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Medicare and Health Care


*This is a non-medical board. This site shall not be used to seek professional, medical or legal consultation.

Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age person with End-Stage Renal Disease (ESRD). There are many different parts to Medicare; with all of these options, it can be confusing.

This forum will allow members to share their experience with medicare and seek advice* on certain medicare-related situations.

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Dave Taylor  
#1 Posted : Tuesday, February 15, 2011 7:08:31 PM(UTC)
Dave Taylor

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I wish to withdraw participation from Medicare Part B.

Currently I am FERS retired.... above 67 years of age.... have Medicare "Part A" and "Part B" and BCBS standard option.

It appears that form "CMS-1763 (05-97) formerly HCFA-1763" will do the job and get me out of Medicare Part B.

Two questions please:

1. Does anyone know if this is the correct paper form to use to withdraw from "Part B" and.... will it work?

2. After withdrawing from "Part B"..... does anyone know if "BCBS Standard Option" will then step up to the plate.... get out of the background as "secondary payer".... and automatically (or otherwise) again become my "primary payer"?

Thanks
freeageless  
#2 Posted : Tuesday, February 15, 2011 7:35:19 PM(UTC)
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I don't know the answer to your first question. The answer to your second question is mostly yes. However, you have to make sure that you notify Blue Cross and give them the effective date that you dropped Medicare. Also, this is not your question. However, if I were you, I would think long and hard before I dropped Medicare.

Hope this helps.
Dave Taylor  
#3 Posted : Thursday, February 17, 2011 8:17:14 AM(UTC)
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Thanks for the reply, FG.
 
FG wrote: " The answer to your second question is mostly yes".
 
How do you know this?
 
What's "mosty"?
 
FG also wrote: "I would think long and hard before I dropped Medicare".
 
Dealing with the staff at my local social security office.... and other SSA entities is making this decision rather easy for me.
samac59  
#4 Posted : Thursday, February 17, 2011 8:44:22 AM(UTC)
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Withdrawing from Medicare Part B

Updated 02/08/2011 03:02 PM   |    ID# 1499

I no longer need Medicare Part B, because I am covered by other health insurance.  How do I terminate my enrollment?

If you wish to terminate your enrollment, talk to us and we will help you submit a signed request for termination or Form CMS-1763.  Termination is a serious decision if you wish to re-enroll later, you may have to pay a surcharge.  

The Centers for Medicare and Medicaid Services (CMS) requires that, when feasible, a personal interview be conducted with everyone who wishes to terminate entitlement.  So, we do not offer form CMS-1763 online.  We will help you fill out the form in-person or on the phone so we can make sure you understand the consequences of termination. 

After the interview, a Social Security representative will give you a letter outlining the consequences of voluntary termination and of the right to withdraw the termination request before coverage ends. 

Termination of Medicare Part B will be effective at the end of the month following the month that you file the termination request.

For an interview, call our toll-free number, 1-800-772-1213 or contact your local Social Security office.

OUtside  
#5 Posted : Thursday, February 17, 2011 9:48:58 AM(UTC)
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The answer to your second question is covered in detail in the Blue Cross Brochure, page 24, under “When you are age 65 or over and do not have Medicare.”

The page is challenging and may take several readings before the information really sinks in, and there are ways to misunderstand the subject discussed; feel free to pose any questions because understanding all the particulars will be valuable.

Once that page is clear, a good idea is then to apply the same toward the following page, 25, “When you have the Original Medicare Plan (Part A, Part B, or both),” which covers the cases when Medicare is primary. This will ensure you have the perspective of both sides of the issue and can compare aspects one vs. the other of how benefits are processed.

If you are like many people, including me, you skipped over those page as irrelevant before you were age 65, and didn’t pay that much attention to them either after retirement.

But the answer to your question is right there where BC is telling how their plan is supposed to work either way.

And if you do drop B and there are any mix ups during the interim, you should know what corrections will be in order.

Dave Taylor  
#6 Posted : Saturday, February 19, 2011 12:04:38 AM(UTC)
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"Sam" writes quoting "Medicare" documentation.
 
Documentation notwithstanding.... three difficult, agonizingly long and fruitless personal visits to SSA (forget days waiting for a phone call to be answered) produced two identical responses to the affect.... "Once, enrolled one is unable to withdraw from Medicare plan B.  There is no mechanism that allows this". 
 
Additionally, no mention of BCBS (or other's) responsibility to step back into primary payee status is made within this Medicare documentation.
 
"OUt" writes quoting BCBS documentation.
 
No statement of BCBS's legal responsibility or acting policy covering a move BACK TO PRIMARY PAYEE STATUS is made within their documentation.
 
Also, what does it mean.... "you should know what corrections will be in order".
 
Thank You
  
samac59  
#7 Posted : Saturday, February 19, 2011 12:59:04 AM(UTC)
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Its obvious SSA misinformed you about being able to withdraw from part b. The info I posted earlier came directly from the SSA website. Here is the link   http://ssa-custhelp.ssa.gov/app/answers/detail/a_id/1499/~/withdrawing-from-medicare-part-b . Once you notify BCBS that you no longer have part b it should be obvious they become the primary payor because they would become the only payor.
upandup  
#8 Posted : Saturday, February 19, 2011 4:04:35 AM(UTC)
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OUtside  
#9 Posted : Saturday, February 19, 2011 5:29:41 AM(UTC)
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Dave, page 24 tells what happens if you do not have Part B. If you do not have Part B (because you never enrolled or dropped it), then page 24 applies.

As you are finding out, not everyone understands the fehb-Medicare interface as well as in an ideal world. And there are ways to misunderstand, for example, your idea that fehb ‘steps back in’ is sort of a metaphor for what happens when someone drops Part B, but the real fact is, if you do not have Part B, your medical benefits should be processed by BC according to page 24 (and it doesn‘t matter why you do not have it).

Here is an example, admittedly a simple one. Let’s say the day after your new status is effective, you visit your primary care PPO doctor for a routine matter and he submits a charge of $300. If the Medicare rate is $150, BC should pay $130 and you should pay a $20 co-pay (as according to page 24).

If the explanation of benefits you receive for this visit indicates Medicare paid $120, BC paid $30, and you owe nothing (or anything else unusual and inconsistent with page 24), you will know the computers have yet to catch up with your having dropped Part B. You can then choose to wait hoping the system soon catches up with the fact that you have dropped Part B, or, using the information on page 24, you can begin making phone calls seeking correction.

rkay48  
#10 Posted : Tuesday, March 08, 2011 1:00:24 AM(UTC)
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I am also struggling with this decision (my wife turns 65 at the end of 2011).  I tentatively plan to NOT pick up Part B, but I am still thinkingon this.....
 
Upandup:  Yes the form is online as you said, but folks should understand that you still have to meet with SSA.  Here is what an accompanying document says:
 
The CMS-1763 provides CMS and SSA with the enrollee’s request for termination of Part B and/or premium Part A coverage.  The CMS -1763 is currently approved under OMB number 0938-0025.

The CMS-1763 is completed by an SSA claims or field representative using information provided by the Medicare enrollee during an interview.  The purpose of the form is to provide to the enrollee a standardized format to request termination of Part B and/or premium Part A coverage, explain why (s)he wishes to terminate such coverage and to acknowledge that the ramifications of the decision are understood.  The form is not completed by CMS staff.

Dave Taylor  
#11 Posted : Wednesday, March 09, 2011 12:12:21 PM(UTC)
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Keeping Part A of Medicare is a no brainer, RK...... cause' it costs nothing.
 
Part B, on the udder' hand, is getting prohibitively expensive for no reason other than SSA staffer inability to decipher English language instructions supplied with Medicare forms.
 
BCBS loves those who enroll in Part B cause (when you do).... BCBS financial responsibility for your health and well being becomes near zilch.
 
Folks who opt for Part B medicare should seriously consider picking up a prescription provider and dumping BCBS as it converts from fed employment.
Kathi52  
#12 Posted : Thursday, March 10, 2011 1:09:30 AM(UTC)
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Dave, I can certainly understand your frustration. But I agree with freeageless, I would think long and hard about dropping Part B. I also have BCBS Standard, Medicare Parts A & B and Tricare. And I know we all pay quite a bit. But considering my own health issues and that of my husband's, I wouldn't be without Part B. Also, understand that by taking Part B, it helps to keep the costs down of those with BCBS. Thus far, I have had plenty of surgeries, procedures and what not. And I like the fact that there are ZERO out of pocket costs. On the other hand, my husband stated this morning that he might just go with Medicare, do as you are considering and have Medicare as Primary and Tricare as secondary. But I warned him...there could be cuts to either/or. And he did say that that is the one thing that would hold him back from dropping the FEHBP. So, long story short, I just simply told him not to make any rash decisions. Of course, he won't retire for two more years but he is looking at this closely. For myself, I might switch to BCBS Basic at some point. But I want to make sure everything I have done is COMPLETELY covered first. Just my two cents worth as I know the SSA can be frustrating at times.
Dave Taylor  
#13 Posted : Thursday, March 10, 2011 4:01:26 AM(UTC)
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Thanks for the message Kathi.
 
I notice Medicare and private insurers like BCBS both play the 'what if' game with us elders..... what if there are program changes..... what if there are cuts.... what if this bill passes and becomes law.... what if this bill does not pass.....
 
Helps keep us in line and paying ever increasing insurance premiums.
 
 
 
raw6560  
#14 Posted : Friday, March 11, 2011 3:32:59 AM(UTC)
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My wife and I will be in a similar boat by the end of this year in deciding weather or not to take Medicare Part B to begin with.  Both the FEHB plans and Medicare premiums will continue increasing and it seems like all our funds will be going is pay for health care.  We now have NALC which has very good benefits including Rx coverage (Which we need) and a good catastrophic cutoff of $5,000.  I also feel they are forcing us to take Medicare Part B when first eligible or pay the 10% penalty for each year we delay coverage.  I am already ticked off about the penalty CSRS retirees get hit with when collecting Social Security if eligible.  The big unknown is what changes are coming down the road to both FEHB and Medicare.

 
One other important point to remember is if you decide that you don't want to stay in the FEHB program is to suspend coverage but never cancel coverage.  Once you cancel this coverage you can never get back in the program but if you suspend coverage you can always get reinstated.

 

OUtside  
#15 Posted : Saturday, March 12, 2011 6:01:30 AM(UTC)
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Re: the amounts BC continues to pay for someone with Medicare Part B, Medicare generally pays 80% for Part B-type services and BC then pays 20%. Obviously, this means Medicare pays the much greater payment.

But another point to consider is how much BC pays vs. how much it pays for subscribers younger than Medicare age. As far as I know, this information is not readily available, but we can get an idea because we know the elderly have far greater medical care than the younger age group. For example, if the number of physician office visits by the elderly is two, three, or four times the number of visits by the younger group of subscribers, the gap between the two groups will narrow.

It will narrow further when the expense of prescription drugs is taken into account because, again, the elderly have far greater use, and there is generally no prescription drug benefit provided by Medicare Part B (ie, BC continues to pay the same benefits but even more benefits for the elderly because of more usage)..

When an overall comparison is made between the two groups, BC retirees with Part B and younger subscribers, I’m guessing BC does not achieve huge savings when subscribers enroll in Medicare Part B.

Dave Taylor  
#16 Posted : Saturday, March 12, 2011 8:25:11 AM(UTC)
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RAW writes.........
* * * *
"if you decide that you don't want to stay in the FEHB program... suspend coverage but never cancel coverage.  Once you cancel coverage you can never get back in the program.  if you suspend coverage you can get reinstated".
* * * *
It's information like this (above) that BCBS reps do not tell retirees that boggles my mind.
 
OUt writes...........
* * * * 
I’m guessing BC does not achieve huge savings when subscribers enroll in Medicare Part B.
* * * *
 
If that is true..... then explain the following please........
 
This tax year 2010 is the first year I have ever had enough personal medical expenses (as opposed to income) to actually take a deduction on Federal taxes..... and I have been paying federal tax since 1955.
 
Of those personal medical expenses.... my Federal BCBS in retirement covered $110.
Thanks bunches. 
 
 
 
 
upandup  
#17 Posted : Saturday, March 12, 2011 11:04:46 AM(UTC)
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Dave Taylor wrote:
RAW writes.........
* * * *
"if you decide that you don't want to stay in the FEHB program... suspend coverage but never cancel coverage.  Once you cancel coverage you can never get back in the program.  if you suspend coverage you can get reinstated".
* * * *
It's information like this (above) that BCBS reps do not tell retirees that boggles my mind.
You can't suspend FEHB unless you are covered under Medicare Advantage plans (part C), Tricare, CHAMPVA, or Medicaid. http://www.opm.gov/insure/glossary/index.asp#sofe


Dave Taylor wrote:

This tax year 2010 is the first year I have ever had enough personal medical expenses (as opposed to income) to actually take a deduction on Federal taxes..... and I have been paying federal tax since 1955.
 
Of those personal medical expenses.... my Federal BCBS in retirement covered $110.
Thanks bunches.
That's hard to know. Did you have a lot of uncovered expenses?

BC/BS Standard is quite expensive...I'd consider other plans before dropping.
OUtside  
#18 Posted : Saturday, March 12, 2011 11:22:55 PM(UTC)
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Dave, if BC paid $110 of your expenses last year, let’s keep it simple and assume that reflected all medical office visits where Part B paid its 80% leaving 20% =$110. Under BC Standard without Part B, you could have made 6 visits to PPO primary care doctor for co-pays totaling $120 ($20 each).

If you accept the premise that because fehb co-pays are low, it is not easy to save more in waived co-pays than to pay in Part B premiums, then your experience last year would illustrate this premise; that is, you paid about $1200 in Part B premiums but only saved $120 in waived BC co-pays.

Deducting medical expenses on your federal income tax requires the expenses exceed a threshold of 7.5% of your adjusted gross income. In other words, because Part B premiums are deductible and are apt to exceed co-pays (also deductible) that you would have paid absent Part B, then you are actually more likely to meet the 7.5% threshold by having Part B than not having Part B.

Not trying to go all the way back to when you paid taxes in 1955, this suggests why last year was your first to itemize medical expenses on your federal tax, ie, 2010 was the first year you were enrolled in Part B.

Here is another general example. BC family enrollment premium last year was about $4800. If both retired spouses were also enrolled in Part B, they paid an additional $1200 each in premiums, for total premiums of $7200. The amount of $7200 is 7.5% of $96000, so if their adjusted gross income was less than $96000, they were able to deduct medical expenses. And if their adjusted gross income was way less than $96000, they were able to deduct quite a bit of their health care expenses including insurance premiums.

Of course, this line of discussion is not meant to address the other usual aspects in Part B discussions, the peace of mind aspect, the penalty for late or lapsed enrollment aspect, etc, etc.

Disclaimer: I don’t take a position for or against enrolling in Part B and believe everyone should make their best decision after learning as much as possible about the subject.

Dave Taylor  
#19 Posted : Sunday, March 13, 2011 1:12:01 PM(UTC)
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Hmmm...... Up and OUt....
Lemme' put this differently.
 
I paid BCBS $2100 in premiums in 2010 and they paid me $110 as loving, caring secondary payers of whatever Medicare part A and Part B did not cover first.
 
Lessee' further..... I also pay a 'premium' premium for Medicare Part B..... which covers first and cares less if I also pay premiums to BCBS.
 
And I'm told.........
 
* * * *
"BC does not achieve huge savings when subscribers enroll in Medicare Part B"
* * * *
 
and I'm cautioned  to consider....
 
* * * *
"the peace of mind aspect, the penalty for late or lapsed enrollment aspect, etc, etc" 
* * * *
The following aint' no newsflash.... nor is it rocket science:
 
The reason I qualify for a Federal tax deduction for the first time since 1955 is..... I now have the good fortune of paying bucco premiums (and rising) for health insurance to two different insurance entities. 
 
Cough cough!
 
Rats!  :---)
bob1092rif  
#20 Posted : Sunday, March 13, 2011 2:03:49 PM(UTC)
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 Form CMS 1763(05/97) is correct form to terminate part B Medical Insurance enrollment. When it is finally terminated you will receive new Medicare Card indicating Only part A coverage plus a letter showing effective date of Part B termination. You submit copies of both to BCBS . The total process takes a 4 to 5 months. I submitted my request in late Nov of 2009 effective Jan 1 of 2010 it was finalized in May of 2010.  You will be reimbursed for any premiums withheld after your termination date. You may encounter problems if you require medical services during the processing time because BCBS is your secondary until  you submit the paperwork from CMS showing date of termination            Been there done ThatSleepy
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