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Insurance options to supplement Medicare.

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  • #16
    I would encourage you to see if there is an independent person that explains benefits and sits with you. Talk with your provider. I found one and she is irreplaceable.


    • #17
      I was diagnosed ESRD at age 55, working full time with Group Health through my employer. Around 30 months after initial dialysis diagnosis and treatments I was advised by the health insurance company that I would need to apply for Medicare and after the 33 month "coordination period" Medicare would become Primary payor and the Group policy would pay the 20% that Medicare did not cover. If I did not go on Medicare, the Group policy would still only pay 20% of the dialysis treatments since Medicare is an entitlement for ESRD. I do have to pay $134/month for Medicare but the Group policy did not give me much choice, either pay for Medicare or 80% of the bills.


      • #18
        I started HHD training and hemodialysis at 58 while working full time and covered under my employer's group plan. I investigated Medicare coverage and determined that at the start of the next calendar year that I would commence Medicare Part B coverage and payment of premiums. It was the smartest thing that I have been able to do regarding management of group health care coverage escalating deductibles and out of pocket expenses during a 40+ year career..

        While in the 30 month Coordination of Benefits period, my employer's group insurance paid as primary and Medicare secondary. In return for my annual Medicare premium expense of just under $1450, I paid no out of pocket for the remaining 24 months of the 30 month period. During that period I otherwise had group insurance annual deductible of $1300 and out of pocket max of $3500. The first 6 months of the 30 month period saw me hit my out of pocket max before I even had the chance to enroll in Part B, making payment of Medicare premiums a waste for that year. Thus I did not sign up until the start of the next calendar year.

        After the 30 month Coordination of Benefits period ended, Medicare became primary and group insurance secondary. Nothing changed for me financially, e.g. I paid no out of pocket as group insurance paid the 20% Medicare did not pay on a greatly reduced Medicare payment, e.g. when group was primary, the single dialysis treatment benefit paid was $750. When Medicare became primary, the single dialysis treatment benefit was $250. Even an annual Medicare premium increase to $1550 was no match for my group insurance out of pocket max of $4000, essentially leaving close to $2500 in my pocket owed to the secondary insurer coverage.

        The economics of the out of pocket costs with Medicare and group coverage are very dependent on the premium, deductible, and out of pockets costs associated with the employer's group plan. I benefited greatly with the primary, secondary insurer coverage arrangement.

        Many employer group plans will force employees eligible for Medicare, e.g. 65 years old, to obtain Part A and Part B Medicare coverage so they only have to cover the 20% that Medicare does not cover on a vastly reduced Medicare negotiated coverage benefit - a great deal for the group insurer. This was not the case with my employer at the time I became "disabled" at under 65 years old and eligible for Medicare because of disability. I had the choice to obtain Medicare Part B coverage and doing so saved me about $9000 in out of pocket medical expenses over 4 years.


        • #19
          Good news. Worth watching


          • #20
            Being retired and older and on medicare advantage, we still have an out of pocket of $6700. per year. I will leave my wife in a financial hole when I'm gone.


            • #21
              Medicare part A for hospital stays is free. Medicare part B cost about 150.00 per month now. Assuming if you have a work related or personal insurance it is necessary you apply for Medicare part B for doctor and supplies will be paid as if you have part B regardless as to rather you do or do not. We have no choice and they work well together at least with my insurance.


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