Health Insurance, most have it & didn't know it

[watchingfromafar]

It's called Medicare
The Medicare Program is the second-largest social insurance program in the U.S., with 58.4 million beneficiaries and total expenditures of $710 billion in 2017. The Boards of Trustees for Medicare (also Boards) report annually to the Congress on the financial operations and actuarial status of the program. Beginning in 2002, there is one combined report discussing both the Hospital Insurance program (Medicare Part A) and the Supplementary Medical Insurance program (Medicare Part B and Prescription Drug Coverage). The Office of the Actuary in the Centers for Medicare & Medicaid Services (CMS) prepares the report under the direction of the Boards.

 

[Harry Dresden]

i think most people know if they have medicare....

 

[my2¢]

I'll sign up for Medicare in June, three months before turning 65. In September the insurance provided by the company I retired from will become the secondary insurer as Medicare becomes the primary. Hopefully it won't be too much of a mess. My wife's Medicare starts next week on January 1st, but for a few months now the company that handles our existing insurance has been acting as if Medicare is already the primary insurer. We've gotten a few hefty bills from doctors because of it.

Yesterday I believe I finally got the private insurance handler straightened out, person I dealt with there really tried my patience but I was able to keep my cool.

 

[dblack]

Get someone else to pay your health care bills!

That's right, with this one weird trick you can lay claim to the health care services that are yours by right!

 

[debbiedowner]

I'll sign up for Medicare in June, three months before turning 65. In September the insurance provided by the company I retired from will become the secondary insurer as Medicare becomes the primary. Hopefully it won't be too much of a mess. My wife's Medicare starts next week on January 1st, but for a few months now the company that handles our existing insurance has been acting as if Medicare is already the primary insurer. We've gotten a few hefty bills from doctors because of it.

Yesterday I believe I finally got the private insurance handler straightened out, person I dealt with there really tried my patience but I was able to keep my cool.

Which insurance pays first | Medicare

I have Medicare and:
expandI'm 65 or older and have group health plan coverage based on my current employment (or the current employment of a spouse of any age), and my employer has 20 or more employees.


If the employer has 20 or more employees, the group health plan generally pays first.


If the In general, a health plan offered by an employer or employee organization that provides health coverage to employees and their families.

" class="inline hover" style="color: rgb(15, 15, 15); border-bottom: 1px dotted; text-transform: lowercase; cursor: help !important;">group health plan didn't pay all of your bill, the doctor or A person or organization that's licensed to give health care. Doctors, nurses, and hospitals are examples of health care providers.

" class="inline hover" style="color: rgb(15, 15, 15); border-bottom: 1px dotted; text-transform: lowercase; cursor: help !important;">health care provider should send the bill to Medicare for secondary payment. Medicare will pay based on what the group health plan paid, what the group health plan allowed, and what the doctor or health care provider charged on the claim. You'll have to pay any costs Medicare or the group health plan doesn't cover.

Employers with 20 or more employees must offer current employees 65 and older the same health benefits, under the same conditions, that they offer employees under 65. If the employer offers coverage to spouses, they must offer the same coverage to spouses 65 and older that they offer to spouses under 65.

 

[my2¢]

the group health plan generally pays first.

Thanks. I was told by the representative of the company that handles my old employer's insurance payments just the opposite. She stated that they were considering the group plan secondary because the cause of the problem was Medicare records had me listed as an employee and not a retiree. Of course I was totally unable to get through to her that while my wife has Medicare Part A (hospitalization) she won't be eligible for Part B until next month and none of the bills were for hospitalization. Thus in my mind Medicare shouldn't have been a factor at all.

 

[watchingfromafar]

We also have Medicaid
Medicaid in the United States is a joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, like nursing home care and personal care services. The Health Insurance Association of America describes Medicaid as a "government insurance program for persons of all ages whose income and resources are insufficient to pay for health care".[1] Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing free health insurance to 74 million low-income and disabled people (23% of Americans) as of 2017.[2][3][4] It is a means-tested program that is jointly funded by the state and federal governments and managed by the states,[5] with each state currently having broad leeway to determine who is eligible for its implementation of the program. States are not required to participate in the program, although all have since 1982. Medicaid recipients must be U.S. citizens or legal permanent residents, and may include low-income adults, their children, and people with certain disabilities. Poverty alone does not necessarily qualify someone for Medicaid.

The Patient Protection and Affordable Care Act significantly expanded both eligibility for and federal funding of Medicaid. Under the law as written, all U.S. citizens and legal residents with income up to 133% of the poverty line, including adults without dependent children, would qualify for coverage in any state that participated in the Medicaid program. However, the Supreme Court of the United States ruled in National Federation of Independent Business v. Sebelius that states do not have to agree to this expansion in order to continue to receive previously established levels of Medicaid funding, and many states have chosen to continue with pre-ACA funding levels and eligibility standards.[6]

Jun 22, 2018 - Medicare is funded primarily from general revenues (41 percent), payroll taxes (37 percent), and beneficiary premiums (14 percent) (Figure 7). Part A is financed primarily through a 2.9 percent tax on earnings paid by employers and employees (1.45 percent each) (accounting for 87 percent of Part A revenue).

https://en.wikipedia.org/wiki/Medicaid

 

[watchingfromafar]

The only problem with universal health insurance is that it would put current private health insurance provider out of business. We need to find a solution that combines the two. One idea is to pay these private insurers to manage the paperwork and one-on-one contacts to the public. This might keep the private insurers in business.

To do this I believe we need to combine Medicare, Medicaid and social security into one service provider.

 

[debbiedowner]

the group health plan generally pays first.

Thanks. I was told by the representative of the company that handles my old employer's insurance payments just the opposite. She stated that they were considering the group plan secondary because the cause of the problem was Medicare records had me listed as an employee and not a retiree. Of course I was totally unable to get through to her that while my wife has Medicare Part A (hospitalization) she won't be eligible for Part B until next month and none of the bills were for hospitalization. Thus in my mind Medicare shouldn't have been a factor at all.

Over 20 employees group primary, under 20 group secondary.

 

[dblack]

The only problem with universal health insurance is that it would put current private health insurance provider out of business. We need to find a solution that combines the two. One idea is to pay these private insurers to manage the paperwork and one-on-one contacts to the public. This might keep the private insurers in business.

No, no - a thousand times no. The only thing worse than socialism is government "partnering" with corporations. It should never be a goal of government to keep private companies "in business".

 

[watchingfromafar]

It should never be a goal of government to keep private companies "in business".

In this case it is not to keep private companies in business. The goal is to provide Americans with affordable health insurance. Paying for the coverage is one thing, paying out the coverage is another thing and last but not least Americans need a live voice on the other side of the line to help them obtain the service they need.

What upsets me the most when I call a government agency for answers to a question I have is the response I get. The automated receiver of my call states, press [1] for this, press [2] for that & press [3] for that. When I press a number [x] the cycle repeats itself; press [1] for this, press [2] for that & press [3] for that and I never connect with a real person. Out of frustration I wind up just hanging up.

Maybe that was their intent all along; who knows.

Anyway, it takes a large staff to answer your call and they need to be experienced and knowledgeable in order to provide the right answers.

Private insurance provider already have the staff and phone lines to accomplish this so what’s the point in reinventing the wheel when the wheel already exists?