I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: Medicare/Insurance => Topic started by: Cowdog on October 26, 2016, 08:43:34 AM
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Hi All,
I'm researching insurance policies to supplement Medicare when I leave my job and lose my employer insurance. (Still a year or two out I hope)
Wanted to get feed back from any who have already plowed this field and can share the good and the bad and what to stay away from.
I'm in a state that offers Medigap for those of us under 65 and on Medicare.
Thanks
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Just went to my wife's employer Medicare Advantage fro Aetna. It's a enhance policy with expanded coverage such as my wife's company pays a expenses when I hit the donut hole. The coverage is so great because my wife's company would have to pay insurance rates fot services instead of Medicare rates. For a single session of hemo that is a price difference of about 1500 dollars for private and 3000 for Medicare and they have to pay only 20 prpercent of that since Medicare pays 80 percent Aetna the rear.
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There seems to be a vast difference in the ability of privater insurance to negotiate.
Here is west suburban Boston, Harvard Pilgrim (the local HMO) has negotiated Fresenius down to around $485 per treatment, or less than twice the Medicare rate.
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Partly it depends on if you have a transplant, or on dialysis. Some Medi gap policies in certain states are not even available to anyone on dialysis . Also , if you do have a transplant and we're on Medicare when you had it , the Medicare policy will pick up 80% of cost of anti rejection Meds .For my hubby , his anti rejection Medi's cost us only 28 dollars a month ! His Dr had to send in a statement that he had a working kidney transplant in order to get the Medi gap policy he has .He had been on my insurance for a few years until I retired. We are in Minnesota, rules are different in every State .
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Also , if you do have a transplant and we're on Medicare when you had it , the Medicare policy will pick up 80% of cost of anti rejection Meds
I believe this is limited to 3 year post Tx.
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Yes. That is true unless you're on disability, then there is no time limit .
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Yes. That is true unless you're on disability, then there is no time limit .
True but I believe you are only considered disabled for one year post transplant, absent another disabling condition.
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Cow dog,
Your request was about medigap policies....each state is a little different. In Georgia, the best deal going is AARP/United Healthcare. It's pricey if you are below age 62 but well worth it due to cost of dialysis. If you buy a Medigap plan f from AARP you will have zero out of pocket expenses for Medicare type expenses. However, you do need a Part D prescription drug plan. Other states have different providers and rules. Your dialysis social,worker can put you,in touch with their financial,person. A warning they will want you on private insurance for as long as you can go as their reimbursement is better.
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AARP/United is also a very good plan here in Missouri.
Many of us are diabetic, there are MAJOR differences in the co=pays for diabetic supplies, such as insulin. Be double SURE that you look at what those co=pays are when comparing different insurance companies plans.
I have seen co-pays vary from a low of $30 to $115 for the very same supply of insulin pens. That can make a huge difference, especially when the cost of the monthly premiums are very nearly the same. Be aware.
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Another fact that pharmacies will not tell you....if you are a type 1 diabetic on an insulin pump on Medicare....then the insulin is an extension of the pumps durable medical supplies therefore covered under part B. This is major as it does not go against the part D donut hole. In other words there is no out of pocket for insulin nor copays under part D. A very big savings. Not true with pens.
I had to print Medicare documentation to prove to pharmacy.