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Sat Dec 8, 2012, 05:12 PM

Anything special about making Medicare your primary insurance?

Up until this year, I had my spouse on my insurance thru my employer. My spouse doesn't work, but collects SSD, so she gets Medicare (disability); thus she also has one of those advantage plans that "handles" her Medicare for her. My insurance was primary, hers was secondary.

The dual premiums became something of a hindrance this year, so we dropped her from my insurance, which made her Medicare advantage plan the new "primary." (I say "primary" because, of course, it's her only insurance now; there is no secondary.)

A couple months into this plan year, doctor offices are contacting us because they're not getting paid. The a**hat, er, representative at the advantage plan snottily claims we didn't "inform them" about the change, and frankly called my spouse a liar who was trying to commit fraud by getting things double-paid.

I'm going to re-fax them the documentation from my insurer showing the date my spouse's coverage ended. Should they need anything else -- besides an attitude adjustment and literacy tests?

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Arrow 22 replies Author Time Post
Reply Anything special about making Medicare your primary insurance? (Original post)
Beartracks Dec 2012 OP
Wounded Bear Dec 2012 #1
eridani Dec 2012 #11
Beartracks Dec 2012 #13
FarCenter Dec 2012 #15
Beartracks Dec 2012 #17
trof Dec 2012 #18
Beartracks Dec 2012 #19
cbayer Dec 2012 #2
Beartracks Dec 2012 #7
Sekhmets Daughter Dec 2012 #3
dixiegrrrrl Dec 2012 #4
CTyankee Dec 2012 #5
Beartracks Dec 2012 #9
Old Codger Dec 2012 #6
Beartracks Dec 2012 #8
Old Codger Dec 2012 #10
Beartracks Dec 2012 #12
Old Codger Dec 2012 #14
Beartracks Dec 2012 #21
Old Codger Dec 2012 #22
Panasonic Dec 2012 #16
Beartracks Dec 2012 #20

Response to Beartracks (Original post)

Sat Dec 8, 2012, 05:15 PM

1. I think I see your problem....

"Advantage" plans are more of an advantage to the insurer IMHO. Any reason you didn't just go straight Medicare and skip the advantage crap I believe they tend to inject too much of corporate Amerika into Medicare, which I have always heard works pretty decently.

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Response to Wounded Bear (Reply #1)

Sun Dec 9, 2012, 09:45 AM

11. The thing is, if your employer does the paperwork for Advantage, it is far less hassle

Although straight Medicare is definitely superior, if your employer makes you jump hoops to get it a lot of people are just going to say hell with it.

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Response to eridani (Reply #11)

Sun Dec 9, 2012, 02:11 PM

13. I think I meant Medicare "supplement." Is that the same thing as "advantage"?

Are those terms interchangeable, in that they describe when you get a private insurer to manage your Medicare plus offer additional features?

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Response to Beartracks (Reply #13)

Sun Dec 9, 2012, 09:03 PM

15. Medicare Advantage and Medicare supplement are two different kinds of insurance.

With Medicare Advantage, a private insurer essentially takes over and becomes prime on your Medicare coverage.

Wih Medicare Supplement, the benefits are paid by Medicare CMS and then you file with the private Medicare Supplement insurer for the amount that CMS didn't cover.

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Response to FarCenter (Reply #15)

Mon Dec 10, 2012, 07:29 PM

17. OK, then I think she has Advantage.

They tell her to inform providers that she has "their plan" as opposed to having "medicare."

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Response to Wounded Bear (Reply #1)

Mon Dec 10, 2012, 07:34 PM

18. Right. Avoid 'Advantage' plans.

They're more like HMOs.
Have a list of doctors they 'approve'.
Cheaper, but you get what you pay for.

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Response to trof (Reply #18)

Wed Dec 19, 2012, 09:15 PM

19. We did an Advantage plan to get the Part D coverage.

I've been looking at the option to go "original Medicare", buy a Part D, and buy Medigap. However, I may eventually just opt to put her back on my employer plan during open enrollment this summer, but I *think* if I drop the Medigap to do that then eventually she may have a problem getting any Medigap plan in the future.

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Response to Beartracks (Original post)

Sat Dec 8, 2012, 05:19 PM

2. Straight Medicare definitely has some advantages.

The major ones are the lack of restrictions on who one can see for care and the generally rapid and relatively fair payment system to the healthcare professionals that you do see.

There are, however, drawbacks. The copays and deductibles can be higher and there are some services that an "Advantage" plan may provide that straight Medicare does not.

For these reasons, many people have Medicare with a low cost supplement from a private insurer. These supplements can cover copays, deductibles and some services that may not be covered by Medicare.

To be fair, you really should have told the doctors offices about the changes you made so they didn't waste their time billing and trying to collect from a company which no longer covers her.

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Response to cbayer (Reply #2)

Sun Dec 9, 2012, 02:14 AM

7. The doctor's offices knew to bill the Medicare supplement plan.

It's the Medicare insurer who is playing dumb and not paying the claims.

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Response to Beartracks (Original post)

Sat Dec 8, 2012, 05:49 PM

3. You are dealing with a health insurer...

that always takes extreme patience.

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Response to Beartracks (Original post)

Sat Dec 8, 2012, 06:22 PM

4. Call the Medicare 800 #, I find them very responsive.

And inform your/her docs that only Medicare is to be billed.
( I assume you are saying she is getting Medicare B for outpatient????
as well as A for inpatient?)

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Response to dixiegrrrrl (Reply #4)

Sat Dec 8, 2012, 07:28 PM

5. I agree. Medicare always has provided knowledgeable people that I can talk to and feel

comfortable with. Try them.

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Response to dixiegrrrrl (Reply #4)

Sun Dec 9, 2012, 02:20 AM

9. We told her docs, who then billed the Medicare suppl plan.

I'll have to see which Medicare "parts" she is getting.

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Response to Beartracks (Original post)

Sat Dec 8, 2012, 08:44 PM

6. I found

That my out of pocket expenses were higher when I had an "advantage" plan as supplementary to my medicare by a lot, I was paying for medicare plus 175 month to supplement and it cost me much more per office visit than without the added insurance.. I am pretty healthy so my case is not necessarily a good example but I get by fine with straight medicare.

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Response to Old Codger (Reply #6)

Sun Dec 9, 2012, 02:18 AM

8. Her supplemental plan is currently $60/month.

It used to be around $120; then they dropped it to $32 in early 2011 ("to be more competitive" they said -- which just made us wonder how much they'd been non-competitively ripping her off before then); then bumped up to $60 about a year ago.

Her Medicare premium comes out of her SSD payment; I think it's pretty low.

This is the time of year that she needs to be examining and comparing plans for 2013, which I guess means comparing these private insurer supplemental plans?

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Response to Beartracks (Reply #8)

Sun Dec 9, 2012, 09:38 AM

10. medicare payment

Is $106.90 for most people, and time for open enrollment in any of them is over for the year.

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Response to Old Codger (Reply #10)

Sun Dec 9, 2012, 02:07 PM

12. ?? Thought she had til end of year...??

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Response to Beartracks (Reply #12)

Sun Dec 9, 2012, 08:56 PM

14. It is too late this year


Medicare Open Enrollment is your opportunity to make changes to your Medicare coverage for the 2013 calendar year. Open Enrollment 2012 begins on October 15, 2012, and ends on December 7, 2012. Any changes that you elect during Open Enrollment will take effect on January 1, 2013. Take note that the Open Enrollment period was lengthened and moved to an earlier start date in 2011, and the new dates remain in effect for 2012: from October 15 until December 7.

http://www.medicaresupplementalinsurance.com/medicare-open-enrollment-2012.html

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Response to Old Codger (Reply #14)

Wed Dec 19, 2012, 09:18 PM

21. I think she's got a special case because...

... her Advantage plan is terminating. The notice we got indicated she had til the end of the year -- or, technically, about 45 days into the new year.

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Response to Beartracks (Reply #21)

Thu Dec 20, 2012, 09:48 AM

22. Ok that may be

I certainly hope so..... Good luck

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Response to Beartracks (Original post)

Sun Dec 9, 2012, 09:06 PM

16. Medicare "Advantage" is nothing but a scam.

 

designed to rip you off by the private insurance companies.

I'd check with Medigap, to find a better rate.

http://voices.washingtonpost.com/ezra-klein/2009/10/the_medicare_advantage_scam.html

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Response to Panasonic (Reply #16)

Wed Dec 19, 2012, 09:17 PM

20. We did an Advantage plan to get the Part D coverage.

I've been looking at the option to go "original Medicare", buy a Part D, and buy Medigap. However, I may eventually just opt to put her back on my employer plan during open enrollment this summer, but I *think* if I drop the Medigap to do that then eventually she may have a problem getting any Medigap plan in the future.

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