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View Poll Results: Does your Public Retirement System pay for Retirees' Health Insurance?
Retirees have fully paid health insurance in addition to pension 3 10.00%
Retirees have partly paid health insurance in addition to pension 21 70.00%
Retirees pay for health insurance, but at lower rates than an individual policy 4 13.33%
Retirees receive neither paid health coverage nor preferred rates 2 6.67%
Other 0 0%
Voters: 30. You may not vote on this poll

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Old 10-24-2010, 11:43 AM   #21
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DH is given a health care allowance amount based on years of service. His 26 YOS earns him 86.67% (and 59.92% for me) of the cost of the best policy offered. From there we can choose between 3 levels of medical insurance. By choosing the lowest option with higher deductibles he gets a credit to his Retiree Medical Account of the amount not used. This credit is reduced by the low option dental coverage that we added on. This year his RMA credit is $72/mo. For 2011 the costs are going up and his RMA credit will be reduced to $45/mo.

New for 2011 is the option to also cover our 23 year old son under the new laws. That will be $40/mo, reducing the RMA credit to $5/mo but our son will reimburse us for the cost. It's a good opportunity for him to get high deductible insurance at a good price, he's been off of our policy since he graduated from college in 2009 and he's been without health insurance.
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Married, both 62. DH retired June, 2010. I have a pleasant little part time job.
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Old 10-24-2010, 09:02 PM   #22
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Quote:
Originally Posted by ziggy29 View Post
One other thought, though -- just because someone selected " Retirees receive neither paid health coverage nor preferred rates " - it doesn't mean they *necessarily* get nothing. They may also have the option to stay in the group plan if they pay the premiums -- something only rarely offered to private sector retirees. For someone with significant health problems or preexisting conditions that can be extremely valuable even if the group coverage isn't subsidized.
isnt that option 3?
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Old 10-24-2010, 10:05 PM   #23
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Medicare is my primary insurer. I'm not sure what "basis for your benefits" means. The doctor/hospital/pharmacy get whatever they can from Medicare, then get whatever else they can from HMSA (my supplemental insurer), then whatever of the bill is left over, I pay. Usually, I pay nothing. Well, I just retired August 1, so I don't have a lot of experience with this system personally, but I did have charge of my mother's affairs for several years, and she had a very similar deal with the Ohio PERS. Except for an occasional glitch, it was always just a matter of handing 2 or 3 insurance cards over, then letting the health provider figure out where to get the money from. A $100,000 hospital bill for recovering from pneumonia? No problem.
Why would you have to pay if medicare is primary and you have s suitable supplement?

"Balance billing" means charging or collecting from a Medicare beneficiary an amount in excess of the Medicare reimbursement rate for Medicare-covered services or supplies provided to a Medicare beneficiary, except when Medicare is the secondary insurer. When Medicare is the secondary insurer, the health care practitioner may pursue full reimbursement under the terms and conditions of the primary insurer, but the Medicare beneficiary cannot be balance billed above the Medicare reimbursement rate for a Medicare-covered service or supply. "Balance billing" does not include charging or collecting deductibles or co-insurance required by the program.

Medicare Balance Billing Main Page
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Old 10-24-2010, 10:07 PM   #24
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One other thought, though -- just because someone selected " Retirees receive neither paid health coverage nor preferred rates " - it doesn't mean they *necessarily* get nothing. They may also have the option to stay in the group plan if they pay the premiums -- something only rarely offered to private sector retirees. For someone with significant health problems or preexisting conditions that can be extremely valuable even if the group coverage isn't subsidized.

I would call this preferred rates but otherwise agree.
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Old 10-24-2010, 10:31 PM   #25
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Why would you have to pay if medicare is primary and you have s suitable supplement?
I doubt that I understand the question. Insurance won't pay all possible medical bills -- right? If a bill isn't fully covered by Medicare plus supplementary insurance, I have to pay it. If I have to pay, I suppose you might say my supplement was not totally suitable -- is that what you're getting at?
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Old 10-24-2010, 10:38 PM   #26
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I doubt that I understand the question. Insurance won't pay all possible medical bills -- right? If a bill isn't fully covered by Medicare plus supplementary insurance, I have to pay it. If I have to pay, I suppose you might say my supplement was not totally suitable -- is that what you're getting at?
the law is very clear
Balance billing of medicare patients by participating physicians is unlawful
Ill put it in again

"Balance billing" means charging or collecting from a Medicare beneficiary an amount in excess of the Medicare reimbursement rate for Medicare-covered services or supplies provided to a Medicare beneficiary, except when Medicare is the secondary insurer. When Medicare is the secondary insurer, the health care practitioner may pursue full reimbursement under the terms and conditions of the primary insurer, but the Medicare beneficiary cannot be balance billed above the Medicare reimbursement rate for a Medicare-covered service or supply. "Balance billing" does not include charging or collecting deductibles or co-insurance required by the program.

Medicare Balance Billing Main Page

So Participating physicians can only collect the deductible or coinsurance required by the program, which is normally paid by the supplement.
Medicare isn't like private insurance. Its a statutory program enforced by the criminal law. If they take money form medicare and balance bill you it may be a crime
42 U.S.C. 1320s-7b(e), Illegal Medicare Balance Billing,

Nonparticipating physicians are not covered by this section but have other limits
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Old 10-24-2010, 10:39 PM   #27
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Quote:
Originally Posted by ziggy29 View Post
One other thought, though -- just because someone selected " Retirees receive neither paid health coverage nor preferred rates " - it doesn't mean they *necessarily* get nothing. They may also have the option to stay in the group plan if they pay the premiums -- something only rarely offered to private sector retirees. For someone with significant health problems or preexisting conditions that can be extremely valuable even if the group coverage isn't subsidized.
isnt that option 3?
Yes, that's option 3.
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Old 10-24-2010, 11:40 PM   #28
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"Balance billing" means charging or collecting from a Medicare beneficiary an amount in excess of the Medicare reimbursement rate for Medicare-covered services ...
So my supplemental insurance or I would only be responsible for paying for a service not covered by Medicare. Is that that what you're saying? Okay. So? I said, previously, that what bills are not covered by Medicare or my supplemental insurance, I must pay. Was that inaccurate? Perhaps you thought I was implying that a bill for a specific service would be partially paid through Medicare and partially by me. But I didn't say or imply that.
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Old 10-25-2010, 04:48 AM   #29
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So my supplemental insurance or I would only be responsible for paying for a service not covered by Medicare. Is that that what you're saying? Okay. So? I said, previously, that what bills are not covered by Medicare or my supplemental insurance, I must pay. Was that inaccurate? Perhaps you thought I was implying that a bill for a specific service would be partially paid through Medicare and partially by me. But I didn't say or imply that.
What you wrote was "Medicare is my primary insurer. ...... The doctor/hospital/pharmacy get whatever they can from Medicare, then get whatever else they can from HMSA (my supplemental insurer), then whatever of the bill is left over, I pay." You also wrote
"If a bill isn't fully covered by Medicare plus supplementary insurance, I have to pay it."

YMMV but that certainly sounds like "a bill for a specific service would be partially paid through Medicare and partially by me"
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Old 10-25-2010, 11:58 AM   #30
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You also wrote
"If a bill isn't fully covered by Medicare plus supplementary insurance, I have to pay it."

YMMV but that certainly sounds like "a bill for a specific service would be partially paid through Medicare and partially by me"
The bills I get are usually for a whole list of services.
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Old 10-25-2010, 12:05 PM   #31
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The bills I get are usually for a whole list of services.
Each service has to be billed either to medicare or not. The provider is either a medicare provider or not. If they are and the procedure is a medicare procedure they have no choice
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