Show #406 Airing Sunday 11/4/07
Are you tired of dancing the health care hustle? You know the tune: you go to the hospital or doctor for care, and you're told that Medicare should cover the costs. Medicare swings you around saying that you have private health insurance. The private company do-si-dos you over to the VA. Pretty soon, the bill collectors start to call. And that's how you dance the health care hustle.
Today I want to try to throw some light on the dim dance floor, and tell you who should be covering your health care costs.
When Medicare first began in 1965, it was always the primary payer, except for people getting workers' compensation. But in 1980, Congress changed the law and made the rules much more confusing.
Let's take a few common situations. First: If you are working, and you are covered by a group health plan sponsored by your current employer, and your employer has at least 20 employees, then your group policy will be the first payer, and Medicare is the backup. This applies if it's your employer, and it also applies if you're covered by your spouse's employer. The employer plan cannot refuse to pay because you have Medicare and cannot trim your benefits based on Medicare's coverage. If the private plan's payment doesn't cover all of your medical costs, then, and only then, will Medicare step in to pay.
So if you're working and have a group plan, the group plan pays. But, if you are retired and getting coverage under a retiree plan, then Medicare has the primary responsibility for paying your medical bills, and the private plan takes the second seat.
If you lose your job and go on COBRA, Medicare is primary and COBRA is secondary. In fact, you lose COBRA after becoming eligible for Medicare unless you choose to pay the full cost plus an administrative fee. In most cases, that won't make sense to do.
Let's switch gears. Say you're insured under both VA and Medicare. In this case, generally Medicare covers Medicare covered services and the VA covers VA services. Where there's overlap, you may elect treatment under either program. Neither is secondary to the other.
And then there's Medicaid. Medicaid is only available to people without much money. But if you are eligible for Medicaid, its coverage is generally better than Medicare. Medicare will pay first, but Medicaid will fill in the gaps. So your Medicaid may pay some or all of your Medicare premiums, deductibles, and co-pays. And Medicaid will step in to cover services that Medicare will not, such as long-term nursing home stays.
So here's my message today. Don't let your health care providers feed you a lot of hokey pokey. If you understand your rights, you can stop them from dancing around their responsibilities. Now, this is complicated. To get more information, contact:
- the Center for Medicare Advocacy, www.medicareadvocacy.org, or 860-456-7790
- the Medicare Rights Center, www.medicarerights.org, or 1-800-333-4114
- Or you can contact Medicare itself at: www.medicare.gov, or 1-800-medicare.
