I just married my fiancée last Friday. We’re delighted to be married, and now some decisions need to be made.
She is currently enrolled in a Medicare Part B plan that she finds generally inadequate, largely due to it being an HMO, with all of the inconveniences that keep the premiums within her budget. I’m still employed, and receiving my coverage through a Federal Employee Health Benefits plan that’s a PPO. My plan is to bring her into my coverage (relieving her of her Medicare Part B premiums), and possibly take advantage of my new 60-day “Open Season” to find something that suits us better than the one I chose when it was me, my late wife, and our daughter (who ages out of Obamacare eligibility in May)
Joan (my new wife) is approaching the age of 71, and is currently being treated for some age-related conditions, most notably a pain management regimen caused by bulging discs in her spine. If she and I switch to a different carrier, do her current treatments suddenly get excluded as pre-existing conditions? If so, then switching to a completely different carrier might be out of the question.
But what if she stays with the same carrier, only with a PPO instead of an HMO? Does that allow her to continue coverage for her conditions, but without the gatekeeper nonsense she’s been putting up with for the past several years?
My understanding is that as long as I retain my employer-provided health care, my deadline for obtaining Medicare Part B without a penalty to my premium doesn’t begin to count down. Is my presumption that Joan also gets to start fresh correct?
I appreciate any informed responses that Dopers are able to provide.
While approvals are still a thing, pre-existing conditions are not. HOWEVER, if your wife is currently undergoing a treatment plan which has already been approved by current insurer A, changing policies in the middle of the treatment may require another approval process, causing a gap in treatment.
Your window for Medicare enrollment, as you noted, is delayed as long as you have your employers coverage. Your wife can get on your plan, drop the Part B, and get back on Medicare when you leave employment.
Question: is your employers ‘+ spouse’ coverage cheaper out of pocket than the Part B premium?
Anyway, when you retire, putting you both back on Medicare…
YOU: GET A SUPPLEMENT. Since this is your Initial Enrollment, you qualify for one w/ no health screening and your premium is based on (effectively) the average MS premium for your county (It’s more complicated than this, but what I lose in precision I make up for in 2am writing efficiency).
Anyway, don’t be fooled by $0 Med Advantage premiums. Just don’t. See my Medicare thread for more.
HER: She may have to go back into the Med Advantage world. If she can get a supplement, it will likely be based on her health and will probably be a bit pricey (but still likely lower than the Max Out of Pocket on her MA plan.)
Perhaps not, but I’m hopeful that it will be less than my employer’s “self” + her current Part B premium.
Even if it’s not, though, I want her to be able to get PPO instead of HMO coverage, so I’m happy to eat that, especially if we go to a different carrier.
This appears to be a qualified assertion. For instance, I’m looking to get her onto my dental plan, and my preliminary inquiries suggest that, say, previously missing teeth, would not be covered for dentures.
I had considered hunting for that excellent thread and posting my questions to it, but as you’ve pointed out, it’s late. Could you post a link to it, pretty please?
Ahhh. Dental plans are not health care plans. Completely different animal. Dental isn’t even covered by Medicare (as you surely know, but the reader may not) nor are they really regulated by the ACA.