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Author Topic: Have some insurance questions  (Read 555 times)

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Offline Mishma

  • Member
  • Posts: 190
    • Marquis de Vauban
Have some insurance questions
« on: June 17, 2014, 03:12:39 PM »
for you bloggers. I think a few of you have been in the industry, help facilitate or have "on the job training," as it were regarding health insurance. A little background.

I am in the VA system with an ID/Primary care doc and countless others with varying degrees of satisfaction. I am on Disabled on SSI (aren't many of us?) with Medicare benefits, but married to someone whose insurance I'm on and use. I'm not happy with the physicians their insurance offers (other than the guy who is yearly replacing my hips and soon knee) and I want a new primary care doc. At our VA you don't have a choice. There is just one anyway.

Questons:

1) Am I obliged to keep my wife's insurance plan coverage? What are the penalties if I do not-other than the obvious?
2) Could I buy my own medicare supplemental coverage and have it be my primary with my preferred choice of doctors? I'm 60.

Appreciate any help or light on the subject as "It takes a Village," and I'm, at times, the Village Idiot. 
2016 CD4 25% UD (less than 20). 27+ years positive. Isentress, Truvada, Acyclovir, Clonazepam, Zolpidem, Bupropion, Lisinopril, Pravastatin, Quetiapine, Doxcycline, Testosterone, Suatriptan/Naproxen, Restasis, Dorzolamide, Latanoprost, Asprin, lortab, Levothyroxine, Fioricet, Restasis, Triamclinolone, Nitrostat.

Offline Theyer

  • Member
  • Posts: 2,514
  • Current ambition. Walk the Dog .
Re: Have some insurance questions
« Reply #1 on: June 18, 2014, 03:31:55 PM »
Mishma would not the forum
Insurance, Benefits.... be a good place to pose this ?
"If we can find the money to kill people, we can find the money to help people ."  Tony Benn

Offline Mishma

  • Member
  • Posts: 190
    • Marquis de Vauban
Re: Have some insurance questions
« Reply #2 on: June 19, 2014, 03:37:43 PM »
You're absolutely correct and I see Jeff did it for me. Thanks.
2016 CD4 25% UD (less than 20). 27+ years positive. Isentress, Truvada, Acyclovir, Clonazepam, Zolpidem, Bupropion, Lisinopril, Pravastatin, Quetiapine, Doxcycline, Testosterone, Suatriptan/Naproxen, Restasis, Dorzolamide, Latanoprost, Asprin, lortab, Levothyroxine, Fioricet, Restasis, Triamclinolone, Nitrostat.

Offline JR Gabbard

  • Moderator
  • Member
  • Posts: 257
  • Union Jacks
Re: Have some insurance questions
« Reply #3 on: June 20, 2014, 09:17:18 AM »
for you bloggers. I think a few of you have been in the industry, help facilitate or have "on the job training," as it were regarding health insurance. A little background.

I am in the VA system with an ID/Primary care doc and countless others with varying degrees of satisfaction. I am on Disabled on SSI (aren't many of us?) with Medicare benefits, but married to someone whose insurance I'm on and use. I'm not happy with the physicians their insurance offers (other than the guy who is yearly replacing my hips and soon knee) and I want a new primary care doc. At our VA you don't have a choice. There is just one anyway.

Questons:

1) Am I obliged to keep my wife's insurance plan coverage? What are the penalties if I do not-other than the obvious?
2) Could I buy my own medicare supplemental coverage and have it be my primary with my preferred choice of doctors? I'm 60.

Appreciate any help or light on the subject as "It takes a Village," and I'm, at times, the Village Idiot.

Hi Mishma,
Picking apart your situation, it looks like your needs are ID, orthopedics, and a better primary care physician.
You're getting ID from the VA, and you're satisfied with that.  Your orthopedics are covered under your spouse's insurance, and you're happy with that.  You're not happy with the VA's primary doc.
So, if you stop using your wife's insurance, you will probably lose your orthopedic doctor.  You could find another using the Medicare you already have (if that happens, ask your current ortho doc for a referral).  Or you could try to get the VA to cover it.
As for a primary care doctor, you can use the Medicare you already have to find one of them.
Depending on the individual policy, Medicare Advantage will cover the 20% that Medicare B doesn't pay out.  They usually come with some other goodies too.  You have to do the math and see if it is to your advantage to pay the premiums, or to pay the 20%.
I don't know the specifics of your wife's plan, but you should be able to use hers for your ortho, and your own Medicare for a primary without any penalties.
Hope this helps!
It goes like this
The fourth, the fifth,
The minor fall, the major lift,
The baffled king composing Hallelujah!

L. Cohen

 


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