Medicare.....question #2

[Pam]

When you have private ins. and medicare does medicare cover all medical costs or just those related to ESRD?
Pam

[okarol]

Medicare covers like any other insurance.

[boclark54]

Medicare pays 80% and your private insurance 20% usually if they have Medicare as your primary, if you have no other insurance Medicare still only covers 80%. In my husband's case we got whats called Medicap policy from Insurance Co. Since they only cover the 20% balance the premiums are much lower than they would be if he had it without Medicare.

[TeenHatesDialysis]

I know that the answer to this question is probably posted somewhere in all of the Medicare information on this board, but after searching endlessly I can't find it.

Jaclyn, my daughter, is covered through United Health Care/Pacificare and Medicare A and B. I was told that this should cover all of her anti-rejection meds through at least 3 years after transplant. I should not have co-pays on any anti-rejection meds, including prograf and cellcept. However, since her kidney transplant just over 1 month ago, I have paid in excess of $500 in co-pays for prescription meds, including more than $250 for prograf and cellcept.

The first set of prescriptions was called into the hospital pharmacy and they informed me that they do not bill Medicare and my co-pays were over $350. Then I transferred all of the prescriptions to Walgreens who assured me that they would bill medicare for the $50 copays on the 3 different prograf prescriptions, different strengths and $50 copay on cellcept. When I arrived to pick them up, they told me that it was more complex than they realized and involved a COB or SNL and I would have to bill Medicare myself.

Has anyone found a national pharmacy that will accept insurance and medicare A&B and covers 100% of the anti-rejection meds without charging a copay. $400-$500 per month is a lot to be paying in medication copays when I am paying $700/month for medical insurance and another $100/month for medicare part A & B.

Thank you in advance for input. I am extremely grateful that Jaclyn is healthy and happy.

Susan, mom of Jaclyn