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Head is spinning

Giggles

New member
Well, I feel your pain. Trying to find out answers about insurance is so hard cause you can get 5 different answers depending on who you talk to. I would suggest if you are not getting your answers or understanding call Beth Sufian she is a lawyer who helps people get SSDI , SI and has Medicare hotline to answer questions. She also has CF. Google her and you can get her office number.

Otherwise based on my experience. I have Medicare and I am on a group plan through my husband. My group plan is primary cause the company has over 100 employees. Whenever I go into the hospital my group plan picks up what they pick up and Medicare picks up. I am not sure exaclty why or how it is working but i am ending up paying nothing for hospital. So, with that said Beth Sufian also suggested that a person or I at the time do keep and take Medicare cause if I was ever in a position where i needed a lung transplant and I was having a hard time with my primary or in your case your private insurance, then Medicare does not tell you where you can get a transplant you just go to the hospital and most hospital are Medicare providers. So in essense it is a safeguard if my primary or in your case private insurance ever had a problem with where i was going to go for a transplant then I could drop that insurance and use Medicare as Primary cause Medicare has no stipulations for that. I have also found having Medicare as secondary has really paid alot on my doctor office visits , I don't pay anything unless it is a copay and in that case Medicare does not pick up copays from primary or deductibles. Pulmozyme, TOBI and ALbuterol are also covered under Medicare Part B so if your primary does not cover it or if you can coordinate care with Primary you could possibly end up paying nothing for those drugs after deductibles etc.

Ask to talk to a supervisor at Medicare and talk with Beth would be my suggestions in figuring this all out.

Good Luck
Jennifer 37 with CF and CFRD
 

Giggles

New member
Well, I feel your pain. Trying to find out answers about insurance is so hard cause you can get 5 different answers depending on who you talk to. I would suggest if you are not getting your answers or understanding call Beth Sufian she is a lawyer who helps people get SSDI , SI and has Medicare hotline to answer questions. She also has CF. Google her and you can get her office number.

Otherwise based on my experience. I have Medicare and I am on a group plan through my husband. My group plan is primary cause the company has over 100 employees. Whenever I go into the hospital my group plan picks up what they pick up and Medicare picks up. I am not sure exaclty why or how it is working but i am ending up paying nothing for hospital. So, with that said Beth Sufian also suggested that a person or I at the time do keep and take Medicare cause if I was ever in a position where i needed a lung transplant and I was having a hard time with my primary or in your case your private insurance, then Medicare does not tell you where you can get a transplant you just go to the hospital and most hospital are Medicare providers. So in essense it is a safeguard if my primary or in your case private insurance ever had a problem with where i was going to go for a transplant then I could drop that insurance and use Medicare as Primary cause Medicare has no stipulations for that. I have also found having Medicare as secondary has really paid alot on my doctor office visits , I don't pay anything unless it is a copay and in that case Medicare does not pick up copays from primary or deductibles. Pulmozyme, TOBI and ALbuterol are also covered under Medicare Part B so if your primary does not cover it or if you can coordinate care with Primary you could possibly end up paying nothing for those drugs after deductibles etc.

Ask to talk to a supervisor at Medicare and talk with Beth would be my suggestions in figuring this all out.

Good Luck
Jennifer 37 with CF and CFRD
 

Giggles

New member
Well, I feel your pain. Trying to find out answers about insurance is so hard cause you can get 5 different answers depending on who you talk to. I would suggest if you are not getting your answers or understanding call Beth Sufian she is a lawyer who helps people get SSDI , SI and has Medicare hotline to answer questions. She also has CF. Google her and you can get her office number.

Otherwise based on my experience. I have Medicare and I am on a group plan through my husband. My group plan is primary cause the company has over 100 employees. Whenever I go into the hospital my group plan picks up what they pick up and Medicare picks up. I am not sure exaclty why or how it is working but i am ending up paying nothing for hospital. So, with that said Beth Sufian also suggested that a person or I at the time do keep and take Medicare cause if I was ever in a position where i needed a lung transplant and I was having a hard time with my primary or in your case your private insurance, then Medicare does not tell you where you can get a transplant you just go to the hospital and most hospital are Medicare providers. So in essense it is a safeguard if my primary or in your case private insurance ever had a problem with where i was going to go for a transplant then I could drop that insurance and use Medicare as Primary cause Medicare has no stipulations for that. I have also found having Medicare as secondary has really paid alot on my doctor office visits , I don't pay anything unless it is a copay and in that case Medicare does not pick up copays from primary or deductibles. Pulmozyme, TOBI and ALbuterol are also covered under Medicare Part B so if your primary does not cover it or if you can coordinate care with Primary you could possibly end up paying nothing for those drugs after deductibles etc.

Ask to talk to a supervisor at Medicare and talk with Beth would be my suggestions in figuring this all out.

Good Luck
Jennifer 37 with CF and CFRD
 

Giggles

New member
Well, I feel your pain. Trying to find out answers about insurance is so hard cause you can get 5 different answers depending on who you talk to. I would suggest if you are not getting your answers or understanding call Beth Sufian she is a lawyer who helps people get SSDI , SI and has Medicare hotline to answer questions. She also has CF. Google her and you can get her office number.

Otherwise based on my experience. I have Medicare and I am on a group plan through my husband. My group plan is primary cause the company has over 100 employees. Whenever I go into the hospital my group plan picks up what they pick up and Medicare picks up. I am not sure exaclty why or how it is working but i am ending up paying nothing for hospital. So, with that said Beth Sufian also suggested that a person or I at the time do keep and take Medicare cause if I was ever in a position where i needed a lung transplant and I was having a hard time with my primary or in your case your private insurance, then Medicare does not tell you where you can get a transplant you just go to the hospital and most hospital are Medicare providers. So in essense it is a safeguard if my primary or in your case private insurance ever had a problem with where i was going to go for a transplant then I could drop that insurance and use Medicare as Primary cause Medicare has no stipulations for that. I have also found having Medicare as secondary has really paid alot on my doctor office visits , I don't pay anything unless it is a copay and in that case Medicare does not pick up copays from primary or deductibles. Pulmozyme, TOBI and ALbuterol are also covered under Medicare Part B so if your primary does not cover it or if you can coordinate care with Primary you could possibly end up paying nothing for those drugs after deductibles etc.

Ask to talk to a supervisor at Medicare and talk with Beth would be my suggestions in figuring this all out.

Good Luck
Jennifer 37 with CF and CFRD
 

Giggles

New member
Well, I feel your pain. Trying to find out answers about insurance is so hard cause you can get 5 different answers depending on who you talk to. I would suggest if you are not getting your answers or understanding call Beth Sufian she is a lawyer who helps people get SSDI , SI and has Medicare hotline to answer questions. She also has CF. Google her and you can get her office number.
<br />
<br />Otherwise based on my experience. I have Medicare and I am on a group plan through my husband. My group plan is primary cause the company has over 100 employees. Whenever I go into the hospital my group plan picks up what they pick up and Medicare picks up. I am not sure exaclty why or how it is working but i am ending up paying nothing for hospital. So, with that said Beth Sufian also suggested that a person or I at the time do keep and take Medicare cause if I was ever in a position where i needed a lung transplant and I was having a hard time with my primary or in your case your private insurance, then Medicare does not tell you where you can get a transplant you just go to the hospital and most hospital are Medicare providers. So in essense it is a safeguard if my primary or in your case private insurance ever had a problem with where i was going to go for a transplant then I could drop that insurance and use Medicare as Primary cause Medicare has no stipulations for that. I have also found having Medicare as secondary has really paid alot on my doctor office visits , I don't pay anything unless it is a copay and in that case Medicare does not pick up copays from primary or deductibles. Pulmozyme, TOBI and ALbuterol are also covered under Medicare Part B so if your primary does not cover it or if you can coordinate care with Primary you could possibly end up paying nothing for those drugs after deductibles etc.
<br />
<br />Ask to talk to a supervisor at Medicare and talk with Beth would be my suggestions in figuring this all out.
<br />
<br />Good Luck
<br />Jennifer 37 with CF and CFRD
 

just1more

New member
Just one note:

I have BCBS and my son also has medicaid (due to being a medical needs adoption).

We list BCBS first on everything and medicaid as secondary. We've not had any issues with BCBS; and like you mention the private insurance is better so then the state just picks up the balance.

I'm not 100% sure medicare would be the same, but I don't see any way BCBS can decide which is primary as they have not given us any issues.
 

just1more

New member
Just one note:

I have BCBS and my son also has medicaid (due to being a medical needs adoption).

We list BCBS first on everything and medicaid as secondary. We've not had any issues with BCBS; and like you mention the private insurance is better so then the state just picks up the balance.

I'm not 100% sure medicare would be the same, but I don't see any way BCBS can decide which is primary as they have not given us any issues.
 

just1more

New member
Just one note:

I have BCBS and my son also has medicaid (due to being a medical needs adoption).

We list BCBS first on everything and medicaid as secondary. We've not had any issues with BCBS; and like you mention the private insurance is better so then the state just picks up the balance.

I'm not 100% sure medicare would be the same, but I don't see any way BCBS can decide which is primary as they have not given us any issues.
 

just1more

New member
Just one note:

I have BCBS and my son also has medicaid (due to being a medical needs adoption).

We list BCBS first on everything and medicaid as secondary. We've not had any issues with BCBS; and like you mention the private insurance is better so then the state just picks up the balance.

I'm not 100% sure medicare would be the same, but I don't see any way BCBS can decide which is primary as they have not given us any issues.
 

just1more

New member
Just one note:
<br />
<br />I have BCBS and my son also has medicaid (due to being a medical needs adoption).
<br />
<br />We list BCBS first on everything and medicaid as secondary. We've not had any issues with BCBS; and like you mention the private insurance is better so then the state just picks up the balance.
<br />
<br />I'm not 100% sure medicare would be the same, but I don't see any way BCBS can decide which is primary as they have not given us any issues.
 

ladybug

New member
Thanks,

Medicare was actually putting me on hold to "ask their supervisor" every person I talked to. As I mentioned above, and as they explained to me, my order will go:

<b>Medicare
BCBS (private policy, NOT group or employment)
Tricare</b>

Tricare is also a federal program so it comes last as Medicare and Tricare (even though Tricare is an employer with over 100) are essentially the same socialized govt. program.

They also said there is NO reason for me to pay a $96 per month premium for Part B if everything is already covered at 100% with Tricare and BCBS. I pay over $250 per month out of pocket for my BCBS policy and will continue to have it.

They also said they will by law have to notify BCBS I have medicare now so BCBS will NOT pay before medicare unless I have what is called "BCBS medicare advantage", which I do not.

Unless they're giving me the wrong information (not unlikely... LOL), I will HAVE TO have medicare part A as primary when i have a hospitalization.

Can anyone speak to how Medicare A handles hospitalizations and home health visits please? Has it been easy or difficult? If I can drop Part A (no one they've heard of has ever done this cause its free) in order to have BCBS as primary, I want to weigh the pros and cons of keeping or dropping it based on what others have had happen with medicare being primary.

Thanks again for the input.
 

ladybug

New member
Thanks,

Medicare was actually putting me on hold to "ask their supervisor" every person I talked to. As I mentioned above, and as they explained to me, my order will go:

<b>Medicare
BCBS (private policy, NOT group or employment)
Tricare</b>

Tricare is also a federal program so it comes last as Medicare and Tricare (even though Tricare is an employer with over 100) are essentially the same socialized govt. program.

They also said there is NO reason for me to pay a $96 per month premium for Part B if everything is already covered at 100% with Tricare and BCBS. I pay over $250 per month out of pocket for my BCBS policy and will continue to have it.

They also said they will by law have to notify BCBS I have medicare now so BCBS will NOT pay before medicare unless I have what is called "BCBS medicare advantage", which I do not.

Unless they're giving me the wrong information (not unlikely... LOL), I will HAVE TO have medicare part A as primary when i have a hospitalization.

Can anyone speak to how Medicare A handles hospitalizations and home health visits please? Has it been easy or difficult? If I can drop Part A (no one they've heard of has ever done this cause its free) in order to have BCBS as primary, I want to weigh the pros and cons of keeping or dropping it based on what others have had happen with medicare being primary.

Thanks again for the input.
 

ladybug

New member
Thanks,

Medicare was actually putting me on hold to "ask their supervisor" every person I talked to. As I mentioned above, and as they explained to me, my order will go:

<b>Medicare
BCBS (private policy, NOT group or employment)
Tricare</b>

Tricare is also a federal program so it comes last as Medicare and Tricare (even though Tricare is an employer with over 100) are essentially the same socialized govt. program.

They also said there is NO reason for me to pay a $96 per month premium for Part B if everything is already covered at 100% with Tricare and BCBS. I pay over $250 per month out of pocket for my BCBS policy and will continue to have it.

They also said they will by law have to notify BCBS I have medicare now so BCBS will NOT pay before medicare unless I have what is called "BCBS medicare advantage", which I do not.

Unless they're giving me the wrong information (not unlikely... LOL), I will HAVE TO have medicare part A as primary when i have a hospitalization.

Can anyone speak to how Medicare A handles hospitalizations and home health visits please? Has it been easy or difficult? If I can drop Part A (no one they've heard of has ever done this cause its free) in order to have BCBS as primary, I want to weigh the pros and cons of keeping or dropping it based on what others have had happen with medicare being primary.

Thanks again for the input.
 

ladybug

New member
Thanks,

Medicare was actually putting me on hold to "ask their supervisor" every person I talked to. As I mentioned above, and as they explained to me, my order will go:

<b>Medicare
BCBS (private policy, NOT group or employment)
Tricare</b>

Tricare is also a federal program so it comes last as Medicare and Tricare (even though Tricare is an employer with over 100) are essentially the same socialized govt. program.

They also said there is NO reason for me to pay a $96 per month premium for Part B if everything is already covered at 100% with Tricare and BCBS. I pay over $250 per month out of pocket for my BCBS policy and will continue to have it.

They also said they will by law have to notify BCBS I have medicare now so BCBS will NOT pay before medicare unless I have what is called "BCBS medicare advantage", which I do not.

Unless they're giving me the wrong information (not unlikely... LOL), I will HAVE TO have medicare part A as primary when i have a hospitalization.

Can anyone speak to how Medicare A handles hospitalizations and home health visits please? Has it been easy or difficult? If I can drop Part A (no one they've heard of has ever done this cause its free) in order to have BCBS as primary, I want to weigh the pros and cons of keeping or dropping it based on what others have had happen with medicare being primary.

Thanks again for the input.
 

ladybug

New member
Thanks,
<br />
<br />Medicare was actually putting me on hold to "ask their supervisor" every person I talked to. As I mentioned above, and as they explained to me, my order will go:
<br />
<br /><b>Medicare
<br />BCBS (private policy, NOT group or employment)
<br />Tricare</b>
<br />
<br />Tricare is also a federal program so it comes last as Medicare and Tricare (even though Tricare is an employer with over 100) are essentially the same socialized govt. program.
<br />
<br />They also said there is NO reason for me to pay a $96 per month premium for Part B if everything is already covered at 100% with Tricare and BCBS. I pay over $250 per month out of pocket for my BCBS policy and will continue to have it.
<br />
<br />They also said they will by law have to notify BCBS I have medicare now so BCBS will NOT pay before medicare unless I have what is called "BCBS medicare advantage", which I do not.
<br />
<br />Unless they're giving me the wrong information (not unlikely... LOL), I will HAVE TO have medicare part A as primary when i have a hospitalization.
<br />
<br />Can anyone speak to how Medicare A handles hospitalizations and home health visits please? Has it been easy or difficult? If I can drop Part A (no one they've heard of has ever done this cause its free) in order to have BCBS as primary, I want to weigh the pros and cons of keeping or dropping it based on what others have had happen with medicare being primary.
<br />
<br />Thanks again for the input.
<br />
<br />
 

Giggles

New member
From how it has been explained to me Medicare was designed originally for hospital so Part A covers your hospital at a certain percentage, I believe 80%. Now, homehealth care it has been a BATTLE for me to get my agency to submit to Medicare and do it CORRECTLY as it stands now homehealth is not being covered by Medicare.

Also, when you have other insurance than Medicare, Medicare will not pay more than what they are set up to pay like 80% so in some cases if your Primary has picked up over 80% then Medicare may not pick up anything. But at the same time my primary and Medicare has picked up all my hospital so who knows! That is how it has been explained to me but it is all confusing.

Sorry you are having problems, I feel your pain!

Jennifer 37 years old with CF and CFRD
 

Giggles

New member
From how it has been explained to me Medicare was designed originally for hospital so Part A covers your hospital at a certain percentage, I believe 80%. Now, homehealth care it has been a BATTLE for me to get my agency to submit to Medicare and do it CORRECTLY as it stands now homehealth is not being covered by Medicare.

Also, when you have other insurance than Medicare, Medicare will not pay more than what they are set up to pay like 80% so in some cases if your Primary has picked up over 80% then Medicare may not pick up anything. But at the same time my primary and Medicare has picked up all my hospital so who knows! That is how it has been explained to me but it is all confusing.

Sorry you are having problems, I feel your pain!

Jennifer 37 years old with CF and CFRD
 

Giggles

New member
From how it has been explained to me Medicare was designed originally for hospital so Part A covers your hospital at a certain percentage, I believe 80%. Now, homehealth care it has been a BATTLE for me to get my agency to submit to Medicare and do it CORRECTLY as it stands now homehealth is not being covered by Medicare.

Also, when you have other insurance than Medicare, Medicare will not pay more than what they are set up to pay like 80% so in some cases if your Primary has picked up over 80% then Medicare may not pick up anything. But at the same time my primary and Medicare has picked up all my hospital so who knows! That is how it has been explained to me but it is all confusing.

Sorry you are having problems, I feel your pain!

Jennifer 37 years old with CF and CFRD
 

Giggles

New member
From how it has been explained to me Medicare was designed originally for hospital so Part A covers your hospital at a certain percentage, I believe 80%. Now, homehealth care it has been a BATTLE for me to get my agency to submit to Medicare and do it CORRECTLY as it stands now homehealth is not being covered by Medicare.

Also, when you have other insurance than Medicare, Medicare will not pay more than what they are set up to pay like 80% so in some cases if your Primary has picked up over 80% then Medicare may not pick up anything. But at the same time my primary and Medicare has picked up all my hospital so who knows! That is how it has been explained to me but it is all confusing.

Sorry you are having problems, I feel your pain!

Jennifer 37 years old with CF and CFRD
 

Giggles

New member
From how it has been explained to me Medicare was designed originally for hospital so Part A covers your hospital at a certain percentage, I believe 80%. Now, homehealth care it has been a BATTLE for me to get my agency to submit to Medicare and do it CORRECTLY as it stands now homehealth is not being covered by Medicare.
<br />
<br />Also, when you have other insurance than Medicare, Medicare will not pay more than what they are set up to pay like 80% so in some cases if your Primary has picked up over 80% then Medicare may not pick up anything. But at the same time my primary and Medicare has picked up all my hospital so who knows! That is how it has been explained to me but it is all confusing.
<br />
<br />Sorry you are having problems, I feel your pain!
<br />
<br />Jennifer 37 years old with CF and CFRD
 
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