do i have to apply for medicare?

[carol1987]

I was on dialysis for a couple of months and received a transplant of 1/6/11. I m fortunate to  have excellent insurance... have not seen a bill except for medication co-pays.   Yesterday I got a call from soc security... the social worker at the transplant surgeons filed for medicare for me. Last I spoke with her she indicated that since I have to used medco for meds  tht it would not be worth it for me to apply. 
The ss representative mentioned the 30 month window  where medicare becomes primary and my private becomes secondary... i though that only applied to dialysis treatments?
If I don't apply and pay for medicare now,can my private insurance refuse to pay after the 30 months? 

who would be the best resource to contact? Obviously I don't want to have to pay for medicare when I already have good insurance... but I don' want to end up in a pickle down the road....

Thanks, Carol

[Jie]

If you pay medicine co-payment, is it easier to sign up medicare to cover your co-payment for the first 30 months? To me, more difficult decision is for someone who has two private insurances and does not need to pay much co-payment. The Medicare answer line informed me that the 30 months apply to both dialysis and transplant. However, she also gave me some wrong answers to the other questions, so I am not sure this is the right answer or not.

[carol1987]

Its frustrating isn't it Jie....  I think that Medco won't take medicare for co-payment...  and my co-payment is not really bad...
Just worried about long term...

[rhood151]

I am working on this very issue right now.  The coordination of benefits rules state that medicare will become the primary payer after 30 months of medicare eligibility if you have ESRD.  The key is eligibility, not enrollment.  In other words, your private payer will become secondary to medicare after 30 months regardless of whether you are enrolled in Medicare or not.  They will then pay as secondary and if you haven't signed up for medicare, you have no primary insurance and your current insurance will pay only 20% of medicare, leaving you with the remaining 80%.

As authority please go to http://benefitslink.com/boards/lofiversion/index.php/t28778.html about half way down the page there is a reference to a Nov. 2, 1993 discussion from HCFA (now CMS)

[carol1987]

Rhood151...
Thanks... do you know if you can wait to sign up for medicare or will they backcharge you for the 30 months of enrollment fees anyway?

I began dialysis  in October... stopped and went on in December for one month and then got my transplant... The social workers all ask if you want to sign up for medicare.... but can't seem to answer any direct questions...
What the heck is the point  of all of the "social Workers" at the hospitals/D centers and dr's offices if they don't help you figure this stuff out?

Which medicare do you enroll in? 

[Jie]

It is correct that the 30 months start from the first month for the home dialysis and 4th month for in-center dialysis. What is not clear is whether an active employee has to sign up medicare after the 30 months. In my workplace, the retiree has to sign up medicare when the age reaches the medicare age. It does not say anything about active employee. For transplant patients, there may be some problems because medicare may not allow some brand name drugs if one needs to switch to medicare sometime after transplant.

I am sure there is not backcharge. If one signs up medicare Part A without Part B, and sign up Part B later, then there is a penalty.

[paul.karen]

Couldnt be any easier

[carol1987]

JIE  Thanks..the medicare a /b VS. b only penalty must be what the soc worker was talking about when she mentioned backcharges...

Paul.karen  you got that right!! easy peasy.. LOL

[cookie2008]

call medicare and ask make a list.

[carol1987]

Thanks Cookie... I will... just frustrating that social workers and the woman from social security all ask do you want to apply and when I ask them if I should they have no answers.  They don't even give the phone number for medicare... 

[tyefly]

 I have private insurance    and   I sign up for medicare part A and B.....   when I went on Dialysis....   I was told by my insurance company that it was my choice if I sign up for medicare part B and if I did my rates would be lowered....   Well that did not happen....   I still pay full insurance rates and I pay 110.00 per month for medicare.... my rates for my insurance company will not go down untill the 30 months when medicare becomes primary....its very confusing..... I called and tried to drop the Part B and I was told that if I did I would loose my private insurance....  I called my private insurance and ask about dropping Part B and they told me that I could but if I did I would either be kick off my group plan or I my rates would go up and I would have a whole new bunch of co-pays....   
I guess if it was me to do it again..... I would NOT sign up for part B until my 30 months was up...and then sign up...I dont think you get a penality for that.....   
So confusing  and it cost alot of money..... 

[Bill Peckham]

I have private insurance    and   I sign up for medicare part A and B.....   when I went on Dialysis....   I was told by my insurance company that it was my choice if I sign up for medicare part B and if I did my rates would be lowered....   Well that did not happen....   I still pay full insurance rates and I pay 110.00 per month for medicare.... my rates for my insurance company will not go down untill the 30 months when medicare becomes primary....its very confusing..... I called and tried to drop the Part B and I was told that if I did I would loose my private insurance....  I called my private insurance and ask about dropping Part B and they told me that I could but if I did I would either be kick off my group plan or I my rates would go up and I would have a whole new bunch of co-pays....   
I guess if it was me to do it again..... I would NOT sign up for part B until my 30 months was up...and then sign up...I dont think you get a penality for that.....   
So confusing  and it cost alot of money.....

What would happen if you did not have Part B is that you would be responsible for the copays that go with your private insurance. If for instance your insurance paid $1,000/treatment and you had a 10% copay (not at all uncommon) you'd be on the hook for $100 each treatment. If you have Medicare B secondary then, if your private insurance pays more than Medicare B would allow, (the Medicare allowable is about $250/treatment, so yes the private insurance is paying more - even at 90%), then the Medicare B rules say that you can not be billed for the difference.

Basically by having Medicare Part B as your secondary you are forcing your dialysis company to take what your private insurance pays and no more. That $110 premium is probably saving you thousand(s) of dollars depending on what percent of what amount your private insurance pays.

[tyefly]

to Add   I was told that I would not have to pay co-pays if I was doing home dialysis..... if I didnt have medicare part B......but all private insurance is different.....I have kaiser..... and I pay a bundle each month.....like 477.00 on my group insurance..... but we own the company so we are self insured......  But I think Bill is correct...I am not going to challenage anything......  110.00 per month is to me just the cost of doing business with medicare and kaiser.....at least that is how I will justify....

[Meinuk]

There are timing and $$ issues when you don't apply for Part B when you start dialysis.  If you apply for Part A (usually no-copay if you qualify with work credits) and you do not apply for Part B ($115.00 as of Jan 1, 2011)

From: http://www.kidney.org/professionals/CNSW/pdf/ESRD_medicare_guidelines.pdf

D. Deferring Medicare Enrollment
When an individual has an EGHP, Medicare enrollment (both A and B) can be deferred. However it is important to fully understand the benefits and limitations of the EGHP before making that decision.

The following will need to be considered:

• Are there yearly deductible or coinsurance costs?
• Is there a yearly renal services limitation? Some policies may have a capitation on the amount paid yearly for renal services. This is typically $30,000.
• What is the lifetime limit of the EGHP and is the individual nearing this limit?

If there are limitations, enrolling in Medicare would be beneficial. If the EGHP does not have limitations and will pay all health costs during the COB the individual may want to delay Medicare enrollment until the COB is over.

When an individual defers Medicare enrollment he/she has options for the start date of Part B. These options are:

• The earliest possible month of entitlement (no more than 12 months retroactivity), if willing and able to pay all back premiums
• The month in which the application is filed or
• The month in which the enrollment is processed

E. Financial Implications of Deferring Medicare Enrollment

An individual can enroll in ESRD Medicare at any point from the initiation of treatment through the COB. There is no penalty for deferring enrollment until this time. However, enrollment must be for Medicare Part A and B. If Part B is not signed up for at the same time, he/she must wait for the General Enrollment period (January – March) to apply. Under a General Enrollment period, Part B is not effective until July of the year in which application is made and the premium rate will be higher. There are no provisions for a special enrollment period specific to ESRD
Medicare.

If an individual has Medicare on the basis of age or disability and is paying higher premiums for Part B because he/she did not sign up for Part B when first eligible, premiums can be reduced by applying for ESRD Medicare Part A and B.

Another resource:   Medicare Coverage of Kidney Dialysis and Kidney Transplant Services http://www.medicare.gov/Publications/Pubs/pdf/10128.pdf

Another resource:  Medicare and You with 2011 updates http://www.medicare.gov/Publications/Pubs/pdf/10050.pdf

Part B Late Enrollment Penalty
If you don’t sign up for Part B when you’re first eligible, you may have to pay a late enrollment penalty for as long as you have Medicare. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it.

As far as the premium for 2011 from:  https://questions.medicare.gov/app/answers/detail/a_id/2307

Most Medicare beneficiaries will continue to pay the same $96.40 or $110.50 Part B premium amount in 2011. Beneficiaries who currently have the Social Security Administration (SSA) withhold their Part B premium and have incomes of $85,000 or less (or $170,000 or less for joint filers) will not have an increase in their Part B premium for 2011.

For all others, the standard Medicare Part B monthly premium will be $115.40 in 2011, which is a 4.4% increase over the 2010 premium. The Medicare Part B premium is increasing in 2011 due to possible increases in Part B costs.  If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $115.40 per month.  For additional details, see our FAQ titled: 2011 Part B Premium Amounts for Persons with Higher Income Levels.  In 2011:

New Part B beneficiaries will pay $115.40 (because they did not have the premium withheld from their Social Security benefit in the previous year).
Beneficiaries who do not currently have the Part B premium withheld from their Social Security benefit will pay $115.40.
Higher-income beneficiares pay $115.40 plus an additional amount,  based on the income-related monthly adjustment amount (IRMAA).