Q: Gwen, I will be turning 65 in a few months, do I need to apply for Medicare?
A: If you are currently drawing social security, then you will automatically be enrolled and mailed a Medicare card. If you are not drawing Social Security, then you can apply on-line, by phone or in person at the local Social Security office. But, are you still working?
Q: Yes, and I have health insurance at work. What difference does that make?
A: If your employer has fewer than 20 employees, then Medicare is primary and you will need to enroll in Part B. If your employer has more than 20 employees, then your insurance at work will be primary and you are eligible to stay on your insurance at work and may want to delay enrolling in Part B until you actually retire. As long as you have credible coverage at work, you will not be penalized for not enrolling now. However, I suggest that you evaluate your options – the insurance at work as compared to the coverage through Medicare. Choose the option that gets you the best benefit from your insurance dollars!

Q: Exactly what IS Cobra?
A: Cobra is an employee or covered dependent’s right to continue their health insurance after a qualifying event that would otherwise cause them to lose their coverage.
Q: So, give me an example?!
A: You son is covered on your insurance at work but is turning 26 so he will no longer be eligible to be covered as your dependent. This is a qualifying event that allows him to continue his current coverage at his expense for a specified period of time.
Q: What are some other instances?
A: Qualifying events would include the termination of employment, a reduction of hours, divorce or legal separation, becoming eligible for Medicare or the death of the employee.
Q: So, I currently cover my family for health insurance at my work. If I were to pass, are you telling me that my family would be able to continue this health insurance after I am gone?
A: Yes, at their expense and for up to 36 months!
Q: That’s comforting to know that they could continue to be covered.
A: That is the purpose of Cobra – to provide that protection! If you have more questions, just give us a call at 815-932-3700.

Medicare Part B covers outpatient services but not “self administered drugs”.  So what does that mean?

Let me share with you my experience with my mother.  She had the port in place and was ready to start her chemotherapy.  I accompanied her to the infusion center (which is an outpatient setting and covered under Part B) for her first treatment.  While we were there, a nurse handed my mother a small tube of ointment and explained that she should put a small dab of this ointment on her port the next time she comes for her treatment.

Imagine our surprise when we received a bill from the infusion center for $37.17.  When I inquired about the charge, I was told that was for the tube of ointment that they had given Mom.  The infusion center has no means to bill Medicare because they are not a Medicare Part D vendor (a pharmacy) so they billed my mom.  I was advised that I certainly could submit a claim to her Part D vendor and hope to be reimbursed.  I can assure you this is much easier said than done!

What should have happened is – we refuse the tube of ointment and ask for a prescription that we could fill at the pharmacy.  Mom didn’t need the ointment until her next treatment so there was plenty of time to run it through the pharmacy.  In that way, the same tube of ointment processes under the Part D benefits.  Lesson learned!

So, my advice is, whenever you are in an outpatient setting, ask them to write a prescription for the medication so you can have it filled at the pharmacy where it is covered under Part D.  If you are in an observation unit in a hospital, you may think you are in the hospital, but you are not.  Observation units are outpatient settings covered under Part B, and “self administered drugs” are not covered under Part B.  So take your own medications with you (or have someone bring them in).  Otherwise, you will be charged by the hospital for the medications.  Hospital observation units are not pharmacies and therefore, cannot bill for Part D services.