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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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fred123  
#1 Posted : Sunday, October 30, 2011 4:27:11 PM(UTC)
fred123

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I have asked this before but did a search and can't find the post. My mom came down with cancer in June of 2009. She died last week. She had chemo and radiation treatments and also broke her hip. Her last chemo treatment was in Sept. of 2010 and that month she fell and broke her hip. She was 82 and had Medicare A & B plus Mail Handlers Benefit Plan.

 The odd thing is she has never got a bill for anything only the explanation of benefits(EOB) from both Mail Handlers and many Medicare summaries. Almost every explanation says that the patients responsibility is $0.00. Over the past 2 years she has accumulated many EOB. Is this the way Medicare works? For me it's a little confusing but it say's right on the EOB pages that she owes nothing.

 On the Medicare summaries it will say you may be billed for a certain amount of the bill but so far no bill has been sent. When I go to the doctor the first thing I get is a EOB from my insurance company telling me what benefit they payed and how much my portion will be then will get the bill from the doctors office. This is very confusing and would appreciate your input. Thank You.
edalder  
#2 Posted : Sunday, October 30, 2011 9:51:39 PM(UTC)
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It is very possible that between Medicare and Mail Handlers, your mother did not have any co-pays.

Many of the FEHB plans pick up the co-pays, except for RX, when the member had Medicare Parts A & B and Medicare is primary as was undoubtedly the case for your mother.


Kivi
Kathi52  
#3 Posted : Sunday, October 30, 2011 10:58:58 PM(UTC)
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fred123, I completely agree with edalder. But first, sorry about your mother. Medicare Parts A & B will be the primary payer; 80% and then the FEHBP plan will be secondary payer. Your mother was very well covered so I have no doubt that the EOB's and summaries are showing a zero balance. Case in point, my mother and myself both have Medicare Parts A & B and BC/BS, Standard, Self. Both of us have had major surgeries yet owed nothing. But as edalder pointed out, there could be costs associated with Rx's. I never have any out of pocket costs on prescriptions because I also have Tricare. But that is beside the point right now. And the reason, I am going to assume, is you continue to pay the co-pays because you are not on Medicare or at least you didn't state you were. Most all of the FEHBP plans waive or at least offer incentives when it comes to Part B. I would read the Mail Handler's brochure and how it works in conjunction with Medicare. But it appears to me she was very, very well covered. Again, I am sorry about your mother. But will add this is precisely why I am so pro Part B; normally many Specialists involved and you just never know.
UJM  
#4 Posted : Friday, December 02, 2011 2:30:45 AM(UTC)
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I have Mail Handlers B P.    My wife has Medicare A & B.
She is starting chemo next week  (Dec 2011). It will be a 6+ months of treatment.
Financial Advisor at the hospital told her that Medicare as primary provider will pick up first 80% of the bills.
Of the remaining 20%:   Mail Handlers B P will pick up 90%
 
So for every  $1000 bill, Medicare will pay $800
Of the remaining $200:  Mail Handlers will pay $180
Our co pay will be $20
 
I hope she is right.
 
upandup  
#5 Posted : Saturday, December 03, 2011 3:27:34 AM(UTC)
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UJM, Mail Handlers has three plans (Standard, Value, Consumer Option), and how the coordination of benefits is handled varies among the plans. Which MHBP insurance option do you have?

If you have Standard, the 10% will be waived. You will have no out-of-pocket expenses for eligible charges.
OUtside  
#6 Posted : Saturday, December 03, 2011 6:58:24 AM(UTC)
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Sorry to hear of spouse’s health problem and hope all goes well with her treatment.

upandup, I looked briefly in the plan brochure under coordination of benefits. For Standard, on page 86 it lists which co-pays they waive when Part B is primary. I did not see hospital outpatient as one of those type co-pays, but did see a waiver for ‘billed by physicians.‘ It sounds like the treatment will be out patient hospital.

Is this one of those instances where it depends on who bills the treatment and, possibly, since the bill would not be from a physician (or for the other waived elements in this list of waivers) that they would not waive the plan co-pay for this out patient treatment?

upandup  
#7 Posted : Saturday, December 03, 2011 10:25:40 AM(UTC)
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I went by the MHBP website at http://mhbp.com/benefit-plans/medicare-coordination/medicare-benefit-summary/index.htm and http://mhbp.com/benefit-plans/medicare-coordination/index.htm
However, I agree that the brochure is silent on outpatient facility care. Since the brochure governs, that's a problem.

At any rate, MHBP Standard is a poor value: it's a very expensive plan. It's even more expensive than BCBS Standard--which is also a very expensive plan. SAMBA Standard (Cigna network), GEHA Standard (various networks), APWU High (Cigna Network), or even NALC (Cigna network; on the expensive side) might be better options [if eligible, Compass Rose (United HealthCare network) and Foreign Service (Coventry network--same as Mail Handlers) are also worthy of consideration). It is Open Season now. Foreign Service has the very best waivers when Medicare A and B are primary, waiving even prescription copays/coinsurance.
OUtside  
#8 Posted : Saturday, December 03, 2011 11:42:51 AM(UTC)
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Sounds like the advisor UJM talked to did their homework.

I can’t comment on the list of other plans you suggested except GEHA Standard’s co-pay requirement of 50% for brand prescriptions, max $200. Especially for someone facing a lot of health care, I think I would be hesitant about that one.

BTW, the Value option of this plan says it will not waive any deductibles, etc when subscriber has Medicare. I’m assuming this means subscriber must pay the Medicare deductibles, co-pays, etc. Is this correct and if yes, how is it different from the HMO discussion recently where you said subscriber does not pay extra for those elements?

upandup  
#9 Posted : Saturday, December 03, 2011 12:24:38 PM(UTC)
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Yes, GEHA Standard has its weaknesses with respect to prescription drugs. It does have a catastrophic cap that applies to prescription drugs. Its monthly employee/annuitant premium is $210.86 for families compared with the huge premium cost of $501 for MHBP Standard. That's $3481 per year in premium savings. I'm not saying that GEHA Standard is the best plan for UJM--mostly saying that something other than MHBP is probably advisable.

The MHBP Value Plan is not a very strong plan. Its premiums are climbing year after year at a rate outpacing overall plan inflation. Its monthly employee/annuitant cost for the Family plan was $142.36 in 2010, and now for 2012 it is $204.49--a whopping 43% 2-year increase. It is no longer that much cheaper than much more generous plans. As for the Medicare coordination issue, it is just as with the HMOs with the key difference being that it uses percentage co-insurance for most services. Thus it pays the percentage left after Medicare pays its share, resulting in a member savings despite not waiving costs. The member does not pay all of the Medicare deductibles, co-insurance, etc.: those unpaid costs are considered by the plain under its normal policies. Some of those costs will be paid by the plan (after meeting plan deductible); some will remain the member responsibility. Just because the plan does not waive costs does not mean they cease paying normal benefits.


upandup2011-12-03 20:32:32
UJM  
#10 Posted : Sunday, December 04, 2011 8:59:04 PM(UTC)
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let me muddy up the picture a little.
 
During this open season, I did sign up to change from MHBP to Blur Cross Blue Shield family Nationwide Plan # 105.  Is it wise ?
 
Other question for someone who is familiar with cancer treatment: Keeping in mind that wife has Medicare A & B,    Will I reach $5000 in HC-FSA during 2012 ?
UJM  
#11 Posted : Sunday, December 04, 2011 9:02:58 PM(UTC)
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It is a standard plan
upandup  
#12 Posted : Monday, December 05, 2011 12:53:09 AM(UTC)
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You may wish, then, to take advantage of Open Season (ends in a week), as MHBP Standard is extremely expensive.
OUtside  
#13 Posted : Monday, December 05, 2011 3:14:31 AM(UTC)
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UJM, you may have muddied up the picture more than a little as mentioned in your post on page 1.

First, if you have FSA while still working and spouse is on your fehb family plan, then fehb plan would be primary for her treatment, meaning fehb would set the rate and would not probably waive fehb co-pays. Also, Medicare probably would not, as secondary, pay 80%.

Second, you were asking about having to pay 10% co-pay under your current plan. BC Standard #105 requires 15% co-pay for out patient hospital care. That’s 50% higher and if fehb (as primary) rate is used (vs. Medicare which might be lower) of a higher amount.

Of course, you have to look at everything, premiums, benefits, co-pays, etc, but muddy waters apply to those, too.

UJM  
#14 Posted : Monday, December 05, 2011 4:42:12 AM(UTC)
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Does it make a lot of difference ?
 
Is it worth not participating in HC-FSA ?
upandup  
#15 Posted : Monday, December 05, 2011 4:49:07 AM(UTC)
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Participating in the FSA doesn't change the benefits. However, it means you are not retired. Therefore, FEHB is primary and Medicare is secondary (probably with limited additional benefit). Most feds don't consider Medicare Part B until retirement. You won't pay a penalty if you enroll in Part B within 8 months of retirement/spouse's retirement (if covered on spouse FEHB).

UJM  
#16 Posted : Monday, December 05, 2011 5:20:43 AM(UTC)
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I am still federal employee, but wife is retired. She has Medicare A & B.
She is facing lengthy chemo/rad
So, for her also, FEHB will be primary, and Medicare secondary?
upandup  
#17 Posted : Monday, December 05, 2011 6:05:45 AM(UTC)
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Yes, FEHB will be primary and Medicare secondary if she is covered under YOUR FEHB coverage (family enrollment). If she is covered under her own FEHB enrollment (if she is also a government annuitant), then FEHB will be secondary.
UJM  
#18 Posted : Tuesday, December 06, 2011 2:16:37 AM(UTC)
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Will it be better if I do not participate in HC-FSA ?
If I do not use HC-FSA, then, Medicare will become primary for her ?
Which will be better way ?
upandup  
#19 Posted : Tuesday, December 06, 2011 3:29:21 AM(UTC)
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UJM wrote:
Will it be better if I do not participate in HC-FSA ?
If I do not use HC-FSA, then, Medicare will become primary for her ?
Which will be better way ?


HC-FSA has no bearing at all on your medical insurance. It is simply a way to reimburse yourself for out-of-pocket expenses. It does not change your out-of-pocket.

The only way Medicare would be primary while you are actively employed would be if you dropped out of FEHB (or went to employee only coverage), but that would leave you with no secondary coverage and gaping holes in coverage.  That would be foolish.
edalder  
#20 Posted : Friday, December 09, 2011 3:51:09 AM(UTC)
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If you are employed and your spouse is on your coverage, given her health issues, you probably will benefit from enrolling in a HCSA via FSAFEDS.

In this scenario, Medicare is unlikely to pay anything, so you and you wife will have the various co-pays, etc, that are applicable to her chemo treatments and any medical care that you receive.

My spouse had colon cancer a few years back and those co-pays do tend to mount up pretty fast as those chemo treatments are typical two or three times a week for six months. However, he did recover. I would hope that the outcome will be similar for your spouse.

I can't comment on whether you will reach 5k. You probably can do a much better projection of what your out of pocket costs will be based upon the frequency and duration of her chemo and what the plan will charge as a co-pay or co-insurance for each tx/visit.

What I would question is why your spouse has Medicare Part B? As long as your FEHB plan is primary and it will be for as long as you are an active employee and she is covered under it, then Medicare Part B won't pay much of anything. That Medicare premium probably is an unnecessary expense at this point. Once you do retire, she can pick up Medicare Part B, without any penalty as long as she does so fairly promptly. (I think that she would have 8 months to get it, but double check that figure with Medicare.)

The answer is different if she has FEHB as a Federal retiree. Then, it's her plan and her plan alone. FEHB prohibits dual enrollments. So, if she has her own FEHB coverage, you should be in a self only plan.




Kivi
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