I had a referral call me today . She’s age 60 and on DI and Medicare only . She’s also on her husbands regular insurance . She uses the va for a lot of her drugs and a few drs .Her husbands insurance pays no drs or anything till she hits $2 k . She can’t drop her insurance till April . The Humana RD told me to sell her a mapd as her regular insurance will be the primary and since it pays nothing for the first $2 k she will pay the Humana copays . What I’m asking is how does it work with Medicare , a commercial policy and a mapd ? Also does it matter if she has a mapd with also having the va for some drugs ?
Question about a under 65 on di and has Medicare card
- Thread starter DonP
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Medicare is secondary to private insurance if the company has more than 20 employees. If less, Medicare pays first, private pays second. If her Primary insurance doesn't pay because of a deductible, MA can come behind and offer coverage.
VA Rx's can only be prescribed by VA doctors. What the PDP does is allow the client to get RX coverage from prescriptions that the VA doesn't prescribe.
VA Rx's can only be prescribed by VA doctors. What the PDP does is allow the client to get RX coverage from prescriptions that the VA doesn't prescribe.
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- 4,136
For a better explanation:
Client would continue to pay the premium for Part B while she had husband's benefits. The coordination of benefits would "decrease" her costs when she used it, but she'd be paying the Part B premium as well.
Once she maxes out the deductible, MA isn't going to pay almost anything. So she's paying the Part B premium for minimal benefit.
Frankly, if she's on a work plan, she shouldn't go on Medicare Part B until she leaves it. Especially when she's getting all her major treatment at the VA.
Client would continue to pay the premium for Part B while she had husband's benefits. The coordination of benefits would "decrease" her costs when she used it, but she'd be paying the Part B premium as well.
Once she maxes out the deductible, MA isn't going to pay almost anything. So she's paying the Part B premium for minimal benefit.
Frankly, if she's on a work plan, she shouldn't go on Medicare Part B until she leaves it. Especially when she's getting all her major treatment at the VA.
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She has part A and B . She’s paying the part b $144 and doesn’t have to as she has credible coverage thru spouse . She’ll be dropping Coverage thru husband in April .Husbands coverage pays zip until she reaches $2 k . So all drs visits cost full to her vs $15 with ma . Her spousal coverage costs at least $200 a month . She’ll save at least $3500 a yr in premium savings and out of pocket to get to $2000 with husbands ins .
- 4,136
She shouldn't have taken Part B until April, when she drops off the plan.
As you can imagine, there's always a debate about MA. You can guess the side Bob falls on.
MA can be a strong benefit for VA participants that use it often. However, a Medigap HD offers more freedom and less total OOP costs.
The commission isn't great, but still...
Then again.. if she fully understands the pitfalls of MA and wants it.. that's her choice.
Agreed, she did not need part B since covered by spouse CREDITABLE coverage group plan.
If/when she drops Part B she can't get a MAPD. Humana RD is STILL an ***.
What part of this thread are you missing?
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- #8
yes I know she shouldn’t have taken part b . She’s unhappy with her spouses coverage and she ca
No she didn’t need part B but that was done before . She’s much better off with a solid Humana mapd with $5 and $15 copays . Right now she gets zero benefit with her husbands $2 k deductible before 1 cent is paid . Also she’ll save $200 a month by exiting her husbands policy . I know you love med sups put what you never tell anyone unless somebody has 3 or more hospital stays of 5 or more days they’ll never get near there $7500 out of pocket max . If everyone were well off of course a med sup is better but people of less Means must take risks
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