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Author Topic: Medicare Advantage for ESRD  (Read 121 times)
Shaks24
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« on: September 27, 2020, 06:15:23 AM »

Starting January 1st 2021 all ESRD will be allowed to sign up for Medicare Advantage plans in lieu of Original Medicare. Right now I have Original Medicare and Medigap F but the premium for Medigap F is now more than $600 per month as I am under 65 and have few options. I think the main benefit of Medicare Advantage is that you will have a limit on your Maximum Out Of Pocket expenses. We should be able to look at these plans for 2021 beginning on October 1st. I know Fresenius is having an online seminar on enrollment options. I saw this on the patient portal and they even appear to have teamed up with a company that brokers Medicare policies. I am going to study the options carefully. My current coverage is awesome as I virtually pay no medical bills (except prescription drug copays) in my plan D. That $600 per month premium for Medigap F is getting tough though. I imagine it will jump to about $700 for 2021 and just keep sky rocketing until and if I make it to 65 years old and get another open enrollment window with no underwriting. By the way after 7 years on PD I had to switch to hemo after my PD Cath failed. We tried to keep me on PD but after 3 surgeries that did not resolve my issues I decided to give up on PD and switch to hemo for now. Its been about 3 months on hemo now and I sure miss the gentle side effects of PD vs the side effects of hemo that kick my but. Is anyone else considering making the switch from Original Medicare plus a gap policy to Medicare Advantage?
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Congestive heart failure 2011
Currently about 19% Kidney Function
September 11, 2013 PD Catheter and Fistula Surgery
September 27, 2013 Started PD
SooMK
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« Reply #1 on: September 28, 2020, 10:50:05 AM »

I noted with interest this "opening up" of Medicare Advantage for ESKD patients. I'm post transplant and have Medigap F like you. Great coverage but the cost goes up every year--over $300 a month now and I'm 71. I'm very skeptical about Medicare Advantage so I will be following your post. Please update as you learn more.
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SooMK
Diagnosed FJHN/UKD 2009
Transplant April 2014
Alexysis
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« Reply #2 on: October 10, 2020, 04:31:32 PM »

I'm in the same situation, although my Medigap type F policy here in NY state is still under $400/month. I'm going to call the insurance coordinator at my clinic this week to ask about this. Probably will stick with what I have for next year, but who knows what the future will bring?
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Simon Dog
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« Reply #3 on: October 10, 2020, 04:48:21 PM »

I believe that one you are in a Medicare Advantage program and decide to go back to a conventional supplement, the insurance company selling the supplement can apply underwriting standards, denying or rating you based on health history.
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Alexysis
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« Reply #4 on: October 11, 2020, 08:30:02 AM »

I believe that one you are in a Medicare Advantage program and decide to go back to a conventional supplement, the insurance company selling the supplement can apply underwriting standards, denying or rating you based on health history.

New York State does not allow insurance companies to do this, so that's not a worry for myself. However, other states have different rules......
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Shaks24
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« Reply #5 on: October 11, 2020, 01:03:16 PM »

I'm in the same situation, although my Medigap type F policy here in NY state is still under $400/month. I'm going to call the insurance coordinator at my clinic this week to ask about this. Probably will stick with what I have for next year, but who knows what the future will bring?

I think I am going to do the same for 2021 and try to see how the medicare advantage works out for those who switch. What scares me the most are the networks you have to stay in to get the lowest costs. Unless you go with a PPO type plan where there is more flexibility but in the plans for my area the maximum out of pocket for the PPO's are a lot higher than the HMO's. The safe bet is to stay on original medicare with medigap F and know what I got for at least another year. I guess we will find out shortly how much the medigap F premium for 2021 is going up.
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Congestive heart failure 2011
Currently about 19% Kidney Function
September 11, 2013 PD Catheter and Fistula Surgery
September 27, 2013 Started PD
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