Medicare vs. private insurance - spousal coverage?

[cattlekid]

So I started dialysis in January.  I am currently being worked up for a transplant.  I am still working full-time and I carry the insurance for both myself and my husband.

I understand (well, I don't understand but I've been told) that I will at some point have to apply for Medicare.  At that point, will I still carry my insurance through my employer?  The time I would be taking off work for the transplant would be covered under our short term disability, at which time I would still be getting 100% of my pay and benefits. 

I just want to make sure that I could continue to carry my insurance so that he can continue to receive healthcare.   Getting insurance through his employer (a much smaller company) is cost-prohibitive on his salary. 

 I want to avoid Medicare as long as possible because I only have a $2000 out of pocket maximum per year on my health insurance with no lifetime maximums.  I don't see a need to pay the extra $110 per month for Medicare Part B as long as I don't have to and my insurance is still paying out.  I just got the EOB's today for my first three months of D and all I can say is WOW is it expensive.  The center is billing out $2235 per week!

Any guidance anyone could give would be greatly appreciated. 

[MooseMom]

Please ask your social worker about this just to be sure, but it is my understanding that for the first 30 months of dialysis, your insurance will pay according to the policy provisions.  Read your policy to find out exactly what they do and do not cover.

After those 30 months are up, you will go onto Medicare, which will pay 80% of ALLOWABLE costs (NOT 80% of TOTAL costs).  So, Medicare will be primary and your private insurance will be your excess layer, ie it will pick up the 20% that Medicare doesn't pick up.  So, it is important to keep your private insurance if you possibly can.

That 30 month period is rather arbitrary.  There are people (including dialysis clinics themselves) who would like to see that 30 month period doubled or done away with altogether.  So, that might change by the time you need to start thinking about it.

In summary, going onto Medicare doesn't mean that you will lose your insurance through your employer.  It just becomes an excess layer for you but should remain primary for your spouse.

[tyefly]

Yes  be sure to talk to a social worker and your insurance.....    I was told that my insurance rates would go down if I signed up for Medicare... so I did ... I pay the 110.00 per month...but my insurance did  NOT go down.. it stayed the same rate ( 477.00 per month )...   I ask my insurance company about this and they told me that my rates will go down after  30 months when Medicare is the primary....  they also told me that I didnt have to sign up for Medicare but if I didnt with in the 30 months then my insurance rates would go up....  I told my insurance that I was going to quit Medicare ( cause I cant see paying 110.00 per month for nothing ) and they told me that If I did that I would   MAY  be cancelled  or  my premiums will go up.... can win... I hate insurance companies.....  Be very careful

[lawphi]

We are double insured and did not pay a dime in expenses for the 30 month period.  Medicare will pay secondary to your employer insurance and save you $800 or so a year after premiums.  You will have zero copays to go to various doctor appointments or for your dialysis supplies.   After 30 months, your employer insurance pays secondary and will pick up your co-pays.   

We are past the 30 month coordination period and pay a few hundred dollars a year out of pocket double insured.

I also think your company insurance could force you on Medicare from the date you became eligible rather than when you enrolled.  After 30 months of dialysis, they can refuse to pay primary. Read the language closely. 

While your insurance premiums will not decrease, you won't be penalized or lose your employer based coverage if you have Medicare.

[cattlekid]

Thanks to everyone for the posts so far.  I am reluctant to talk to the social worker at my center, she's pretty much a moron.  I don't think she has the first clue about how/when to apply for Medicare to ensure it will work with the transplant.  My center is so fixated on people who are on dialysis permanently that they can't even contemplate transplants - they are continuing to try to talk me into a fistula, which really pissed me off when I found out that the dialysis center and access center are financially linked - can you say racket?!?!? 

I will give the social worker at my transplant hospital  a call and see if I can meet with her over the phone to get better answers - she seems much more on the ball than the SW at my center.

[Whamo]

I have a 100% coverage through my wife's insurance, but she wants me to sign up for Medi-Care as well.  The Social Worker said it would cost $100 a month so I would probably want to skip it, but we're concerned she will lose her job or get sick and we'd lose coverage.  She thinks I should sign up now while I'm relatively healthy.  I also have a transplant appointment coming up this month.  It last five hours.  What do they do?

[Joe]

whamo, the transplant appointment is your first foray into the transplant hospitals system. When I went, I met with the transplant coord, social worker, finance team, transplant surgeon and resident neph. Also did a full lab run. It did take the full 5 hours, with a break for lunch that I took while I did my mid-day PD exchange. We covered a lot of material that day. The results of the day were a set of tests they wanted me to take to ensure I was a good candidate for transplant. I wrapped up the last of those 2 weeks ago and they have the results as of last Friday. My coordinator takes my file to the board when the meet on Thursday, so I should hear this Friday if I passed everything.

[lmunchkin]

Cattlekid, my husband has carried me on his insurance plan through his employer since we married in 1994.  He was diag in 2004 with ESRD and still worked.  Yes after 2 1/2 years, he had to pick medicare up as prim and employer 2nd.  But his employer insurance remainded my Primary as his spouse!

Now he stopped working in Jan. of this year.  He still has Medicare a prim. and cobra through employer ins., but has to pay the cobra part for us both!  I believe after 18mths, Cobra will stop on us both.  I will be without coverage and don't know what will happen then.

I so appreciate that you are thinking of your spouse and coverage for him! I know it is never intentional, but the caregivers are just not thought about when it comes to Health Ins.  I know that Im in good health and J. is not, for now, it should be about him. But you know, (Im not complaining) something could go wrong with the healthy too!  I pray not!  But one never knows, do they?

Im pretty sure he will maintain M'care and will pick up a 2ndary for him, but I may be left out cause I can't get it through where I work  due to not enough hours for full time.  It is there if I want to put hours in, but it would be tough to do!  Will cross that bridge when we come to it.  Just enjoying life in the moment!  That is all I can do!

lmunchkin