Private insurance vs Medicare

[MooseMom]

I understand that if you have private group medical insurance through your employer, that policy is the primary layer for the first 30 months on dialysis and Medicare is the excess layer.  Can anyone tell me how that 30 month figure came about?  That seems so arbitrary. 

Have there been any efforts to have that thirty month period extended in an effort to reduce Medicare expenditure?  I'm just curious.

[noahvale]

***

[Rerun]

I'm sure the insurance companies don't want the time extended number one, and the clinics probably want Medicare to be primary asap for those that don't have any private insurance.  As much as the clinics bitch about Medicare not paying enough at least Medicare is a sure thing for them.  And then for people like me who have both, I pay more than most and get nothing extra.  Not even the time I want.  Well, in the past.... I'm getting what I want now, but it is not because I pay more!  Now I should get coffee or something extra.  Plus the Nephrologist gets $245 extra a month from my private insurance which he would not get if I dropped my private insurance.  I've often thought why do I keep paying these premiums if I would get the same care anyway!  But, I've decided my drug plan is worth it.

Sorry I rambled!

[Jie]

Just cost shifting. Medicare cannot reduce the payment too low unless there are enough private guys to rob from.

[cookie2008]

I have private insurance and medicare, if the employer has less than 100 employees than medicare is primary, check into everything.

[HouseOfDialysis]

I have private insurance, and got my first bill of a remaining $250 from my dialysis clinic. I applied for Medicare back on Feb 7th, started home dialysis on Feb 21st.  And this charge looks to be monthly... Holy hell... This will get pricey soon. And it seems it takes around 3 months to verify that I'm on dialysis? Really?

[okarol]

I have private insurance, and got my first bill of a remaining $250 from my dialysis clinic. I applied for Medicare back on Feb 7th, started home dialysis on Feb 21st.  And this charge looks to be monthly... Holy hell... This will get pricey soon. And it seems it takes around 3 months to verify that I'm on dialysis? Really?

Ask your social worker, but I think PD coverage is supposed to begin right away.

"If you chose peritoneal dialysis or home hemodialysis, Medicare can become activated immediately and can retroactively cover services provided even before you start dialysis if they are done in the same month in which you began dialysis. For example, if you start peritoneal dialysis on May 22, Medicare coverage will begin on May 1.  If you were to start in-center hemodialysis on May 22, Medicare coverage would not begin until August 1."
http://www.davita.com/treatment-options/paying-for-treatment/medicare-and-chronic-kidney-disease/t/5645

[HouseOfDialysis]

I got the Medicare card. The premium is 60% less than the monthly out of pocket charge for the dialysis treatments.... I can't complain.

[Bill Peckham]

I understand that if you have private group medical insurance through your employer, that policy is the primary layer for the first 30 months on dialysis and Medicare is the excess layer.  Can anyone tell me how that 30 month figure came about?  That seems so arbitrary. 

Have there been any efforts to have that thirty month period extended in an effort to reduce Medicare expenditure?  I'm just curious.

Here's some info on MSP's regulatory history http://www.billpeckham.com/from_the_sharp_end_of_the/2008/01/post.html


The Bush administration proposed extending MSP to 60 months but the proposal was shot down by Michigan legislators on behalf of unions. The big dialysis providers would love for MSP to be extended ... an MSP extension was regularly put forward as a "pay for" over the last 10 years but in the end MSP wasn't changed.