Medicare Part B & Private Health Insurance?

Question

My mom is 67 and still works. She has a group health policy through her job. She declined Part B since she is an active employee with group coverage. She works for a small employer, with under 20 employees, so Medicare is primary. The problem is that her group health plan is denying ALL of her claims incurred outside of the hospital, including doctor's visits, telling her that she should have enrolled for Part B.

She was advised by SSA to not take Part B since she was still working and has major medical insurance for charges outside of the hospital. But, now, her private insurance is not covering her claims. She feels deceived by her insurance company.

I have always heard that it was best to decline Part B when you are actively working and have group health insurance. Can someone help?

Answer 1

If the group policy is under 20 employees that does not allow you to postpone Part B because Medicare will be primary and if Medicare doesn't pay, neither will the group. This is a federal Medicare guideline and SSA should have known. Proving that the government employee at SSA told her that she didn't need it will be difficult if not impossible. (does anyone here see a problem that will plague univeral healthcare?)

The bad news: since she has declined Part B there are time restrictions and penalties for when she does get on the plan. She will have to apply between Jan 1 and March 31 of next year and Part B will become effective July 1. She will have a 10% penalty for each 12 month period she was without Part B and she will have to pay that penalty for as long as she is on Medicare.

Wish I had better news for you.

Answer 2

The owners of our company stayed on our policy here as well, but both of them took Medicare as well.  Because they were still working, the insurance was primary and their claims were not denied.  It sounds like this is just the opposite of what is happening with your mother.  

Both of my parents are on Medicare and have a supplemental BCBS plan 65, so they pay nothing at all (for the most part) other than their premiums.  

If I were you, I would read through your mother's plan booklet and see if there is a provision stating that they won't cover claims if you are 65.  It seems to me they should decline coverage before doing that.  If they are taking premium payments and not paying claims, they need to be reported to your state's insurance commissioner.

Good Luck!