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» LymeNet Flash » Questions and Discussion » Medical Questions » Insurance Question - Medicare as a secondary

   
Author Topic: Insurance Question - Medicare as a secondary
Judie
Frequent Contributor (1K+ posts)
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Hi Everyone,

I've had medicare for the past several years (just plain medicare without a supplemental insurance, except for part D).

I've had to pay out of pocket for my LLMD, who I need to go back to.

I have the option to go on my husband's insurance plan now.

I could submit a superbill to his insurance and maybe get some reimbursement. His plan has something like $1000 deductible. I'm trying to figure out if it's worth it.

Medicare has been great for me in some ways, it paid for my Igenex test and metamatrix test.

My husband's plain doesn't pay for these tests.

Does anyone know if medicare will pick up the tab as a secondary if I need to do these again?

I've called medicare before and have gotten different answers for coverage, I plan to call again, but wanted to see if anyone has gone through this.

Is it worth it to have extra insurance along with medicare or is it just a waste because no one really pays for our meds and treatments except us?

Posts: 2839 | From California | Registered: Jul 2012  |  IP: Logged | Report this post to a Moderator
sammy
Frequent Contributor (5K+ posts)
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Medicare does work well as a secondary with another primary ins plan. In my experience, it usually picks up most of your copays. It also greatly helps cover medications and treatment cost.

You do still have to pay your deductible first but once you reach that then you are good.

If you can afford to have both, then I would do it, it will probably save you a substantial amount of money in the long run. But that is just my opinion and experience from having my own plans.

Good luck to you

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Judie
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Thanks Sammy!

That's good to know from someone who's been through it. [Smile]

All this insurance stuff is a bit overwhelming with my Lyme brain right now and I need to make a decision before the cutoff.

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randibear
Honored Contributor (10K+ posts)
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Oh my yes. Get a supplement. My bil had open heart surgery with complications that cost almost 400 grand. Luckily they had kept their government supplement low cost plan and it picked up a lot. They still had to pay but not nearly what they were billed for.

I'm going on medicare in april and I'm keeping my bcbs low. Cost plan as backup.

I'm just too afraid of what will happen

--------------------
do not look back when the only course is forward

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Rumigirl
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But check it out thoroughly before you do anything though, because in some cases, if you have private insurance + Medicare, it

doesn't work together, and if you do, it will invalidate your private insurance, and you can never get private insurance again. I think that was if you had a Medicare Advantage plan + private insurance.

It's tricky! ANd it's hard to get an answer that you can trust. My DO said that you can call Medicare 5 times and get 5 different answers. I've experienced some of the same.

Maybe go to a Medicare office (don't think they exist anymore), or an advocacy office for help. Arghhh! Bureaucracy!

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randibear
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One thing about government insurance is that if you cancel it at any time you cannot get it back...ever....

Dont know if its the same for private insurance but at least government supplements are compatible with medicare.

--------------------
do not look back when the only course is forward

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Judie
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Thanks Everyone!

Randibear - How's your BIL doing? That sounds awful!

I don't plan to ever get rid of medicare. I just have the opportunity to go on my husband's plan because it's open enrollment.

Rumigirl - "My DO said that you can call Medicare 5 times and get 5 different answers."

Yes! That's what happened to me! I had a colonoscopy last year. Medicare said they would pay (I questioned them thoroughly about it), but afterwards we were getting billed by the hospital.

I called Medicare again and they said they wouldn't pay because it was diagnostic and not routine.

I just don't trust their answers.

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Keebler
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-
I don't know how Medicare can get away with not covering diagnostics, for crying out loud. Oh, I know they get away with it but it just seems to be against what good health care is all about, prevention through early identification as much as possible.

Medicare has been nearly useless to me (mostly because the secondary in my case, Medicaid won't pay a dime to a doctor for anything they say they will such as the first appt. of year, copay, etc. - they are literally told to "just write it off" but if they don't pay, then Medicare won't either - and they won't allow me to do so on my own - so no access to any doctor at all),

and it's true, Medicare (nor Medicaid in my state) cannot be counted on to tell the truth about what will or won't be covered in advance.

I'm better off gazing into a crystal ball or asking a Ouija board as trying to get a straight answer out of Medicare.

The WAY procedures are billed, though, is part of the problem. For one procedure such as a colonoscopy, there can be many different providers or vendors who all want to be paid separately. And not all are covered by the same insurance groups.
-

[ 10-27-2013, 01:35 AM: Message edited by: Keebler ]

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faithful777
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I have Medicare but am on disability. Medicare pays first and Tricare pays second.

--------------------
Faithful

Just sharing my experience, I am not a doctor.

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Judie
Frequent Contributor (1K+ posts)
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Medicare will be my secondary if I opt in to my husband's insurance. Just having just part D or the years, a lot of my meds were paid for.

Now that I'm ill again and none of my LLMD visits were covered by medicare, I'm wondering if I should opt in, especially if there are other problems (like the colonoscopy).

I'm been having horrible chest pain since being reinfected. Now I'm imagining Medicare not paying for that to get checked because it's diagnostic. I can't trust what they say over the phone. UGH!

Keebler - "I'm better off gazing into a crystal ball or asking a Ouija board as trying to get a straight answer out of Medicare. "

LOL. That's how I feel.

Apparently since I was in pain BEFORE The colonoscopy it's considered diagnostic so medicare won't pay.

They'll only pay for the colonoscopy if you have NO SYMPTOMS and are healthy.

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Lymetoo
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Moving to General Support

--------------------
--Lymetutu--
Opinions, not medical advice!

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