medicare and medigap not enough for transplant

[marlinfshr]

I just got off the phone with the financial adviser for the transplant unit. They are taking me off the list.

She says my current insurance wont be enough to cover a transplant. OK! They told me at the evaluation everything was good but I can accept that since it is up at the end of the year anyways, and since I just got listed recently and have type O, I wouldn't need to worry about one any time soon any way and was planning on waiting to get a new policy starting Jan. 1st, as my social worker recommended due to already paying out of pocket max for this year.

Then while talking to her I got even more confused. First I made the mistake of saying that the AKF was covering my deductible and she told me that doesn't get looked at very well in regards to getting a transplant. I brought that up because I was confused when she mentioned about me needing to apply with the states KDP (kidney disease program) for any post transplant assistance. Me and my big mouth (I thought they were the same). My social worker never mentioned that. But it probably doesn't matter because I am already on there bad list because of using the AKF for helping with my current premiums. She didn't believe that I could afford my premiums post transplant if I don't qualify for the state's KDP because I'm having the AKF pay my current premiums which they stop doing once transplanted

So then I bring up that I was planning to call SS this week to start applying for medicare. I was planning to apply for part A, B, then get part D and a medigap policy in which due to my age (45) I only qualify for medigap part A level 1. She stated that the medigap policy part A won't cover part B. That any hospital stays (which there will be many post transplant) will require a high deductible EACH visit. So now it doesn't look like I would qualify for a transplant with medicare because the medigap doesn't cover anything. She also brought up how expensive the part D donought hole is (about $3000) and that most people would have other insurance for their prescriptions as they cost 5 to 6000/ month. She doesn't see how I can afford the donought hole. (of course she doesnt know my financial info so how would she know that?) I guess even with part D I'd be paying several grand/month for medication? I thought once I went through the donought hole all would be covered. Oh well, wrong again.

Then she wanted to check my claim since I stated that I applied for SSDI back in May. UH OH, another negative. It seems that since I applied for SSDI I wont be able to get medicare for 24 month's. ?? Huh? I thought haveing ESRD and being on dialysis (hemo starting may 1st and home PD for the past 1 1/2 month's) qualified me for mediacre and that it would start at home dialysis. Another notch against me.

Then the final blow was when she tried to check my current claim and I stated the number having an HA at the end. She said that was it, I only qualify for medicare hospital (part A) since my current SS claim number has those letters following it. Oh well.

I guess I have to study these new insurance plans that they came out with to see if I can decipher what they will cover since it doesn't seem medicare really covers anything in regards to a transplant.

Does this sound legit? I understand they want to make sure they'll be covered, but everything I read shows medicare covers this. Am I missing something? Is it best just to get a new policy if I can afford one and bypass medicare altogether?

The not qualifying for medicare part B even though I have ESRD, not being able to start medicare for 24 month's, and the medigap not covering anything and me still having to pay the 20% or so medicare doesn't cover really has me confused.

I'm also a little upset in that when I went to the transplant evaluation back in Aug they said everything looked real good with my insurance for now. That I should get on medicare with a medigap so I could get part D for prescriptions though. Today I was told that what they said doesn't matter because she is the one who is actually in charge of seeing if everything was OK.

[Shaks24]

Definately does not sound right to me. If you get medicare part A and B and D for prescriptions along with a Medigap like F you would have pretty darn good coverage.  The biggest void I would see in this is the donut hole in prescription D. Medigap policies for ERSD folks under 65 have high premiums and may not be available in all states.

[Shaks24]

My plan is to get the coverages I listed in the above post as soon as I can. I researched it in my state of Tennessee and spoke with a couple of brokers. This coverage would cost about 500 a month in Tennessee.  The Medigap F for under 65 is the most costly part at about 350 in 2013. Still a bargain compared to not being covered.

[marlinfshr]

I'm trying to sort through this mess. I believe i still have time as I want any new policy to go into affect as of Jan. 1st.

I looked back at the BCBS site and available medigap policy's for me. Since I'm under 65 (45) I only qualify for the medigap plan A. Looking at what it covers, it seems to cover everthing that regular medicare pln A & B does not cover, except for the deductibles which are $1184 part A and $147 part B. It says both are ANNUAL deductibles. The financial lady at the transplant center specifically told me that with that medigap policy that the deductibles would have to be payed EVERY time I went into the hospital.She said they used to be a toatal for the year but now are to be payed each time. I'm usually pretty good at deciphering forms and info and I swear the BCBS site showes clearely that the deductibles are annual in which case I should only pay them once. What am I misunderstanding? Or is this lady mis-interpreting the info and just trying anything NOT to list anybody.

I have no problem coming up with an 1184 deductible for the year but per visit?

[nursey66]

Medicare part A does have a deductable of around 1100 dollars each hospital admission, unless the admits are real close together, a certain # of days between, however ,your part C or suppliment /medigap/ whatever else you get to go with the Medicare should be picking that up. My hubby had 4 admits this year and all the extras were picked up by his part C coverage, BCBS Cost Plan available in our state for 109.00 a month. Every state is diferent, though, you need to talk to an Ins. person that specializes in Medicare Plans. I would not count on the Social Workers for help.

[marlinfshr]

Thanks, so it sounds like she is right then. Now I am under the impression since I'm under 65 I cannot get medicare part C. So I am stuck with only medigap part A for the state of MD.

I did get through with SS today believe it or not and they will get back with me in the next couple of days for an appointment. However, it seems based on having to pay that deductible with every visit I will probably be better going with one of the new policy's on the exchange, or at least through BCBS. I'm sure that once I get a transplant (if reinstated) that I'll be spending more then one visit in the hospital. It looks like the platinum is very good and total out of pocket per year would probably be less going that route then if I go with medicare part A,B D and medigap A. It looks like the platinum plan has good prescription coverage as well without a doughnut hole. Perhaps I'm reading the info wrong. has anybody checked it out? Or does anybody know of any prescription plans other then part D or any supplemental plans to cover what medicare covers without using medigap?

The more I'm thinking it might just be better to go with a regular insuarance policy instead of medicare. Any ideas.

[jeannea]

You can get medigap Part C. You cannot get what are called Advantage Plans. Do a search on the Medicare website (if it works during shutdown) for plans by zip code.

[marlinfshr]

Well, I'm approved for medicare part A & B so now it's time to get a medigap. as I stated in my earlier posts, I am under 65 so plans are very limited. BCBS offers only a plan A medigap and Omaha offer a plan A and a plan F. The difference in premiums is about $300/month which is a lot for me.
Would a plan A be acceptable? Does anybody here have a plan A and is it covering everything with the exception of deductibles? Or are over charges and balance billing common enough that a medigap plan A would be useless and it would be preferable to pay the extra 3600/year for a plan F?

As far as deductibles go, that extra 3600/year for a medigap plan F is equivalent to 3 part A hospital deductibles if I have to go in on three different periods. I'm type "O" so I don't foresee a transplant for at least several years so I'm thinking of just saving my money and getting the medigap A. It's just the possibilities of extra charges for my dialysis treatments that worry me.

[Shaks24]

I pondered the same thoughts. My conclusion was that with kidney failure and dialysis in play, numerous other complications could possibly arise. Based on that I went with F as a safety cushion. I too hate paying the extra premium for F but I look at it as insurance based on the premise that kidney patient generally have complications. I guess time will tell.

[marlinfshr]

Well, I guess my question has been answered, Even though when I punch in "plans for MD residents under 65" i come up with 3 plan A's available and one plan F which says is available from Omaha insurance, but when I called Omaha insurance they have no plans available for under 65. It looks like the only plan available in MD for under 65 is a plan A through either BCBS or AETNA for $10.00 less. Oh well, kind of makes my decision easier. But I will be worried about the overage charges beyond the 80/20 percent I might get that a plan A won't cover. It's not the deductibles I'm worried about as I'd have to pay them anyway if I just went with a regualar insurance policy.

[Shaks24]

Try contacting your states SHIP (i think thats what its called) They should have the latest on medigap policies in your state.  They change every year.

[jeannea]

I'm confused by you saying a Plan A and Plan F available. Part A is what we all get. That's original Medicare. i have Part C and that seems to cover my extra costs. Plan F is supposed to be a little fancier with a little extra coverage.

[marlinfshr]

Part A is part of medicare. There is also a plan "A" medigap coverage which seems to be the only medigap policy I can get in MD since I'm under 65. Plan "A" medigap is the basic plan which covers the 20% medicare does not cover. It does NOT cover any overages or deductibles.

[nursey66]

In our state Minnesota, age under 65 doesn't matter. If you are on  Medicare, you qualify for a suppliment/or part C as it's called. My hubby just turned 61 & has a very good part C for 109 a month. His bills this past year were over 300,000. Yes that is in dollars!! We had no copays or deductable to pay so far. Medicare paid first and the part C picked up the rest !!  We feel very fortunate.

[Shaks24]

Unfortunately every state is different on medigap for under 65. There are still states where you can not even buy it because the insurance companies will not sell it to you knowing they will have to pay out because if you are under 65 and have medicare something is seriously wrong. The feds need to step in on this and mandate uniformity like they do with medicare. Premium prices are all over the place depending where you live but in most states if your under 65 you will pay quite a bit more than a 65 year old. In this instance being younger bites you in rear and in the wallet in most cases.