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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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PattyPies  
#1 Posted : Saturday, July 27, 2019 8:26:48 PM(UTC)

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My father got really sick last year and my sister ended up taking FMLA and then retiring on February 2nd. She is 70 and paperwork has never been her forte and with everything she's been through in the past 10 months she can't focus on anything. My father passed away earlier this month. I am trying to help her. The problem is my sister has very few health problems but a really high pension after 40 years with the government so her medicare premiums will probably be $300 plus a month, then $245 for BCBS. I'm trying to research if she should even get Medicare part B. She doesn't go to the dr unless she REALLY has to. My question is if she doesn't get part B (I know about the penalty) how does BCBS work. Do they still pay the same amount as if you were working? Any input would be appreciated. She has to sign up within 8 months )by October 2nd)and with everything else we are dealing with I just don't have hours to research and don't know what to do so any input would be appreciated to help me make a decision (I do all the paperwork)
OUtside  
#2 Posted : Monday, July 29, 2019 1:34:21 PM(UTC)

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It basically works like this. The retiree continues to pay the same copay amounts as prior to turning age 65, for example, $25 for a primary care visit to doctor.

BC will use the Medicare rate for this visit, which likely will be lower than for age less than 65, this means BC will pay less bc the total will be less, but retiree will still pay the same as earlier, $25 in this example. If retiree has more primary care visits as an older person, there will be more co-pays in total but but each will be $25, as in this example.

If the co-pay is based on a percentage, than it will likely be less than age 65 bc the total will be less (ie Medicare rate), so the percentage will be based on a lower amount.

Read page 157 in BC brochure to understand this subject further. Note that most doctors accept Medicare assignment, where they are paid directly by Medicare for Part B enrollees based on the Medicare rate mentioned above, that is the same rate BC will use for non Part B enrollee. For the smaller percentage of doctors who do not accept assignment, the rule is they can charge up to 115% of the Medicare rate (ie 15 % higher). Both retirees with and without Part B would likely pay the additional 15% out of pocket, I say likely bc some plans don't require the extra 15%, for example based on their preferred agreements with provider. As the Medicare rate is usually lower than earlier, sometimes quite lower, the 15 % would be based on a lower amount.

There are ways to misunderstand page 157, so it is worth reading carefully and asking additional questions if necessary.
PattyPies  
#3 Posted : Monday, July 29, 2019 2:04:00 PM(UTC)

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Thank you so much for the detailed post
GSBS  
#4 Posted : Monday, July 29, 2019 2:39:49 PM(UTC)
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Originally Posted by: PattyPies Go to Quoted Post
Thank you so much for the detailed post
Glad you understand OUtside's answer, love reading OUtside's stuff, more confused than ever! I personally have no clue what to do when I turn 62 on OPM D.R. as I am forced to take Medicare or at least pay for it. Why would I need both again, I am basically healthy yet see many health claims in my future?

OUtside  
#5 Posted : Monday, July 29, 2019 3:20:55 PM(UTC)

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Why are you forced to enroll in Medicare at age 62?

As far as Fehb with Part B, Checkbook has an analysis plan by plan which suggests which plans would likely result in a cost effective enrollment paired with Part B. The original poster mentioned the situation of a high income retiree, where cost effectiveness would be unlikely, but it may be likely for you in certain plans. You would then have to review those plans to see if they would work for you.

If you are confused about the subject, you could start with page 157 of the BC brochure, or the comparable page if you are not with BC, be sure you understand it, and move on from there.

GSBS  
#6 Posted : Tuesday, July 30, 2019 12:37:14 AM(UTC)
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Originally Posted by: OUtside Go to Quoted Post
Why are you forced to enroll in Medicare at age 62?



Always appreciate a reply from you. Being that I have to sign up for SS soon at 62 (a requirement for OPM D.R.) I thought I am required to sign up for Medicare. Are you saying I can put that off until at least age 65?

PattyPies  
#7 Posted : Tuesday, July 30, 2019 6:02:09 AM(UTC)

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If hes been on SS disability for two years medicare is mandatory at that point
TheRealOrange  
#8 Posted : Tuesday, July 30, 2019 6:31:34 AM(UTC)
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Originally Posted by: PattyPies Go to Quoted Post
If hes been on SS disability for two years medicare is mandatory at that point

I know that if you are receiving either Social Security retirement or disability benefits, then you cannot opt out of Medicare Part A. But, is that also true for Part B? It seems to me that GSBS would be enrolled in Part A, which is premium-free, but could still opt out of Part B to avoid the associated premiums. I thought that Part B was always optional, but perhaps I am missing something.
OUtside  
#9 Posted : Tuesday, July 30, 2019 7:51:28 AM(UTC)

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I'm always interested in learning something new on these subjects, so on this one I would like to see some chapter and verse on it.

My impression formed some time ago while reading the Disability Forum at this web site is that a disability retiree has the opportunity to sign up prior to age 65, but not the requirement to sign up. This would mean that retiree, as a fed retiree, would have to decide on Part B the same as the rest of us but at a younger age.

On this point check out the 2019 Medicare and You booklet, page 15, it says if you are receiving SS benefits, you will be automatically enrolled and if you do nothing, you will have to pay the premium. But you can choose not to keep Part B, in which case I assume you would contact an SS office to unenroll.

If you then unenroll, you would pay a penalty if you later enroll again up until age 65. At age 65, you then have a new opportunity to enroll sans penalty as the clock starts over.

Edited by user Tuesday, July 30, 2019 7:52:44 AM(UTC)  | Reason: Not specified

GSBS  
#10 Posted : Tuesday, July 30, 2019 5:41:28 PM(UTC)
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Originally Posted by: OUtside Go to Quoted Post
I'm always interested in learning something new on these subjects, so on this one I would like to see some chapter and verse on it.

My impression formed some time ago while reading the Disability Forum at this web site is that a disability retiree has the opportunity to sign up prior to age 65, but not the requirement to sign up. This would mean that retiree, as a fed retiree, would have to decide on Part B the same as the rest of us but at a younger age.

On this point check out the 2019 Medicare and You booklet, page 15, it says if you are receiving SS benefits, you will be automatically enrolled and if you do nothing, you will have to pay the premium. But you can choose not to keep Part B, in which case I assume you would contact an SS office to unenroll.

If you then unenroll, you would pay a penalty if you later enroll again up until age 65. At age 65, you then have a new opportunity to enroll sans penalty as the clock starts over.
So are you saying even though I am required to sign up for SS @ 62, I can at request at that time to waive Medicare until the age of 65 and any penalty would be waived as well? I'm still wondering why I would want or need both, and I thought it was required for those on OPM Disability although that doesn't even sound right to me? Many providers do not accept Medicare, and I live in an area with limited medical care which is really difficult.



OUtside  
#11 Posted : Tuesday, July 30, 2019 8:22:33 PM(UTC)

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Here's is a link to the Medicare and You booklet, page 15 refers to this, https://www.medicare.gov/medicare-and-you. Receiving SS benefits, you will be automatically enrolled, so if you want to decline, you will have to take action to notify SS that you want to unenroll. From posts at this web site, people have said they had to meet with a representative for counseling, which am pretty sure means they want to be sure you are not putting yourself in position where you do not have any health insurance; and also that, if you change your mind between the ages of 62 and 65, that there would be the penalty for late enrollment applied to your premium. But at age 65, you then get a new opportunity to enroll without penalty.

I suggest you spend the $10 for a Checkbook subscription https://www.checkbook.org/newhig2/hig.cfm; once you provide them info on your age (say you're 65 because at 62 I don't think you will get the Medicare input from it), zip code, enrollment type, income level, and expected level of health expenses (low, average, or high) they will provide estimates of out of pocket costs (premiums plus copays) fehb plan by plan both with and without Medicare for your evaluation. Then take a serious look at the fehb plans which when paired with Part B result in less costs to you than the fehb plan alone. If they don't work for you, you can also look at the fehb plans one by one vs each other from the same perspective, ie, which would cost less and are highly rated, would they fit your needs and save you money?

The other thing to do would be to look into Medicare Advantage, Medicare Part C. If you are eligible for Medicare, you can enroll in Part B and then suspend (but do not cancel) your fehb plan in order to select a Part C plan. Part C is a very economical way to go but there are some drawbacks such as weaker Rx coverage. Checkbook has a good discussion of Medicare Advantage but as far as I know they do not rate individual plans, so you would have to evaluate individual plans yourself or ask other retirees in your area perhaps. I know a few people who have it and say they really like it.

If you have suspended your fehb plan to take Medicare Advantage and are not happy, you can come back to fehb January following the next open season.

Edited by user Tuesday, July 30, 2019 8:27:13 PM(UTC)  | Reason: Not specified

GSBS  
#12 Posted : Tuesday, July 30, 2019 9:56:10 PM(UTC)
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@OUtside, wouldn't you know it, I click on your Medicare Link and its an error. Wouldn't I be just as covered staying on FEHB from age 62 to 65? As I will need to apply for SS at 62 with my OPM D.R. are you are saying I can opt-out at no penalty if I decide to apply for Medicare @ 65. If there is no requirement by the Government or the FEHB to apply for Medicare, why can't I just stay on it for the rest of my life? There are no Medicare Advantage Plans in my area, we don't even have a Grocery store. Not sure Checkbook can answer my question as I'm almost 61
GSBS  
#13 Posted : Tuesday, July 30, 2019 10:02:11 PM(UTC)
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@OUtside, wouldn't you know it, I click on your Medicare Link and its an error. Wouldn't I be just as covered staying on FEHB from age 62 to 65? As I will need to apply for SS at 62 with my OPM D.R. are you are saying I can opt-out at no penalty if I decide to apply for Medicare @ 65. If there is no requirement by the Government or the FEHB to apply for Medicare, why can't I just stay on it for the rest of my life? There are no Medicare Advantage Plans in my area, we don't even have a Grocery store. Not sure Checkbook can answer my question as I'm almost 61
Polar Bear  
#14 Posted : Wednesday, July 31, 2019 12:44:07 AM(UTC)
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Originally Posted by: GSBS Go to Quoted Post
@OUtside, wouldn't you know it, I click on your Medicare Link and its an error. Wouldn't I be just as covered staying on FEHB from age 62 to 65? As I will need to apply for SS at 62 with my OPM D.R. are you are saying I can opt-out at no penalty if I decide to apply for Medicare @ 65. If there is no requirement by the Government or the FEHB to apply for Medicare, why can't I just stay on it for the rest of my life? There are no Medicare Advantage Plans in my area, we don't even have a Grocery store. Not sure Checkbook can answer my question as I'm almost 61


Part A, Hospitalization Insurance (HI) is free for most people and you are automatically enrolled. If you refuse part B , which is Supplemental Medical Insurance, (SMI) at 65 you will be charged a 10% penalty to the premium per 12 months when/if you finally come onto SMI. You have to have HI and/or SMI before you get Part D btw. You can be forced to pay more for SMI, as well as Part D coverage depending on your income prior to retirement. I think Outside is also with SSA, but I'm not sure. Your best option is to schedule an appointment with your local SSA office. They 'should' be able to look at your numbers and give you actual firm estimates.

As to the person with the 70 year old relative. If that person is not already enrolled in SS, they should be asap. You cannot gain any more credits past the month before you turn 70. No reason to not get on now, otherwise whatever your benefit would be will be wasted. Also be sure to have that person look at all their options. They may be eligible to come onto someone else's record for a higher monthly benefit than their own, or both, or neither. (for example if they are a divorced spouse or otherwise deemed eligible). Again, your best option is to make an appointment with your local office ASAP.
Polar Bear  
#15 Posted : Wednesday, July 31, 2019 12:53:58 AM(UTC)
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btw, when you say you're on disability retirement through opm, are you also already on your own SS record as a disabled worker as well? That will change HI/SMI things. You can be on a DIB record until you turn 65, which you will then automatically be converted over to RIB.
wlls  
#16 Posted : Wednesday, July 31, 2019 1:54:14 AM(UTC)
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If your still interested...

From the post above:
"Here's is a link to the Medicare and You booklet, page 15 refers to this, https://www.medicare.gov/medicare-and-you …"

Edited by user Wednesday, July 31, 2019 1:56:07 AM(UTC)  | Reason: Not specified

GSBS  
#17 Posted : Wednesday, July 31, 2019 9:49:10 AM(UTC)
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Originally Posted by: Polar Bear Go to Quoted Post
btw, when you say you're on disability retirement through opm, are you also already on your own SS record as a disabled worker as well? That will change HI/SMI things. You can be on a DIB record until you turn 65, which you will then automatically be converted over to RIB.
No I didn't qualify for SSDI. My Disability retirement is recalculated at age 62 and that is when I thought Medicare comes into play. I am going to read the link provided above and darn if OUtside's link is out of order. If the premium for Part B is about $150, and the FEHB is $250 for better more complete coverage, why would I want or need Medicare if not required?

Polar Bear  
#18 Posted : Wednesday, July 31, 2019 11:50:14 AM(UTC)
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You can always fight that denial. It might take 2 years but you'll get back pay if awarded. Just fyi, don't know your particulars. Consult an ss attorney.
GSBS  
#19 Posted : Wednesday, July 31, 2019 1:04:01 PM(UTC)
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Originally Posted by: Polar Bear Go to Quoted Post
You can always fight that denial. It might take 2 years but you'll get back pay if awarded. Just fyi, don't know your particulars. Consult an ss attorney.
You can fight until you run out of Work Credits, then the answer is no. I did appeal a few years back but I no longer qualified with Zero credits, and besides the Judge said I could operate a Chair & Desk so I could work anywhere?

Edited by user Wednesday, July 31, 2019 5:20:15 PM(UTC)  | Reason: .

GSBS  
#20 Posted : Wednesday, July 31, 2019 5:18:52 PM(UTC)
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Originally Posted by: OUtside Go to Quoted Post
Here's is a link to the Medicare and You booklet, page 15 refers to this, https://www.medicare.gov/medicare-and-you.
I think I found the publication @ https://www.medicare.gov...50-medicare-and-you.pdf. Couldn't get anywhere with the original link. Already I'm confused, what if you don't plan to elect Medicare by keeping your current plan?. I'll read up more and probably have more questions. I was planning on reviewing every one of your posts in the next year. The counseling comment of yours was interesting, who would give up their FEHB to save $100 a month (or so) and to limit their health options?

So bottom line, is my FEP BCBS better than anything I would get with Medicare, at least at age 62
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