Under Age 65, Disabled – Should you always take Medicare Coverage?

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Disability Medicare Options

Mary is 55 and just going onto Disability Medicare due to pancreatic cancer. She has received calls from insurance companies that she should now buy her Medicare Plan now and come off of his Blue Cross high deductible plan. Is that really what Mary should do?

She is currently doing well and the treatment is keeping the condition at bay, but barring a miracle, she will probably never be cured. Mary’s current plan has a $5,200 family deductible. She takes a number of drugs, several of which are expensive. Mary also receives a shot monthly which cost $6,000. As you can easily calculate, she reaches their family deductible each year in January.

Mary’s husband Bob is proactive and wants to know what the options are, how they would work: pro and con; and was actively gathering information. What Bob did not know is that he could keep Mary under their current plan when she went onto Medicare. Neither his premiums nor his coverage would change because of Medicare eligibility. However, if Medicare is involved and pays, their insurance plan would pay as secondary coverage, so the total benefits payments would end up being the same as they already have; but Medicare would pay first, and a portion of many expenses.

So why would it be better if Mary waived off Medicare Part B (medical) coverage and did not take a Medicare Plan. First, she is utilizing their plan a lot, and she and her providers know the coverage that she has. Any pre-authorizations necessary for current expenses have already been done. Secondly, Mary would not have any additional limitations caused by a Medicare Plan (e.g. provider or treatment limitations). By waiving Medicare Part B, she would not need to pay the Medicare Part B $104.90 (2013) monthly premium. Her out of pocket costs, premiums and their family deductible of $6,000 are set for a time period and are known costs. Medicare has no out of pocket maximum on drug coverage and she would have to contend with coordinated coverage for all expenses including drug coverage through the coverage gap (donut hole). The coordination, Medicare were also involved will require more tracking of expense and possible errors, making Mary’s family deal with paperwork when they would rather spend quality time with Mary.

This, best path for Mary, does not work in all situations, It is always best to secure quality insurance advice from a professional agent. In addition, you should read your policy, especially benefits, limitations and exclusions. That is where most of this information is found. Medicare information can be found at www. medicare.gov, by calling 1-800-medicare, or by going to your local Social Security office

Written by

Steven A. Buttice is the president of Medical Reimbursement & Management Services, Inc., a firm specializing in issues affecting seniors, including seminars and consultation on Medicare Plans, Long Term Care and other types of insurance, claims issues, and sales/service of insurance products since 1984.

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