Medicare and private insurance

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Lavender Lady

Distinguished member
Joined
Jul 6, 2010
Messages
445
Reason
PALS
Diagnosis
08/2010
Country
US
State
WA
City
Lake Stevens
I thought Medicare was my primary Insurance but I was told that because I am on my husbands plan through his work that his is primary. I will have to drop my insurance with him to get Medicare to be primary. So if I do that how do I have a secondary plan to pick up the 20% and have RX coverage?
 
You can choose straight Medicare or Medicare Advantage with or w/o RX plan. You can choose a separate RX plan through Medicare. There are supplemental plans (not through Medicare) available to help with the 20%, but I don't know if they are worth it or not, as my husband does not have one.

Take a look at the Medicare site:

Coverage choice Original Medicare or a Medicare Advantage Plan
 
I believe Medicare will always be the secondary if there is another insurance company involved. That is the case with us until we lose our employer based insurance.

We just found out that my husband is now eligible for Medicare. We are trying to decide what supplement to get. I don't know how high the costs can be for treating ALS. We thought we'd go with Original Medicare A and B, pick a D, then add supplement F. Does anyone have any advice? These together will cost $265 a month, but the only out of pocket costs we will have will be for medication. Does this sound like it would be beneficial? I think it will help us with budgeting too, knowing our exact costs per month, as we have three children and our income is being drastically reduced.
 
I have Medicare A & B also Blue Cross Blue Sheild it cost me $133.40. I haven't been out a lot due to ALS other than the vitamins I take. There doesn't seem like much they can do for us.
 
This has been the biggest question we've had. My husband is on long-term disability from his employer because of his ALS, but is still considered an employee and we still pay for his insurance (BlueCrossBlueShield) through his employer. We understood that BCBS would be his primary with Medicare picking up where it left off. But both the wheelchair company and Dynavox say that Medicare is his primary, in spite of the fact that we have durable medical coverage through BCBS. Very confusing and frustrating.
 
I guess I worded that wrong. I know there aren't a lot of costs involved with 'treating' als, as there is no cure. Sure wish there was. How much could 20% of the durable medical equipment and 20% of doctors visits cost? I don't want to waste money on a supplement plan, but they also pay the deductible for Medicare, almost 1200 a year. Supplement F is about 135 a month for us, and medicare's deductible is about 100 a month. Sorta sounded like a no brainer for me, but I might be missing something. Doesn't look like Medicare gives you a lot of second chances, you have one open enrollment per year, and for the supplements I think you have to enroll in one of them at the first 6 months of becoming elegible for medicare, unless you leave a ppo or hmo plan. But then again, you'll have to wait until the end of the calendar year to get into that. Am I making any sense? Wouldn't it be easier if the medicare system were set up differently?
 
Our insurance is not great. We have a $3000.00 deductible each year and then they only pay 50% for durable medical equipment up to a $5000.00 max. Which means for a hoyer lift we would have to foot the entire bill of $6000.00. After our deductible does medicare kick in? Does medicare then pick up the remainder of the balance?

Also, If something like a power chair costs say $60,000.00 if you had to pay 20% that would be $20,000.00 out of pocket. So 20% can costs a lot of money. A hoyer lift $6000.00 and 20% would be $2000.00. ALS is a very very expensive disease. Thank God for the ALSA and for guardian angels.
 
Rox, the company we bought my wheelchair from did all the work with our insurance company. Do you have a dealer for a chair yet? Does the dealer also sell the lifts? Ask them about your dilemma with insurance/Medicare. They're experts at getting paid.
 
I do not have the chair order in process yet. I found this out trying to get a hoyer lift. Definately I will be digging deeper into the coverage. But you are right they are good at getting money.
 
Rox-
If you are seen at an ALSA clinic, you should have been assigned to a Social Worker whose job it is to help you through this maze. You should at least be able to contact your chapter to ask for help in this matter.
I'm not sure how the MDA-ALS works, but I would think there is an equivalent.?.

A PWC is not $60,000 (that I know ); just received the statement on hubby's Permobile
that was $22,000 +.
As for some of the other equipment (e.g. hoyer lift), always check with the ALSA or MDA loaner closests first!

Pursue all your options- hope you find all the help you deserve!
 
All you need for a hoyer lift is keep it so many months enither 11 or 13 months and Medicare pays for all of it. You need a prescription take it to a medical supply store here they deliver it set it up and bill Medicare monthly. They do this for bed side commodes, regular wheel chairs and hospital beds. But always ask your doctor for a prescription. They billed Medicare $42000. but Medicare only approved $22000. for my power wheel chair. Doctors and nurses can help alot if asked. I had to pay for my shower chair. Also a medical supply store can tell you what Medicare will pay for.
 
Mare, the 60,000 was a hypothetic # easy to work with.Thank you however for the info. After we meet our deductible it should be easier. I truly appreciate the wisdom you all have who have had to do this.
 
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