I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: Medicare/Insurance => Topic started by: bansix on May 12, 2015, 05:59:37 AM
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Hi I need a quick answer and not having luck finding what I need to know with my searches. I'm going through open enrollment and it ends next week, so need to hurry up and make a decision.
This question is especially for those who are on Dialysis, under 65, still working, and possibly living in Virginia. I keep getting the run around when I call Medicar, Anthem, Blue Cross Blue Shield, my HR Benefits department.
I got on Medicare last year because I was past my 30 month coordination period. So my Primary insurance moved to Secondary. Problem is, it won't pay for any of the remaining balance (20%). They said they are only contractually obligated to pay up to the 80% and since medicare picking up the 80% they aren't paying anything. So what was the point of having my insurance?
Do I just have crappy insurance? I opted for the highest plan available through my job too. Makes no sense that they won't cover the 20% when they were willing to pay for the 80% before...
If you don't have this problem, who do you have for your Secondary insurance? or did you get a supplemental? So far all the Providers I talked to for a supplemental medicare plan say they don't offer it to people under 65, on dialysis, living in VA. not sure which part of that answer is the reason, but I get the same answer every time.
Thanks for any feedback!
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I'm in VA but am still in the 30 month coordination period, so I'll watch this.
Question will they pick up that 20% after you have met your annual deductibles? For me with Medicare secondary after I pay (or Medicare pays) something like after $3k the insurance covers everything 100%.
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We went through that process extensively last year when I still had Cobra from my company. We had Aetna insurance. After consulting with many people, including Emory Hospital financial people, two independent insurance people, the decision was made to go on Medicare with an supplement Plan F (for the 20%) along with an AARP drug supplement. My wife is under 65 so there are issues of costing and coverage for most insurance companies for supplemental insurance. AARP with United Healthcare was the best option for us. While I was on Cobra, my employer's health care provider was primary and Medicare was secondary since I had the employer insurance first.
Now that cobra has expired, Medicare is prime and AARP/UHC is secondary. As a result, our out of pocket expenses have been smaller since Medicare kicked in January 1. I think there are some rules on when you have to buy the medicare supplement so we decided to buy upfront when we started Medicare. A lot of people will follow the Medicare Advantage marketing but several people told me its best to stick with plain on Medicare with a supplement rather than going with Medicare Advantage. The rationale is the insurance companies change the rules off to their benefit on what they will pay. Medicare is stable in their approach year after year without a lot of hassleI cannot speak for what is best for you but this is what worked for my wife so far. The whole process of selecting is a bit daunting but just keep talking to folks and you will figure it out. The Medicare website has tons of information.
Joe
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I did a google search for help finding insurance in Virginia. I got a link for something called Health Markets. The lady help me understand it a little more. I pretty much don't qualify for a Medigap or Medicare Advantage. But she couldn't understand why my insurance wouldn't cover the remaining 20%. She's never heard of that. She told me to contact the Bureau of Insurance at the State Corporation Commission. But one thing we talked about was that the company I work for is actually based out of Texas and their insurance is in California. So they may not follow the same rules as other companies in VA follow. I guess I;ll find out tomorrow.
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I have the same issue. The way it was explained to me is that the EGHP is there as catastrophic insurance. I had my transplant in April 2013 and was still in my 30 month coordination period. It switched six months after transplant and that's when I had to start paying bills. I asked the same question of my benefits department and I was told that because Medicare pays more than my insurance would pay, they will not cover anything until I meet my $4000 OOP maximum. I only keep my employer insurance at this time because I have to cover my husband whose insurance at his employer would eat up his check. I was told that because I *can* cover him, he is not eligible to go on the Marketplace himself even though his individual income would allow it if I weren't in the picture.
I will be so happy when I can finally tell Medicare to take a hike next April.
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I guess I do not understand the issue...Our findings were that a person can qualify for Medicare below the age of 65 due to ESRD and also qualify for a supplement with AARP being the most cost effective. It was recommended by the independent insurance agents. My employers insurance was primary and Medicare secondary until the cobra expired. The cost for the combined AARP and Medicare programs were much more effective that the alternatives.
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I asked the same question of my benefits department and I was told that because Medicare pays more than my insurance would pay, they will not cover anything until I meet my $4000 OOP maximum.
So the key point is you pay until you hit your insurance plan's Coinsurance limit? So that would mean bansix might want to look at the limits in each plan, compare that to the cost of the plan to decide which will have a lower cost? (Also keeping in mind any gauges of which insurance company is easier to work with.)
i.e. three plans, in this random example the lower cost, higher deductible plan is best
| Biweekly cost | Annual cost | Coinsurance limit | Annual out of pocket |
| 50 | 1300 | 3500 | 4800 |
| 75 | 1950 | 3000 | 4950 |
| 100 | 2600 | 2500 | 5100 |
Hootie, I think the key here is bansix is employed with the employer paying a good bit of the insurance costs so likely it is best for bansix to get the additional insurance via the employer.
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You are probably right on getting the max out of the employer's insurance.
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You are probably right on getting the max out of the employer's insurance.
My employer has been paying zero dolllars. So it's been pointless to have them it seems. They said they will only pay up to the 80% of the original bill unless it's covered by someone else (medicare), after that they will pay nothing.
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I'm on Medicare for the first 80%, primary, and then the hospitals in-house program for employees and spouses for the other 20%. My wife is a patient manager for a cardiac ward. I wonder who I would sign with if she lost her job due to disability (she has Rheumatoid Arthritis). She was off for months before she went back to work. What program do transplant and dialysis patients sign up for in California? I've been so lucky to have health insurance during my career as a teacher, and now as spouse to a nurse. I would have lost everything without it. I'm still waiting for my Disneyland book to be published. I signed the contract a couple of weeks ago.