Question
Myself and my wife both work and her insurance is very bad so i want to put her on my plan and not use her plan at all. my work is telling me I must pay an extra fee because of the birthday rule. I know that it applies if we have children but we just got married and have no children. Is this legal for my work to do? I live in Ohio. It just seems silly that to put her on my insurance I must pay an extra $240 a month because I was born at the end of the year.
Answer
Hi Daniel!
The birthday rule is very common for many insurances......and if this is their rule then yes you have to pay more to add your wife.
The birthday rule has nothing to do with children, it is usually a spouse rule.
Good Luck!
Tricia
Tuesday, March 16, 2010
Medicare B special enrollment period
Question
"your spouse or family member stops working, or the date the Group Health Plan (GHP) or Large Group Health Plan (LGHP) coverage ends"
My question is what "coverage ends" means. My employer health insurance for couples has become very expensive. We can save a lot of money if my husband dis-enrolls and could take Part B without the penalty (he is 80 years old, I am 61 y/o).
My insurance is not ending. If he leaves my insurance voluntarily would this be considered "coverage ends". Many thanks.
Answer
Interesting question. Does your group have more than 20 employees? If so, did he ever sign up for Medicare Part A (free)? I would call Medicare so that you can explain to them your status. You probably will have to wait til the enrollment date to do this. Is Medicare the secondary coverage for him?
(I am going away on vacation so probably will not be able to get your response)
"your spouse or family member stops working, or the date the Group Health Plan (GHP) or Large Group Health Plan (LGHP) coverage ends"
My question is what "coverage ends" means. My employer health insurance for couples has become very expensive. We can save a lot of money if my husband dis-enrolls and could take Part B without the penalty (he is 80 years old, I am 61 y/o).
My insurance is not ending. If he leaves my insurance voluntarily would this be considered "coverage ends". Many thanks.
Answer
Interesting question. Does your group have more than 20 employees? If so, did he ever sign up for Medicare Part A (free)? I would call Medicare so that you can explain to them your status. You probably will have to wait til the enrollment date to do this. Is Medicare the secondary coverage for him?
(I am going away on vacation so probably will not be able to get your response)
Posted by
zhengyun jin
health care coverage for my daughter
Question
My daughter was being covered by my ex-husband on his insurance. He lost his job in December of 2008. He was suppose to get coverage for her. There is no communication with him at all and I can't find out if she is covered. I am now having to add my 20 year old son because he is going back to college. I want to add my daughter because I don't think she is covered. I do know that her father still does not have a job. My company does not want to allow me to add her. Is there anything that I can do?
Answer
Tough question. Is the coverage for your daughter part of a divorce settlement. How old is she? How can the father be covering the child if he is not working. You would need a note from the insurance company with the status of her coverage to show your employer. Not an easy thing..
My daughter was being covered by my ex-husband on his insurance. He lost his job in December of 2008. He was suppose to get coverage for her. There is no communication with him at all and I can't find out if she is covered. I am now having to add my 20 year old son because he is going back to college. I want to add my daughter because I don't think she is covered. I do know that her father still does not have a job. My company does not want to allow me to add her. Is there anything that I can do?
Answer
Tough question. Is the coverage for your daughter part of a divorce settlement. How old is she? How can the father be covering the child if he is not working. You would need a note from the insurance company with the status of her coverage to show your employer. Not an easy thing..
Posted by
zhengyun jin
Emergency room charge
Question
Hi, my son has been laid off for almost 2 years with no medical insurance but is getting unemployment which is ending soon - he went to the emergency room recently and just received a $250 bill - does he have to pay this or is there agencies that will take care of it or help out. We live in Dayton, OH - thank you for your help
Answer
Hi Doris!
Some hospitals have "charity care" or some name similar where patients without insurance coverage can qualify.
First call the hospital and ask if they have such a program. If not, contact your state and perhaps they can help.
Good Luck!
Tricia
Hi, my son has been laid off for almost 2 years with no medical insurance but is getting unemployment which is ending soon - he went to the emergency room recently and just received a $250 bill - does he have to pay this or is there agencies that will take care of it or help out. We live in Dayton, OH - thank you for your help
Answer
Hi Doris!
Some hospitals have "charity care" or some name similar where patients without insurance coverage can qualify.
First call the hospital and ask if they have such a program. If not, contact your state and perhaps they can help.
Good Luck!
Tricia
Posted by
zhengyun jin
Preexisting conditions
Question
Hi,
I'm 24 years old, just finished grad school, and am currently unemployed. Shortly before my graduate student health insurance ran out, I visited two urologists for a chronic problem (dysuria). Neither doctor ever arrived at a diagnosis. Here are my questions:
If I was never given a diagnosis, but was given a prescription as a diagnostic tool (which I will not refill, as it had no effect), is there any way around being described as having a pre-existing condition? If I begin to experience new symptoms that were not part of my condition before, can I go to the same urologist for those symptoms and not have it count as a pre-exsting condition?
Alternatively, will Medicaid cover pre-existing conditions? Will it be difficult for me to apply for Medicaid as a recent graduate?
Answer
Hi!
Pre-existing clauses are all different per insurance company.....some do not even allow them anymore. It would be impossible for me to tell you whether they would consider this as pre-existing but it does fall into that category, being treated a condition prior.
Medicaid is state specific so you would have to go on their website to see if they cover pre-existing. As far as applying, again Medicaid in each state has different guidelines. Most states have a quick application on their website where they will tell you right away if you may qualify or not.
Good Luck!
Tricia
Hi,
I'm 24 years old, just finished grad school, and am currently unemployed. Shortly before my graduate student health insurance ran out, I visited two urologists for a chronic problem (dysuria). Neither doctor ever arrived at a diagnosis. Here are my questions:
If I was never given a diagnosis, but was given a prescription as a diagnostic tool (which I will not refill, as it had no effect), is there any way around being described as having a pre-existing condition? If I begin to experience new symptoms that were not part of my condition before, can I go to the same urologist for those symptoms and not have it count as a pre-exsting condition?
Alternatively, will Medicaid cover pre-existing conditions? Will it be difficult for me to apply for Medicaid as a recent graduate?
Answer
Hi!
Pre-existing clauses are all different per insurance company.....some do not even allow them anymore. It would be impossible for me to tell you whether they would consider this as pre-existing but it does fall into that category, being treated a condition prior.
Medicaid is state specific so you would have to go on their website to see if they cover pre-existing. As far as applying, again Medicaid in each state has different guidelines. Most states have a quick application on their website where they will tell you right away if you may qualify or not.
Good Luck!
Tricia
Posted by
zhengyun jin
Medicare while your working
Question
I am 65 (last April), I am working full time. I am paying $45.oo a week out of my paycheck for company insurance. Company insurance doesn't cover all of my hospital bills. When I turned 65 last April did the part of Medicare that covers (not primary) hospital bills automatically start so that I can tell the hospital to bill Medicare for the part that my insurance did not cover.
Answer
Hi Karen
You need to do two things:
Call the Coordination of Benefits(COB) at 1-800-999-1118 and make sure that they have the right information in their computer regarding your coverage. They will probably send you a form to fill out with any new information not in their file.
Call 1-800-Medicare====As soon as the automated service answers, say AGENT====you will be transferred to the agent representative section====when they answers, tell that person that you want to speak with a claims specialist=== you will be transferred to the claims department==when they answer, inform them of the situation and after they explain the process for submitting claims they will send you the proper forms.
Do not call on Monday or early in the morning, or you will be on the phone all day.
Hope this helps.
John
I am 65 (last April), I am working full time. I am paying $45.oo a week out of my paycheck for company insurance. Company insurance doesn't cover all of my hospital bills. When I turned 65 last April did the part of Medicare that covers (not primary) hospital bills automatically start so that I can tell the hospital to bill Medicare for the part that my insurance did not cover.
Answer
Hi Karen
You need to do two things:
Call the Coordination of Benefits(COB) at 1-800-999-1118 and make sure that they have the right information in their computer regarding your coverage. They will probably send you a form to fill out with any new information not in their file.
Call 1-800-Medicare====As soon as the automated service answers, say AGENT====you will be transferred to the agent representative section====when they answers, tell that person that you want to speak with a claims specialist=== you will be transferred to the claims department==when they answer, inform them of the situation and after they explain the process for submitting claims they will send you the proper forms.
Do not call on Monday or early in the morning, or you will be on the phone all day.
Hope this helps.
John
Posted by
zhengyun jin
medicare coverage
Question
My mother (82) in otherwise good heath has just learned she has uterine cancer.My preference for her necessary surgery is Froedert Medical center rather than the general oncology surgeon(s) here in in Oshkosh. How much, where who etc. will her Medicare coverage pay for the doctor, anesthesiologist, hospital bills?
Answer
Hi Jean
Not enough information.
If she has original Medicare with a Medigap policy, there should be very little difference,If she has a Medicare Advantage plan like a HMO or a PPO, then: once again there should be little difference if the Advantage plan makes the referral and Froedert accepts the agreement.
However if Froedert is not a plan provider, and her plan will not make a referral, it amounts to a private contract, and she is responsible for the whole thing. especially if they have her sign an Advance Beneficiary Notice.
Hope everything is successful.
John
My mother (82) in otherwise good heath has just learned she has uterine cancer.My preference for her necessary surgery is Froedert Medical center rather than the general oncology surgeon(s) here in in Oshkosh. How much, where who etc. will her Medicare coverage pay for the doctor, anesthesiologist, hospital bills?
Answer
Hi Jean
Not enough information.
If she has original Medicare with a Medigap policy, there should be very little difference,If she has a Medicare Advantage plan like a HMO or a PPO, then: once again there should be little difference if the Advantage plan makes the referral and Froedert accepts the agreement.
However if Froedert is not a plan provider, and her plan will not make a referral, it amounts to a private contract, and she is responsible for the whole thing. especially if they have her sign an Advance Beneficiary Notice.
Hope everything is successful.
John
Posted by
zhengyun jin
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