My mother died last February. Part of her pension from the job she retired from many years ago was a supplemental (? I think that’s the term?) health insurance policy. After she died, my father was eligible for it via COBRA. It costs a couple hundred bucks a month, and I figured we’d try it out and see what it covered that Medicare would not cover for him.
So now it’s a few months later, and I’m looking over the EOBs and heck if I can tell if the $230 or so he pays every month is worth anything. Like any other EOB, I can see what the doc billed, what the insurance paid, and what his out-of-pocket expenses are. But what I can’t see is “Medicare covered $X and the supplemental insurance covered $Y”, which is what I need to make the decision on whether or not to keep this extra insurance.
Given the current state of health care in the US, this fills me with dread. Is there something I’m missing? Is there a Medicare website I should check out for their portion (I’m just looking at Blue Cross Blue Shield, the place that provides the extra insurance). Or is this yet another nightmare of health care that is pretty much impossible to figure out?
What you want to look at first is the secondary policy’s coordination of benefits rules.
Fee for service Medicare covers basically 80% of the cost of care. There are some exceptions around preventative services. So he would be left with the 20% if he did not have any supplemental insurance. (Most people with ffs have Medigap plans, which are very explicit about what they cover, and are required to be identical.)
Depending on the exact parameters of the secondary coverage, it might make more sense for him to drop it and switch to a Medigap, or drop ffs Medicare and switch to a Medicare Advantage plan. The coverage rules of the secondary insurance is something they are required to give to your father. If you don’t have it, ask them for it.
Are there special Medigap eligibility rules in this scenario? I thought guaranteed issue (with no underwriting) only applied in the first 12 months after starting Medicare?
(I am a big fan of Medigap - no 20% obligation and unlike Advantage, no insurance company second guessing my doc or limiting my network.)
The rules for Medigaps are really complicated, and I can’t rattle them off. I think it’s only 6 months of Medigap open enrollment after enrolling in Medicare Part B. But it can still make sense to switch to a Medigap under some circumstances, which will vary by person and by state.
So in any event he will have to be looking for other insurance in not too distant future.
My understanding is that people on Medicare with a supplement get two Explanation of Benefit forms: one from Medicare and one from the supplementary insurance carrier.
This is true but often the supplemental carrier neglects to send out a timely statement setting forth their payment. For the OP, your best method to determine what the supplemental carrier paid is to call them and ask. Otherwise, you may not receive this info until the end of year when they finally provide a list of their payments. Usually, they will pay the 20% that Medicare does not pay for covered expenses and is considered coinsurance.
I know of no full proof method to determine if the monthly premium for a supplemental policy is worth it unless you can anticipate annual future medical expenses. If you can project these expenses, a general rule of thumb is to deduct 20% to see if that amount justifies the annual premium for supplemental coverage. Unfortunately, most of us cannot project future medical costs which is one of the reasons we purchase insurance; to protect us from the unknown.
The COBRA statement he received said that it was good for 36 months. Not sure why the discrepancy, but that’s our time frame.
I’m getting timely EOBs from BC/BS. From what i can tell, it says nothing about Medicare payment; it’s the same info that’s on my EOBs, and I’m not on Medicare. For example, I see “Billed amount”, “Amount Charged”, “Amount Approved”, “Plan Paid”, and “Amount you Pay” on every EOB.
For example, in the one I happen to be looking at right now:
Billed Amount: $240
Amount Approved: $104.59
Plan Paid: $94.13
Amount you pay: $10.46
IE, looks like they adjusted the payment to the approved amount, made a payment minus a co-pay or something, and then my Dad will owe $10.46. Nothing about “Medicare paid $x, we’re paying $y”
The actual name of the plan is “Medicare plus Blue.” Maybe this is something different than supplemental insurance?
I know nothing is foolproof, but knowing the breakdown of who is paying what would certainly give us some usable information.
You probably have seen this site, but just in case…
To me, it appears that you have a retired employee group Medicare plan. This looks a bit different from both Advantage and Supplemental plans sold to individuals (and might be better). My mother is still covered by one of these plans, five years after my father passed.
It might be helpful to speak with an insurance broker who specializes in Medicare Advantage and Supplemental (Medigap) policies and could explain your options.