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Turning 65: A Medicare Snafu

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This is the eigth in a series of posts that examine the process of signing up for Medicare, navigating its rules, choosing supplemental coverage and planning for health care in a program with a very uncertain future. 

I didn't expect to write a sequel to my seven-part series about signing up for Medicare. Just when I thought I was on the program, and all was fine, it wasn't. After I submitted two bills for routine exams, I learned Medicare would not cover them as my primary carrier. That threw me into a tizzy. All my years of reporting about the program taught me that once you retire Medicare is primary. The benefits administrator for my retiree insurance, which I chose as my Medicare supplement, also assured me Medicare was primary. As proof, my monthly insurance premium dropped from $1,200 to $545, which meant most of the costs for my care were to be paid by Medicare.

WHO'S ON FIRST?

The problem turned out to be Medicare's rules about whose and what insurance coverage is primary or secondary while either you or a spouse is actively working'. and you have still have health coverage from the active person's employer. I thought I had no reason to look up the rules since I was no longer actively working. Thousands of others signing up for Medicare are likely to experience a similar coordination of benefits conundrum.

For a brief time after my Medicare benefits were effective, I had coverage under my husband's employer plan until he took me off the plan when he retired five weeks later.  I know having double coverage from two employer plans sounds weird given today's realities, where people are lucky to have any employer coverage at all.  But my husband and I decided that I would stay on his policy until I turned 65 just in case my former employer dropped retiree coverage, as many employers have done. Because we are a family unwilling to take the risk of having too little health insurance coverage, it was worth the extra premiums until we were confident that Medicare had kicked in.

MY DOC'S BILLING OFFICE CALLS

Then one day recently, a clerk from my ophthalmologist's billing office called to say Medicare had denied payment on a $423 bill; Medicare claimed that I had insurance through something called Employer Group Health Plan.  Was what Medicare said was Employer Group Plan actually my retiree coverage under Aetna? If so, the billing office said they thought Aetna was supposed to pay. But it turns out, Aetna wouldn't have to pay until my husband's insurance company paid, and then Medicare would cover the remainder.  Only if there were still an amount left unpaid would Aetna have to pay.

The billing clerk advised calling Medicare to straighten out the mess. A Medicare representative explained the rules. If either spouse is still working, and beneficiaries are covered by the active worker's insurance, that policy is primary. Medicare becomes the secondary payer. My own supplemental coverage, in this case the Aetna retiree plan, would pay third. The Medicare rep said until I was off my husband's plan, my claims for medical services had to be submitted to his carrier first.

SO IF YOU STILL WORK AFTER 65

People signing up for Medicare need to be aware of these rules to avoid bills they might have to pay out of pocket and/or be prepared for a lot of hassle getting their doctors to resubmit claims forms to different insurers. With many more people continuing to work past age 65, this is not a trivial matter. The eye doctor's office has resubmitted my bill'this time to my husband's carrier. What about my second bill snared in these rules?  Last week a bill for $130 showed up for a routine skin exam I had while still covered under my husband's policy. It said Medicare had paid $81.08 leaving me with a balance of $48.92. I thought Medicare wasn't paying first for this. Go figure.

Once I got on Medicare, I thought billings and claims forms would be easy to follow. So far, that hasn't been the case. I am going to set up a notebook to keep track of my medical bills and how much is paid by Medicare and any supplemental insurance I have. I suggest others do the same.

 

More Blog Posts by Trudy Lieberman

author bio

Trudy Lieberman, a journalist for more than 40 years, is an adjunct associate professor of public health at Hunter College in New York City. She had a long career at Consumer Reports specializing in insurance, health care, health care financing and long-term care. She is a longtime contributor to the Columbia Journalism Review and blogs for its website, CJR.org, about media coverage of health care, Social Security and retirement. As a William Ziff Fellow at the Center for Advancing Health, she contributes regularly to the Prepared Patient Blog. Follow her on twitter @Trudy_Lieberman.


Tags for this article:
Medicare   Health Insurance   Trudy Lieberman   Health Care Cost   Pay for your Health Care   Trudy Lieberman - Turning 65  


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