Medicare...Do I need it?

[Pam]

Are you required to sign up for Medicare? I have privatei]insurance. They pay everything 100% except for copays on meds. I will be elagable for Medicare on Aug 1. I know getting Medicare will save the Ins Co. money but will it do anything for me other than be another bill I have to pay every month. I confess.....I just don't understand have of this stuff.
 
Pam

[MIbarra]

I never bothered with it. My private insurance was good enough. However, your insurance may contact you and have you get it if you are eligible for medicare to be your primary insurance. That way they get out of paying for you.

[paul.karen]

Im not 100% but i (think) i read that private insurance will only pay for dialysis for three years then they drop you???

Hopefully someone will say true or false...

Ps.  if you get medicare you have to pay for it???

[MIbarra]

They don't drop you. They become your seconday insurance. Yes you have to pay for it. When I was given the option it was about $80 a month.

[paul.karen]

 
 

[Pam]

Yes .you have to pay for it. My husband is retired from GM and he had to sign up for Medicare this yr. GM used to pay for the cost but as part of their restructuring they don't cover that any more. Paying $160/mo for both of us is way more than I can afford. Guess I will have to call the Ins Co. and hope I get somebody that knows something.
Pam

[cariad]

I have medicare and private insurance currently. I probably would have taken them both regardless, because in my life, there is simply no such thing as "overinsured". However....

I was told by one financial person at a transplant hospital that if you do not sign up for Medicare when you first become eligible, then you will have to pay a penalty rate (medicare says 10% more per year for every year that you do not sign up) if you ever decide you do need it.

Then an employee down at Social Security said that is not necessarily true, and (surprise, surprise) it is complicated. It's possible that the person at the transplant hospital was thinking of situations where you turn 65 and turn down Medicare, then change your mind. It did scare me, though, and it is not something I want to toy with. Part A is automatic and free (or so I was told) so I assume you are just asking about Part B? I thought once it came to dialysis and transplant, a patient was on Medicare, like it or not. It costs $96/month right now, but you can get help with that so long as you are very close to the poverty line and have few assets. (They will send you a questionaire to fill out to see if you qualify for help with payments.)

I hope someone can clear this up for you. I would call Medicare and ask what the consequences of refusing coverage are for your specific case.

[Wenchie58]

I had my transplant in October.  According to my insurance company I MUST apply for Medicare within 30 months after transplant.  At that time my insurance will become secondary.  To add another twist...Medicare will only cover me for 36 months after transplant.  I opted to wait until month 30...therefore I only have to pay for Medicare AND my insurance for 6 months.  After the 36th month post transplant my insurance will once again become primary.
Only took me three conversations with the finance person at transplant clinic to get this all straight in my head.  Good luck.

[MIbarra]

From what I received from medicare, you do not have to pay the penalty for signing up with medicare later one as long as you can prove you had other insurance beforehand.

[Pam]

  everyone! I am going to try and get ahold of a benefit rep tomorrow. I wish I could do this in person and not on the phone. I feel like if I can talk to someone face to face I can tell if they understand what I'm saying. I hate telephones! In a perfect world I would let DH figure it out but that will never happen. He doesn't even want to what day the bills are due  or how much they are.
Pam

[Jie]

I can get something to clear up here, but I also have questions.

First, for ESRD patients, during the first 30 months after the dialysis, medicare is the secondary and private insurance is primary if one has it. One can sign up medicare when starting dialysis. Part A is free and Part B costs money. If one signs up part A only, then there are a penalty later when signing up Part B. If one does not sign up medicare at the beginning of dialysis, then he or she can sign up during the oppening enrolment period each year (Jan-March, effective July 1). After 30 months, medicare becomes primary. Part B must be signed up at the time of translant or earlier for medicare to cover the post-transplant medicines.

My question is
Do these 30 months include transplant? Suppose one has 6 months of dialysis and then has a transplant, and this person has private insurance, does medicare become primary to cover the transplant cost?
If one has two private insurances, medicare will not pay a single cent if it is not primary. So in this case, it is not worthy to have medicare if it is not primary. However, if one does not sign up part B at the time of transplant, then medicare will not cover any post-transplant drugs.

For those who have done transplants, how have you dealed with this problem with medicare?

[TeenHatesDialysis]

Help!  This is so confusing! I pay for Pacificare/United Healthcare insurance for Jaclyn and I added Medicare A & B prior to her transplant. Part A is free, but I pay an additional approx $100 per month for part B. LPCH @ Stanford does not bill Medicare for the copays so I was stuck paying $200 copay for 3 different doses of Prograf and one prescription of Cellcept the first week after transplant. I transferred her prescriptions to Walgreens who over the phone said that they would bill Medicare, but when I picked up the prescriptions I was stuck with another $200 copays for anti-rejection meds because they said that the COB or SNL paperwork was too complicated and I would have to fill it out myself. $50 copay for 5mg prograf, $50 copay for 1 mg prograf, $50 copy for .5 mg prograf and $50 copay for cellcept should be covered by Medicare. She also takes valcyte and bactrim and norvasc and a couple of other $50 copay meds. I can't beleive that I am still paying so much in meds with healthcare and medicare.

Any advice would be greatly appreciated!

[Chris]

! thing not mentioned about insurance is  the total amount  per person that they will cover, which could be used up quick with dialysis and then transplant. This was discussed with another member on here and filling for Medicare is the best option.

THD, yes there is a $96.40 amount per month Meddicare dectable that you have to pay each month unless you are on state Medicaid and meet requirements for them to pay each month. As far as prescriptions go,I don't pay anything for anti rejection meds. However I use a mail order pharmacy for those. Local pharmacy did that to me and the price kept changing each month until I finally found another mail order pharmacy. I had a really good local mail order pharmacy nd they were bought out by CVS and service went down hill, but never had to pay for those meds even after switch. Only local pharmacy has billed me for those meds. I would go on Medicares website and sign up for their mail order prescription plan. Your daughter should be able to get Part D Coverage even though it is Part B that is billed. It's complicated, but basically I have to talk to 2 different departments when ordering meds. One for Immunos and the other for the maintenance drugs. Only use local pharmacy for meds I need ASAP.

[magsbyt]

I have continued to work and have Human as my primary insurance.  I have Medicare Part A and have opted out of the Part B program since Humana has continued to pay for all of my dialysis, my meds, etc.  After nearly 2 1/2 years at a DaVita clinic, I recently switched to a Fresinius clinic at Vanderbilt Hospital.  I've been there for over a month.  Just recently, the counselor told me she was reviewing my chart and notified me that December was my 30 month on dialysis and I should have had Medicare as my primary payer.  I informed her that I had fantastic coverage thru Humana and didn't need Medicare wherein she explained to me that it was the law that I should have Medicare Part B as my primary coverage and that the counselor at the DaVita clinic should have met with me in September to get all of this going since it takes roughly 90 days to get this going.  I haven't found anything Medicare's website that states it's mandatory for me to have it as my primary coverage and in speaking with Humana, they have not indicated that they are no longer paying as primary.  I am confused by all of this.  My fear now is that Humana will reprocess claims as secondary, leaving me to cover all of the remaining 80% of the dialysis treatments and meds since December.  Can someone help me sort all of this out?  And what can I do about the counselor at DaVita if this should have been handled by her at the time?  Who knows all of this stuff? 

[Chris]

magsbyt  I would first call Medicare and actually talk to some one live there. They have people there even after you get off work, which is good since you maybe on hold for many minutes. Explain what was told to you and what your concerns are. Somethings on their site are hard to find or not there, so best to actually talk to a live person.
 
Good Luck