Asking re Medicare, group ins, etc?
Lynn B
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Dated : February 15, 2001 at 22:04:58
Subject: Asking re Medicare, group ins, etc?
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Husband has been on PD since end November and we have been advised to apply for Medicare by social worker. We currently have a group employee Blue Cross plan that is fine and we feel will cover him through the 30 month period until Medicare takes over, and we do intend to apply for Medicare then. We don’t want to apply 1-2 yrs early and have to pay the $50 mo. m/care premium for nothing, we already pay plenty for our group plan.
We have read the recent m/care book dated Aug/2000 which is somewhat clear and somewhat confusing. In fact social worker at our center said other s/workers are calling her and all around to get clarification re our same situation – where PD patient is under 65 and still working and has own insurance. Has anyone encountered this and what did you do? We don’t want to make a mistake, yet don’t want to spend money we don’t need to. Social worker will not advise us other than to say read the book and call them. When I called Soc. Security they offered no help and said to call Blue Cross! Blue C. said they didn’t think it would benefit us to have Medicare while they are paying more than m/care will pay. Help and thanks! Lynn B
Karen
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Dated : February 15, 2001 at 22:46:10
Subject: Re: Asking re Medicare, group ins, etc?
http://brumley.com/renal/pdmessages/3454.html
We encountered the same situation and finally my husband has applied for Medicare. The Soc. Worker explained to us that if we only had Blue Cross they would charge more for dialysis costs and therefore we would have to pay a good portion of it; however, if we had Medicare as well, they would write off the extra. I do not know exactly why this is so, but it seems to be the case. SO we decided to eat the $50/month and get on Medicare so that we won't have to pay any dialysis costs at all. Apparently this is the best way to manage it all although it sounds screwy.
Fred Ray
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Dated : February 16, 2001 at 08:47:16
Subject: Re: Asking re Medicare, group ins, etc?
I am or was in the same boat. I applied for medicare and
I do have very good health insurance. My HMO said they cover
dialysis and me for 20 months after dialysis started then
medicare will take over. I made the mistake of getting
medicare started when I started dialysis so now I am paying
for medicare and the HMO and not using medicare for 20
months. I was told not to stop medicare as some times it
is hard to get it started again.
Unknown
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Dated : February 16, 2001 at 09:18:03
Subject: Re: Asking re Medicare, group ins, etc?
I am glad you are posting this!
So often on this Forum patient get
advice from other patient to apply for Medicare.
I have been told otherwise, since my HMO gives
good coverage with no deductable and Medicare
has an $800 deductiable.
barba
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Dated : February 16, 2001 at 14:06:20
Subject: Re: Asking re Medicare, group ins, etc?
Lynn, I was in the same boat. I had BCN and they paid 100%. So I waited to sign up for Medicare. If your decide to do this make sure you enroll in Jan or Feb since this is the only time thru the year there is open enrollment. So if your BCBS only pays a portion it is a good idea to enroll, because Medicare will become your secondary insurance and cover the balance.
Good Luck, Barba
Nerissa
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Dated : February 16, 2001 at 15:19:40
Subject: Re: Asking re Medicare, group ins, etc?
Dear Lynn,
Your social worker should have a publication from Medicare (Pub. No. NCFA-10128, Aug., 2000) called "Medicare Coverage of Kidney Dialysis and Kidney Transplant Services". In there, there is a section on How Medicare Works with Employer Group Health Plan Coverage. There's a 30 month coordination period wherein your employer's insurance is primary and Medicare secondary. After that, it flip-flops. I also was told to sign up for it right away to make sure that coverage was in place when I needed it.
You should be able to get the booklet from the US Dept. of Health & Human Services; Health Care Financing Administration; 7500 Security Blvd; Baltimore, MD 21244-1950.
Nerissa
Celeste
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Dated : February 16, 2001 at 21:24:16
Subject: Re: Asking re Medicare, group ins, etc?
If for some reason your husband looses his job, is unable to work, gets laid off, etc and you loose your primary coverage you have now. You will be glad you have the Medicare. Pay the money it's well worth it.
Celeste
Transplant Resource Page
http://www.TransplantResourcePage.com
Unknown
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Dated : February 17, 2001 at 08:37:15
Subject: Re: Asking re Medicare, group ins, etc?
Definitely read the Medicare coverage for kidney dialysis/transplant
book! Coverage begins the 4th month after you start dialysis unless
1.you take part in a home dialysis training program at a Medicare-approved
clinic, you start training before the 3rd month of dialysis, you expect
to finish training and give yourself daily treatments or
2.you are admitted to a Medicare-approved hospital for a transplant or
health care services you need before a transplant if the transplant
takes place that month or within the following two or
3. 2 months prior to the month of transplant if transplant is delayed
2 months after you are admitted for transplant or health care services
required before transplant.
Medicare will not pay anything if you have other health care coverage
first 3 months of dialysis. After that, Medicare becomes your secondary
coverage and MAY pay the remainder of the bill from your primary insurance.
Although it states that if your current insurance is paying 100% and if
you have no deductible/co-insurance, to wait the 30 months but if they don't
pay 100% or you do have a deductible/co-insurance that Medicare MIGHT pay
those. Also keep in mind that Medicare pays 80% of what they ALLOW and you are
responsible for the remaining 20%.
Although we also have good insurance, we went ahead and applied for Medicare when
my husband started dialysis training/dialysis. Yes, we are currently eating
the monthly cost of Medicare, but I guess we sort of looked at it as a safety net
just in case he would have to apply for disability. Medicare coverage would have
been retro-active to when he started training but it saves us the waiting period
to get the ball rolling if he would have to apply now.
Once transplanted, Medicare becomes the primary insurance for 36 months to cover
immunosuppressive drugs. After that, you're on your own.
Some states also provide a supplemental insurance at a fee for ESRD patients. Call
one of your representatives for info to see if you qualify. Also available is
Medigap and Medicaid which do set limits on annual incomes.
Social workers are a howl, aren't they? They never seem to give you a straight
answer, they always seem to throw it back in your lap. Guess they are concerned
if they say yes, do it that someone will complain about the cost and no benefits
but if they say no, don't do it, then it could flip flop on them too.
Bottom line is, it is your call. Just keep in mind that Medicare only pays
80% of what they concider reasonable charge and the facility must be Medicare-
approved. Alot to concider.
Good luck. Know it is an extra cost if you already have insurance, but it might
be worth it in the long run.
Ilene
http://brumley.com/renal/pdboard.html
Dated : February 17, 2001 at 13:53:08
Subject: Re: Asking re Medicare, group ins, etc?
My husband Charles and I were in a similar situation insurance-wise. While Charles (46) has been disabled for about three years (due to a heart problem, not ESRD), when he became eligible for Medicare, we already had excellent insurance through my work. Although he wasn't on dialysis at that point, we knew it was coming. Ultimately, we decided the $50 a month was a small price to pay for a safety net. Even though I've been on my job for years, you just never know what could happen. What if I get laid off or became disabled myself or whatever.
It isn't a total waste anyway because of a couple of important details. First, even though my insurance is primary, if my insurer should happen to pay less than a provider charges due to one of those "reasonable and customary" issues, the provider (as long as it's a Medicare provider) has to accept what Medicare considers reasonable. This was a big issue for us with a heart monitoring company that charged thousands of dollars but our insurance only paid a few hundred. Ultimately, they had to eat the loss because we were also on Medicare. Also, I don't know what your out of pockets are likc, but we have a $1,000 a year maximum out of pocket, and Medicare picks up most of that.
Hope that helps,
Best of luck,
Ilene