I need help and would like opinions from the experts in this forum before I start calling my insurance carriers. The following is my personal situation:
1)        I am over 65, unemployed, and Medicare is presently my primary ins. (traditional fee for service)
2)        I am also covered by a retiree policy from a former employer (traditional fee for service) plan which includes a stand alone prescription plan. The plan book states the typical COB policy concerning my, or my spouses, employment taking precedence over the retiree plan.
3)        My wife recently became enrolled in a managed-care (HMO) policy through her employer (more than 20 employees) which covers her and our teenage daughter. At the time of enrollment a few months ago, we declined enrolling me in the plan because I thought I was well-covered under my present plans.
4)        I have a history of HTN, CHF, MI, reduced kidney function, skin cancers.
I am afraid I may already know most of the answers, but my questions here are the following:
1)        Will Medicare claim they are secondary and only pay as if my wifes plan is primary and as if I were included in her plan, although I am not?
2)        In determining Medicare coverage, would Medicares payment (likely) be based upon, or applied to, only the normal copay portion from the HMO in coordination with Medicares allowable fee?
3)        What would happen if my present providers are not contracted with my wifes HMO? Would I then be responsible for my providers full (U&C) charges, or are their charges limited by/to Medicares allowable fee?
4)        If I were able to enroll in my wifes HMO plan at some future date, what is the likelihood that the HMO would decline coverage of me, partially or totally, due to my pre-existing conditions? Would I then be covered in full by my own current policies on those declined conditions?
IMHO, I think it should be a crime for one insurance company to force its members to purchase another insurance companys plan just so it will lower the formers payouts of benefits. Otherwise, both companies should be required to pay their full normal coverage for each claim. It certainly is too one-sided to the benefit of the insurance companies now and our lawmakers should act to level the playing field IMO. If we as beneficiaries are required to pay for two policies, against our will, we should be entitled to receive full benefits from each of two policies for each claim.
I desperately need advice and appreciate any and all answers.
Claude
1)        I am over 65, unemployed, and Medicare is presently my primary ins. (traditional fee for service)
2)        I am also covered by a retiree policy from a former employer (traditional fee for service) plan which includes a stand alone prescription plan. The plan book states the typical COB policy concerning my, or my spouses, employment taking precedence over the retiree plan.
3)        My wife recently became enrolled in a managed-care (HMO) policy through her employer (more than 20 employees) which covers her and our teenage daughter. At the time of enrollment a few months ago, we declined enrolling me in the plan because I thought I was well-covered under my present plans.
4)        I have a history of HTN, CHF, MI, reduced kidney function, skin cancers.
I am afraid I may already know most of the answers, but my questions here are the following:
1)        Will Medicare claim they are secondary and only pay as if my wifes plan is primary and as if I were included in her plan, although I am not?
2)        In determining Medicare coverage, would Medicares payment (likely) be based upon, or applied to, only the normal copay portion from the HMO in coordination with Medicares allowable fee?
3)        What would happen if my present providers are not contracted with my wifes HMO? Would I then be responsible for my providers full (U&C) charges, or are their charges limited by/to Medicares allowable fee?
4)        If I were able to enroll in my wifes HMO plan at some future date, what is the likelihood that the HMO would decline coverage of me, partially or totally, due to my pre-existing conditions? Would I then be covered in full by my own current policies on those declined conditions?
IMHO, I think it should be a crime for one insurance company to force its members to purchase another insurance companys plan just so it will lower the formers payouts of benefits. Otherwise, both companies should be required to pay their full normal coverage for each claim. It certainly is too one-sided to the benefit of the insurance companies now and our lawmakers should act to level the playing field IMO. If we as beneficiaries are required to pay for two policies, against our will, we should be entitled to receive full benefits from each of two policies for each claim.
I desperately need advice and appreciate any and all answers.
Claude
