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Topic: Spouse employer insurance and medicare  (Read 890 times)
gardenia
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« Reply #15 on: April 19, 2017, 09:54:04 PM »

If you were eligible for Medicare first and then went on your spouse's insurance, you will have to pay a penalty for Medicare when you retire. If you were eligible for Medicare after you were already on your spouse's insurance and then waived Medicare, you do not have to pay a Medicare penalty when you retire. Read this:

https://www.medicarerights.org/PartB-Enrollment-Toolkit/Medicare-Part-B-Enrollment-Periods.pdf
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stellamartin123
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« Reply #16 on: April 19, 2017, 11:13:30 PM »

If you were eligible for Medicare first and then went on your spouse's insurance, you will have to pay a penalty for Medicare when you retire. If you were eligible for Medicare after you were already on your spouse's insurance and then waived Medicare, you do not have to pay a Medicare penalty when you retire. Read this:

https://www.medicarerights.org/PartB-Enrollment-Toolkit/Medicare-Part-B-Enrollment-Periods.pdf

Are you sure about having to pay the lifelong penalty when needing Medicare when reaching 65 (retirement age)? 
LNR wrote this on page 1: "Part B enrollment based on age 65 is considered separately from a potential prior enrollment based on disability."
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stellamartin123
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« Reply #17 on: April 19, 2017, 11:47:31 PM »

If you were eligible for Medicare first and then went on your spouse's insurance, you will have to pay a penalty for Medicare when you retire. If you were eligible for Medicare after you were already on your spouse's insurance and then waived Medicare, you do not have to pay a Medicare penalty when you retire. Read this:

https://www.medicarerights.org/PartB-Enrollment-Toolkit/Medicare-Part-B-Enrollment-Periods.pdf

I just called Medicare and spoke with a supervisor about dropping Part B and lifelong Part B penalty consequences.  She said that as long as you have continuous coverage you will not have a lifelong Part B penalty.  Knowing that I currently have Part B coverage, she said that if I get married, get on my spouse's insurance, then drop Medicare Part B (by writing SSA a letter requesting that Medicare Part B be dropped because I have coverage under my spouse's employer insurance), then get Medicare Part B again in the future due to divorce (allows a special enrollment period due to change in life circumstances) or turn 65 (triggers a special enrollment period) then I won't have a lifelong penalty.  She said the lifelong penalty is only incurred if you have a gap in medical coverage.

Just wanted to post this because it contradicts what has been posted in this thread about dropping Medicare Part B due to spouse insurance coverage and the lifelong Part B penalty consequences.
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Lit Love
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« Reply #18 on: April 20, 2017, 01:46:45 AM »

Have you also verified with your husband's company that you can refuse part B?  I thought that can be an issue as well?
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stellamartin123
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« Reply #19 on: April 20, 2017, 02:57:32 AM »

Have you also verified with your husband's company that you can refuse part B?  I thought that can be an issue as well?

Why would this be an issue? 

I wasn't planning to tell my husband's company that I have Medicare through disability.  Do I need to tell them this?

I was planning to enroll in my husband's employer insurance, and then cancel my Medicare Part B without telling my husband's company.  I didn't know that I might need to tell my husband's employer about my Medicare Part B insurance. 
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Helper
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« Reply #20 on: April 20, 2017, 05:27:52 AM »

Have you also verified with your husband's company that you can refuse part B?  I thought that can be an issue as well?

Why would this be an issue? 

I wasn't planning to tell my husband's company that I have Medicare through disability.  Do I need to tell them this?

I was planning to enroll in my husband's employer insurance, and then cancel my Medicare Part B without telling my husband's company.  I didn't know that I might need to tell my husband's employer about my Medicare Part B insurance. 

Yes, you need to tell your husband's insurance about your Medicare Coverage before you drop it.  Some companies require you to keep the Medicare  - even if it is due to disability. 

And yes, even if you don't report it, husband's insurance company could find out about the Medicare coverage because there is an insurance (sorry brain fog this morning & I am having trouble coming up with the right word) directory/index that insurers can check to find out about any other coverage you have.

For example, at one point I changed insurers & the new insurance started mid-month.  They told me the old insurance would be cancelled as of the new insurance effective date.  However, I found out it was actually effective until the end of the calendar month because the new insurance company rejected the claim & said the old insurance  was primary until the end of that month.

And if they require you to be enrolled in Medicare, you might have months of paying your claims without coverage because you can only enroll in Medicare at certain times of year for a later start (unless you get a divorce & would be eligible for a special enrollment).
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: April 20, 2017, 05:30:28 AM by Helper »
Lit Love
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« Reply #21 on: April 20, 2017, 05:37:17 AM »

Medicare would be the second payer so you need to notify his employer's insurance.  It does appear you won't have to carry Part B: https://www.medicare.gov/supplement-other-insurance/how-medicare-works-with-other-insurance/how-medicare-works-with-other-insurance.html

But, there is a qualifier of "generally" Medicare pays second, which is a little concerning, so you might want to verify with his insurance plan that this is a non-issue since you have to contact them anyway: https://www.medicare.gov/supplement-other-insurance/how-medicare-works-with-other-insurance/who-pays-first/which-insurance-pays.html#collapse-2453

It might be best to do so in a way that establishes a paper trail?


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newdawn
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« Reply #22 on: April 20, 2017, 10:03:40 AM »

Medicare would be the second payer so you need to notify his employer's insurance.  It does appear you won't have to carry Part B: https://www.medicare.gov/supplement-other-insurance/how-medicare-works-with-other-insurance/how-medicare-works-with-other-insurance.html

But, there is a qualifier of "generally" Medicare pays second, which is a little concerning, so you might want to verify with his insurance plan that this is a non-issue since you have to contact them anyway: https://www.medicare.gov/supplement-other-insurance/how-medicare-works-with-other-insurance/who-pays-first/which-insurance-pays.html#collapse-2453

They might say "generally" because medicare pays first if the company has fewer than 100 employers and doesn't join with other employers to form a multi-employer plan with a company with 100+ employees. The example below says "group health plan coverage based on my current employment" but further in the answer they say "or the current employment of a family member".

"I'm under 65, have a disability, and have group health plan coverage based on my current employment.

Generally, if your employer has fewer than 100 employees, Medicare pays first if you're under 65 or you have Medicare because of a disability.

Sometimes employers with fewer than 100 employees join with other employers to form a multi-employer plan or multiple employer plan. If at least one employer in the multi-employer plan or multiple employer plan has 100 employees or more, Medicare pays second.

If the employer has at least 100 employees, the health plan is called a large group health plan. If you're covered by a large group health plan because of your current employment or the current employment of a family member, Medicare pays second.

If you go outside your employer plan's network, it's possible that neither the plan nor Medicare will pay. Call your employer plan before you go outside the network to find out if the service will be covered."


https://www.medicare.gov/supplement-other-insurance/how-medicare-works-with-other-insurance/who-pays-first/which-insurance-pays.html#collapse-2437

https://www.medicare.gov/Pubs/pdf/02179.pdf

See also:

"I'm under 65 and have a disability

Ask your employer or union benefits administrator if they require you to sign up for Medicare if both of these apply:
  • You, a spouse, or family member is working.
  • You're covered by an employer or union group health plan (with at least 100 employees) based on that employment.
If the employer doesn't require you to sign up for Medicare right away, you can sign up later during a Special Enrollment Period without a late enrollment penalty."[/i] [bolding mine]

https://www.medicare.gov/sign-up-change-plans/get-parts-a-and-b/employer-coverage/i-have-employer-coverage.html#collapse-5569

To me it appears that you must check with the employer to see if they require you to sign up with medicare or else you risk a late enrollment penalty later on down the line. It may be that the employer says you're not required to sign up with medicare and then you don't have to worry.
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Name: Dawn
Location: IL
Age at Application: 31
Disability: Depression, anxiety
Date Applied: 11/2013
First Approval/Denial Date: 03/2014
Reconsideration Approval/Denial Date: 11/2014
Hearing Date: 11/13/2015 (Friday the 13th!)
ALJ Approval/Denial Date: 01/15/2016 Fully Favorable (rec'd 01/21)
Date Award Letter Received: 02/17/2016 (rec'd 02/20)
Date Back Pay Received: 02/13/2016 (paper check)
Additional Info: 02/09/16 mySSA account updated with approval info. 02/22 rec'd medicare card in mail. Hired lawyer after reconsideration denial. Requested an in-person hearing.
stellamartin123
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« Reply #23 on: April 20, 2017, 05:53:55 PM »

Lit Love, newdawn, Helper, and other mods,

I want to say thank you and I appreciate all the insight you offer to so many for free on these forums. 

This website was not working today until just now.  I kept getting a website from Host Gator and saying that the web host needed to be contacted.  I was having so much anxiety and stressing out.  I was really worried that the website would be permanently down due to financial reasons or something else.  I'm so glad the website is back up.

You guys make a meaningful difference in people's life and we really appreciate you volunteering your time and wisdom.
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Lit Love
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« Reply #24 on: April 20, 2017, 07:20:45 PM »

Lit Love, newdawn, Helper, and other mods,

I want to say thank you and I appreciate all the insight you offer to so many for free on these forums. 

This website was not working today until just now.  I kept getting a website from Host Gator and saying that the web host needed to be contacted.  I was having so much anxiety and stressing out.  I was really worried that the website would be permanently down due to financial reasons or something else.  I'm so glad the website is back up.

You guys make a meaningful difference in people's life and we really appreciate you volunteering your time and wisdom.

Thank you.

And while we volunteer, the owner of the site pays any expenses not covered by donations out of the goodness of her heart.  So, donations are very much appreciated and will help to ensure the site continues.
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stellamartin123
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« Reply #25 on: April 23, 2017, 06:45:34 PM »

Have you also verified with your husband's company that you can refuse part B?  I thought that can be an issue as well?

Why would this be an issue? 

I wasn't planning to tell my husband's company that I have Medicare through disability.  Do I need to tell them this?

I was planning to enroll in my husband's employer insurance, and then cancel my Medicare Part B without telling my husband's company.  I didn't know that I might need to tell my husband's employer about my Medicare Part B insurance. 

Yes, you need to tell your husband's insurance about your Medicare Coverage before you drop it.  Some companies require you to keep the Medicare  - even if it is due to disability. 

And yes, even if you don't report it, husband's insurance company could find out about the Medicare coverage because there is an insurance (sorry brain fog this morning & I am having trouble coming up with the right word) directory/index that insurers can check to find out about any other coverage you have.

For example, at one point I changed insurers & the new insurance started mid-month.  They told me the old insurance would be cancelled as of the new insurance effective date.  However, I found out it was actually effective until the end of the calendar month because the new insurance company rejected the claim & said the old insurance  was primary until the end of that month.

And if they require you to be enrolled in Medicare, you might have months of paying your claims without coverage because you can only enroll in Medicare at certain times of year for a later start (unless you get a divorce & would be eligible for a special enrollment).

My spouse's employer insurance would be primary due to company size and Medicare would be secondary.

Why would an employer insurance require you to keep Medicare if the employer insurance is primary? 

The employer insurance requiring me to keep Medicare sounds odd to me because as the primary insurer, the employer insurance would have the responsibility of paying for medical expenses as long as I stay in their insurance network.  So I don't know why me keeping Medicare would be relevant to them.
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Helper
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« Reply #26 on: April 23, 2017, 08:57:49 PM »

Have you also verified with your husband's company that you can refuse part B?  I thought that can be an issue as well?

Why would this be an issue? 

I wasn't planning to tell my husband's company that I have Medicare through disability.  Do I need to tell them this?

I was planning to enroll in my husband's employer insurance, and then cancel my Medicare Part B without telling my husband's company.  I didn't know that I might need to tell my husband's employer about my Medicare Part B insurance. 

Yes, you need to tell your husband's insurance about your Medicare Coverage before you drop it.  Some companies require you to keep the Medicare  - even if it is due to disability. 

And yes, even if you don't report it, husband's insurance company could find out about the Medicare coverage because there is an insurance (sorry brain fog this morning & I am having trouble coming up with the right word) directory/index that insurers can check to find out about any other coverage you have.

For example, at one point I changed insurers & the new insurance started mid-month.  They told me the old insurance would be cancelled as of the new insurance effective date.  However, I found out it was actually effective until the end of the calendar month because the new insurance company rejected the claim & said the old insurance  was primary until the end of that month.

And if they require you to be enrolled in Medicare, you might have months of paying your claims without coverage because you can only enroll in Medicare at certain times of year for a later start (unless you get a divorce & would be eligible for a special enrollment).

My spouse's employer insurance would be primary due to company size and Medicare would be secondary.

Why would an employer insurance require you to keep Medicare if the employer insurance is primary? 

The employer insurance requiring me to keep Medicare sounds odd to me because as the primary insurer, the employer insurance would have the responsibility of paying for medical expenses as long as I stay in their insurance network.  So I don't know why me keeping Medicare would be relevant to them.

The only answer I can give you is insurance companies are special & they sometimes have policies & rules that do not make sense to us. 

Your policy may not require you to keep Medicare.  But it is better to find out before you disenroll because there are only limited re-enrollment periods.
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
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