Medicare B

[JAM]

Hello, PAL’s just approved for SSD (Ty everyone for your help on that issue!) with approval they automatically enrolled him in Medicare part B for $178/mo. We can opt out by submitting paperwork. My question is should we keep it? He has good private insurance but deductible is $6k/year. Is there a benefit to having both? If so is the benefit worth the $178/mo plus what we pay for private insurance?? Note: I am on his insurance as is our 24 y/o as well , so we have to keep it for now. TIA

 

[Nikki J]

What should happen with part b if this is his former employer is medicare pays first The medicare prt b deductible is going to be 252 I believe and after that they pay 80% except for diagnostic labs they pay 100% from the start. Your other insurance would be billedfor 20% of part b after you pay the medicare deductible. I am not sure what they do about your deductible - whether they count the money medicare paid towards it or not so find out Then do the math expecting to hit your deductibles

 

[Bike Mike]

If your husband is no longer working and the employer based insurance is through COBRA, you and your 24 yo can continue with it without your husband. Due to the disability, I believe you both can remain on COBRA for at least 29 months (18 months std COBRA plus 11 month extension due to his disability). If a power wheelchair is needed (big bucks), Medicare B plus a supplement or Medicare B plus employer insurance should cover it well. The question is would the cost of the employer insurance premiums and $6000 deductible be more or less then the Medicare B premium ($185/month in 2025) plus a supplement ($150-200/month). I assume the COBRA premium if only you and your 24 yo would be a lot less than all 3 of you. You would have to factor in any other planned healthcare expenses for your family, assuming the $6000 is not an individual deductible.

 

[JAM]

Thank you Mike. My husband is a retired teacher. We get insurance as retiree (pay monthly for it). It is very good insurance but we have the $6k deductible. We pay for the family plan since our 24 y/o can be covered also until he’s 26.

 

[lgelb]

Edit: I now see your husband is a retiree, so the comments about COBRA do not apply, but leaving them for someone else.

It is impossible to answer the question about whether he should enroll in Medicare now without knowing what the copays and out-of-pocket limits are for his employer plan, how narrow a network it is, whether it's an HMO or PPO design, etc. Re the deductible, I do not believe a commercial plan will prorate the deductible against another payor, but you can verify.

To avoid the Part D late enrollment penalty, he will need to have/document creditable drug coverage if he stays in the retiree plan would do that as soon as Part B starts so he doesn't have to "undo" the penalty later.
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The COBRA duration for dependents depends on a few dates.

See COBRA Continuation Coverage | CMS.

The 29 months applies if disability is determined during or made retroactive to the first 60 days of COBRA coverage. If the Medicare eligibility date precedes termination, COBRA may run as long as 36 months.

That is one reason why terminating employment (which drives the COBRA effective date) with strategic attention to dates is important -- disability benefits and retirement benefits are others. I advise everyone, especially those with a choice of secondary payors, to contact SHIP/SHIBA and your most savvy HR benefits person before making any moves, including termination of employment.

Using a COBRA plan as a secondary payor to Medicare can be a hassle if the plan is heavily managed. You can ask your benefits person what the experience has been.

 

[Nikki J]

While you are doing pricing look at what it might cost if you keep the retiree for you ,your husband does medicare with a supplement and your child gets an aca plan ( open enrollment is now). If they are their own household and not high income a subsidized plan might be very affordable. I don’t know what plan options are like there though.

Usually keeping the retiree plan is the best option but your deductible is high. Another issue is sometimes retiree plans require you to take medicare when eligible. Usually an issue when 65 but check it doesn’t apply here

 

[JAM]

Thank you both. We will keep the plan no matter what bc aca is more money for both my son & I then the monthly family plan cost.
**question is whether to have both/pay for Medicare B in addition to our insurance? Is there a benefit to paying for that bc our deductible is so high? We have a PPO.
I know zero about Medicare D so I’ll talk to him about that later today.

 

[Nikki J]

Medicare part b pays 80% after the small deductible of outpatient services. You would owe 20% of the allowed medicare charge unless your ppo paid or you also had a medicare supplement. My experience is the medicare allowed amount is significantly less than my previous insurance paid for the same thing. But if you think you are going to need expensive equipment and services it still could be a good chunk of money

Part d is another issue. Although next year oop will be capped at 2000 I have found the coverage more expensive than my prior insurance with riluzole in the hundreds instead of my previous copay of 40. If he is taking radicava and it is covered and especially if you are getting help from mt pharma you will end up paying more. Mt pharma can’t help if you have medicare.

 

[JAM]

Thanks Nikki. He is only on Riluzole which he only has a small co pay on, thx to his insurance. I’ll let him figure it out, he’s better at that than I am