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Topic: Can we talk medicare...  (Read 629 times)
chiarigal
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People helped 6
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« on: February 08, 2017, 04:10:56 PM »

I have not received my medicare card yet, but know that I eventually will when my claim finishes processing. I have medical coverage from my spouses work. And know that along with my SSDI will be getting part A medicare.

Is anyone else in the same boat I am where they are covered by a spouse? What did you do or do you do besides part A? Do you elect for part B, C, D, E... etc.
Logged
Age at Application: 37
Disability: ACM, PTSD, ADD, Carpal Tunnel, Occipital Neuralgia, spinal stenosis, degenerative disk disease of cervical spine, migraine, chronic widespread pain.
Date Applied: June 7th, 2013
First Approval/Denial Date: Denied 10/08/2014
Reconsideration Approval/Denial Date: Filed appeal 10/10/2014 hired lawyer
Date OTR requested: 10/23/2015
Date Hearing Notice Received: 11/08/2016
Hearing Date: 01/09/2017
ALJ Approval/Denial Date: 01/23/2017 Appeal Under Review A medical decision has been made and we are working to process your decision. A Social Security Representative may contact you or your appointed representative directly if we need any additional documents or information.
Date Award Letter Received: 01/27/2017 FULLY FAVORABLE 2/11/2017 Letter on SSA account confirming approval
Date Back Pay Received: 02/14/2017 Happy Valentines day to me. 02/13/2017 SSA page showing one time deposit for 02/14
Helper
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Posts: 1725


« Reply #1 on: February 08, 2017, 04:21:12 PM »

There is no Medicare Part E.  Only Part B (which covers doctor's visits), Part C (which is Medicare advantage plans & replace the normal part A & B), supplemental plans, & Part D (prescription plans). 

Does the employer require you to sign up for Medicare Part B (some do so you should check)?

How big is your spouse's employer? Does it have 100 or more employees? It will effect whether his plan is primary or secondary to Medicare.  100+ makes Medicare secondary.  https://www.medicare.gov/supplement-other-insurance/how-medicare-works-with-other-insurance/who-pays-first/which-insurance-pays.html#collapse-2437

Do you take any expensive prescriptions?  You might be better off staying on the employer plsn than getting Part D.
Logged
Age at Application: 26 age of onset (but I did not apply until 28)
Date Applied: August 2011
First Approval/Denial Date: November 2011
Additional Info: I was fortunate to be approved on my initial application due to extensive medical records (12+ doctors) & documentation of unsuccessful work attempts even with significant accommodations
chiarigal
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People helped 6
Posts: 66



« Reply #2 on: February 08, 2017, 05:04:24 PM »

I got carried away with the lettering system lol...

So to answer your questions...
It is a very large company. We have Anthem BCBS for our 2017 coverage. I believe there are about 8000 of us on the plan within the company so yes they cover a lot of us.

I do take some very expensive medications. And I have a pretty crappy prescription plan. They deny everything my specialist writes it seems and then they tell him what he should write in its place. I am currently out of pocket over 400$ a month my part on medications.
Logged
Age at Application: 37
Disability: ACM, PTSD, ADD, Carpal Tunnel, Occipital Neuralgia, spinal stenosis, degenerative disk disease of cervical spine, migraine, chronic widespread pain.
Date Applied: June 7th, 2013
First Approval/Denial Date: Denied 10/08/2014
Reconsideration Approval/Denial Date: Filed appeal 10/10/2014 hired lawyer
Date OTR requested: 10/23/2015
Date Hearing Notice Received: 11/08/2016
Hearing Date: 01/09/2017
ALJ Approval/Denial Date: 01/23/2017 Appeal Under Review A medical decision has been made and we are working to process your decision. A Social Security Representative may contact you or your appointed representative directly if we need any additional documents or information.
Date Award Letter Received: 01/27/2017 FULLY FAVORABLE 2/11/2017 Letter on SSA account confirming approval
Date Back Pay Received: 02/14/2017 Happy Valentines day to me. 02/13/2017 SSA page showing one time deposit for 02/14
Helper
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People helped 180
Gender: Female
Posts: 1725


« Reply #3 on: February 08, 2017, 05:47:58 PM »

Medicare.gov has a prescription plan finder that works really well.  You can input your medications & it determines what your costs will be.  https://www.medicare.gov/find-a-plan/questions/home.aspx  However,  you will definitely end up in the Medicare Part D coverage gap. 

https://www.medicare.gov/part-d/costs/coverage-gap/part-d-coverage-gap.html

Will you qualify for Extra Help?  https://www.medicare.gov/your-medicare-costs/help-paying-costs/save-on-drug-costs/save-on-drug-costs.html   If you do, it changes the math.  But since your husband is employed, I am guessing you might not qualify.
Logged
Age at Application: 26 age of onset (but I did not apply until 28)
Date Applied: August 2011
First Approval/Denial Date: November 2011
Additional Info: I was fortunate to be approved on my initial application due to extensive medical records (12+ doctors) & documentation of unsuccessful work attempts even with significant accommodations
chiarigal
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People helped 6
Posts: 66



« Reply #4 on: February 08, 2017, 05:56:25 PM »

Thanks Helper! You are a wealth of excellent information!
We would not qualify for any extra help. We are blessed that he makes decent money, then when my benefits start that will increase our household income so then we really wouldn't be able to get any help. We have somehow been able to manage for the past 4 years. Just getting a little help by means of medicare is going to be a huge blessing. I get so confused over the plans but will eventually get it figured out. I think I need to call Anthem BCBS and see like you stated which would be my primary when it kicks in then go from there to see if I need extra modules.
Logged
Age at Application: 37
Disability: ACM, PTSD, ADD, Carpal Tunnel, Occipital Neuralgia, spinal stenosis, degenerative disk disease of cervical spine, migraine, chronic widespread pain.
Date Applied: June 7th, 2013
First Approval/Denial Date: Denied 10/08/2014
Reconsideration Approval/Denial Date: Filed appeal 10/10/2014 hired lawyer
Date OTR requested: 10/23/2015
Date Hearing Notice Received: 11/08/2016
Hearing Date: 01/09/2017
ALJ Approval/Denial Date: 01/23/2017 Appeal Under Review A medical decision has been made and we are working to process your decision. A Social Security Representative may contact you or your appointed representative directly if we need any additional documents or information.
Date Award Letter Received: 01/27/2017 FULLY FAVORABLE 2/11/2017 Letter on SSA account confirming approval
Date Back Pay Received: 02/14/2017 Happy Valentines day to me. 02/13/2017 SSA page showing one time deposit for 02/14
Helper
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People helped 180
Gender: Female
Posts: 1725


« Reply #5 on: February 08, 2017, 06:25:34 PM »

Thanks Helper! You are a wealth of excellent information!
We would not qualify for any extra help. We are blessed that he makes decent money, then when my benefits start that will increase our household income so then we really wouldn't be able to get any help. We have somehow been able to manage for the past 4 years. Just getting a little help by means of medicare is going to be a huge blessing. I get so confused over the plans but will eventually get it figured out. I think I need to call Anthem BCBS and see like you stated which would be my primary when it kicks in then go from there to see if I need extra modules.

Since his employer has over 100 employees, the BCBS is primary & Medicare is secondary. 

However, if you sign up for a part D plan, then you would just bill the Part D plan for prescriptions  - not both.

If you keep his insurance, then you should not need any Supplement or Advantage plan.  It is just if you want to buy a Supplement or Advantage plan & go off of the BCBS.  Not sure what the premium cost for having you on the BCBS employer plan vs not having you on the plan cost difference would be.....
Logged
Age at Application: 26 age of onset (but I did not apply until 28)
Date Applied: August 2011
First Approval/Denial Date: November 2011
Additional Info: I was fortunate to be approved on my initial application due to extensive medical records (12+ doctors) & documentation of unsuccessful work attempts even with significant accommodations

« Last Edit: February 08, 2017, 06:28:26 PM by Helper »
chiarigal
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People helped 6
Posts: 66



« Reply #6 on: February 08, 2017, 06:28:42 PM »

Excellent Thank YOU!
I know I post a lot of questions but I seriously get confused with some of these loopholes.
Logged
Age at Application: 37
Disability: ACM, PTSD, ADD, Carpal Tunnel, Occipital Neuralgia, spinal stenosis, degenerative disk disease of cervical spine, migraine, chronic widespread pain.
Date Applied: June 7th, 2013
First Approval/Denial Date: Denied 10/08/2014
Reconsideration Approval/Denial Date: Filed appeal 10/10/2014 hired lawyer
Date OTR requested: 10/23/2015
Date Hearing Notice Received: 11/08/2016
Hearing Date: 01/09/2017
ALJ Approval/Denial Date: 01/23/2017 Appeal Under Review A medical decision has been made and we are working to process your decision. A Social Security Representative may contact you or your appointed representative directly if we need any additional documents or information.
Date Award Letter Received: 01/27/2017 FULLY FAVORABLE 2/11/2017 Letter on SSA account confirming approval
Date Back Pay Received: 02/14/2017 Happy Valentines day to me. 02/13/2017 SSA page showing one time deposit for 02/14
Helper
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~ Platinum ~
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People helped 180
Gender: Female
Posts: 1725


« Reply #7 on: February 08, 2017, 06:30:54 PM »

The only bad question is the one you don't ask!
Logged
Age at Application: 26 age of onset (but I did not apply until 28)
Date Applied: August 2011
First Approval/Denial Date: November 2011
Additional Info: I was fortunate to be approved on my initial application due to extensive medical records (12+ doctors) & documentation of unsuccessful work attempts even with significant accommodations
grove800
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People helped 27
Gender: Female
Posts: 600


« Reply #8 on: February 09, 2017, 09:40:55 AM »

In my case Medicare auto enrolled me in part B and deducted premiums from my back pay and I could not get back the months I was covered by private insurance.  I found out in Feb of 16 approved and my Medicare part B was deducted since December of 15.  Some here was able to get a refund but they said no to me.  At that point I did not care as much since was happy that I was approved.
Logged

😊
Name: Vicki
Location: IL
Age at Application: 59. Age now 62
Disability: Hypogammagobulimannenia , aggressive arthritis spine, 4 level cervical fusion, chronic pain, DDD,COPD,
Date Applied: 7/2013
First Approval/Denial Date: 11/2013
Reconsideration Approval/Denial Date: 5/2014
Date OTR requested: 6/2014
Hearing Date: January 19, 2016
Date Award Letter Received: February 3, 2016. per benefit letter on my SS website
Date Back Pay Received: February 4, 2016 direct deposit
Additional Info: fully favorable letter by mail Feb 6, 2016. Medicare started Dec 2015
chiarigal
~ Silver ~
*

People helped 6
Posts: 66



« Reply #9 on: February 09, 2017, 12:39:18 PM »

I don't mind at all paying for part B if I can get it to work like a gap plan. Years ago I had a gap plan that really worked out well for us as it covered all our portions that the primary did not cover. I wish we still had that as we would not be in debt for medical like we are.

I have a friend who sells modules for medicare and I have asked him to stop in when he can and go over some things with me in preparation so we know what to do once I do get my medicare started. I have a couple of major surgeries lingering in the horizon so I want to make sure I have all my bases covered.
Logged
Age at Application: 37
Disability: ACM, PTSD, ADD, Carpal Tunnel, Occipital Neuralgia, spinal stenosis, degenerative disk disease of cervical spine, migraine, chronic widespread pain.
Date Applied: June 7th, 2013
First Approval/Denial Date: Denied 10/08/2014
Reconsideration Approval/Denial Date: Filed appeal 10/10/2014 hired lawyer
Date OTR requested: 10/23/2015
Date Hearing Notice Received: 11/08/2016
Hearing Date: 01/09/2017
ALJ Approval/Denial Date: 01/23/2017 Appeal Under Review A medical decision has been made and we are working to process your decision. A Social Security Representative may contact you or your appointed representative directly if we need any additional documents or information.
Date Award Letter Received: 01/27/2017 FULLY FAVORABLE 2/11/2017 Letter on SSA account confirming approval
Date Back Pay Received: 02/14/2017 Happy Valentines day to me. 02/13/2017 SSA page showing one time deposit for 02/14
Helper
-
~ Platinum ~
*

People helped 180
Gender: Female
Posts: 1725


« Reply #10 on: February 09, 2017, 01:35:23 PM »

I don't mind at all paying for part B if I can get it to work like a gap plan. Years ago I had a gap plan that really worked out well for us as it covered all our portions that the primary did not cover. I wish we still had that as we would not be in debt for medical like we are.

I have a friend who sells modules for medicare and I have asked him to stop in when he can and go over some things with me in preparation so we know what to do once I do get my medicare started. I have a couple of major surgeries lingering in the horizon so I want to make sure I have all my bases covered.

You can also get free help from SHIP to learn about your Medicare options.   https://www.shiptacenter.org/
Logged
Age at Application: 26 age of onset (but I did not apply until 28)
Date Applied: August 2011
First Approval/Denial Date: November 2011
Additional Info: I was fortunate to be approved on my initial application due to extensive medical records (12+ doctors) & documentation of unsuccessful work attempts even with significant accommodations
chiarigal
~ Silver ~
*

People helped 6
Posts: 66



« Reply #11 on: February 09, 2017, 01:40:16 PM »

I don't mind at all paying for part B if I can get it to work like a gap plan. Years ago I had a gap plan that really worked out well for us as it covered all our portions that the primary did not cover. I wish we still had that as we would not be in debt for medical like we are.

I have a friend who sells modules for medicare and I have asked him to stop in when he can and go over some things with me in preparation so we know what to do once I do get my medicare started. I have a couple of major surgeries lingering in the horizon so I want to make sure I have all my bases covered.

You can also get free help from SHIP to learn about your Medicare options.   https://www.shiptacenter.org/

Thank you! That link pointed me in the direction for the link for the actual agency that covers my county.
Logged
Age at Application: 37
Disability: ACM, PTSD, ADD, Carpal Tunnel, Occipital Neuralgia, spinal stenosis, degenerative disk disease of cervical spine, migraine, chronic widespread pain.
Date Applied: June 7th, 2013
First Approval/Denial Date: Denied 10/08/2014
Reconsideration Approval/Denial Date: Filed appeal 10/10/2014 hired lawyer
Date OTR requested: 10/23/2015
Date Hearing Notice Received: 11/08/2016
Hearing Date: 01/09/2017
ALJ Approval/Denial Date: 01/23/2017 Appeal Under Review A medical decision has been made and we are working to process your decision. A Social Security Representative may contact you or your appointed representative directly if we need any additional documents or information.
Date Award Letter Received: 01/27/2017 FULLY FAVORABLE 2/11/2017 Letter on SSA account confirming approval
Date Back Pay Received: 02/14/2017 Happy Valentines day to me. 02/13/2017 SSA page showing one time deposit for 02/14
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