Lena

Brian Gilmore, I was so grateful to see you response. I read many of your other posts and had fervently hoped you would respond to mine. I really appreciate it. Thanks for explaining the machinations of how Medicare interacts with COBRA in terms of the behind-the-scenes billing, etc. I am happy to report that I got a written response from Aetna that was clear and helpful. They said that I would need to submit a letter from the non-participating provider affirming their non-participation and listing some other information. That is a big relief. Thanks again for your input, Lena

Hi everyone, I hope that I am posting this question in the correct forum. Thanks in advance for any input you can give me. I am 66. My job at a large company ended June 30, 2025. I enrolled in Medicare so that everything except Part A would be effective July 1 (Part A is retroactive to August 1, 2024). Specifically, I enrolled in Part B, Plan G, and Plan D and the coverage became effective July 1. The information that my employer provided me was confusing as to whether I'd be offered COBRA so it was not in my sights until I just got the COBRA paperwork. The benefits administrator (a company they engaged to do the billing) confirmed when I inquired that I could be enrolled in both Medicare and COBRA since both started (or would start, for COBRA) on the same day. The cost of COBRA coverage, through Aetna, would be $800/month. I would not consider paying that amount since I am already taking a beating through IRMAA, but I have two mental health providers who do not take Medicare. Because of the shortage of good mental health providers, I do not want to switch to someone who does take Medicare just so it costs less. Therefore, if COBRA would pay the benefits I have become accustomed to, I would at least break even if I did elect COBRA and have Aetna pay as the secondary insurer. Before I commit to COBRA, I have a few questions that I have not been able to find clear answers for, even when calling Aetna and Medicare. The Aetna representative was obviously not familiar with the complexities of Medicare since she just kept repeating "submit an EOB from the primary insurer" as if that insurer were not Medicare. Does anyone know how I would get an EOB if the provider does not take Medicare (and therefore would not file a claim)? Another Aetna rep I spoke to said "if the provider opted out of Medicare, we will cover it." However, the provider did not strictly opt out, they just don't take Medicare. Do I have to submit the Medicare claim form before submitting to Aetna? (Section 3 of the form asks about other insurance, so perhaps not?) In terms of the claim form, does anyone know what the difference is between (a) "refused to file a claim," (b) "is unable to file a claim," or (c) "is not enrolled with Medicare." If I don't go with COBRA and have to file this form, would I choose (c)? If my Plan D coverage has a very high cost for a medication, can I file for reimbursement with Aetna to get my amount down to what I would pay with them? Does anyone have any other cautions about embarking on this somewhat risky plan, since I could end up paying for COBRA and not getting those non-accepting Medicare providers' costs covered? Thank you so much, and please let me know if any additional information is needed. Lena