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Medicare and Health Care


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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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retiredfed2004  
#1 Posted : Tuesday, November 01, 2011 2:36:39 AM(UTC)
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I am a retired federal employee enrolled in the FEHB Program.  I  turn 65 this year and am eligible for premium-free Medicare Part A.  (I have already decided that I will not enroll in Part B at this time.)
Do I have to enroll in Part A when eligible or will I be able to enroll  in Part A at any later date (e.g. 3 years from now)?  If I enroll at a later date will it still be free or will I incur a penalty. 
upandup  
#2 Posted : Tuesday, November 01, 2011 3:05:11 AM(UTC)
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There's no penalty for late Medicare Part A enrollment for those entitled to premium-free Part A, but unless you are avoiding Medicare coverage to be able to continue to make HSA contributions, I don't see why you'd turn down free Part A coverage. In many FEHB plans, having Part A as primary will waive many of your copays/coinsurance for hospital services.
retiredfed2004  
#3 Posted : Tuesday, November 01, 2011 11:47:26 PM(UTC)
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Thanks for the information.  The reason I am not inclined to sign up for Part A at this time is that I have an HMO that specifically states "We do not waive any costs if the Original Medicare Plan is your primary payor"  By not participating in Medicare, my HMO would be the primary payor and I would only be subject to the copay requirements of the HMO. 
OUtside  
#4 Posted : Wednesday, November 02, 2011 1:23:00 AM(UTC)
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This is an interesting thread.

Thanks for the clarification re: your HMO. If you care to, I’d be interested in reading your comparison between co-pays for in hospital care under your plan vs. the $1100 deductible of Part A-- just curious.

I was not aware an employee could make contributions to an HSA after retirement.

As to delaying enrollment in Part A after age 65, I learned on another thread here recently that enrollment in Part A can be retroactive for up to 6 months. Just for fun, this prompted me to write this little skit which I call:

 

‘HOW TO TEST THE SENSE OF HUMOR OF HOSPITAL STAFF’

Hospital Staff: Good afternoon, Mr. Smith, I see you are checking in to have surgery first thing in the morning?

Retiree: Yes, Doc says I have a pretty good chance if I have this surgery right away.

Hospital Staff: Best of luck to you, then. How will you be paying for your visit here in the hospital?

Retiree: Well, I have Blue Cross federal but I won’t be using that because it would cost me a co-pay of several hundred dollars. No, I will be using Medicare Part A, instead.

Hospital Staff: Yes, good idea. May I see your Medicare card, please?

Retiree: Well, actually, I don’t have a Medicare card, but I learned on line that Part A is retroactive for up to 6 months, so I plan to apply soon as I am discharged in a few days.

Hospital Staff: But Mr. Smith, you are supposed to present your Medicare card the day you check in….

Retiree: Not to worry, as I said, Part A will be retroactive for up to 6 months, you can Google that, if you don’t believe me. And I told my wife, if surgery does not go as expected, she should apply for the Medicare Part A card right after she calls the undertaker. She promises to do that, ok?

Hospital Staff: Well, yes, I guess so, Mr. Smith, go right on up to Room E429 and get settled in. I’ll send these notes down to Accounting just in case they have any question for billing purposes.

upandup  
#5 Posted : Wednesday, November 02, 2011 1:29:53 PM(UTC)
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OUtside wrote:
I was not aware an employee could make contributions to an HSA after retirement.
An HSA-Health Savings Account (as opposed to an FSA-Flexible Spending Account) is not tied to an employment relationship. Anyway can contribute if they have an eligible health plan and don't have other medical insurance coverage.
upandup  
#6 Posted : Wednesday, November 02, 2011 1:31:50 PM(UTC)
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retiredfed2004 wrote:
Thanks for the information.  The reason I am not inclined to sign up for Part A at this time is that I have an HMO that specifically states "We do not waive any costs if the Original Medicare Plan is your primary payor"  By not participating in Medicare, my HMO would be the primary payor and I would only be subject to the copay requirements of the HMO. 

They don't waive any costs, which means your normal copays/coinsurance still apply--they still provide benefits! However, that could still be a savings to you, especially if you have a percentage co-insurance on some hospital services. Having Medicare Part A as primary would not cost you MORE in copays than if you had no Part A.
retiredfed2004  
#7 Posted : Thursday, November 03, 2011 3:44:01 AM(UTC)
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Now I am getting confused!  If I sign up for Medicare Part A and am hospitalized, I would have a Medicare deductible of about $1100.  Under my HealthNet HMO policy my copay for inpatient hospital room and board is $200 per day for up to 3 days per admission and my copay for other hospital services and supplies (e.g., operating and recovery rooms, rescribed drugs, diagnostic lab tests, x-rays, dressings, medical supplies, etc) is also $200 per day for up to 3 days.   Seems that if my HMO is going to pay any benefits as a secondary payor, I would have to pay the $1100 Medicare Part A deductible plus as much as $1200 copay (worse case senario) to my HMO.  What am I missing here???

OUtside  
#8 Posted : Thursday, November 03, 2011 4:10:30 AM(UTC)
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Good point, and there does seem to be something missing. For example, suppose the hospital bill is $50000, after a $1200 deductible (Part A’s or your plan’s) why would your plan want to pay the other $48800 if Medicare would be paying it under Part A assuming you were enrolled in Part A?

Have you asked your questions to the plan? One HMO plan brochure I glanced at said they advised subscriber to take Part A if subscriber could have it free. Same question comes up, why would subscriber if hospitalized want to pay the Part A deductible and the plan hospital co-pay, as well?

Perhaps there is something missing from the fine print that plan Rep would explain.

upandup  
#9 Posted : Thursday, November 03, 2011 9:34:20 AM(UTC)
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You wouldn't pay both the Medicare deductible and the HMO copay.

For a hospital stay of up to 60 days, Medicare Part A would pay everything except the $1132 deductible. Then, the FEHB plan would pay. In this case, since the FEHB plan in question is a flat copay based plan, then for a three day hospital stay, the plan would pay only $532. The member liability would be $600. This liability wouldn't change based upon whether or not the member has Part A, but since Medicare Part A is premium-free, there is no reason not to enroll.

There may, however, be better FEHB plans for your situation.
OUtside  
#10 Posted : Thursday, November 03, 2011 12:27:30 PM(UTC)
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upandup, you’re saying the most he would have to pay having Part A is the Part A deductible of $1132.

He’s saying the maximum in hospital co-pay under his plan (without Part A) is $1200. He’s also saying the daily co-pay is $200 for room and board and up to $200 for everything else. Let’s say the ‘everything else’ is always $200, that means his daily co-pay would be $400 for a max of 3 days.

Taking both of those situations means that if he has an in hospital stay of a day or two costing less than $1132, he would be better off not having Part A. For example, if the total cost for one day is $1132, with Part A would cost him the entire $1132, but without Part A would cost him only $400.

I agree for a stay costing more than $1132, Medicare will pay everything except $1132, so he would not pay more than $1132. But I still am wondering why his plan would risk subscribers not taking Part A because for a stay costing big money, you would think the plan would much prefer Medicare paying it.

There is similar non waiver of Medicare co-pays in HD and CD plans, but in those plans they provide a spending account which can be used for the Part A deductible. That changes the situation somewhat, plus in the conventional insurance stage, I think the liability for the Part A deductible would only be the plan percentage, such as 15% in one plan I am familiar with.

upandup  
#11 Posted : Thursday, November 03, 2011 1:13:30 PM(UTC)
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OUtside wrote:
 For example, if the total cost for one day is $1132, with Part A would cost him the entire $1132, but without Part A would cost him only $400.
No...
It's never going to cost more out of pocket to have Part A than it would be to not have Part A. It may not cost any less out of pocket, but it will not cost any more.
If the FEHB HMO is secondary, they will pick up costs not paid by Medicare (e.g., deductible) applying normal cost-sharing rules. The end result would be paying the normal copay applicable even without Medicare Part A. The member in this case isn't saving a dime, but the plan would save.
phauser  
#12 Posted : Thursday, November 03, 2011 1:37:41 PM(UTC)
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upandup wrote:
OUtside wrote:
I was not aware an employee could make contributions to an HSA after retirement.
An HSA-Health Savings Account (as opposed to an FSA-Flexible Spending Account) is not tied to an employment relationship. Anyway can contribute if they have an eligible health plan and don't have other medical insurance coverage.
   
To add a personal comment:   My spouse and I are both retired but not yet 65.  We both plan to opt out of Medicare Part A when we turn 65.  This is because we wish to continue contributing to our HSA's for as long as possible (for as long as we do not have regular hospital expenses and need Medicare Part A).  But when our health situation changes, and we feel we need Medicar Part A, we will sign up for Medicare Part A at that time (without a penalty).  It is just more beneficial in tax-savings for us to contribute to our HSA's until that time.  (Opting out of Medicare is something we can do because we will not receive social security benefits, and the two are tied together from what I have read.)  And we do not plan on selecting Medicare Part B.
OUtside  
#13 Posted : Thursday, November 03, 2011 2:29:51 PM(UTC)
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I would like to read the plan brochure on this issue and couldn’t find it on line. The HMO brochure I glanced at (I’m assuming it says the same as we’re talking about) said they do not waive any Medicare costs if Original Medicare is the primary payer. I think this conflicts with upandup’s point ‘If the FEHB HMO is secondary, they will pick up costs not paid by Medicare (e.g., deductible) applying normal cost-sharing rules.’

How can they use normal cost sharing rules if they say they will not waive any Medicare costs when Medicare is primary? In fact, how are we to understand a plan’s statement that it does not waive any Medicare costs if they in fact pay part of them anyway?

I did not read the entire brochure and there may be something to read ‘between the lines’ or how the federal programs interact with each other which is not stated here, but lacking those, I’m really puzzled.

On phauser’s point re: waiting to enroll in Part A, I looked at the IRS publication, it says

the qualifying health plan must be a High Deductible plan, which I guess is what is being referred to in this thread. Perhaps this is one reason Part A can be retroactive for 6 months. One other thing I wanted to mention about Part A is there are a few other benefits, example, post hospital nursing care, which I take it would be considered as well in any decision to delay enrolling and when to enroll in a timely way.

Also his point about SS and Medicare being linked re: opting out, I’m not sure this is a hard and fast link, so would be worth further reading if it is a basis for his decision.

phauser  
#14 Posted : Thursday, November 03, 2011 10:15:13 PM(UTC)
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OUtside,
 
Yes we have Aetna HDHP with HSA.  And our Aetna plan does provide good skilled nursing (post-hospital) care.  And as I said, if our health starts declining, we will give up our HSA's, and sign up for Medicare, retroactively if needed and if possible.
 
http://www.elderlawanswers.com/Resources/Article.asp?ID=9017 - The title is:

You Can't Opt Out of Medicare Without Losing Social Security, Judge Rules

This article addresses the link between Medicare and Social Security, about how you cannot give up Medicare without giving up Social Security benefits.  Since we will not receive Social Security benefits, this is a non-issue.  Obviously, if we were to receive Social Security benefits, we probably would not decline the Medicare.
OUtside  
#15 Posted : Friday, November 04, 2011 12:49:12 AM(UTC)
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Thanks for the information and the link to the article, very interesting and has reference to the subject of Health Care Reform.

I think I have to add this element to the list of concerns that can be used for the Part B enrollment decision which I posted on another thread here yesterday, to add this:

--13. Concern of High Deductible Plan subscriber re: ability to continue making pre-tax contributions to Health Savings Account (which would be ended on enrolling in Medicare).

Does that sound about right?

phauser  
#16 Posted : Friday, November 04, 2011 2:15:35 AM(UTC)
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OUtside,
Yes, that sounds right.  People need to understand they have to decline Medicare Part B and give up Medicare Part A, in order to continue contributing to an HSA.  And, in order to opt out of Medicare Part A, they have to also give up Social Security benefits.
 
 
upandup  
#17 Posted : Friday, November 04, 2011 3:29:00 AM(UTC)
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The plan says they don't waive their normal copays if Medicare is primary--many plans waive copays and coinsurance when Medicare is primary (leaving zero out-of-pocket). They don't say they don't pay anything if Medicare is primary. In other words, copays are still payable if Medicare is primary, but anything above the HMO copay is still paid by the plan subject to normal rules.

The brochure for the AZ HealthNet HMO is at: http://www.opm.gov/insur...012/brochures/73-283.pdf
OUtside  
#18 Posted : Friday, November 04, 2011 1:20:26 PM(UTC)
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Thank you for the link to the brochure.

In view of your apparently limitless knowledge of the fehb plans and program, I have to agree with your interpretation on this matter.

However, the brochure language, in my opinion, seems to suggest a different interpretation. The brochure language is:

‘We do not waive any costs if the Original Medicare Plan is your primary payor.’

It says ‘any costs.’ There are only two costs to consider from subscriber‘s point of view, one is the plan co-pay for in hospital care, the other is the Medicare deductible of about $1100.

And your post does not address the element of the Part A deductible. You said: ‘…many plans waive copays and coinsurance when Medicare is primary (leaving zero out-of-pocket).’

And did not identify who pays the Part A deductible.

Let’s look at Blue Cross, which is one of the plans you are referring to. It says ‘When you have the Original Medicare… We limit our payment to an amount that supplements the benefits that Medicare would pay under Medicare Part A….’

In other words, they will pay what Medicare doesn’t pay under Part A (ie, the Part A deductible).

I don’t find a similar statement in the HMO brochure (maybe it’s in there and I did not see it); but I do find a statement that says they don’t waive any costs, etc. which is very close to saying the HMO will not pay it.

There is the Part A deductible, the Part B deductible, and the Part B co-pay under Medicare. Often for shorthand convenience in these discussions, we say if retiree has Medicare, a plan such as Blue Cross will waive co-pays. But this omits mentioning the Parts A and B deductible and Part B co-pay. Who pays them? Answer, Blue Cross and other plans so configured.

But HMO, HD, and CDHO plans say something different such as ’we do not waive costs.’

Seems to me such verbiage means they don’t pay those costs.

Perhaps it’s just a matter of semantics.

shelter1  
#19 Posted : Friday, November 04, 2011 9:40:15 PM(UTC)
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In doing my research as to whether or not to enroll in Medicare Part B, I remember reading that if you have an HMO it doesn't make as much sense to have Part B since HMO plans do not waive deductibles and copays. The feeling is that the out of pocket costs associated with an HMO are so low that it would not make much sense to pay for Part B premiums when the HMO won't waive deductibles and copays.
phauser  
#20 Posted : Friday, November 04, 2011 11:29:28 PM(UTC)
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I know this doesn't pertain to that specific HMO plan, but I found it interesting that some FEHB plans limit what they pay or a service that they cover depending on whether you have Medicare Part A or not.  An example of this is the NALC plan, under its Extended Care Benefits/Skilled Nursing Care Facility Benefits (I extracted this from the brochure).  According to this, NALC would not pay for skilled nursing/extended care facility if you do not have Medicare Part A.  Am I reading this wrong? The way I read it, if you do not have Medicare Part A, NALC would not cover this benefit at all.   (It says this benefit is)



.   Limited to care in a skilled nursing facility (SNF) when your Medicare Part A is primary, and:

• Medicare has made payment, we cover the applicable copayments; or

• Medicare’s benefits are exhausted, we cover semiprivate room, board, services, and supplies in a SNF, for the first 30 days of each admission or readmission to a facility

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