Hello Everyone,
I am on Social Security Disability after breaking my back while working. To make a long story short I currently am on Medicare with a Medicare Advantage Plan. Deducted from my monthly benefit is $100 to cover the cost of my Medicare plan. This is all well and good except the prescription plan on either Medicare part D or through the Medicare Advantage Plans is lacking. The cost of my prescriptions are going higher and higher and now it is time to choose a new Medicare Advantage Plan.
This lead me to think that it would be better to get off of Medicare and go with my wife’s insurance provided by her employer. The drug coverage is much better. It would cost me $115 per month, however I would no longer have the deduction of $100 a month from my benefit, so I would pretty much come out even. Especially since we just got a 3.5% raise in our monthly benefit, but it will be offset by an to be announced increase in our Medicare premium.
So, with that said my question is: Does anyone know if I come off of Medicare and go with private insurance can I ever go back to Medicare? I called Medicare and they told me that I could go back on Medicare if I gave them notice within 8 months of terminating a private plan. The reason I am asking here is that it is vitally important that I have medical coverage. If my wife would for some reason lose her job in the future and not have coverage I have to have it due to my injury. I feel confident in what the Medicare rep told me, but with something this important I need to double and triple check what the rep said. If she is wrong I could be royally screwed. Does anyone know what the rule is here?
Unless they’ve changed the rules since I was working for Social Security, that sounds right. If you have other health coverage, like from a spouse’s employment, and that coverage ends you have eight months from the month the other coverage ends to apply (or re-apply, as in your case) for Medicare. There’s also no premium penalty because of the period you were not covered by Medicare, although you may need to provide proof that you were covered for that entire period.
Contact your wife’s insurer first and fully explain your intentions before making any changes to your coverage.
Your wife is covered by her employer’s coverage and often they restrict Medicare eligible individuals from taking full advantage of the employers insurance coverage.
Here’s how many employer supplied insurance companies handle your situation. If you drop Medicare and go with them, they settle any claims as if you still had the Medicare coverage and only pay what they would owe had Medicare been available. They consider themselves as secondary to Medicare whether or not it’s actually in force.
Do not concern yourself with the fairness of this decision as it will serve no useful purpose. Just be certain you understand how your wife’s insurer will handle claims for Medicare eligible individuals.
Thanks so much for the heads up. I will certainly ask the question. So, maybe it isn’t a good move to go with her insurance. I do know that I need to get away from the Medicare Advantage Plan I am currently on. They lured me away from Humana and I got royally screwed. They told me that my co-pays for meds would be exactly the same as with my Humana MCAP, $4 co-pays on all of my medication. They were correct, except after the 3 month period that you could switch if you were unhappy they suddenly raised my co-pays from $4 to $40 per prescription! My out of pocket went from $16 a month to $160 or more. When you are on disability that kind of hit is a major one.
I still can’t believe that Medicare and the government will allow an insurer to make such drastic changes before the year is up. I wasn’t the only one screwed. A meeting with my doctors patients to discuss this just about had a mob with pitch forks and torches heading down to this insurers building.
Not to hijack my own thread, but anyone here very happy with their MAC plan? Low prices on scripts? Any suggestions would be appreciated.
Typically, a Medicare Part D or Medicare Advantage plan can’t just raise your co-pays on a whim. They’re required to give you notice which is usually done in their Annual Notice of Change or ANOC. These are sent out in the late summer or early fall. One possibility is your co-pays changed due to the type of medication (generic vs. brand-name). Regardless, if you’re not happy, you should look into all your options. This can be a little daunting, but take a look over on www.medicare.gov. You can compare plans and even look up the drugs you take to see which plan covers them best. Now’s a great time to explore your options since it’s the Annual Enrollment Period until Dec. 7th when you can switch plans. Good luck.