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I spoke to a friend of mine last night about insurance. She is seventy years old, and still works full time. She has a small pension, SS benefits that are about one thousand a month, and falls just inside the poverty line that she can get extra help with Medicare Part D, so she is not on the hook to pay the monthly premium of about 40 dollars. She takes a minor amount of medications and pays little for the RX.

It took me a lot of legwork for her to get the Part D help, but she makes a bit too much to get the Part B, for the MD visits paid for. I believe that Part B costs her about 100 dollars a month out of her SS check.
She just had a terrible fall right before Christmas, and fell down an entire flight of steps at her home. I ask her if she is getting paid, for she has benefits at work. She told me last night that she has to use her vacation time up first. OK.

Then there seems to be some sort of confusion with this employer sponsored insurance. She tells me that she was on the phone " all day" with the Medicare folks, and the insurance people. Uh oh. Somehow I see me getting involved here again. I was somewhat non committed, for I don't know how involved she got in this. I know that a few years ago, she had run up some very high bills thinking that that because some company gave her a free meter for diabetes, they would also give her free medicine. That took many phone calls to get right,and I finally told the company they were wasting their time trying to recoup the money, for this woman has nothing to live on month to month.
I am not an expert on Medicare, but have a sense of how it works. For folks of limited means, Part A is free, Part B you have to be really poor to get paid for, and Part D for RX's she is getting aid for, thanks to my doggged fighting for her.

Last night, we are having this conversation, and she tells me that she is paying 222 dollars a month!!! for insurance. She works 32 hours a week and I highly doubt if she makes 13 dollars an hour.
Vision benefits are 14 dollars twice a month. She does have dental benefits, that she pays for, and got her upper plate fixed up for a small charge.
My questions are...

1. Why would you pay 100 dollars to Medicare Part B and pay money to a private insurer through work as well? This woman does not spend any kind of time at a hospital.

2. If you are paying for Medicare Part B, do you have the option to quit? Will your employer's insurance try to make that difficult for you?

3. She still has copays when she goes to the MD. Why s she paying all this money out for, when she has such limited means? Does this sound high to anyone else, or is it just me?

Everything in me says this woman is being ripped off. She has no clue here, and has had APPRISE folks try to advise her, and that went badly. I see some afternoons over there trying to figure this out.
Sigh.. Ideas welcomed.

wild :)
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1. Why would you pay 100 dollars to Medicare Part B and pay money to a private insurer through work as well? This woman does not spend any kind of time at a hospital.

Because even if you have Medicare A, B & D, it doesn't cover 100% - that's why there are "gap" policies and why retirees who are eligble to stay on a former employer's health insurance by paying out-of-pocket for the premium often do. My mom was a Fed Govt worker, so she's been able to stay on their insurance even though she's now also on Medicare.

I don't know the answers to points 2 & 3
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I just stopped over there and spoke to her. She feels comfortable putting all this $$ out and tells me that Medicare is her primary provider. Since she has suffered a recent injury, no one knows when she will be cleared to go back to work.
However, her health insurance company is now looking for money since the short term disability folks are unrelated to the health care folks.

What a mess.

wild :)
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1. Why would you pay 100 dollars to Medicare Part B and pay money to a private insurer through work as well?

My mom, who is now 84, lives on her SS benefits of $888/mth plus about $20/mth in oil and gas royalties, is on Medicare and also pays $150/mth for gap insurance. Medicare doesn't pay for everything.

This woman does not spend any kind of time at a hospital.

My mom didn't either, until she had a car wreck that required surgery on her shoulder, another surgery on her hand, and then had a fall at home that resulted in a broken arm.

Thank God she had the extra insurance, or she wouldn't have been able to afford 3 hospital visits in 4 years.

Insurance is to cover the costs of the unexpected. As we get older, those unexpected things can mount up quickly.

As Mom has pointed out to me in the past "Getting old isn't for wimps"

LWW
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However, her health insurance company is now looking for money since the short term disability folks are unrelated to the health care folks.

What a mess.

wild :)


It is not unusual for short term disability to be unrelated to the health care company.

It isn't unusual for short term disability to have a waiting period, and vacation time can be used during that time. I would check if she has to use all of her vacation time first or only that there is a waiting period.
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