I have heard that there is a loophole in Medicare Part B and Medigap where your prescription medications are not paid for by either one if the hospital provides the medications.
Yes I think you did! We just got smacked with this one. My husband has group insurance through his employer, and he did not sign up for Medicare at 65. He had a high deductible insurance plan, and contributed to his Health Savings Account each week. I thought I was being wise in putting a large lump sum last December to max out our contributions. My husband is leaving his job (and group insurance) this spring, which will allow him to go ahead and apply for Medicare. What we did not know, is Medicare backdates from the time you apply, up to 6 months, whether you want them to or not. So, it will render any contributions to an HSA ineligible. We've already had to take out the lump sum, and will have to take out some weekly contributions as well. Nobody told us that Medicare would backdate, and you need to prepare by stopping any contributions to an HSA 6 months prior to applying for Medicare, if you've delayed applying past 65. I've read that congress has attempted to correct this (at least make it optional!), but so far has not been able to do anything about it. I don't know yet what penalties we'll fax, taxes for sure, but possibly some penalties for over contributing. Thanks for your videos, I've learned a lot!
@@janethouse1779 Hi Janet! Thank you for sharing this. Yes - very dumb rule that nobody knows about. I even asked my accountant what happens if people still contribute - he didn't know! But the rule is - you have to stop HSA contributions 6 months before Medicare starts. Good luck everyone!
Non of these rules are dumb. These aren't even rules, these are LAWS period. No social comments from Medicare. I am in the middle of a Medicare/Medicaid Nightmare. The rules are exactly the same - the only significant difference is if something goes wrong and someone doesn't get paid, they can't sue me because I am legally indigent and you can't take SSA or SSI and that's sadly what sustains me. IN ADDITION to this I won an APPEAL for the Dexcom G6 - the Judge - Judge Grow wrote his order demanding the company SELECT HEALTH OF SOUTH CAROLINA [ own in full by Blue Cross Blue Shield - checked with SOS ] under the plan called First Choice et al. Well Well they never complied and when I said something - Medicare says 'Hire a lawyer.' There is no enforcement arm to compel Medicare insurance companies - like this or any to make the payments. People are getting robbed - millions - hundreds of millions and no one even knows about it. Insurance Companies run Medicare and that is just a fact of life - no wonder it's broke. It's not old people - it's the insurance companies like BCBS who in my opinion would just as soon see you dead. Years of this tell me this is true. Prove me wrong.
Late to the party here, but I would have to say my #1 "Dumb Medicare Rule" is not allowing the use of any prescription drug coupons if you have Part D coverage! Just one of the diabetes medications I was on prior to Medicare is over $300/month, and there is no doubt it works vastly better than Metformin. But no way am I going to pay the drug company sharks that kind of $$ for a medication that probably costs them considerably less than $1 a pill to make. If they would stop running TV commercials for this and other drugs several times every hour, their precious drugs might be more affordable. There oughta be a law...
I learned about "observation" the hard way when my elderly mother suddenly was unable to walk or stand one day due to severe back pain. She was hospitalized for four nights and given test after test to try and determine what was wrong. The diagnosis, based on an x-ray, turned out to be a small fracture of the sacrum, for which the treatment was rest and rehab in a skilled nursing facility (nursing home). I was told about halfway through her hospital stay that she was not considered an inpatient but was admitted "under observation." I protested strongly and her admitting physician agreed that she should be classified as an inpatient. He changed her to that status but the hospital changed her back to "observation." My mother had to pay more than $8,000 of her own funds to the skilled nursing facility for her rehab, and it could have been a lot more if she had not made good progress in several weeks. I went through four of the five levels of the Medicare appeal process to no avail. The first two levels are pretty much rigged in favor of Medicare so losing the appeal at that level was no surprise. Then I got to appear before an administrative law judge on my mother's behalf. His decision was so convoluted and illogical that both Medicare and I appealed it! That brought me to the fourth level of appeal, which was the Medicare Appeals Council. They also supported Medicare's position, and in their decision made the amazing claim that they did not have the power to change the hospital's classification! If they do not have that power, then who does? The fifth level of appeal is Federal District Court, but I did not go there because the fees for an attorney to take the case would have exceeded the amount at issue. There is a simple legislative solution, which is to require all nights in the hospital, whether as an inpatient or "under observation," to count toward the required three-day hospital stay requirement that Medicare imposes for coverage. I stopped following this issue closely several years ago so I don't know what happened to that legislation but I'm sure it didn't pass because Health & Human Services opposed it.
So if my company has more than 35 employees and I wait until age 67 to retire... I have to keep their insurance and use Medicare as my supplement then get penalized when I do retire???
You don't have to keep it. If it is not great and your employer doesn't pay for most of it them Medicare should be better. If you do stay on it don't start Part B - then no penalty later.
I’m an inpatient RN, and working alongside Care Managers/Social Workers, they are REQUIRED to notify a patient if they are hospitalized under Observation. And, you can argue with a physician that your hospitalization is an Inpatient.
It would save some confusion if this was properly identified as Medicare USA. Many other nations have National Health schemes that are also called Medicare and have been in place a lot longer but have different rules to this.
One of the dumbest rules is that if you become disabled you have to wait two years when if you had the proper insurance you had a chance to go back to work and be off the system
@@MedicareonVideo the problem in my case as a stroke survivor any neurologist will tell you you get your most recovery I’m the first year. And the plans on the exchange don’t cover much
@@newbirth35 I’m sorry it took that it took that long it’s sad the ropes we have to jump it’s not like we are faking mri and ct scan results showing the brain damage in my case
The coverage rules during IEP are stupid. They give you 7 months to sign up around the time you turn 65, however if you sign up 1 month after you turn 65 coverage begins 2 months later, and if you sign up 2 or 3 months after turning 65 coverage is delayed for 3 months. So if you quite a job soon after you turn 65 you can have gaps in health insurance coverage. And you can't qualify for SEP during IEP so the 8 month allowance doesn't apply.
My neighbor who is disabled due to an injury at work applied for Medicare after having GHI for many years. He applied and because is disabled applied for the wrong one. He chose the prescription plan when he was supposed to pick the Medical plan! He now has GHI secondary with no Medicare primary. He is depressed and does not know what he’s going to do. He will have to pay out of pocket for his visits then see how the secondary plan pays. He is so sad. I don’t know how to help him.
Yeah, the nursing care thing is dumb. Also, when they switch your status back and forth without moving you. My wife was in the same hospital, same bed, same nurse and doctor, but she was first "acute" care and then "swing bed", which is considered nursing home, then they would switch her back to acute care for a day to do a procedure, then back to swing bed!! Crazy. She never went anywhere! This happened over and over during her stay.
I have no idea be honest with you but my brother found a plan that Kroger is offers which case your prescriptions especially your co-pay cost most of my meds I take right now I can get for six dollars for a 90 day supply or some of them are free
@@MedicareonVideo Hospitals will provide maintenance meds but will charge you vs. any medication new and pertaining to your stay. Always been my understanding,
Where do you normally get the maintenance drugs? If part d pays for them wouldn't they still pay for them? Just have a relative pick them up at the pharmacy as usual and bring them to you, but remember to have the nurse clear them with your doctor and the hospital pharmacy.
If they were under observation during hospital stay&then discharged2skilled facility the patient can request home therapy instead.Most plans will be covered by medicare for home therapy,and can even order home care services.
Observation vs inpatient also comes in premedicare. On employee coverage, I went to an emergency room, was transferred to another hospital emergency room and placed in the hospital for three nights. I shared a room with an older person, and the doctor explained to his wife "Yes, this looks like an inpatient hospital room, but...." and he explained that rehab wouldn't be covered because he wasn't an inpatient (didn't know why till your explanation!). For me, the impact was milder, since I had visited an ER and had NOT been "officially" admitted, I had to pay 2 ER fees (a total of about $500)
Question, I retired at age 58 from my company with company insurance that I paid a portion of. About 3.5 years into retirement the company cancelled my retirement insurance that I had. I started going to the VA since I was service connected. I will turn 65 in 2023 and go on Reg Medicare or an advantage plan. So will the VA medical benefits be considered adequate coverage for starting Medicare without the penalties? Thanks.
The entire number of employees federal laws/rules needs thrown out and reaches far beyond Medicare. Employers can't openly discriminate (the few protected traits) IF they employ a specified number of people. If they do not have that many employees they can violate you all they want. Discrimination also needs some adjusting as it is done frequently but denied. You would have to conduct a sting operation to just achieve reasonable suspension unless you could obtain the company President admitting such and it on company letterhead... and notarized. 🐸
I work in a Chiropractic office. Only spinal manipulation is covered. Not the exam (which they require), no treatment for hips or knees or shoulders, or other therapies that can reduce pain and speed recovery. That is all out of pocket for the patient.
My Mother was admitted for septic UTI and a mild heart attack and they wanted me to sign a CMS form stating I understood she was being admitted for observation - I read everything. I refused telling them her admission diagnoses should be the heart attack not the UTI. Demand they code the admitting diagnosis as the most serious, because one may be an observation diagnosis the other may not. My Mother was discharged to a SNF after 7 days in the hospital. I only know this because an employee's Mother is a SNF administrator, and I'd been asking many questions.
Hi Cathy! Yes. be very careful. Watch this video I just did and it will help. czcams.com/video/hrkbOjBtBsw/video.html Give us a call and we can walk you through everything. 877-885-3484
I'm in this boat. I've chosen to be with a PPO (under Humana) with prescription drug coverage. Granted I qualify for "extra help" from my state and Medicare for my meds and my Medicare B premium.
IRMA tax against Part B when you make too much money in a given year. I can understand paying against the tax year where you withdrew the large amount of money. But Social Security/Medicare charges the IRMA penalty for TWO YEARS!!!
What do you think is the dumbest Medicare rule? Did I miss any?
I have heard that there is a loophole in Medicare Part B and Medigap where your prescription medications are not paid for by either one if the hospital provides the medications.
Yes I think you did! We just got smacked with this one. My husband has group insurance through his employer, and he did not sign up for Medicare at 65. He had a high deductible insurance plan, and contributed to his Health Savings Account each week. I thought I was being wise in putting a large lump sum last December to max out our contributions. My husband is leaving his job (and group insurance) this spring, which will allow him to go ahead and apply for Medicare. What we did not know, is Medicare backdates from the time you apply, up to 6 months, whether you want them to or not. So, it will render any contributions to an HSA ineligible. We've already had to take out the lump sum, and will have to take out some weekly contributions as well. Nobody told us that Medicare would backdate, and you need to prepare by stopping any contributions to an HSA 6 months prior to applying for Medicare, if you've delayed applying past 65.
I've read that congress has attempted to correct this (at least make it optional!), but so far has not been able to do anything about it. I don't know yet what penalties we'll fax, taxes for sure, but possibly some penalties for over contributing.
Thanks for your videos, I've learned a lot!
@@janethouse1779 Hi Janet! Thank you for sharing this. Yes - very dumb rule that nobody knows about. I even asked my accountant what happens if people still contribute - he didn't know! But the rule is - you have to stop HSA contributions 6 months before Medicare starts. Good luck everyone!
Non of these rules are dumb. These aren't even rules, these are LAWS period. No social comments from Medicare. I am in the middle of a Medicare/Medicaid Nightmare. The rules are exactly the same - the only significant difference is if something goes wrong and someone doesn't get paid, they can't sue me because I am legally indigent and you can't take SSA or SSI and that's sadly what sustains me. IN ADDITION to this I won an APPEAL for the Dexcom G6 - the Judge - Judge Grow wrote his order demanding the company SELECT HEALTH OF SOUTH CAROLINA [ own in full by Blue Cross Blue Shield - checked with SOS ] under the plan called First Choice et al. Well Well they never complied and when I said something - Medicare says 'Hire a lawyer.' There is no enforcement arm to compel Medicare insurance companies - like this or any to make the payments. People are getting robbed - millions - hundreds of millions and no one even knows about it. Insurance Companies run Medicare and that is just a fact of life - no wonder it's broke. It's not old people - it's the insurance companies like BCBS who in my opinion would just as soon see you dead. Years of this tell me this is true. Prove me wrong.
Late to the party here, but I would have to say my #1 "Dumb Medicare Rule" is not allowing the use of any prescription drug coupons if you have Part D coverage! Just one of the diabetes medications I was on prior to Medicare is over $300/month, and there is no doubt it works vastly better than Metformin. But no way am I going to pay the drug company sharks that kind of $$ for a medication that probably costs them considerably less than $1 a pill to make. If they would stop running TV commercials for this and other drugs several times every hour, their precious drugs might be more affordable. There oughta be a law...
Great video as always, thank you. (27 year Medicare agent here.)
Thanks Bob!
I learned about "observation" the hard way when my elderly mother suddenly was unable to walk or stand one day due to severe back pain. She was hospitalized for four nights and given test after test to try and determine what was wrong. The diagnosis, based on an x-ray, turned out to be a small fracture of the sacrum, for which the treatment was rest and rehab in a skilled nursing facility (nursing home). I was told about halfway through her hospital stay that she was not considered an inpatient but was admitted "under observation." I protested strongly and her admitting physician agreed that she should be classified as an inpatient. He changed her to that status but the hospital changed her back to "observation."
My mother had to pay more than $8,000 of her own funds to the skilled nursing facility for her rehab, and it could have been a lot more if she had not made good progress in several weeks. I went through four of the five levels of the Medicare appeal process to no avail. The first two levels are pretty much rigged in favor of Medicare so losing the appeal at that level was no surprise. Then I got to appear before an administrative law judge on my mother's behalf. His decision was so convoluted and illogical that both Medicare and I appealed it! That brought me to the fourth level of appeal, which was the Medicare Appeals Council. They also supported Medicare's position, and in their decision made the amazing claim that they did not have the power to change the hospital's classification! If they do not have that power, then who does? The fifth level of appeal is Federal District Court, but I did not go there because the fees for an attorney to take the case would have exceeded the amount at issue.
There is a simple legislative solution, which is to require all nights in the hospital, whether as an inpatient or "under observation," to count toward the required three-day hospital stay requirement that Medicare imposes for coverage. I stopped following this issue closely several years ago so I don't know what happened to that legislation but I'm sure it didn't pass because Health & Human Services opposed it.
So if my company has more than 35 employees and I wait until age 67 to retire... I have to keep their insurance and use Medicare as my supplement then get penalized when I do retire???
You don't have to keep it. If it is not great and your employer doesn't pay for most of it them Medicare should be better. If you do stay on it don't start Part B - then no penalty later.
@@MedicareonVideo thank you so much for the info!!! This is so confusing to me and I’m planning on retiring in 3 years.
I’m an inpatient RN, and working alongside Care Managers/Social Workers, they are REQUIRED to notify a patient if they are hospitalized under Observation. And, you can argue with a physician that your hospitalization is an Inpatient.
It would save some confusion if this was properly identified as Medicare USA. Many other nations have National Health schemes that are also called Medicare and have been in place a lot longer but have different rules to this.
I work for a huge company with thousand of employees scattered in three or four countries.
Thanks for your help about Medicare
One of the dumbest rules is that if you become disabled you have to wait two years when if you had the proper insurance you had a chance to go back to work and be off the system
That is also pretty dumb!
@@MedicareonVideo the problem in my case as a stroke survivor any neurologist will tell you you get your most recovery I’m the first year. And the plans on the exchange don’t cover much
@@scottwhite2583 Agreed 100%
It took my husband two years to get disability. Since it took that long, he automatically qualified for Medicare.
@@newbirth35 I’m sorry it took that it took that long it’s sad the ropes we have to jump it’s not like we are faking mri and ct scan results showing the brain damage in my case
The coverage rules during IEP are stupid. They give you 7 months to sign up around the time you turn 65, however if you sign up 1 month after you turn 65 coverage begins 2 months later, and if you sign up 2 or 3 months after turning 65 coverage is delayed for 3 months. So if you quite a job soon after you turn 65 you can have gaps in health insurance coverage. And you can't qualify for SEP during IEP so the 8 month allowance doesn't apply.
Thanks again
Thank YOU
My neighbor who is disabled due to an injury at work applied for Medicare after having GHI for many years. He applied and because is disabled applied for the wrong one. He chose the prescription plan when he was supposed to pick the Medical plan! He now has GHI secondary with no Medicare primary. He is depressed and does not know what he’s going to do. He will have to pay out of pocket for his visits then see how the secondary plan pays. He is so sad. I don’t know how to help him.
What if my employer has more than 20 employees, but I'm not enrolled in their health insurance (because it's a really crappy insurance plan)?
Yeah, the nursing care thing is dumb. Also, when they switch your status back and forth without moving you. My wife was in the same hospital, same bed, same nurse and doctor, but she was first "acute" care and then "swing bed", which is considered nursing home, then they would switch her back to acute care for a day to do a procedure, then back to swing bed!! Crazy. She never went anywhere! This happened over and over during her stay.
Great information,
How about a video on Medicare and Tricare For Life situations?
My employer has approximately 35 employees.
R, that is a good number if you want to keep your employer insurance past age 65. 20 employees is the cut-off for Medicare becoming primary insurance.
What about your maintenance prescription medications you have to take while in the hospital?
The hospital won't provide?
I have no idea be honest with you but my brother found a plan that Kroger is offers which case your prescriptions especially your co-pay cost most of my meds I take right now I can get for six dollars for a 90 day supply or some of them are free
@@MedicareonVideo Hospitals will provide maintenance meds but will charge you vs. any medication new and pertaining to your stay. Always been my understanding,
Where do you normally get the maintenance drugs? If part d pays for them wouldn't they still pay for them? Just have a relative pick them up at the pharmacy as usual and bring them to you, but remember to have the nurse clear them with your doctor and the hospital pharmacy.
If they were under observation during hospital stay&then discharged2skilled facility the patient can request home therapy instead.Most plans will be covered by medicare for home therapy,and can even order home care services.
Observation vs inpatient also comes in premedicare. On employee coverage, I went to an emergency room, was transferred to another hospital emergency room and placed in the hospital for three nights. I shared a room with an older person, and the doctor explained to his wife "Yes, this looks like an inpatient hospital room, but...." and he explained that rehab wouldn't be covered because he wasn't an inpatient (didn't know why till your explanation!). For me, the impact was milder, since I had visited an ER and had NOT been "officially" admitted, I had to pay 2 ER fees (a total of about $500)
What if you have SLMB? Do I need any additional insurance?
Question, I retired at age 58 from my company with company insurance that I paid a portion of. About 3.5 years into retirement the company cancelled my retirement insurance that I had. I started going to the VA since I was service connected. I will turn 65 in 2023 and go on Reg Medicare or an advantage plan.
So will the VA medical benefits be considered adequate coverage for starting Medicare without the penalties?
Thanks.
The entire number of employees federal laws/rules needs thrown out and reaches far beyond Medicare. Employers can't openly discriminate (the few protected traits) IF they employ a specified number of people. If they do not have that many employees they can violate you all they want. Discrimination also needs some adjusting as it is done frequently but denied. You would have to conduct a sting operation to just achieve reasonable suspension unless you could obtain the company President admitting such and it on company letterhead... and notarized. 🐸
Only America could come up with the best and the dumbest healthcare plan.
I thought once you turned 65, you have to sign up for medicare wither you are still working or not
I work in a Chiropractic office. Only spinal manipulation is covered. Not the exam (which they require), no treatment for hips or knees or shoulders, or other therapies that can reduce pain and speed recovery. That is all out of pocket for the patient.
My Mother was admitted for septic UTI and a mild heart attack and they wanted me to sign a CMS form stating I understood she was being admitted for observation - I read everything. I refused telling them her admission diagnoses should be the heart attack not the UTI. Demand they code the admitting diagnosis as the most serious, because one may be an observation diagnosis the other may not. My Mother was discharged to a SNF after 7 days in the hospital. I only know this because an employee's Mother is a SNF administrator, and I'd been asking many questions.
What is the best Medicare plan?I am new to medicare and am drowning in phone calls from telemarketers selling plans! HELP!!
Hi Cathy! Yes. be very careful. Watch this video I just did and it will help. czcams.com/video/hrkbOjBtBsw/video.html
Give us a call and we can walk you through everything. 877-885-3484
@@MedicareonVideo Thank you so much for what you are doing for us old folks!This is like learning a foreign language except worse-money is involved!
Disabled people get medicare too.
So, you dont have to be 65 to get it.
Ive had it since I was 20
I'm in this boat. I've chosen to be with a PPO (under Humana) with prescription drug coverage. Granted I qualify for "extra help" from my state and Medicare for my meds and my Medicare B premium.
IRMA tax against Part B when you make too much money in a given year. I can understand paying against the tax year where you withdrew the large amount of money. But Social Security/Medicare charges the IRMA penalty for TWO YEARS!!!
I'M-A???