posted
this is a tough question for me... in january, i am eligible for medicare with my disability -- i have never had medicare before, but have heard mixed reports about it. i also have coverage under a private insurance HMO as part of a family plan -- my family could save money if i went with medicare, and the hmo seems to be very restrictive about covering services for out-of-plan providers.... so i just wanted to check with anyone on lymenet who might have some thoughts on this? thank you in advance for your insights & help.
Posts: 13 | From philadelphia | Registered: Aug 2006
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springshowers
Frequent Contributor (1K+ posts)
Member # 19863
posted
I am on medicare and also kept my private insurance. I am too afraid of when i get well never getting coverage again.
But that decision was 10 years ago. The good thing about keeping both is that your private insuarnce should act as secondary and pick up all that medicare will not cover and help with scripts too.
I would keep both .. at least for awhile until you can see what medicare can or can not do for you.
They have not done too much for me...not really. Except the fact that if they deny something my other insurance pays most all the time the full amount..
Posts: 2747 | From Unites States Of America | Registered: Apr 2009
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TerryK
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Member # 8552
posted
Whether another insurance is secondary or medicare is secondary depends on the size of the employer who is providing the other coverage. I don't know how it works if the insurance is not provided through an employer. In my instance, medicare is secondary.
I do know that many insurance companies will not write a policy for you if you have or are eligible for medicare EXCEPT for the special policies that are governed by law and are automatically secondary to medicare. They are sold specifically for people who have medicare.
I declined HMO coverage when my husband's employer offered it because they informed me that they would take over my medicare policy which means I would not have choices as to who I see for healthcare.
So much depends on your current policy. It's possible that they will force you to get medicare coverage if they know you are eligible. This way, if you stay with them, they take over the benefits from the policy and this cuts down on their costs. I would look at your company policy to determine what they say about medicare before calling them. You don't want to be forced into anything.
If you can get a medicare policy that allows you to pick and chose your health care providers, that could be very valuable in your situation. You could then get prescription coverage as well. If you pick and choose that coverage carefully, you can come out far ahead.
Plan to spend considerable time and energy researching. You will often get different answers from people at both your insurance company and at medicare, at least that has been my experience.
Good luck, Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
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Tincup
Honored Contributor (10K+ posts)
Member # 5829
posted
I would never advise someone to try to pick the lesser of two evils.. and give advise on which is which... but in my experience...
Medicare is straight forward... pretty much. They pay 80%.. you pay 20%.
No meds covered... usually with either unless more is forked out.
With private insurance it is very expensive and you never know if they will come through or not.
I've worked with LOTS of patients with insurance problems over the years....
ALWAYS the big problems are due to private insurance companies ... and not once have they been due to Medicare.
Maybe that will help you?
But do NOT rely on my information. I don't want you jumping on my head if you pick one and it is hard on you... or the wrong choice.
sutherngrl
Frequent Contributor (1K+ posts)
Member # 16270
posted
I would probably keep both, because the latest info from the government, is they will be cutting back on what medicare is going to cover. My dad who keeps up with this stuff, just happened to mention this to me the other day, since he is on medicare and is concerned about what they will cut back on.
Posts: 4035 | From Mississippi | Registered: Jul 2008
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TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
TC is correct. It would be impossible for anyone to advise you on what to do without knowing all the details of your coverage. It very much depends on your current coverage and your needs.
Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
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quote:Originally posted by sutherngrl: I would probably keep both, because the latest info from the government, is they will be cutting back on what medicare is going to cover.
Not the benefit they are talking about cutting, but the waste.
Posts: 822 | From midwest | Registered: Apr 2009
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TF
Frequent Contributor (5K+ posts)
Member # 14183
posted
In the area where I live, the good lyme doctors will not see you if you have Medicare, period. (They will not let you sign any paper waiving submission of Medicare claims, etc.)
This has become a major problem in my area for people with Medicare. I have 2 friends who suspect they have lyme disease but have nobody locally who is experienced who will take them.
I just learned there are some lyme docs in Pennsylvania (a few hours drive from me) who will let Medicare recipients waive their Medicare coverage and pay out of pocket to see the doc.
Since I have good insurance now that I can keep for life, I have decided that when my husband and I are eligible for Medicare, I am not going to take it.
This way, I know 2 good local lyme doctors who will be available to us if needed.
Posts: 9931 | From Maryland | Registered: Dec 2007
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TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
TF, The only time I've seen this is if a doctor has NOT opted out of medicare. IF they have not done the paperwork to say that they opt out, they would be breaking the law by seeing a medicare patient and allowing them to pay out of pocket.
IF they have opted out, there is no problem. At least legally.
When I first looked into seeing an LLMD, I found one that wasn't taking new medicare patients but he had some patients that he'd been seeing for a long time who were on medicare so he hadn't opted out. He was not allowed to see me and let me pay out of pocket thus the opportunity to see that doctor was lost to me.
Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
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TF
Frequent Contributor (5K+ posts)
Member # 14183
posted
TerryK, you are exactly right. The lyme docs have not opted out of Medicare, so there is nobody any good for the people on Medicare in my area.
It's a terrible situation, with all the lyme disease and ticks we have around here.
Years ago I know the one took Medicare patients. But, no more. So, maybe there is no way for them to opt out now.
Posts: 9931 | From Maryland | Registered: Dec 2007
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springshowers
Frequent Contributor (1K+ posts)
Member # 19863
posted
I would dig deeper on the issue of doctors not seeing medicare patients. I was told this initially by a doctor and when i went and sat with the billing department .. well they were wrong to tell people that. I was able to work around the medicare issue and have no problem seeing them now.
Also a second doctor .. the same thing. Sometimes the billing people do not get who it works and they turn away people who are on medicare.
Even after my case I hear the receptionist turn away people who call or come in. It is wrong...
I do not get it because I have worked out....
Mostly by law they have to bill them even if they do not participate or are part of them... Usuaally they do not want to deal with all that.. But there is a way to work around it. I was able to keep a permanant notice on record with my second insurance and they process all claims straight away because of the permanent note in my file that my doctor does not take medicare instead of waiting on claims to come through them..
Well..its that law... that the have to bill.
I am going to bill myself on this second doctor I am seeing even though i read the law that they are supposed to by law. i agreed to that before starting with him. As well i will try the above method before billing them though since I know he is not participating. Otherwise it will be just to get a denial..
Well i am not sure if i made any sense.
I have never heard that Medicare Federal Funded Insuarnce is not always first. I was told it was the law that all federal insurnance has to be primary..
Posts: 2747 | From Unites States Of America | Registered: Apr 2009
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TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
Hi ya Spring -
Spring wrote: I was told it was the law that all federal insurnance has to be primary..
I'm not surprised that you were given wrong information. This happened to me a number of times before I finally decided it would be best to verify it in their manuals or on their website. http://tinyurl.com/ykfxqdp
Employers must provide the Centers for Medicare & Medicaid Services (CMS) with information regarding health coverage of their Medicare-eligible workers and spouses of Medicare-eligible individuals whenever CMS identifies those individuals to the employer.
This process, the IRS/SSA/CMS Data Match, is used to identify situations where another payer may be primary to Medicare. The Data Match process helps Medicare intermediaries and carriers identify claims on an ongoing basis for which Medicare should not be the primary payer.
I talked to a supervisor at medicare who finally located all the specifics in a manual on their website. It was like pulling teeth. LOL
-----------------------------------------------
I'm fairly certain that a physician who has opted out cannot bill medicare for services. I'd have to dig up their opt out contract but I read it a few years ago on the medicare site.
Also, you as a patient are not allowed to bill medicare unless that has changed since I last checked. I lost quite a bit of money because my doctor's billing service screwed up and I only had a few days left to have medicare billed. My doctor was out of town and medicare absolutely was adamant that the patient is not allowed to bill medicare.
Spring wrote: I was able to work around the medicare issue and have no problem seeing them now.
IF a doctor has NOT opted out of medicare, they are obligated by a contract with medicare to bill medicare for all medicare patients. Same thing with labs that have a contract with medicare which is why IgeneX bills medicare but no other insurance.
This means they cannot see you if you are a medicare patient unless they comply with their contract with medicare. Meaning they have to bill medicare and accept agreed upon fees for services.
The low payment that medicare insists on is a big reason why so many doctors are opting out. This applies to many doctors besides LLMD's.
TF
Frequent Contributor (5K+ posts)
Member # 14183
posted
The lyme doctor told me right to my face that he won't take Medicare patients.
So, it's no mixup with the billing dept.
I am friends with this doctor. He is the one I want to see if I or my hubby get lyme. He got me well. He is the best.
I'm sure it is all about the low Medicare reimbursement. I don't blame the docs one bit.
My discussions were all with the doctor, asking him who my friends on Medicare can see. It is a MAJOR problem in my area.
Posts: 9931 | From Maryland | Registered: Dec 2007
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posted
My experience has been that some Dr.'s in my area are not accepting Medicare period. Medicare is my secondary insurance and I had to beg for an appt. with a specialist due to having Medicare. They do not want to fool with it. In my case it would be better for me not to have it, because it has been nothing but problems. I do realize though that I am probably the exception and not the rule.
Posts: 366 | From Louisville KY. | Registered: Nov 2003
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posted
Great healthcare system we have, that patients have to go thru all this to figure out the rules, and frequently still can't figure it out. And insurance tells you something different every time you call about a claim. I have called six times on one insurance claim. The latest story is that even tho the doctor is not accepting my insurance, is non-participating, he has to correct his provider file because it now shows that he is the only one that can get paid. So, I pay at the office full price, submit a claim which insurance says they can only pay him, not reimburse me! Then they don't pay him either. Then they say it was sent to the wrong P.O. box number. Then they say........ Is any of what they say correct? My guess is that it is all a stalling tactic to avoid paying and avoid a denial which triggers an appeal.
I want a simpler more honest health care system. Don't think I can go back to the doctor with these endless hassles. He is tired of it and so am I. So now, my insurance company is ruining my access to medical care! It doesn't help that his billing until recently was rather haphazard, presumably because of the kind of doctoring he used to do. Now he has a part time billing person who knows what information has to be on the bill. But what doctor does want to deal with the extremely complicated and poorly administered system that we have? And neither do I. But what choice do patients have who are not independently wealthy?
[ 10-29-2009, 11:02 AM: Message edited by: lou ]
Posts: 8430 | From Not available | Registered: Oct 2000
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posted
The lymemd blogger in Germantown, MD accepts Medicare.
Posts: 348 | From maryland | Registered: Jul 2008
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randibear
Honored Contributor (10K+ posts)
Member # 11290
posted
mine does not take any insurance, period. pretty clear cut.
right now i have federal bc/bs and tricare.
but i was just advised that part of the health care plan cuts tricare. you (if it passes) will have to pay about 50 percent of tricare yourself.
so i'm thinking of continuing my insurance.
but hubbie says he was told at his outbriefing that we are forced into medicare at age 65 and can't continue our federal insurance.
anybody know??
-------------------- do not look back when the only course is forward Posts: 12262 | From texas | Registered: Mar 2007
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bettyg
Unregistered
posted
terry,
that was a good explanation. using my example from going to 2nd llmd who OPTED OUT OF MEDICARE!
since they do NOT bill medicare; medicare has NOT turned down your request for reimbursement.
so 2nd party insurance, bcbs, does NOT HAVE TO PAY ANYTHING since medicare NEVER turned us down!!
took me 1.5 yrs. of hog wash to get this determination and going thru iowa's insurance commissioner's lawyer to get what i got!!
whenever you find that info, please put it in MINOUTCAT'S DISABILITY info link at top of support; it's too valuable of info NOT to have available to read
and copy to treepatrol's newbie links too .... big thanks terry!
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posted
Betty has posted what I have finally concluded: that if Medicare does not pay, then neither does secondary insurance. So, you sign up for medicare, have a doctor who doesn't take it, then no one pays anything, and you are stuck for the whole bill.
The end result is a person with two kinds of insurance and no reimbursement!
How much effort is it for doctors who don't take Medicare to opt out? And wouldn't this help the patients?
Posts: 8430 | From Not available | Registered: Oct 2000
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TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
lou - that only applies to medicare with medigap as secondary, not private insurance as primary or secondary to medicare.
Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
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posted
According to my contract, a doctor who does not accept medicare assignment still cannot charge more than 115% of the medicare allowable amount. This is undoubtedly why some doctors are rejecting medicare patients even if they offer to pay the bill themselves.
To avoid this, doctors can ask patients to sign a private contract. If this is done, then medicare will not pay any portion of the bill, and the secondary insurer will pay only that part they would normally pay after medicare pays, which is not going to be much.
If the doctor does not take insurance or medicare, then the patient pays deductibles, coinsurance, copayments, and any balance up to 115% of the medicare approved amount. This is for people who have medicare and a secondary insurer, but go to a doctor who accepts neither.
This is why I think anyone on medicare can get taken to the cleaners.
But maybe not all insurers have these rules, and there are a few lyme docs who take medicare and/or private insurance. Anyone who has only an HMO is not going to get much help with paying for lyme treatment. Neither is anyone on private insurance.
If anyone has a different understanding of this fouled up system, please feel free to enlighten us. It is nearly impossible to figure this stuff out.
Posts: 8430 | From Not available | Registered: Oct 2000
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TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
lou wrote: According to my contract, a doctor who does not accept medicare assignment still cannot charge more than 115% of the medicare allowable amount.
lou - that has not been my experience.
Are you talking about your medicare contract? I talked to medicare over and over about these issues 2 years ago and they said that if a doctor opts out they won't pay anything but the doctor can charge anything he wants.
I was also told by 3 medicare workers that if medicare is not primary (not something I have any control over, it is determined by the law), then there is no limit as to what I can be charged by the doctor. This seemed very unfair to me and stupid on their part if they want me to have other insurance that pays but the supervisor I talked to said it was determined by Congress.
There are different kinds of medicare policies now. There was only one type when I signed on. Which type do you have? Mine allows me to go to any doctor I want and I don't need to have a primary doctor or referrals.
Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
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TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
lou - if you are right, this would be a disaster for anyone on medicare!! Takes our choices away and in some cases, some of us will not have a doctor who will see us.
More and more doctors are opting out because they cannot afford to stay in business with the meager amount that medicare pays.
Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
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bettyg
Unregistered
posted
terry, thanks for your updates! hugs
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posted
Terry, what I posted is written in my insurance contract. I do not have medicare, so I was trying to explain what I have seen regarding the situation re reimbursements for people who do have medicare as primary, and private insurance as secondary.
It is my understanding that medicare is always primary except under certain conditions such as a person who is still employed and has private insurance and medicare.
The fact that you have gotten different information from medicare demonstrates that it is very hard to get a straight story. So hard to understand opting out, accepting assignment, private contracts, etc.
Do you have personal experience in going to a doctor who does not accept medicare or private insurance? Assuming that you do have medicare, what kind of reimbursement, if any did you get?
Here is one explanation I have found on the net It could explain why doctors who don't take medicare don't want medicare patients even if they self pay. The only way around this is the private contract, which means medicare will pay nothing and the secondary will pay very little.
*What does it mean if my physician "accepts assignment?"
*If my physician does not accept assignment, what is the most he can charge beyond the Medicare approved rate?
When an item or service is determined to be coverable under Medicare Part B, it is reimbursed at 80% of a payment rate approved by Medicare, known as the "approved charge." The patient is responsible for the remaining 20%. Unfortunately, the "approved (or "reasonable") charge," is often substantially less than the actual charge. The result of this reimbursement system is that Medicare payment, even for items and services covered by Part B, is often inadequate. The patient is left with out-of-pocket expenses.
When a physician accepts "assignment," he or she agrees to accept the Medicare approved charge as full payment for the services provided. Medicare pays 80% of the approved charge. Either the patient or supplemental insurance pays the remaining 20% co-payment. No further payment is due to the physician.
When a physician does not accept assignment, however, he or she may "balance bill" the patient above the Medicare approved charge. "Balance bill" refers to a physician's charge above the Medicare approved rate. Federal law sets a limit known as the "Limiting Charge" on the amount a physician may balance bill. The Limiting Charge is based upon a percentage of the Medicare approved charge for physician services.
Generally, a physician who does not accept assignment may not charge a total of more than 115% of the Medicare approved amount. The patient's Explanation of Medicare Benefits (EOMB), the written notice which is sent to patients after a Medicare claim is processed, will state the approved charge for the doctor's services. The Limiting Charge should be listed on the EOMB; if it is not the patient can calculate it by multiplying the Medicare approved charge by 115%.
For example, assume the patient goes to a doctor who does not accept assignment. The doctor's actual charge is $600, but the Medicare approved charge allows only $349.37. The doctor's total bill may not exceed $401.89 (115% x $349.47); this is the Limiting Charge. Medicare will pay $279.50 (80% of the $349.37 approved charge). The physician cannot charge the patient more than $122.39 ($401.89 minus Medicare payment of $279.50). If the doctor bills above $401.89 he is billing above the Limiting Charge and is violating federal law.
Again, a Medicare beneficiary is usually correct in assuming that the Limiting Charge is 115% of the approved charge noted on the EOMB; the actual limiting charge will be stated on the EOMB. In a few instances it will be more or less than 115% of the approved charge.
Posts: 8430 | From Not available | Registered: Oct 2000
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TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
I think some of the confusion in this thread is related to the difference between a doctor who has opted out of medicare vs a doctor who does not accept assignment.
Here is a medicare publication that talks about private contracts with doctors who have decided not to provide services through the medicare program. This is the situation that I was talking about. The doctor signs a 2 year contract with medicare in order to opt out. The patient signs a contract with the doctor. The doctor can charge anything he wants to charge. http://www.medicare.gov/Publications/Pubs/pdf/pc.pdf
I don't usually get info from other sites regarding medicare because so many get it wrong or the info only applies to a particular combination of policies but I can't readily find a reasonable comparison on the medicare site at the moment. These are reputable organizations and the info matches my understanding so I'm including these links which help explain the situation.
lou wrote: It is my understanding that medicare is always primary except under certain conditions such as a person who is still employed and has private insurance and medicare.
It is my husband's insurance that is primary for me and it is based on number of employees that his company has. Seemed very odd to me but I was able to verify it with information on the medicare website.
Lou wrote: The fact that you have gotten different information from medicare demonstrates that it is very hard to get a straight story. So hard to understand opting out, accepting assignment, private contracts, etc.
Yes, it is. I have gotten different answers from different people about the same issue almost everytime I have a question. Very frustrating and time consuming when trying to make an important decision about insurance.
In my experience, the best thing to do if you can't find the info on their website or in the pamphlet is to ask that they give you the URL on their website that verifies the information. If they can't, ask for their supervisor and just keep calling back until you find someone who can show you the information in writing.
Lou Do you have personal experience in going to a doctor who does not accept medicare or private insurance? Assuming that you do have medicare, what kind of reimbursement, if any did you get?
Yes I do have medicare and yes, I do have personal experience with a doctor who does not accept any insurance. This doctor has opted out of medicare entirely. I paid the full amount of $275 to the doctor at the time of the visit. I got no re-imbursement from medicare but $192 from my primary insurance when I billed them myself.
To make matters even more confusing for people trying to understand what is and is not covered under medicare, one can also get a policy that is written by private insurance companies but that provide medicare part A and B but also include part C or other coverages that are not included under the original plan. I think they are called Advantage plans and are typically HMO's or PPO's, NOT the origial plan like Betty and I have.
TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
To address the medicare as primary, private insurance as secondary, I'll tell what my experience was with that from 2000-2003.
I had a policy that was private insurance through my husband's employer that was secondary to medicare. He was working for a smaller company which is why this policy was secondary vs my current insurance which is through a larger employer so is primary.
Even though BCBS was secondary, they paid considerably more to my providers than medicare paid. This was to my benefit because my providers were getting a reasonable amount of reimbursement for their services which made me a more desirable patient.
BCBS treated medicare just like any other primary insurance meaning they did not cap their re-imbursement based on medicare allowable charges. They based their re-imbursement on their own allowable charges.
That was the best coverage I ever had. So much depends on your specific set of policies. Too bad it has to be so darn complicated.
edited to add: At that time I was not seeing anyone who had opted out of medicare but I assume that they would have paid whatever they would normally pay to that provider just like they did for all my providers.
Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
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posted
Very good explanation, Terry. Thanks. I guess I am still confused to some extent, but not sure my lyme brain can wrap itself around such complexity anymore. But maybe that is true of others who need to use insurance or medicare. Seems like it ought to be simpler, considering sick people are the ones who need to know.
Your BCBS policy was very good, but does not apply to all private insurers and definitely not to all BCBS. Each one is different. In one state, they will pay two thirds of the bill of an out of network doc. In an adjoining state, they only pay one third. Does this make any sense?
And to answer your question, I don't have medicare. Am still fighting with the insurance co stinkers.
Posts: 8430 | From Not available | Registered: Oct 2000
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TerryK
Frequent Contributor (5K+ posts)
Member # 8552
posted
lou - glad my explanation made sense. I've sure spent a lot of time researching this stuff. Still a lot I don't know because it is so complicated.
Many seniors, including my mother, had to get help to figure out the prescription coverage. It is insanely time comsuming to find a company that will cover your specific drugs and will provide the best coverage for YOU. Crazy set-up in my opinion.
lou wrote: Does this make any sense?
Yes it does. It gets worse than that though because when you start adding private insurance coverage you get many different variations, not just by State but within the State as well.
Over-riding all of it are the laws that apply to medicare itself.
Sorry you have to fight with the insurance company. They drive me nuts too. My husband and I are convinced that most insurance companies figure there will be a certain number of people who go away because they don't have the time or energy to deal with trying to get payment. They make it hard and get out of paying a certain percentage of people who really do have money coming.
It makes me mad! I'll just keep calling and writing until I get my money.
Terry
Posts: 6286 | From Oregon | Registered: Jan 2006
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bettyg
Unregistered
posted
terry, thx for your outstanding job of researching and not letting the buck stop here for answers!
i constantly learn from you. i can't remember if i asked you or not, but would you include your link here in MINOUCAT'S disability/insurance post at top of support ... it will help so many members. thanks
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TF
Frequent Contributor (5K+ posts)
Member # 14183
posted
Regarding the lyme docs in my area who will not take Medicare patients, I think I know what is going on.
A few years ago, these docs took Medicare patients. They are still treating some of them. And, they want to always let former patients come back to see them if they relapse or have another problem with lyme.
Therefore, they cannot opt out of Medicare. Since they don't want to take any new Medicare patients, all they can do is refuse to take any new patient that has Medicare as one of their insurances.
Posts: 9931 | From Maryland | Registered: Dec 2007
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Tracy9
Frequent Contributor (1K+ posts)
Member # 7521
posted
I thought Medicare paid for all tests/procedures and hosptializations at 100 percent, and you only had to pay 20 percent for outpatient doctor office visits? Is this incorrect?
13 years Lyme & Co.; Small Fiber Neuropathy; Myasthenia Gravis, Adrenal Insufficiency. On chemo for 2 1/2 years as experimental treatment for MG. Posts: 4480 | From Northeastern Connecticut | Registered: Jun 2005
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