My husband will be eligible for Medicare starting in January. He’s disabled. We’re trying to determine if the Medicare coverage makes sense for us. He’s currently covered under my plan and Medicare would become the primary payer with my plan as the secondary.
What’s weird is that we don’t know anyone on Medicare. My father had just started when he passed away last year. I don’t have any grandparents. All of my older relatives are still working, have declined Medicare for some other reason, or simply have never used the coverage they have.
What we’re most curious about is coverage for mental health issues (my plan’s coverage sucks) and using Medicare as a primary payer when you have a secondary payer as well. So, any stories, facts, statistics, horror tales, or anything else about actually using Medicare would be useful to me.
A lot of doctors limit their Medicare patients or won’t take any at all due to their poor reimbursement rates, so if choice is an issue, you might want to stick with your plan.
Hi, cher3. That’s a good point. Do you have any idea what my options would be if they didn’t want to take Medicare but would accept the secondary insurance?
My mother (she’s 81 now) went on Medicare without a hitch . She didn’t have to change doctors; no service she’d been receiving previously was denied.
Of course this might’ve been due to her Medex (BC/BS) supplemental, which she now pays quarterly. When she worked, her employer picked up 80% of it.
What I’d do is first ask your husband’s doctor if s/he takes Medicare. AFAIK, a lot of doctors do; some don’t. The other thing I’d do is contact your insurance carrier to get a listing of their doctors who participate in the Medicare program, as well as details as to what they (the insurance) will and will not cover.
Medicare can be hazy in some instances. It won’t cover certain procedures (podiatry, eye exams, for example) unless the doctor documents that there’s an overwhelming medical reason as to why the patient needs the service. My mother has dementia; there’s no way in hell I’d let her near her toenails with anything sharp. Medicare covered it.
As for mental health…I honestly don’t know. It’d be the first question I’d ask when calling a clinician for the first time, though.
Exactly, and it goes as far as to whom you’re seeing, as I explained in my past reply.
An example: If you need an eye exam, Medicare will not pay for an optometrist, but they will pay for an ophthamologist (did I spell that correctly?) I only found this out after taking my mother to my optometrist. Medex quickly squashed any argument I tried to make, and yes, I/she was stuck with the bill.
Medicare also has a program called “Supplemetal A” and “Supplemental B”, both of which cover the gaps Medicare and your regular supplemental don’t. I don’t know which supplemental covers what, but I’d look into it.