Navigating the Insurance Maze Post Transplant

[Meinuk]

I am unemployed.  (Technically, I am a full time student)  Last June, after a fight with my Dean, I read the writing on the wall and walked out - I had been there for 9 long years - tied to my job because I needed the insurance, finally enough was enough.  There was a new administration coming and the welcome mat was not being flung out for me. I was just six months out of my transplant and I never stopped working - I worked from the hospital and home, and was back at the office after taking three weeks of vacation/sicktime.  I claimed six month's disability to keep the health coverage and the University fought me.  (I won - after all, stress isn't good for a new transplant, and I was galled that the university that I worked at all through dialysis and transplant was all of a sudden saying that I had no disability - my temper is a disability all on its own - the CKD just adds to it)

My disability ended on 12/26, and then I started paying COBRA @ $444 a month.  I did not  have Medicare part B coverage, due to errors when I first started dialysis, and me not following up after I had my transplant, so I needed to enroll during the open enrollment in 2010.  Well, I did.  I mailed off my form on February 2nd.  Of course, for the second year in a row, Medicare lost the form.  So, on Monday morning, I am marching into the SS office @7:30 in the morning to enroll in person.

I figured, since I have written about everything else before here on IHD, I'll keep a running post of my experience with Medicare, and my future experience with the high risk pool (I plan on being a member).  My school health insurance isn't very good, and I need the Immuno coverage, that is why I am keeping my COBRA until I have a better plan (and my COBRA also includes dental).

Eventually, I will get a job with benefits, but I want to work on being a student for now and make my next career choice wisely. So, I figure I'll be a test case for the new Health Care Law.  (did you hear about it?  Our Government is reforming health care - I'm not sure if it has been in the news, the CKD advocacy groups aren't really talking about it.  )

Tuesday, March 30, 2010

I was at the SS office at 7:37 am.  THere is not enough coffee in the world to the monsoon that is NYC today, but I made it in, and only had to wait half an hour.  The people were plesant, helpful and bi-lingual.  My advice, get there at the crack of dawn, because by 8:45 when I left, the place was filling up.

Because I did not have Medicare part B at the time of my transplant, and I had had it previously (my error - once you sign up for it, KEEP IT!) I had to wait until the general emrollment (January - March) and I will be paying a 10% surcharge for not keeping it when I was on dialysis.  (again, lesson learned) But it is still a lot cheaper than my $444 a month COBRA.

In theory, you can do everything by phone, mail.  But in truth.  Don't trust the system.  Do it in person.  They lost my paperwork last year, and I was not on top of it (really, I was working then and Medicare was just a safety net) You should call  a month or so after applying (still within the enrollment period) and make sure that your paperwork is in process.  This is how I found out that they lost my paperwork this year too.

This morning, I sat and watched as the Representative typed in my nformation.  SS then sends the info to Medicare, and fingers crossed, up to six weeks later, I should get my first bill, and coverage will start as of 7/1.

[Chris]

And keep all the mailings too is another heed of advice. Scan it into your computer to have it on file and a paper copy. You can always burn it to a CD, Memory Card (or stick).

[Rerun]

Anything new on this?

             

[Meinuk]

I got my card in the mail on Monday night, and tonight's notice was that my premiums would be $132.00 per month.  I was surcharged for not taking part B when I was in center - social worker screw up, I never should have enrolled at all, it should have just filled out the survey.  Sigh....  Live and learn.

Whoo hoo this is a heck of a lot cheaper than the $444 I am paying now! I'll deal with the 20% as needed.

I am now (well, as of 7/1) officially on Medicare.  Dang, and I found a gray hair the other day....

[Chris]

You got Part A, B, and D (prescription) right?
With part D, you may qualify for extra help so you do not have as high of a copay for meds.

[Jie]

I think you are lucky to enroll Part B before. Without it, your part B would not cover your post-transplant drugs. You have to enroll Part B before or at the time of transplant for it to cover the drugs.

[Meinuk]

I think you are lucky to enroll Part B before. Without it, your part B would not cover your post-transplant drugs. You have to enroll Part B before or at the time of transplant for it to cover the drugs.

Jie, I enrolled in it 18 months post transplant, where did you hear/read this? I am really curious.

Here is a link to the current Medicare Booklet RE: ESRD

http://www.medicare.gov/Publications/Pubs/pdf/10128.pdf

This is my situation, I enrolled in Medicare Part A in April 2007, and I enrolled in Parts B & D during open enrollment 2010 for B to start on 7/1/2010.  The wording that pertains to my situation is that I will pay a penalty.  Nowhere have I seen the exclusion that you mention.

From page 10 of the pdf:

If you qualify for Part A, you will also be offered Part B. Remember, they are both needed to get all the Medicare benefits available for ESRD, and there is a premium for Part B. If you decide not to get Part B right away, you can only get it between January 1–March 31 each year. Your coverage will begin on July 1. Also, the cost of Part B will go up 10% for each 12-month period that you could have had Part B but didn’t sign up for it.

[Jie]

Hi Meinuk,

I get this information from the social worker of my transplant center. The social worker said that it covered other things but not transplant medicines if Part B is not enrolled before or at the transplant. Since you enrolled Part B before your transplant but your dropped off, your re-enrollment may be different from patients who enrolled first time. Please contact Medicare to find the exact answer for this question. I am interested in the right answer for it too.

[Meinuk]

Jie,

I've spoken to Medicare, my social worker and my pharmacy, they all state that I am covered as of 7/1 - including immuno.  I think that is is possible that your center is confusing the wording with "eligible at time of transplant" and "enrolled at time of transplant". Or, everyone I am working with is wrong (that could also be a possibility - and Medicare has screwed up more than once in my case).

We'll know the answer around July 20th, when I try to fill my first prescription.

[Chris]

Jie I would say don't always trust whaat you are told and go to the source for comfirmation or gain better understanding and tell that social worker that they are misinformed or misspoke.
 
I had an experience with my dialysis social worker and I couldn't trust what she was telling me after giving me old out of date  information that I found out after going to the office.