Going to SSA office tomorrow, anything I should know?

[cattlekid]

So since I'm marching towards getting listed at Univ. of Wisconsin for transplant, I thought it was high time that I get my behind down to the SSA office and get signed up for Medicare.  I have an appointment tomorrow morning - at 9:06 AM.  Not 9:00, or 9:15, 9:06 (I guess that's the government for you!).  I was told to bring my birth certificate, marriage license and doctor's contact information so they could get my medical records. 

Anything else I should be prepared for?  The person on the phone seemed nice enough and said that it should be a quick and easy signup.  Hope that is the case.

[lmunchkin]

Cattlekid, back in 2006 when my husband got Medicare, we did it over the phone because of his amputations.  He was diagnosed with ESRD in 2004 but had company insurance for 1st 30 months, then medicare took over.  The clinic he was going to was very instrumental in getting him on without a hitch!  Then in 2011 when he stopped working, he filed SSD and that was done over the phone too!  He was one of the lucky ones!  I give kudo's to a neph who is staying on top of his care from the start!

You shouldnt have any problems whatsoever, but then every place (state) is different I quess.  Prepare for anything, I guess, cause all gov't entities are a pain, but worth it in the long run.  Good Luck in the AM.

God Bless,
lmunchkin

[smcd23]

Do you have private insurance through work (yours or a spouses)? If so, you would only need part A. If not you should probably take A and B. If you have any paperwork from the clinic, bring it. Specifically a blue form (I forget the form number, we just call it the blue form) because that shows the dates of dialysis and determines your eligibility month. Usually the centers complete if when you start dislysis and send it to SSA if you want/need Medicare but if you don't they generally hang onto it.

As for the 906 time slot, it probably has to do with the # of visitors in the office each day. My offices appointments start at 9 but we let people shuffle in about 5-10 minutes before 9. If they don't unlock the doors til 9, then they might make the appointments a few minutes past to give people a chance to check in. I've seen 905 in other offices but 906 is very odd.

[cattlekid]

Thanks for the feedback.  I do have private insurance, which is why I've been putting this off for so long (I started dialysis in January of 2011).  I would love to be able to take Part A only, but isn't there a penalty for taking Part A but not Part B?  I would love to be able to put off paying for Part B as long as possible.  Heck, I don't even want to be on Part A honestly, but I'm doing this because I know that I have to.

I remember filling out some form at my old center when I first started.  But it's been eons and I never had to do anything like that with my new center now that I do home hemo.  I'll make sure to have the contact information for both centers as long as my neph's contact information so that I should have all the bases covered.

[smcd23]

As long as you or your spouse is working for that private insurance, you DO NOT need to take Medicare Part B. However, Part B is what covers the transplant drugs post transplant. So at that point you may want to look into it depending on the drug coverage on your current plan. There is no penalty for not taking Part B - for starters you have ESRD so you can enroll at any time, and second, because you have private health insurance, you get a special enrollment period when that insurance ends or the work stops.

Why do you *have* to take Part A??

[cariad]

As long as you or your spouse is working for that private insurance, you DO NOT need to take Medicare Part B. However, Part B is what covers the transplant drugs post transplant. So at that point you may want to look into it depending on the drug coverage on your current plan. There is no penalty for not taking Part B - for starters you have ESRD so you can enroll at any time, and second, because you have private health insurance, you get a special enrollment period when that insurance ends or the work stops.

Why do you *have* to take Part A??

This is how it was explained to me: Once you qualify for Medicare, if you do not take it then after the 30 month coordination period private insurance can say that they should be secondary and only be responsible for 20%, and you will have to get Medicare or else pay 80% out-of-pocket. If you don't take Medicare when you are first eligible, you pay a sizable penalty (10% per year that you were eligible but did not have it?).

Part A is free, so I don't know why you'd refuse it, and I would not want an insurance company to be able to argue that they should not have to pay because I was Medicare eligible but refused the free coverage.

I am not the most conversant in these issues, though, so I could be wrong. I would just ask the people down at SSA. It amazes me how maligned government workers are - I have had overwhelmingly positive experiences with SSA and Medicare employees helping me navigate the system. Best of luck!

[smcd23]

If you're on private insurance, you can sign up for Part B anytime, not just when that coverage/employment ends. So you need to find out when your 30 month coordination of benefits period began - In Tony's case it began with the month of the 1st transplant. After 30 months your private insurance may require you to take it, they may not. Many employers do not realize that ESRD patients are special people in regards to Medicare. I know Tony's union had NO idea, and after our whole fiasco with COBRA, they have rewritten their benefits book.

Honestly, Medicare apps are easy peasy. You shouldn't have a problem. They are going to ask if you want A and B and it's up to you, but do ask the claims rep you see when your 30 month coordination period began so you will know when you should maybe contact your private insurance to find out if you need Part B. They will probably tell you that they need to get that blue form I mentioned from your facility before they can process the claim, but I know in my office we have a good relationship with the dialysis unit social worker and can usually obtain the info we need easily from them.

Cariad - the 10% per year penalty really only ever applies to people who are 65 or on disability (not on Medicare for ESRD) that get penalized. The enrollment period for people on ESRD is very different. I can site all the policy and try to explain it if anyone is really interested... it's interesting, and can be confusing. The one explains how to figure out when it might be best to enroll in A and B https://secure.ssa.gov/apps10/poms.nsf/lnx/0600801251#b

Basically you can enroll in A, and then you can take B effective that month. If you don't you can enroll in it later, but may have to pay back premiums if you need your part B to have the same start date as Part A. If you don't you can elect to delay Part B and take it effective the month you file in the future.

But once again, I ask why you feel like you need to apply for Part A?? You do need to have Medicare in place at the time of the transplant if you want your immunosuppressants covered, but if you're not listed *yet* then why rush it? This is especially true if you're still in your 30 month period.

[cariad]

Cariad - the 10% per year penalty really only ever applies to people who are 65 or on disability (not on Medicare for ESRD) that get penalized. The enrollment period for people on ESRD is very different. I can site all the policy and try to explain it if anyone is really interested... it's interesting, and can be confusing. The one explains how to figure out when it might be best to enroll in A and B https://secure.ssa.gov/apps10/poms.nsf/lnx/0600801251#b

Huh. That's odd, because I requested to be taken off Medicare and they said I could do that but would be penalized when I next signed up for it. I think that's what she said, anyhow. The woman seemed to know her stuff, but then, I believe you know yours as well. I think the whole thing is just too bloody complicated and my case is beyond complicated.

I thought I'd read that Anna (Meinuk) had to pay a penalty for not signing up for Medicare by a certain point. I'll have to look through her posts and see if I misunderstood something.

I would love to understand this once and for all, but I won't ask you to explain it as we're most likely leaving the country imminently and I plan to quickly forget all I know about Medicare, private insurance, HIPPA, COBRA, and any other term that makes foreign member's eyes glaze over. Sorry if I confused anyone - I'm just repeating what I heard but never fully understood.

[smcd23]

You wouldn't be penalized, especially if your husband had private insurance. My disability folks that go back to work start and stop all the time because they get other coverage. It's really hard to generalize because everyone has a unique situation. And sadly, many folks don't realize the difference between Medicare for ESRD and Medicare for Disability. A person on disability medicare who never converted to ESRD medicare could easily be told they'd be penalized if they disenrolled because it's true, but that's also not their fault if the dialysis unit, SSA etc didn't get the record updated to reflect the ESRD entitlement. How would the individual know? I've been with the agency 10 years and only fully understood the ESRD medicare rules after I had to live through it with Tony.

[cattlekid]

Thanks again for all of the information.  I have 13 months on the transplant list here in Chicago.  I am going to Wisconsin next week to get worked up there.  Since their waiting list is only 6-9 months for my blood type and I plan on transferring all of my waiting time to Wisconsin, I want to have all of my ducks in a row on the assumption that a transplant will be around the corner.  I want  NO roadblocks to getting listed.  Even if I don't end up signing up today, it will be worth it to sit down and talk to someone about it.

[cattlekid]

Well, nothing is ever easy.  I went to the office today and while the staff member was pleasant enough, sure enough I didn't have the right forms with me.   I needed the "blue form".  I know I filled it out when I started dialysis in January of 2011 but it was a formality at the time as I did not have the need for Medicare to pick up the remainder of what my private insurance did not pay as I have a very low OOP maximum.  I also didn't want to start paying the Part B premiums for basically no reason while I languished on the transplant list here in Chicago.

Now that things on the transplant side are becoming more real, I NEED that Part B to pay for the drugs.  As good as my insurance is on the medical side, the prescription side sucks.  I have to pay 25% of retail for all brand-name drugs.  If I can get away with generics, it's all good, but if not, the costs can add up quickly.

So I called my old dialysis clinic today and the SW there is going to search around in my file for the "blue form".  If she can't find it, I'll have the SW at my current clinic fill one out for me.  I just want this over and done so that there can be NO financial reason why this transplant won't go through.  I know in Chicago, they were pretty adamant that Medicare had to be in place when you started moving up on the list.

[jeannea]

No you can't just sign up for Part B any time. I had COBRA so I only got Part A. Then when it was about 6 mos to the end of COBRA I went to sign up for Part B. This was in Oct. They told me I couldn't have it til July. I had to get my congressman to help.

Also, Part B doesn't pay for most of your drugs. You need Part D for that.