My wife is disabled, and became eligible for Medicare in December of 2006. Where I was working at the time, and she was already covered under my insurance, she opted not to enroll in Medicare Part B (although she was automatically enrolled in Part A). No one explained to her the benefits of enrolling at that time, nor the potential penalties and drawbacks of not enrolling at that time.
Through several changes in insurance companies this was not a problem, save for occasionally having to sort out that she did not have Part B; I guess it’s a rarity that people have A and not B, which perhaps should have clued us in to something being awry. Now, however, we have new insurance coverage, and this company refuses to pay the portion of her bills which Part B would have covered.
Where we never ran into this before, is this something new that insurance companies can do, or is this something specific to the particular BC/BS plan of which we are a part?
Can’t tell you about the law, but my wife is turning 65 and her insurance (through the employer she retired from) tells her she must have Medicare B and they will only offer a wraparound policy. It’s the same for active employees who are turning 65.
Yes, there’s no doubt we failed to do the research. As I told her, ignorance is not a valid defense.
It’s mainly a matter of curiosity as to whether this requirement to have Medicare Part B is something that was recently enacted, maybe as part of the ACA, or if we were just unfortunate enough to venture into a stricter health plan.
I know that large employer sponsored group health plans can, and sometimes do, do this.
Some questions - how old are you?
How old is your spouse?
Are you employed?
If so, are you both covered under your employer’s health plan?
Or, did you purchase coverage directly from the local BCBS, broker, agent, etc.?
Pretty sure it is a small employer plan (BC/BS PPO), and I know it was purchased by my company through a broker. I am employed and we are both on my plan. Spouse is 61, I am 45. Unfortunately, due to extended COBRA use (temporarily out of work, then worked as a contractor), she cannot enroll in Part B until January, with it not taking effect until July 2013.
FYI - in general insurance speak, any employer with 50 or more employees is considered “large.”
That said, it sounds to me like it’s an employer decision. If your employer is 49 employees or smaller, or if they are large but fully funded, they may fall under your state’s coordination rules/laws - if they have any.
Employers can do this. Behind the scenes it’s called “phantom” COB (coordination of benefits). You should have a summary plan description (benefit book) with a section about coordination of benefits and it should be detailed in there. If it’s not, you may have appeal rights.
You can also read up on it by searching phantom COB or phantom coordination of benefits.
Thanks, thatguyjeff. It’s definitely in the benefits description, and its presence would not have changed my situation given that COBRA was due to expire within months. I believe we have more than 50 employees (but not by much), and it’s a company staffed mainly by younger folk, such that there’s only one other employee with a spouse who it eligible for Medicare.
Looking into getting her off of my plan altogether and into a Medicare Advantage plan, probably AARP/UnitedHealthcare. Her medication costs are very high, so we’ll have to deal with the donut hole, but given that her meds are >$3700 month, and there’s a $3000 deductible on my plan and a 20% coinsurance after the deductible, it will probably end up a wash monetarily.
It does happen that people have “A” but not “B”. Typically it’s people age entitled to Medicare that are still working and covered under their employers plan. They take Medicare “A” because it’s “free”, but decline Medicare “B”, maybe not fulling understanding the ramifications of doing so. (Much rarer is someone with “B” but not “A”, but it doesn happen ocassionally, I think eligibility for “A” is strictor so some immigrants, etc may not be elligable for the “A” but elligible for “B”.)
One of our subscribers wound up owing over $10,000 because she refused Medicare “B” and her group had Phantom Cob. We don’t like doing it because every claim for these subscribers has to be processed by hand, but if we didn’t offer groups a discount for having it they’d go to one of our competitors who would. I don’t think HR does a good job explaining this “lack of benefit” to their employees, and generally the employees opt-in when the bills start coming in.
When I qualified for part B, my private health insurer made it quite clear that if I opted out of part B, they would reimburse me under their plan as if I actually had Part B. In other words, I would be responsible for that portion as an out of pocket expense.
As an incentive, my private insurer premiums were cut in half and my $1,500 deductible was waived. Naturally, I selected Part B.