Tao Economics Forum

Full Version: i need Medicare Advice!
You're currently viewing a stripped down version of our content. View the full version with proper formatting.
Pages: 1 2
OMG! For the AVERAGE person, Medicare is easy enough choices.
but (as is the story of my life) I'm in a super unique position and answers seem nearly impossible to find and seem mainly DISHONEST.
It seems there are infinite people/companies who claim to know Medicare - but NONE that specialize in professional advice for us in a unique situation.


BACKGROUND.
I'll be turning 65 in a few months.

SYSTEM (as I understand it)
when I turn 65 CMS (center medicare services)  automatically signs me up for Medicare A&B  
A is Free and is mandatory, (Hospital)
B costs and is optional so I can drop the automatic sign up, (Doctor etc)
neither is as good as most group health insurance plans. for one thing, they both have big copays and deductibles. You can buy "suplement insurance" but ONLY if you have B.



COMPLICATIONS:
1. Rules are different if you are "still employed" and "have employer insurance".
2. Because I own my own business I can be either or neither of the above at MY CHOICE.
3. MY business size is such that it may or may NOT qualify as a "qualified employer".
         3.a. CMS says I am, my insurance company says I am NOT.
4. My health insurance company is bullying/threatening me to kick me off
5. it is ILLEGAL for my employer (AGE Discrimination) to kick me off when I'm still working! (BUT law does not clearly address whether my insurance company can simply drop covering my business if I refuse to drop out of our plan. 



CHOICES
IF I refuse B, I save monthly premiums AND have much better coverage AND my Wife and child are still on my insurance!
IF I take/keep B, the opposite of above happens AND I should buy supplement insurance AND must find my family another (and very expensive) Plan!
ALSO if I don't take B and later it is determined that I SHOULD HAVE, I will be penalized by higher premiums for B for the rest of my LIFE.


NOW THE MAIN PROBLEM
Well, my current insurance (BCN) says I MUST take B because BCN calls me a "small employer" and they say they don't care what CMS says. They say they just won't pay my claims if I don't take B.
CMS says I do not have to take B (but will penalize me severly if I choose wrong), because CMS considers me a "large employer".  and of course, they say they don't care what BCN says = "the law is the law".


AS I know, definitions are always KEY. The law defines large vs small, HERE, as "ten or more employees", CMS says that's ANY employee, BCN says only employees on the Health insurance plan count. I'm sure CMS is correct, that won't keep BCN from dropping my coverage and not paying claims. (even though it's illegal for my employer to drop my BCN coverage, BCN may do it in place of my employer dropping me)

You would think I could hire a LAWYER to straighten this out?
NOT A SINGLE LAWYER I can find has ANY experience or knowledge of how all this works.



I'm confused and worried.
(08-30-2019, 12:32 PM)DaveGillie Wrote: [ -> ]You would think I could hire a LAWYER to straighten this out?
NOT A SINGLE LAWYER I can find has ANY experience or knowledge of how all this works.



I'm confused and worried.

How about an insurance agent ?  Maybe one of the independent ones who work with multiple insurance companies, there should be a few in a city the size of Flint.
(08-30-2019, 12:37 PM)aqua Wrote: [ -> ][quote pid='20924' dateline='1567168322']
DaveGillie

You would think I could hire a LAWYER to straighten this out?
NOT A SINGLE LAWYER I can find has ANY experience or knowledge of how all this works.



I'm confused and worried.

How about an insurance agent ?  Maybe one of the independent ones who work with multiple insurance companies, there should be a few in a city the size of Flint.
[/quote]


thanks, I have gotten my best advice from agents,
(mainly, to not trust them)

but they only know sales and policies, NOT LAW.


NONE seem to have any idea what to do if insurance company violates the law, or even what the law says they must do or can't do.
(08-30-2019, 03:37 PM)DaveGillie Wrote: [ -> ]NONE seem to have any idea what to do if insurance company violates the law, or even what the law says they must do or can't do.

Does CMS have a lawyer you can talk to ? ?

Sometimes a letter from a lawyer will give an insurance company  another reason to look at your situation.
(09-02-2019, 04:54 PM)aqua Wrote: [ -> ]
(08-30-2019, 03:37 PM)DaveGillie Wrote: [ -> ]NONE seem to have any idea what to do if insurance company violates the law, or even what the law says they must do or can't do.

Does CMS have a lawyer you can talk to ? ?

Sometimes a letter from a lawyer will give an insurance company  another reason to look at your situation.

great suggestions again aqua,

CMS won't let us talk to one of them,
HOWEVER they do have a complain form which I want to fill out claiming my insurance company is illegally threatening me.

My wife thinks I should not, as we don't have clear objective evidence.
However, I think it will put CMS and my insurance company on notice AND give me guidance for future issues.
may be even give me a hint of where to get better info.........
(09-03-2019, 03:20 PM)DaveGillie Wrote: [ -> ]
(09-02-2019, 04:54 PM)aqua Wrote: [ -> ]
(08-30-2019, 03:37 PM)DaveGillie Wrote: [ -> ]NONE seem to have any idea what to do if insurance company violates the law, or even what the law says they must do or can't do.

Does CMS have a lawyer you can talk to ? ?

Sometimes a letter from a lawyer will give an insurance company  another reason to look at your situation.

great suggestions again aqua,

CMS won't let us talk to one of them,
HOWEVER they do have a complain form which I want to fill out claiming my insurance company is illegally threatening me.

My wife thinks I should not, as we don't have clear objective evidence.
However, I think it will put CMS and my insurance company on notice AND give me guidance for future issues.
may be even give me a hint of where to get better info.........

Good luck !

I really am out of my element on the minutia of insurance.

Even the poster here who advertises himself as "an expert on everything" seems stumped.

I thought this comment on the health insurance mess to be both funny and descriptive:

"Let’s be honest. Our system of private insurances does not facilitate the delivery of healthcare in any way. Insurance is an inefficient, expensive and complicated billing scheme designed to enrich some people by denying reimbursements to ill and vulnerable people and then entangling their victims in endless morbid bickering at their weakest moments. This is no way to do business.


Think of the hospital as a grocery store. Ten customers are in line at the checkout, each of them hoping to leave with identical packages of frozen peas. Each client is charged a different amount for the same bag of peas, each will pay a different amount at the register, each insurance company will reimburse different amounts (or nothing) to the store, some clients will be reimbursed  by the insurance company or the store in the future, and most customers will end up paying yet another amount when the dust has settled.

Some insurances will only cover a different brand (or size) of pea, and may or may not partially cover the cost of the peas being sold in that particular store. Some customers will have to prove that they really need the peas, especially if their insurance only approves of carrots. Some people that need peas won’t get them and some people that don’t want peas will get them. No wonder healthcare systems feel the pressure to outsource the accounting jobs to sweatshops overseas. The billing system has been so screwed up by the privatizing Republicans that we “can’t afford” to do it in America!"

https://www.dailykos.com/stories/2019/8/...=spotlight
I have an insurance quandry too. Until this year I always had insurance with my wife's policy, but she's 65 and retired so is on medicare. I'm 62 so don't qualify for medicare.
I won't go into details, but will say the best advice I have gotten is thru Amac whose reps helped my wife with her insurance, and gave me an understanding of my options ( none of them good). They gave honest advice in both instances.. AMAC is the conservative alternative to AARP.

Dave, your case does seem rather fubar and complicated, but maybe one of their reps can help you. You have to join AMAC first, but it only costs 16 bucks.

Details: I really only need catastrophic health insurance, but that's not available in Maryland because liberal MD still wants to push everyone into Obamacare. There is short term insurance but it is for only 3 months. If you end up in an ICU at the end of three months, you are basically screwed because then you have a " pre existing condition" and they won't cover you. Other States have 3 year policies, but not Maryland. My AMAC rep told me this. So it's Obamacare or nothing for me until I'm 65. So far I have chosen no insurance. That may change when the Obamacare enrollment period starts in November, but probably not. Depends on the cost.
In response to Aqua, If insurance companies were allowed to provide real insurance without interference from the state it would go a long way in solving many peoples health care issues. THAT means letting insurance companies make their own terms and EXCLUDING people they don't want to cover.  On the other hand, the customer can decide what he wants covered and what he is willing to pay for. The customer can look for the best deal for what they WANT.  If it's not available in a free market then that means it is not economically viable.  This used to be common sense until the likes of aqua got into power.  Having POLITICIANS with their something for nothing appeal to masses mentality determine my and everyone elses healthcare is crazy.  Mandating health insurance for those with pre- existing conditions is like mandating home insurance for someone whose house has already burnt down. 

What about those with pre- existing conditions?  Do what you will, but it is not a health INSURANCE issue regardless of what the idiot politicians augmented with the likes of aqua say.  It is because of them I can't get the insurance I want and because of them we live in a healthcare insurance system that's insane. In other words, Obamacare.
(09-10-2019, 04:33 PM)doubletroublejim Wrote: [ -> ]In response to Aqua, If insurance companies were allowed to provide real insurance without interference from the state it would go a long way in solving many peoples health care issues. THAT means letting insurance companies make their own terms and EXCLUDING people they don't want to cover.

We all know how that works.

[Image: universal-health-care-cartoon.png?w=480]

x

[Image: cartoon-insurance-companies.jpg?w=1400]
Yes, and insurance I WANT! No one, including insurance companies, and certainly individuals, should be FORCED to pay for something they don't want. How difficult is that to understand?
Pages: 1 2