Just a quick question regarding this. My husband is covered under my insurance and has Medicare. (due to SSD), Will I be able to do spousal refusal if he is covered under my insurance? Should I drop him now and keep him on only Medicare (my insurance has a "donut hole too--it sucks frankly). I am so confused by all of this! My husband is considered "pre-motor" but I am just trying to think ahead.

It's a hard call. I had my wife on Medicare, medicade, and my insurance. The way the thing shook out was my insurance was the Primary. I thought this would protect us from paying for services since there were 3 levels.

What ended up happening was my insurance would refuse treatment that Medicare would approve. It was pretty bad actually. Each of the three would argue responsibility, and my wife's treatment suffered for it. Not to mention, I got a lot of bills that had to go toward deductibles all year, and that amounted to $3000 a year sometimes.

My insurance wouldn't cover some services Medicare would, and that proved to be a big obstacle. Because if the Primary refuses, all the others refuse automatically.

I eventually decided to drop her from my insurance, and it worked out well. Nobody would tell me to do that, as they really won't give you financial advice. Maybe because social workers aren't qualified to do that, or they don't have a clue as to what is the best way to go.

So my feeling (without specific info) is that you should keep all of the insurance for now. You have to know how to put in claims for all of it, and explain to the care providers who is first, second, third in the pecking order.

If you find that your private insurance is getting in the way of care, you may have to dump it. It really made my wife's care more streamlined.

My husband only had the catastrophic portion of Medicare. I chose this because of Fred's advice years ago.

We are fortunate in that our company benefits are 100% paid while he is on disability.

Since the Medicare is only catastrophic everything goes through our insurance.

I agree with Fred, I currently have my husband covered under medicare, private insurance, and medicaid, respectively in order of primary. He is currently in NH and this is working well for us (for now). medicaid covers all the nursing facility costs. medicare is primary for any medical treatement outside the daily care of NH and then private insurance & medicaid cover the copays and deductables.

My husband also has insurance through my job, medicare and medicaid. Even though my insurance has a high family deductible, it works out well because all of his "stuff" goes toward my deductible, when gets met pretty easily, and I have no out of pocket expenses toward any of his bills. It would actually be stupid for me to take him off because I would be paying the same amount either way. Any time someone accepts medicaid, whether it's a nursing home or doctor's office, it's illegal for them to bill the difference to the patient. Even if no other insurance is involved they are legally obligated to accept it as payment in full.

I think somebody owes you money Fred because medicaid should have picked up everything after insurance and medicare. Might be worth checking in to.

Judyf,

Tell that to my state. Medicade varies state to state, and I had to pay. It wasn't much, but it was my responsibility.

The worst part I ran into was that Blue Cross wouldn't pay, so the others wouldn't. After I removed her from BCBS, I didn't see any of the bills.

Now, 3 years later, they (medical providers) still try to bill BCBS. But she gets all the care she needs with just the one. But I waited 4 years to come to that decision.

I was just told by the financial person at the nursing home that the Medicare advantage plan I have my phd on is actually worse then putting him on straight Medicare and adding a suppliment plan.
Because we're on a PPO, after 20 days I have to pay $125.00/day for his nursing home care.
If I had him on straight Medicare with a suppliment, then after the first 20 days Medicare would pay 80% and then the suppliment would pay the remaining 20% for days 21-100 of skilled nursing care.

If he's approved for Medicaid then he becomes Medicare/Medicaid and then I can drop the suppliment.

Glad its time to change providers right now. Looking into a good suppliment. Any recomendations anyone?