[jnieman]

Originally Posted by Byte1

If he has BC/BS Federal, why are you going to pay for Medicare B? What does B cover that BC Federal does not?
We have BC/BS federal Basic and like it. Although, we have had problems with Florida Blue mishandling it compared to the state we moved from.
I have Federal BC/BS basic and ONLY Medicare A. We save over $200 a month by NOT having to pay for Medicare B.

Read my earlier post on this. We have BC/Standard and had plenty out of pocket by my not being old enough to get Medicare to go with it.

[HappyRetired]

I am not familiar with your Federal insurance, but if your husband becomes eligible for Medicare he has a time limit to make changes to any insurances--he doesn't have to wait until the open enrollment for current beneficiaries. Go to mymedicare.gov where you can get information about some of your options. But SHINE can help you determine if you want to keep what you have vs taking TV options or Medicare with a supplement. The more information you can get to make a decision based on your needs the better. Good luck.

[Byte1]

Originally Posted by retiredguy123

Your out of pocket expenses are the Medicare Part B premiums. If you do the math, you may find out that you would have spent less money by not having Medicare Part B at all.

👍 agree

[Byte1]

Originally Posted by jnieman

Read my earlier post on this. We have BC/Standard and had plenty out of pocket by my not being old enough to get Medicare to go with it.

Yes, that is the Standard policy. You have to pay a deductible. The basic option, you pay a Co-payment. I do not see the benefit of having Medicare B. If you have "B" you have to pay approx. $105 each or more. Like I said, I have the Federal BC/BS basic and Medicare A only. We save over $200 per month or over $2400 per year. Maybe I am looking at it wrong, but I see no benefit of having Medicare B if you have a full BS/BC policy. Just my opinion.

[jnieman]

Originally Posted by Byte1

Yes, that is the Standard policy. You have to pay a deductible. The basic option, you pay a Co-payment. I do not see the benefit of having Medicare B. If you have "B" you have to pay approx. $105 each or more. Like I said, I have the Federal BC/BS basic and Medicare A only. We save over $200 per month or over $2400 per year. Maybe I am looking at it wrong, but I see no benefit of having Medicare B if you have a full BS/BC policy. Just my opinion.

I just had to go to the emergency room. I have standard BC/BS Federal and no medicare (not old enough yet). I now have a bill staring me in the face for almost $800. While there I had a Cat scan, blood work, EKG. I have to pay co-insurance on all of that. If I had medicare part B my out of pocket would have been probably zero.

[retiredguy123]

Originally Posted by jnieman

I just had to go to the emergency room. I have standard BC/BS Federal and no medicare (not old enough yet). I now have a bill staring me in the face for almost $800. While there I had a Cat scan, blood work, EKG. I have to pay co-insurance on all of that. If I had medicare part B my out of pocket would have been probably zero.

Yes, it would be zero. But, you need to calculate how much your Medicare B premiums will be when you turn 65. My annual premium would be about $3,300. I would rather pay an occasional $800 bill then pay $3,300 every year even if I don't have medical bills. And, I am always protected against a major illness expense because of the Blue Cross $5,000 catastrophic limit.

[jnieman]

Originally Posted by retiredguy123

Yes, it would be zero. But, you need to calculate how much your Medicare B premiums will be when you turn 65. My annual premium would be about $3,300. I would rather pay an occasional $800 bill then pay $3,300 every year even if I don't have medical bills. And, I am always protected against a major illness expense because of the Blue Cross $5,000 catastrophic limit.

I guess I need to study that $5000 catastrophic limit because I have never been able to benefit from it. Last year we had over $20,000 in medical expenses to deduct. $7000 of that was in premiums for my husband's medicare and our BC/BS, but that leaves over $13,000. I wonder if the catastropic only kicks in for a major event.

[Byte1]

Originally Posted by jnieman

I just had to go to the emergency room. I have standard BC/BS Federal and no medicare (not old enough yet). I now have a bill staring me in the face for almost $800. While there I had a Cat scan, blood work, EKG. I have to pay co-insurance on all of that. If I had medicare part B my out of pocket would have been probably zero.

With BC/BS Basic, you do not pay deductibles, only co-pay. A $22000 knee replacement cost $150 hospital co-pay and a $150 doctor co-pay. I believe I got the doctor co-pay right. A family with the Standard policy will pay something like $10000 deductible. But, I think the whole thread was the idea of having Medicare B WITH private insurance. My opinion is that it is not needed. Medicare A pays hospital costs. Having a great private insurance like BC/BS FEDERAL, it just about covers most most of costs.

[jnieman]

That is if you are admitted to the hospital you don't have the large co-pays. So many of the surgeries now a days are out-patient. Even larger ones like some of the back surgeries. If you are just "under observation" and stay overnight but never get admitted then you may have to pay all of those copays. It would be 15%-20% of the allowed amount. I had this happen with a gynecological surgery. I had to pay almost $2000.

[retiredguy123]

Originally Posted by jnieman

I guess I need to study that $5000 catastrophic limit because I have never been able to benefit from it. Last year we had over $20,000 in medical expenses to deduct. $7000 of that was in premiums for my husband's medicare and our BC/BS, but that leaves over $13,000. I wonder if the catastropic only kicks in for a major event.

The Blue Cross catastrophic limit applies to all out of pocket charges related to paid claims by Blue Cross. That includes copays, coinsurance, including prescription drug coinsurance, hospital coinsurance, and surgery and doctor charges. You can see how much has been applied to your catastrophic limit for the year by looking at any of your "explanation of benefits" statements. When you reach the catastrophic limit, all valid claims are paid at 100 percent. But, your premiums are not part of the catastrophic limit.

[jnieman]

Originally Posted by retiredguy123

The Blue Cross catastrophic limit applies to all out of pocket charges related to paid claims by Blue Cross. That includes copays, coinsurance, including prescription drug coinsurance, hospital coinsurance, and surgery and doctor charges. You can see how much has been applied to your catastrophic limit for the year by looking at any of your "explanation of benefits" statements. When you reach the catastrophic limit, all valid claims are paid at 100 percent. But, your premiums are not part of the catastrophic limit.

I am still skeptical. Based on what I've had to pay over the years we are being nickle and dimed to death by the co-pays. My medicare can not be here soon enough. My husband has had it for 3 years now and he has yet to pay even a dime and he has had plenty of procedures. I don't think you are going to be able to convince me on this forum. I have to use my experience with all of this as a guide.

[Villageswimmer]

Originally Posted by jnieman

I am still skeptical. Based on what I've had to pay over the years we are being nickle and dimed to death by the co-pays. My medicare can not be here soon enough. My husband has had it for 3 years now and he has yet to pay even a dime and he has had plenty of procedures. I don't think you are going to be able to convince me on this forum. I have to use my experience with all of this as a guide.

As in many decisions in life, sometimes you need to go with what allows you to sleep at night. I hope your decision brings you peace. Namaste.

[jnieman]

I called my Federal BC/BS about the $777 hospital bill I received from last fall when I went to the emergency room. I was not admitted but received a pain shot and some fluids, a CAT scan, EKG and bloodwork. My co-pay is the amount above.

I asked her what the difference is in the standard option and the basic option of the federal plan. She said the biggest difference are the out of network services. With the standard plan they are covered but she said with the basic plan you might have a large out of pocket expense with non-covered doctors. She said the doctors drop out and go back in the plan often so it is very difficult to keep track of who is in and who is out of network. She said the doctors may be practicing in a preferred plan hospital but are non-participators. I don't know if this would be a problem at all for those who have medicare in addition to their BC/BS federal plan.

[Villageswimmer]

Originally Posted by jnieman

I called my Federal BC/BS about the $777 hospital bill I received from last fall when I went to the emergency room. I was not admitted but received a pain shot and some fluids, a CAT scan, EKG and bloodwork. My co-pay is the amount above.

I asked her what the difference is in the standard option and the basic option of the federal plan. She said the biggest difference are the out of network services. With the standard plan they are covered but she said with the basic plan you might have a large out of pocket expense with non-covered doctors. She said the doctors drop out and go back in the plan often so it is very difficult to keep track of who is in and who is out of network. She said the doctors may be practicing in a preferred plan hospital but are non-participators. I don't know if this would be a problem at all for those who have medicare in addition to their BC/BS federal plan.

Have you discussed your situation with SHINE? Also BCBS? I’ve never heard that doctors go in and out of the plan frequently. I, for one, have never had a doctor who did this; but that’s just me. I’d do some research on this statement before taking it at face value.

I may have missed it but were any of the doctors who treated you during this recent visit out of network?

[jnieman]

Originally Posted by Villageswimmer

Have you discussed your situation with SHINE? Also BCBS? I’ve never heard that doctors go in and out of the plan frequently. I, for one, have never had a doctor who did this; but that’s just me. I’d do some research on this statement before taking it at face value.

I may have missed it but were any of the doctors who treated you during this recent visit out of network?

Not on this visit but on a previous visit to a surgery center last year I received a bill from an anesthesiologist who was out of network and the surgery center was in network. The customer service representative is the one who told me the doctors at the hospital go in and out of plans and that it is hard to keep track. I can't prove this, I just am quoting what she told me.