Why should ANY of us have to do that? No one does in ANY other developed country. It’s crazy and we accept it as though it’s normal! 
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There are lots of things (not just in medical care and medical insurance) that people in general “should know” but don’t.
Some common examples around these forums are college bound high school students who seemingly do not know how to calculate their unweighted high school GPAs.
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But who knows what really went on. Figuring out if something is in network can be really hard. I just went through that with my colonoscopy…one week before the procedure I got a cyrptic letter saying I may have to pay which was odd because it’s the place lots of people from my office go. And my H had 3 that were all covered.
Long story short, it took many hours over several days on both the doctor’s office end, my insurance rep’s office to figure out that it was covered. I literally had 2 phone calls in 1 hour from the doctor’s insurance people - one person said it was covered, the other said no. Same thing happened on the insurance office end. Somehow they figured out it was covered. Something about having 2 tax IDs. But it was not fun.
Hubby turns 65 next year.
I’m still in my 50s and working FT.
I emailed my work health care rep and inquired; she said he can remain on my policy until I retire.
Now I’m worried. Is this a good thing? Is there any reason he should go onto Medicare or MA?
My husband is younger. Until he stopped working, he did take Medicare Part A which is no charge to anyone. He added the rest when he fully retired.
When I turned 65, it was cheaper for me to go fully on Medicare than to pay for coverage through my husband’s employer. You might want to check that.
It depends on how the cost and coverage of the employer plan compare to the Medicare options.
It depends on how the cost and coverage of the employer plan compare to the Medicare options.
Well, at my job it’s a flat rate for a family plan; kids are still on it, so the rate wouldn’t decrease if hubs went fully over to Medicare.
But the .gov site says he can sign up for Medicare Part A for no premium (because he’s already getting SS and he paid Medicare taxes. Then it says “Your job-based insurance pays first, and Medicare pays second.”
So… maybe Medicare would cover his deductible? Seems worthwhile if yes.
My husband signed up for Medicare part A while he was still getting and using employee funded health insurance. I don’t recall that Medicare paid his deductibles…or copays.
Plus…Medicare part A has its own deductible…doesn’t it?
This is what Part A covers:
- Inpatient care in a hospital.
- Skilled nursing facility care.
- Nursing home care (inpatient care in a skilled nursing facility that’s not custodial or long-term care)
- Hospice care.
- Home health care.
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He should sign up for Medicare part A to avoid a penalty later. It will not cost anything. Then he can stay on your insurance since you will still be on a family plan for the children. Or he could sign up for part B and get a supplement or get a Medicare Advantage program. But I would only do that if your work policy has a super high deductible and he anticipates needing expensive care.
It should not be this complicated, but it is.
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Because health care in the US is regulated by states. There is no national health insurance. Even medicaid is state run and the feds reimburse the states.
In England, do you get to say “Hey, I’m not getting this surgery at the local hospital, I’m checking myself into Top hospital in London and only Dr. X is doing the surgery?” Do people in Italy get to say “I’m going to France for my surgery” which may be closer in mileage than travel from California to Lehigh PA.
Parents of college students learn the difference between emergency care OOS and continuing care all the time. My friend’s son broke his leg or knee or something. The initial care was covered as an emergency, but the continuing care and rehab was all out of network if done in NY. Blue Cross Colorado is not Blue Cross NY, and they aren’t in the same network.
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Be careful with Medicare if your employer has a high deductible plan and your are contributing to a HSA. (HSA contributions are a no-no if you enroll in Medicare.)
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There is no penalty for Part A for those who qualify for free Part A (majority of us who worked and paid into the system for 10 plus years).
https://www.medicare.gov/basics/costs/medicare-costs/avoid-penalties
There is a penalty for Part B, unless the work plan does not qualify him for penalty waiver (not a “creditable plan”).
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Be careful with Medicare if your employer has a high deductible plan and your are contributing to a HSA. (HSA contributions are a no-no if you enroll in Medicare.)
Right. We don’t have an HSA. Small deductible.
There is a penalty for Part B, unless the work plan does not qualify him for penalty waiver (not a “creditable plan”).
No penalty if he signs up/qualifies for a special enrollment period, is how I read it. (That period being: when my insurance ends upon my own retirement.)
To wit: " * Your 8-month Special Enrollment Period to sign up for Part B starts when you stop working, even if you choose COBRA or other coverage that’s not Medicare.
- If you lose your job-based health coverage before you or your spouse stop working, you have 8 months to sign up."
This is worse than doing your own taxes. Literally, a whole new universe of Special Words and charges/costs/penalties.
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No kidding!! My husband refused to sign up for part A because he is still working and is covered by his employer’s policy. I asked him - but why? He says he does not want to deal with this red tape more than once!
My husband did the same, didn’t sign up until he retired at 68. Liked his work coverage and was afraid something would go wrong if Medicare was added. 
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When H continued to work, I got him to sign up for Medicare A at no cost. His insurance remained primary for all of us. His insurer was confused and would always try to get Medicare B to cover H as primary but we kept reminding them he only had A. He never needed A. Once he finally retired at 70, he got Medicare B in the 7th month after he retired. We had to go to SS twice to have them process the Medicare B application.
We put off getting B as long as possible as we were in no rush to pay another premium.
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One of the main reasons we have mom’s 24/7 caregivers is to help her avoid falling en route to the bathroom, which she goes to very often. They also provide sone company, help her exercise and remember to eat regularly. Caregiving is definitely exhausting.
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I fully understand how the system works. My question is, why did we build it that way? The answer is that with more opacity, there are more reasons for companies not to pay. There’s no legitimate reason other than preservation of corporate profit to parse the system as we do. It’s anti-patient, and we accept it as though it’s normal. It’s not.
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My understanding is that the health insurance business grew after wWII as a benefit employers gave to employees. Unions were growing and this was another benefit. Employers got a tax break so it didn’t really cost them anything.
Other countries went for the government taxing the people and setting up health benefits.
My cousin was a doctor in a little town. Almost everyone just paid her in cash. Many of her patients were Amish or Mennonites. Of course the cash they were paying her was $5. I have no idea what large groups of uninsured people do today as I doubt there are docs like my cousin with an office off her kitchen and willing to see patients for $5.
Many things evolve over time and laws adapt. You still can’t buy insurance across state lines even though it’s been sought after for many years. It would increase price competition. Why doesn’t it pass? Insurance company lobbying to preserve perverse corporate profits. You could design a more Rube Goldberg system if you tried. It’s illogical, done for a single reason…profit, at the expense of the health of the citizenry. It’s mind blowing that we not only tolerate it, we justify why it’s good. It’s not. Look at per capita expenditures graphed against life expectancy. It’s embarrassing. Any sane country would implement Medicare for all and let privates continue to sell supplements. Medicare runs far more efficiently than any private insurance. We don’t do it though because we’re too entrenched in tribal warfare.
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