Medicare primary for dialysis

[jdavren]

Can anyone help? If Medicare is primary for ESRD treatment for a patient who is still covered by an employer's health plan, is Medicare primary for all services?  For example, if that ESRD patient needs a knee replacement, is Medicare or the employer's policy primary?  If the employer's policy, is Medicare secondary for the knee replacement?

[jeannea]

Once your Medicare becomes primary, it is primary for everything. If you get bills you don't understand, unfortunately you'll have to start calling doctor's offices, insurance companies, and Medicare to figure it out.

In good news, I've had only a little trouble with Medicare and my Medicare supplement. Mostly it's a call to the billing office to make sure rhey have all the right info for both in their computer. Your social worker at dialysis can help with some things.

[Sydnee]

We were told Medicare becomes primary after 30 months or in other words after 2 1/2 years of being on dialysis. I guess they figure they got all your money by then

[Speedy1wrc]

Yes on the 30 month waiting period.

Yes, on Medicare being primary for everything once it becomes primary due to ESRD.

Once it happens just make sure every Dr is informed of the change and it should? go smoothly. Depending on your other insurance being in the waiting period might be cheaper.

[amanda100wilson]

Sorry to tag onto this, but if Medicare is primary, and you also  have a secondary private insurance, can you to a provider that doesn't take Medicare but is network with your secondary insurance?

[WishIKnew]

My breast cancer showed up after my 30 months on dialysis so Medicare was primary and yes, Medicare covered my cancer treatments as well.

[jeannea]

I would think you could go to a doctor that only takes your secondary insurance. Be prepared for phone calls and bills where they ask you why Medicare wasn't billed. But it's very unusual to find doctors who don't take Medicare unless they are alternative medicine.

[Speedy1wrc]

Have never found  Dr that doesn't take Medicare.

I have a supplement plan so I have to make sure that the Dr is on the supplement plan's list. It's not a Medicare issue but a plan issue.

That said, they pay for everything fro dentists to eyecare.

I'm an expensive patient too. They aren't making money on me for sure.

[lmunchkin]

We went through this with John.  Here is my understanding of it.  Your employer's insurance will be primary for 30 months, then medicare is primary.  Now when Medcare becomes primary, please note, that your employers provided plan will become 2nd.  If Employer's plan pays everything, no ded or out of pocket, you should be ok as long as you go to their Network.  Now if it is a plan that has a Ded and/or out of pocket amount, then regardless of what medicare pays, you will have to pay what employers plan states.
Lets say Medicare Ded is 350 and your employers plan has a 500 ded with and 80% until you have met an out of pocket of 1500.  Then the empl plan may pay 100% after all is met.  With ESRD, you will have to pay that in the first month, because dialysis is so Darned expensive.  So if your plan looked as I stated above then you would only pay $2350 and both insurance will cover the rest.

Now if your employer has several different plans to pick from, it is possible, that they may offer a supplement to medicare.  But not all do!  Johns did not offer a supplement to Medicare, but his plan did not have any ded or out of pocket. It covered 100% provided we went in Network.  We were lucky, his doctors and hospital were in his network.

Hope this helped.

Happy Easter!!!!   
lmunchkin

[lmunchkin]

We went through this with John.  Here is my understanding of it.  Your employer's insurance will be primary for 30 months, then medicare is primary.  Now when Medcare becomes primary, please note, that your employers provided plan will become 2nd.  If Employer's plan pays everything, no ded or out of pocket, you should be ok as long as you go to their Network.  Now if it is a plan that has a Ded and/or out of pocket amount, then regardless of what medicare pays, you will have to pay what employers plan states.
Lets say Medicare Ded is 350 and your employers plan has a 500 ded with and 80% until you have met an out of pocket of 1500.  Then the empl plan may pay 100% after all is met.  With ESRD, you will have to pay that in the first month, because dialysis is so Darned expensive.  So if your plan looked as I stated above then you would only pay $2350 and both insurance will cover the rest.

Now if your employer has several different plans to pick from, it is possible, that they may offer a supplement to medicare.  But not all do!  Johns did not offer a supplement to Medicare, but his plan did not have any ded or out of pocket. It covered 100% provided we went in Network.  We were lucky, his doctors and hospital were in his network.

Hope this helped.

Happy Easter!!!!
lmunchkin