When should I sign up for Medicare?

[Sax-O-Trix]

I am a bit confused about when you you should actually sign-up for Medicare.  If I sign-up now (15% function, hoping for a living donor, but you never know how things will go) and work full-time, so I currently have good health insurance (have been approved for the tx.)  Do I need to sign-up for Medicare?

When should I sign-up for Medicare?  Should I purchase the drug part?  Do I have to wait until I am on dialysis?  I have read through the gov't website and am still confused, lol.  The hospital team mentioned Medicare when I was at the very beginning of the eval for the transplant (last December) and said the premiums were such and such and blah, blah, blah. 

Any suggestions other than talking to the social worker (that'll take weeks)?

[amyloid man]

I was told that you have to go on Medicare 30 months after starting dialysis-which stinks for me because I will only be 63 and employer was going to pay for my insurance until I was 65.  Now I will have to pay for the suppliment.

[boswife]

i thought that with renal failure at a certain point (gfr type thing) you could start medicare as a secondary, that way preparing for dialysis or??  Hubby went out of work with heart problems, and kidney problems.  He was on my insurance at that time and i think he kept both until i was done, and then it combined to Kiaser medicare.  Wish i could remember for sure.. big help!!  I do know he did all this before dialysis though..

[rsudock]

hey Sax,
 I have my private insurance and medicare. As soons as you start dialysis you qualify.  I am not sure what the rules are for folks who are not yet starting dialysis. So now for me medicare is secondary and my insurance is primary but after so many months (30?...if somone knows for sure please add the correct info) medicare will be primary and my insurance will be secondary...but of course I am not going to work at my job after this year. When I quit this job I will apply to the National Kidney Foundation to help me pay the COBRA premiums for my private insurance to last me until my boyfriend gets out of college and we get married. 

if I were you take a day off of work and go to the social security adminstration building and ask them personally. I went around 1pm and no one was there and I got all my questions answered!

xo,
R

[thegrammalady]

if you are under 65 and on dialysis you qualify for medicare. there is a 4 month waiting period from application. if you are covered by private insurance they are primary for 30 months and medicare secondary. at 30 months the reverse is true. if you are under 65 you do not qualify for a supplemental medicare policy even though you qualify for medicare. at any rate that's my understanding. if you are with a fresenius clinic and need insurance the finance office will help you, talk to your social worker. they really don't want to write off the 20% medicare doesn't pay but will if there is no other available option.  when you sign up for medicare be sure you sign up for part a, b and d. you need all three. if your income is low enough there is state and federal help for paying the part b and d premiums.

[Sax-O-Trix]

Okay, here I sit potentially 16 days away from a preemptive transplant and still can't get a straight answer about when I should sign up for Medicare...  I even called Medicare and they read from the flipping script and won't give you "advice" and then referred me to SS.

Medicare states that if you don't sign up for Medicare A before you have your transplant, you do NOT qualify to sign up for Medicare B afterwards.  So, if I do not sign up for Medicare A now, I will not get help with the immunosuppressent drug costs afterwards if I need to sign up for part B.  The Medicare site clearly states this fact.

The potential issue is that wiith all the budget cuts in my state, I could be out of a job in September or next year or the year after, who knows.  No job = no insurance.  I could potentially make it 11 years until I can retire at 55 (and pay for the insurance at the retirement rate), have a job/insurance for 20 years if I am healthy enough or lose everything in 6 months.  You cannot tell your transplant social worker that you are worried about your job/insurance, they will not let you get a transplant if they think you can't pay for the drugs afterwards...


What do I need to sign up for Medicare on my own or does the transplant social worker have to sign me up?  I need to get this done this week...  I think it is in my best interest to sign up for part A now in case I need to sign up for part B sometime in the next 36 months. 

Any thoughts?

[billmoria]

Sign up as soon as possible..........

[onestronglittlelady]

If you sign up as soon as possible, then your application is on file. Even if they need additional information (copies of old taxes/other paperwork) your application date is what is important. Somethings have a waiting period, other things are back dated to your filing date. I filed my Medicare stuff while in the hospital, on the internet. Depending upon what State you live in, there may be other assistance you qualify for. Good luck with your transplant!

[Jie]

Medicare states that if you don't sign up for Medicare A before you have your transplant, you do NOT qualify to sign up for Medicare B afterwards.  So, if I do not sign up for Medicare A now, I will not get help with the immunosuppressent drug costs afterwards if I need to sign up for part B.  The Medicare site clearly states this fact.

Could you provide a link to the Medicare page that has this policy? It seems this is a confusing area and some posters in the past said this was not true.

[carol1987]

Medicare states that if you don't sign up for Medicare A before you have your transplant, you do NOT qualify to sign up for Medicare B afterwards.  So, if I do not sign up for Medicare A now, I will not get help with the immunosuppressent drug costs afterwards if I need to sign up for part B.  The Medicare site clearly states this fact.

Could you provide a link to the Medicare page that has this policy? It seems this is a confusing area and some posters in the past said this was not true.

Well my Social worker at the transplant center asked if I wanted to sign up for Part B after I had my transplant... and I was not on medicare yet. So I do not know if that is accurate...
    then when she found out I had Medco she made it seem that it would not be beneficial to sign up for Part B now..

[Sax-O-Trix]

This is from the Medicare.Gov link (page 14): www.medicare.gov/Publications/Pubs/pdf/10128.pdf

Do I Have to Get Medicare if I Already Have an Employer or Union Group Health Plan?  No, but you should think carefully about this decision. If you get a kidney transplant, you will need to take immunosuppressive drugs for the rest of your life, so it’s important to know if they will be covered. If you’re entitled to Medicare only because of ESRD (you’re not over 65 or disabled), Part B will only cover your immunosuppressive drugs (see pages 30–32) if you already had Part A at the time of the transplant, and the transplant surgery was performed at a Medicare-approved facility.
Note that Part B will only cover the immunosuppressive drugs after you’re enrolled in Part B. There won’t be any retroactive coverage.
Note: If you don’t meet the conditions for Part B coverage of immunosuppressive drugs, you may be able to get coverage by joining a Medicare Prescription Drug Plan. See pages 37–39.:

P.S. My Social worker assured me that I did not have to sign up for Medicare before the transplant, but that it not the way I read the above statement...  I didn't sign up.  She says I have to at 30 months.  I asked her "what if I lose my job?" and she said I can sign up then.  I even showed her the above statement and she assured me she has been doing this job for 20 plus years and I did not have to sign up pre-transplant.  I just hope I don't lose my job and have to find out she is wrong.

[carol1987]

This is from the Medicare.gov/publications link:

Do I Have to Get Medicare if I Already Have an Employer or Union Group Health Plan?  No, but you should think carefully about this decision. If you get a kidney transplant, you will need to take immunosuppressive drugs for the rest of your life, so it’s important to know if they will be covered. If you’re entitled to Medicare only because of ESRD (you’re not over 65 or disabled), Part B will only cover your immunosuppressive drugs (see pages 30–32) if you already had Part A at the time of the transplant, and the transplant surgery was performed at a Medicare-approved facility.
Note that Part B will only cover the immunosuppressive drugs after you’re enrolled in Part B. There won’t be any retroactive coverage.
Note: If you don’t meet the conditions for Part B coverage of immunosuppressive drugs, you may be able to get coverage by joining a Medicare Prescription Drug Plan. See pages 37–39.:

frankly I think that it sucks that there are social workers at the hospitals, dialysis centers, transplant centers  etc and none of them seem to give any guidance !!!
I can only share my experience...  I have private insurance and when I was on D they said nothing about medicare... and the transplant social worker said what was in my above post...after transplant...
I still have private insurance covering all immunosupressant meds... with a relatively small co-pay.   Medicare will only pay the first 3 years after transplant anyway and   god-willing my private insurance should be in effect those 3 years...
This whole thing makes me  want to pull my hair out...

[carol1987]

This is from the Medicare.Gov link (page 14): www.medicare.gov/Publications/Pubs/pdf/10128.pdf

Do I Have to Get Medicare if I Already Have an Employer or Union Group Health Plan?  No, but you should think carefully about this decision. If you get a kidney transplant, you will need to take immunosuppressive drugs for the rest of your life, so it’s important to know if they will be covered. If you’re entitled to Medicare only because of ESRD (you’re not over 65 or disabled), Part B will only cover your immunosuppressive drugs (see pages 30–32) if you already had Part A at the time of the transplant, and the transplant surgery was performed at a Medicare-approved facility.
Note that Part B will only cover the immunosuppressive drugs after you’re enrolled in Part B. There won’t be any retroactive coverage.
Note: If you don’t meet the conditions for Part B coverage of immunosuppressive drugs, you may be able to get coverage by joining a Medicare Prescription Drug Plan. See pages 37–39.:

P.S. My Social worker assured me that I did not have to sign up for Medicare before the transplant, but that it not the way I read the above statement...  I didn't sign up.  She says I have to at 30 months.  I asked her "what if I lose my job?" and she said I can sign up then.  I even showed her the above statement and she assured me she has been doing this job for 20 plus years and I did not have to sign up pre-transplant.  I just hope I don't lose my job and have to find out she is wrong.

But all of this starts after the 4 month waiting period that begins when you start dialysis.... and there is also something about the 30 month co=ordination of benefits.... in the next few paragraphs after the one you quoted.
so how does that work with pre-emptive transplants or when you get a transplant , as I did an month after beginning D ... when you can't sign up yet??

[cookie2008]

If you have private insurance thats the way to go but if your employer has less than 100 employees then medicare becomes primary before the 30 months, that is what happened to me.

[KarenInWA]

I have excellent insurance through my union-job right now.  I just started D yesterday, and signed the Medicare paperwork at my clinic to get the ball rolling on that.  I went thru transplant eval on Dec 1st and it was suggested to me by the social worker to sign up for Medicare, if only so they will pay for my immunosuppressive meds once I turn 65 (or whatever age they're going to make us wait for with all these budget cuts).  I figure it's better to be safe than sorry. 

I do think it is ridiculous all the hoops we must jump through just to stay alive in the USA.  What a joke.

KarenInWA

[Jie]

This is from the Medicare.Gov link (page 14): www.medicare.gov/Publications/Pubs/pdf/10128.pdf

Do I Have to Get Medicare if I Already Have an Employer or Union Group Health Plan?  No, but you should think carefully about this decision. If you get a kidney transplant, you will need to take immunosuppressive drugs for the rest of your life, so it’s important to know if they will be covered. If you’re entitled to Medicare only because of ESRD (you’re not over 65 or disabled), Part B will only cover your immunosuppressive drugs (see pages 30–32) if you already had Part A at the time of the transplant, and the transplant surgery was performed at a Medicare-approved facility.
Note that Part B will only cover the immunosuppressive drugs after you’re enrolled in Part B. There won’t be any retroactive coverage.
Note: If you don’t meet the conditions for Part B coverage of immunosuppressive drugs, you may be able to get coverage by joining a Medicare Prescription Drug Plan. See pages 37–39.:

P.S. My Social worker assured me that I did not have to sign up for Medicare before the transplant, but that it not the way I read the above statement...  I didn't sign up.  She says I have to at 30 months.  I asked her "what if I lose my job?" and she said I can sign up then.  I even showed her the above statement and she assured me she has been doing this job for 20 plus years and I did not have to sign up pre-transplant.  I just hope I don't lose my job and have to find out she is wrong.

Thanks.

The social worker told me at my evaluation that one had to sign up Medicare at the time of transplant in order to get the covery of immunosuppressive drugs.  However, several posters said it was not true based on their experience. I did not sign up Medicare at the time of transplant. I have two private insurances and Medicare does not pay anything within the first 30 months. I am thinking to sign up Medicare at Month 30. One thing I am concerned for signing up Medicare is that Medicare does not pay for brand name immunosuppressive drugs I am taking. It is not good to switch to genetic versions. I am not sure my workplace requires me to sign up Medicare at month 30 or not, It not, I will not sign it up. It is frustrating to get information from Medicare through the phone.

[*kana*]

I was told by Medicare that I didnt need to sign up until I got close to the 30 mth mark or was in the hospital getting a cadaver transplant up until I think 30 days post transplant. 

[WfMonkey]

I'm sure that to get a job at Medicare you need to have first been fired from the DMV for being too rude and too slow.

I tried to sign up for Medicare and got the runaround, and a lot of script reading. First they tried to process a disability claim for me, which I didn't want. My English accent was apparently very hard to understand, because I said 5 times that I didn't qualify for disability because I work. When the script got to "when did you last work" I answered "I'm at work now" and got told I was formally being denied disability...ok good, on to Medicare.

After being told that I was too young for Medicare and explaining that I did qualify because of ESRD, I finally got her to the ESRD script. First question: when was your transplant? I haven't had it yet. When is it scheduled? It's not yet scheduled. How long have you been on dialysis? I'm not. Then you have no claim. At this point I was ready to quit and told her I would call back from the ambulance on the way to hospital. Somehow this worked and she asked if I had any proceedures relating to ESRD. I told her I had a ultrasound recently, and she said I could file a claim for that, but the hospital needed to fill out a form documenting the proceedure and confirming that I have ESRD. I asked my nephrologist to help me with this and they said they had never heard of this form. They even checked with the dialysis unit, who said I couldn't get Medicare until I'm on dialysis.

I'm taking a break from it because it's not getting me anywhere, but it does sound like if you have a transplant date you should be able to process a claim, which seems to be the key to getting coverage.

[HouseOfDialysis]

You wouldn't qualify for Medicare until you are on dialysis, either hemo or PD, or if you have a transplant.

[Willis]

You wouldn't qualify for Medicare until you are on dialysis, either hemo or PD, or if you have a transplant.

That is my conclusion as well. It seems that the month you start dialysis you are eligible for Medicare back to the first of that month. Don't hold me to that because every time I talk to someone at SS the story changes. 

And now there is a really big snag in dealing with SS...they will no longer mail out personal history statements EVEN IF PERSONALLY REQUESTED. And when you try to sign-up online so you can get into the system and download the statement for yourself you can't complete the online forms unless you are old enough to apply for regular Medicare. In other words, you answer all sorts of eligibility questions and the process even says (my paraphrase from memory): "OK, since you have ESRD you are eligible to apply for Medicare. Click this link to apply..." Click the link and start to fill out the form and then "BOING!" error! You aren't old enough to apply for Medicare.