Aug 5, 2018

I'm Not A Medicare Expert; I Just Play One On TV

     From Philip Moeller writing for PBS News Hour:
Sharilyn – Ind.: My daughter has cancer. She is on disability and Medicare. She is getting married in two months. Can she stay on Medicare or will she have to get on her new husband’s insurance?
Phil Moeller: If she is receiving Medicare through her Social Security disability, it will be her choice whether to continue it or, if available, choose to be covered by her husband’s health plan. She could even keep both, using one as primary and the other as supplemental, depending on which has the best benefits.
     How many ways can you mislead someone in two sentences? First, Moeller fails to mention the very real possibility that the daughter is on Disabled Adult Child benefits. If so (apart from a very unusual circumstance) marriage will end not just the Medicare but the cash benefits as well. That's more than a theoretical possibility since the question probably concerns a young woman. It is important to warn people who may be at risk about this trap. Second, no, you don't get to choose between Medicare and private healthcare insurance. If you're Medicare eligible, any private healthcare insurance is a secondary payer even if you decline Medicare Part B coverage. In other words, you better have Medicare Part B because your healthcare insurance won't pay for anything Medicare Part B would have paid for. You can't decline Medicare Part A. You don't have to pay a premium for Part A. The young woman needs to be told to ask her new husband's insurer about any options they would offer her but what they offer will only supplement Medicare, not substitute for it.


Anonymous said...

Agree with you on the CDB thing. Mr. Moeller could end up with some bad PR, and the daughter with the even worse scenario of loosing Medicare if they are a CDB.

Disagree with you regarding the Medicare primary/secondary payer stuff. Many disabled people refuse Part B coverage with no problem when they are covered under health insurance through their own current employment or through the employment of a spouse. In disability cases, so long as the employer has over 100 employees, Medicare is always the secondary payer of benefits to the large group health plan. There are also circumstances under which Medicare pays secondary for employers with more than 20 employees as these smaller employers will often group together with other smaller employers to get better rates, to the point where the collective "group" ends up covering more than 100 employees and thus the large group health plan provisions kick in.

Anonymous said...

Many group health plans do not require you to accept B if eligible but you do have to accept A and most will only pay what A does not pay.

Anonymous said...

Also, while the father's use of the term "medicare" implies his daughter is insured under Title II, there is a significant possibility he is mislabling her coverage. If his daughter is covered under medicaid through SSI, marriage could be a significant issue for assets/income.