Topic: ? about Medicare and group health plan, need help please!
sammy
Frequent Contributor (5K+ posts)
Member # 13952
posted
I have a question about Medicare and group health plans. Hoping that you all might be able to help me with this.
I was recently found to be disabled/ unable to work due to my severe health conditions. I am currently enrolled in Medicare as my primary insurance and Anthem BC/BS as my secondary ins.
This has worked well over the past couple months that I've had it because whatever Medicare didn't pay for Anthem usually picked up the rest of the cost. I'm no longer receiving large bills.
I just found out that my dad's work is willing to put me on their group health plan as his "disabled" child. This is great news! I will no longer need my costly individual Anthem BC/BS plan.
But now I am being warned by others that group health plans can kick you off if you have active Medicare. Is this really true?
I called Medicare, was transferred to about 6 people and got 6 different answers, most leaning towards "yes".
I explained that my dads group policy (Cigna) will be my primary and Medicare will be my secondary. I need both plans because one plan never pays for all of my needs. Having a secondary also greatly helps reduce out of pocket cost of copays and deductibles.
For example right now my Medicare part D drug plan covers my IVIG and IV antibiotics but it does not cover anything else. I need Anthem BC/BS to pick up the Saline bags, IV tubing, flushes, needles, syringes, dressing change kits, etc...
Of course Medicare told me to contact Cigna to ask for more information.
Do any of you have a group health plan and Medicare? Do they work well together? What to you recommend that I do to get my two companies to cooperate for my good?
Any other thoughts or advice would be greatly appreciated! Thanks so much!!! Posts: 5237 | From here | Registered: Nov 2007
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posted
I wish I could help you!!! I know nothing about this.
-------------------- --Lymetutu-- Opinions, not medical advice! Posts: 96222 | From Texas | Registered: Feb 2001
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poppy
Frequent Contributor (1K+ posts)
Member # 5355
posted
I don't have this situation, but was under the impression that medicare is always the primary. If that is true, then cigna should not object, as it will reduce the amount they will have to pay out, when they are only picking up what remains after medicare pays.
It is too bad that you can't get a better answer out of medicare than this.
Posts: 2888 | From USA | Registered: Mar 2004
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posted
I had this issue. I became permanently disabled 7 years ago at the age of 48....and could no longer work. At first, I was told by Medicare and Cigna (my husband's insur.) that Medicare would automatically become primary. So that is how my claims were being processed for about 5 months....UNTIl after a visit to Memorial Sloan-Kettering, where they informed me this was incorrect. BECAUSE my husband worked for a company with "more than 100 employees"- HIS insurance would be my primary....and medicare 2nd. It IS an unusual scenerio- most of the time Medicare IS primary.
But in my case and maybe yours.....because I was on my husband's Insurance (Cigna) and his company had more than 100 employees- THAT becomes primary.
I will tell you that I could NOT get straight answers from Cigna or Medicare and it was quite a nightmare trying to get it straightened out. It actually took several months and MANY angry phone calls.
I don't think your situation is exactly the same and I probably did not answer your question....but I wanted you to know that it IS difficult to get straight answers from either- as my experience shows. Be persistent!!!
-------------------- Corinne Posts: 529 | From Raleigh, NC | Registered: Jun 2006
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posted
and unfortunately- my husband said he "did not sign up for all this illness" and is in the process of divorcing me. I will end up losing the Cigna coverage.
-------------------- Corinne Posts: 529 | From Raleigh, NC | Registered: Jun 2006
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poppy
Frequent Contributor (1K+ posts)
Member # 5355
posted
I'm so sorry Corinne. You deserve better support than this from him. One of these days he will be the sick one from something or other. Then the shoe will be on the other foot.
Posts: 2888 | From USA | Registered: Mar 2004
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posted
Sammy, I think you literally have to contact both Cigna and Medicare and ask them the questions you're asking here,
like can you have both, will one be primary, will one kick you off if you have the other -
I think you have to find out what you're getting into, and then make your best decision.
Posts: 13116 | From San Francisco | Registered: May 2006
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poppy
Frequent Contributor (1K+ posts)
Member # 5355
posted
A lot of people have medicare and something else, you, for instance, already have two kinds of insurance. It looks like you are just swapping out one kind for another, but maybe that is not an accurate way to look at it.
Any chance of making an appointment with an SSDI rep to discuss this? Someone in your family since you are in bad shape? When a relative was eligible for medicare, she made an appt. to visit the office and discuss it. Seems like you might get more knowledgable answers than you have been getting.
Also, there is an office in each state that counsels medicare recipients, they get federal money to do this. Maybe contact them, since it sounds like this might be up their alley:
What is the Ohio Senior Health Insurance Information Program (OSHIIP)?
The Ohio Senior Health Insurance Information Program (OSHIIP), founded in 1992, is a state and federally funded program that educates, counsels and advocates for Medicare beneficiaries. OSHIIP assists Ohio Medicare beneficiaries and their family members through a toll free hotline at 1-800-686-1578, the Department web site, a speakers' bureau, educational publications, and a network of approximately 1,200 statewide trained and certified volunteers.
Dogsandcats
Frequent Contributor (1K+ posts)
Member # 28544
posted
Maybe, this one this is a dream. But if you did go in or thru a phone call-ask for a letter confirming what they are telling you, i.e. who is on first for coverage, etc?
Or maybe there is a page in one of their many booklets they could refer you to-just to see it in writing.
Of course then the book could be changed, but just a thought.
-------------------- God will prepare everything for our perfect happiness in heaven, and if it takes my dog being there, I believe he'll be there.
Billy Graham Posts: 1967 | From California | Registered: Oct 2010
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poppy
Frequent Contributor (1K+ posts)
Member # 5355
posted
OK, look at your medicare booklet. The answer is in there, on page 22 of the 2013 edition. In the section titled "How does my other insurance work with Medicare?" it says:
If you're under 65 and disabled, have group health plan coverage based on your or a family member's current employment, and the employer has less than 100 employees, then Medicare pays first. If more than 100 employees, then group health plan pays first.
So, it is as cordor said.
Why Cigna would kick you off if you have medicare is a mystery to me. This is where you need more information, from Cigna, not medicare.
Posts: 2888 | From USA | Registered: Mar 2004
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poppy
Frequent Contributor (1K+ posts)
Member # 5355
posted
You there sammy?
Have you looked at the cigna booklet for this information?
Posts: 2888 | From USA | Registered: Mar 2004
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sammy
Frequent Contributor (5K+ posts)
Member # 13952
posted
Sorry it's taken me a few days to get back online. I've not been well, started some new meds, saw a new neuro surgeon, and learned that I need major back surgery ASAP. So, I've been distracted.
I did take the time to call Cigna and ask them directly if they would coordinate with Mediare. Explained my situation, that I am a dependent on my dad's group health plan. That Cigna would be primary and Medicare secondary.
Cigna said that they would work with Medicare. That they do all the time.
They said that if my father stopped working then Cigna can chose not to cover us if we have Medicare as an alternative insurance option.
I finally got my Cigna card yesterday so now I can at least rest assured that I will have coverage with the new year.
Thanks for all your help friends. Maybe this thread will help someone else later. Medicare rules are so confusing at times.
Posts: 5237 | From here | Registered: Nov 2007
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poppy
Frequent Contributor (1K+ posts)
Member # 5355
posted
That's great about the insurance. A big relief, I'm sure.
Sorry about the back surgery. Sending best wishes.
Posts: 2888 | From USA | Registered: Mar 2004
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nonna05
Frequent Contributor (1K+ posts)
Member # 33557
posted
Double check,,Please...Sammy I'm sorry you're having a rough time again
My husbands was through UMR /Rocky Flats ,,Several thousand employee's.
They said and it read on this years sign up, that if you qualified for Medicare A &B that has to be your primary and your second comes in to cover only it's 20%.
Now I have to call and drain myself again..
Triplets didn't make it..hope for the 28th/big mess .I sleept 20 or so /interrupted hours Christmas.
I sure hope he was planning on me resting in Him..
I hope Ins .works your way ,,cause I'm disabled and 56 so if you could make it ,maybe it would work for me. Posts: 2563 | From Denver,CO | Registered: Aug 2011
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