COBRA and Medicare

[cariad]

I hope someone can help us with this question - I am teetering on the edge of an anxiety attack.

My husband's position was eliminated last July. We have been on COBRA ever since (Anthem Blue Cross). My husband has a great job now, but he is a contractor, therefore no employer health insurance option and not a hope in hell that any private insurer would take us on if I were part of the package.

I am on disability and just became eligible for Medicare. I do not meet the qualifications for Medicare due to ESRD, even though ESRD is my disability. (Have I lost you yet?) One of the financial counselors at a hospital where I am listed called me yesterday to say that I probably cannot keep COBRA under these circumstances. I was advised to call Medicare Coordination of Benefits and they were useless: "Ma'am we only coordinate different Medicare benefits, not Medicare and private insurance." Fabulous!

My husband rang Blue Cross. They apologized for the stress this had caused and said that I was still eligible for their plan, as secondary insurance. Of course, if this is not true, they will just deny payment and claim they are not responsible for what their individual reps say. (And yes, we learned of this trick the hard way.)

We are paying $1400/month for Anthem, plus the $96/month for Medicare. If I can't use Anthem, we would be better off putting my husband and kids on a private policy. Everything I have read says that if you have COBRA and then become eligible for Medicare, you cannot continue the COBRA. However, my husband thinks this rule only applies to the primary (i.e. him). Does anyone know how this works? Can Anthem refuse to keep me on the policy now?

Is it any wonder that we hope to move to Britain the moment this transplant is behind us?

Thank you for reading!

[breezysummerday]

http://www.medicarerights.org/medicare-answers/

Not sure if this will help, give it a look


 

[okarol]

I can only speak to what we've been through. My husband was disabled and when he left his job our Cobra continued for our family. (We have been paying $1200 per month for 6 years!) Jenna has Medicare which she got when she began dialysis, and she is also covered on our private insurance. I am pretty sure that if anyone on the policy is disabled, you qualify for the Cobra extension. I will double check with my hubby.

[aharris2]

Short answer (I'm late for work)
1. We are in Florida
2. Rolando has both Medicare and COBRA (the cobra plan is through his wife's prior employer and is secondary because he has been on dialysis for more than 36 months)
3. The Kidney Fund is paying 100% of the COBRA premium for him - it is their program (check with your unit's social worker)

[cariad]

Thanks so much for the info!

I feel much calmer. It looks like my husband was right (hey, it does happen now and then!). 

And with all the tests, labs, and prescriptions I have coming up this summer, it looks like the $1400/month is still worth it, even if COBRA is only covering the remaining 20%.

 

[TiffanyJean]

So Just to add in our experience and 

Richie went on TDI when he was first diagnosed (feb 08) at that time he was a cook/server at a restaurant here in honolulu; at that time he had the cath in his chest (what its called has totally left my brain at the moment.) Since he couldn't get that wet/sweaty he had not returned to work; the restaurant closed in about june last year, and so the company that he worked under that managed the staff at the restaurant put him on cobra. When he first started clinic our social worker immediately helped him get medicare; as well as arrange for his cobra/medicare to be paid for by the kidney fund, just like aharris2 said. Richies cobra runs out in DEC. so his mom is going to employ him at her advertising office, so that he can be covered by her insurance.

not sure if any of this helps. but all i can say is work with your social worker- make them help you - there are many options!

Tiffany Jean   

[dialysisbiller]

once Medicare becomes your primary ins, the secondary is based on what medicare allows- like, medicare allows approx $150 per HD tx, they pay 80% of that and the 20% is billed to secondary. Some secondary plans might have copays and then you pay that after the secondary payment is made.

Definitely contact your billing dept for your center and discuss with them what should be billed to you if at all. Anthem is great to work with, I work with them daily as I manage 5 centers in VA.