Advanced Prostate Cancer
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Making Medicare as a Primary Insurance

Has anyone had any experience with what insurance is primary if they have medicare and their spouse has a policy through her work place?

Joel

13 Replies
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Medicare is primary.

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I have used my wife's insurance as my primary and medicare as my second insurance for the past four years. We upgraded my wife's insurance to a PPO and we virtually have not had to pay a copay for any procedure once we reached the max family expense of $2500 for the year.

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I have Medicare as primary and I'm on my wife's policy as the secondary. So far so good with few out-of-pocket expenses (for scans, radiation, Lupron, MRIs). The secondary issurance is covering most of the cost of Zytiga through CVS specialty pharmacy; don't know what will happen if my oncologist wants to try Xtandi after Zytiga fails (my PSa is rising).

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Steve, I can tell you that at this time CVS will NOT pay for the Xtandi. You need to join us and contact CVS as I suggested and object. It is best if you would send an email and make a phone call. We are trying to make CVS take heed and pay a price for this decision.

Next week I will be launching a next step to our protest. CVS needs to understand that this decision has a human cost.

Please, if you are willing forward a copy of your email to the Malecare ED at Darryl@malecare.org

Joel

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I was informed by Medicare that when your wife or husband is working and has insurance and you are on the insurance as the secondary Medicare has to be the back up to your wife/husband's insurance?

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I think your medicare is primary if your spouse has other insurance but is retired. I made the mistake of continuing being covered by her despite my reaching medical age. It would have been cheaper if I had just gone on Medicare at age 65 and dropped her coverage of me.

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Yes Joel. I was on my wife's policy when I turned 65. And I did not apply for Medicare, as I thought I would just wait until I needed to. Well guess what? I applied a year later, and they charged me a 10% penalty, taken from my Social Security. So the lesson here, is regardless of what insurance you have or are under, when 65, apply for your Medicare. You can always add on a Supplemental the fist time at any time of the year. If you do get a Supplemental, that would be "heaven sent", as they would "probably not" take you with Prostate Cancer--calling your situation as having a pre-condition. In my case I already had my supplemental before my Pca--so they have to live with me--and pay 100% of what Medicare does not pay.

Hopefully if we get rid of Obamacare, and they[?] address pre-existing conditions, for every type of insurance--living with this disease, gets a little easier.

Nalakrats

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Nalakrats , I thought that was a caveat of obamacare and all insurance is that they could not refuse you for preexisting condition?

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If on Medicare and you apply for a supplemental policy--which I suggest should be the G or F plan--they cannot deny you coverage on the initial sign-up of a Supplemental Medicare Plan. If you try to change insurance companies, or change plans within a company, they then can deny you. Trust me on this. My wife and I both got denied, due to pre-existing conditions, when trying to change insurance companies and trying to go to a G plan from an F plan, as it offered yearly savings, based on how we use medical resources.

Nalakrats

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I just signed up for plan F with AARP UnitedHealthCare. This was an upgrade from last year's HMO type plan also with AARP UnitedHealthCare. Despite being diagnosed last year with prostate cancer I was quickly approved for this plan. When I signed up last year I had no health concerns and took the cheap plan. This year I know better and want the option to see specialists without a referral. I think thinks will work out well. I recall in the application process that they were keen on knowing whether you were on dialysis or not. That seemed like the only discriminator I could see.

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WSO----you are good to go--with the F plan---everything gets paid for, unless it is not approved by Medicare.

Nalakrats

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I'm on Medicare with Cigna (carried over from work after retirement) as supplementary. I reach my maximum copay within half-year and the rest is free. All my PCa meds come from UVA where I get treated and so I don't have any issue. I'm thinking if you go to an institution (like a University hospital), you can get prescribed by your doc there and obtain your meds through the university pharm.

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The "Welcome to Medicare" brochure outlines the circumstances under which Medicare is primary or secondary. (CMS Product No. 11095) Google "Welcome to Medicare brochure".

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