Confused rejected for transplant because medicare is not primary

[jimvaughan]

I went through all the tests for transplant and everything ws good but I was rejected because my primary care was not medicare but a supplemental plan I got before dialysis. I have been told by both major hospitals in my area that they will not put me on the list unless I drop my current coverage and go to basic medicare. Basic medicare will cost $110 per month and I will be unable to get a medigap or supplemental plan to accept me because of the dialysis. I currently pay $89 for my policy plus about $450 per month in co-pays for dialysis. I am concerned that if I drop my current coverage for medicare my costs will skyrocket due to no secondary or medi-gap. Anyone have this experience?

[jbeany]

Talk with the social worker or a financial adviser at your clinic.  When I lost my primary insurance, my social worker quickly found me a gap coverage insurance and switched things around so Medicare was primary.  Policies that will cover the 20% even for a pre-existing condition are out there.

[okarol]

I went through all the tests for transplant and everything ws good but I was rejected because my primary care was not medicare but a supplemental plan I got before dialysis. I have been told by both major hospitals in my area that they will not put me on the list unless I drop my current coverage and go to basic medicare. Basic medicare will cost $110 per month and I will be unable to get a medigap or supplemental plan to accept me because of the dialysis. I currently pay $89 for my policy plus about $450 per month in co-pays for dialysis. I am concerned that if I drop my current coverage for medicare my costs will skyrocket due to no secondary or medi-gap. Anyone have this experience?

How long have you been on dialysis? Medicare becomes primary after 36 months (I think that's right, someone please correct me if I am wrong.)

[Desert Dancer]

I currently have a Medicare Advantage plan that is pulling out of my state at the end of the year. Because of this, I have a special right to purchase a Medigap policy - guaranteed issue, they call it. I just have to wave my cancellation letter in their face.

You may want to find out if loss of your supplemental policy gives you the right to buy another one. That's the impression I've gotten from the Medicare site.

[jimvaughan]

I have been on dialysis for 19 months. Thanks for the replies...I will talk to my social worker although she strikes me as a flake!!

[amanda100wilson]

I thought  Medicare becamerimary after 30 months.

[bleija]

if u dnt like your social worker, then talk to the one at the transplant center.i dnt particularly care for the one i have iether

[willowtreewren]

When Carl first tried to get listed the social worker at the transplant center gave him incorrect information about insurance that kept him off the list for nearly a year.

Question the information that you were given.

Aleta

[smcd23]

I went through all the tests for transplant and everything ws good but I was rejected because my primary care was not medicare but a supplemental plan I got before dialysis. I have been told by both major hospitals in my area that they will not put me on the list unless I drop my current coverage and go to basic medicare. Basic medicare will cost $110 per month and I will be unable to get a medigap or supplemental plan to accept me because of the dialysis. I currently pay $89 for my policy plus about $450 per month in co-pays for dialysis. I am concerned that if I drop my current coverage for medicare my costs will skyrocket due to no secondary or medi-gap. Anyone have this experience?

This supplemental plan - is it through an employer? Because Medicare is only secondary to a group health plan (GHP) for 30 months for someone who is Medicare eligible due to ESRD. You are not required to take Medicare A and B if you have a GHP plan, but if you are buying insurance from a company and it's not work related, you should take the Medicare and switch to a Medigap policy. What state do you live in? They do vary state to state.

We ran into a similar problem with Tony and his Medicare/COBRA when he went on dialysis. He was Medicare eligible back to 2008 when the first transplant happened, then started D in 5/09 and on COBRA in 3/10 (he was in a Union where you pay for your coverage in advance for account for periods of time where there may be little or no work). He never took the Part B because of the 30 month period because it would have cost him money per month, and it really wouldn't have paid anything. Long story but because he switched to COBRA, in order to keep the COBRA, we had to pay 1 year of retro premiums to get him on the Part B before the COBRA started, which the AKF paid for us.

Because you have ESRD, you can enroll in Part B whenever, so it may be worth it. I'll look around and see if I can find anything on Medigap policies in your state for D patients. I know in our state there is only 1 company that does them, and the AKF will pay for it for you. He was on PD, but we only got billed for about $150/month for his supplies, which we filled paperwork out for to have Fresenius "forgive" or waive. He also had to take a Medicare part D plan for drugs. The drug plans cost between $20 - $50+ per month and copays at the pharmacy starting around $5 per drug depending on which one you pick, but you can get extra help through Social Security if you have low income.

[jeannea]

You are incorrect that dialysis keeps you from buying supplemental insurance. You cannot apply for an advantage plan but you can buy Part C from whoever offers it in your area. I use Blue Cross. I pay the approx. $100 for Part B, approx $280 for Part C and approx $100 for Part D. I get pretty good coverage except for the prescription donut hole.

If you go to the Medicare website you can type in your drugs and search for plans. Good luck!

[stringbandbeth]

You might want to contact the American Kidney fund. They pay supplemental insurance premiums for many dialysis and transplant patients. the income guidelines are quite generous.