationForever]

I'm still a few years away from Medicare, but I guess the moral of this story is to remember that when dealing with a government program, there is no such thing as customer service or a customer-oriented mentality. I have health insurance now through Kaiser Permanente here in California, and I love it. Great system, excellent care, very customer and patient-oriented. But when we make the switch to Medicare in about 6 or 7 years after I retire, we're going to need to remember to assume nothing, realize that anybody who is actually helpful in a government bureaucracy is an anomaly and not the norm, and that we're going to need to be our own advocates because no one is going to squire us through the morass of rules and procedures but ourselves.

To be honest, it's a little daunting. I'm not looking forward to it.

If you like Kaiser, you can continue with Kaiser through Medicare.... in addition to standard Medicare premiums, Kaiser (Medicare Advantage) charges something like $89 per month to be on their plan. It also has a co-pay. Some other Medicare Advantage plans cost nothing and with no co-pays.

 

[isisdave]

we're going to need to remember to assume nothing, realize that anybody who is actually helpful in a government bureaucracy is an anomaly and not the norm, and that we're going to need to be our own advocates because no one is going to squire us through the morass of rules and procedures but ourselves..

In my experiences with Medicare, I'd have to say that this is true about 70% of the time ... either incompetent or don't-care. The other 30% of my interactions were with people who fixed the others' mistakes in minutes or days, told me how to get things done faster/easier, and generally seemed happy to be doing what they're doing.

At the post office, I know which clerk's line to stand in; you probably do too.

 

[WinniWoman]

After reading this post, I am dreading having to deal with this in less than 2 years when my husband turns 65. UGH!

 

[SmithOp]

If you like Kaiser, you can continue with Kaiser through Medicare.... in addition to standard Medicare premiums, Kaiser (Medicare Advantage) charges something like $89 per month to be on their plan. It also has a co-pay. Some other Medicare Advantage plans cost nothing and with no co-pays.

and they have free Medicare plan orientation classes because they want you to stay with them. My insurance does it also, they had me at free coffee and muffin.


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