when to apply for medicare and how long

[marlinfshr]

Since the end of the year is approaching I need to start thinking of next years insurance.

My social worker had told me earlier that I shouldn't get set up for medicare until the beginning of the year because I have already paid all of my out of pocket for BCBS. I was approved for SSDI quickly but wont receive my first payment until Nov for the month of Oct. Also I started hemodialysis on May 1st and am now about a month into PD and have just got placed on the transplant list.

So, how long does it usually take to get started on medicare once applied for?

Should I start the process now (end of Sept/early Oct) to allow time for it to go through or is something that goes through quickly in which I can wait till later? I guess I'll want A, B and D.

Would it be best to go through my social worker or just go straight through the SS administration

The next question is what to do with my current insurance. Does everyone usually just keep their same policy or look for something else just to cover what medicare doesn't cover?

Thanks

[Deanne]

I have BCBS through work and my social worker suggested applying for Medicare anyway, even though my insurance is great. She filled out the application for me. It sounds like it takes a couple months for it to go through, but I think it takes effect immediately. I can't remember exactly what she said, but when I talked to her, I figured I might as well do it now. I remember she said they're way behind on processing applications, so I probably won't get my insurance card for a couple of months and I should plan on a huge first bill because they bill quarterly, and I'll be billed for two quarters at once because of their backlog. In my case, if I was going to stay on dialysis, I'm not sure if I would have applied, but the transplant wait list is 2 - 3 years here and the transplant center said I'd likely be closer to the 2-year mark. I passed my 2-year anniversary on the list a couple of weeks ago.

Next year I'll be able to skip funding my flexible savings account and Medicare will cover those expenses instead.

I hope I understood that all correctly. It's very confusing!

[Joe]

I would have your Social Worker get the paperwork going for you now. My SW took care of everything but actually going down and applying for SSDI for me. That made the process really easy.

[jeannea]

You need to find someone who can give you the correct advice. I'll give you the little I know. As soon as you have a dialysis treatment the center tells Medicare. You should receive a letter with a scheduled time when Medicare will call you to get some information. If you sign up for everything at once, you'll be ok. If you refuse one then you have to wait for open enrollment. So if you get A,B, and D they'll take effect soon. You should be able to ask Medicare and find out when for A and B. For Part D you have to apply with a company that offers that. Go to the Medicare website and you can find plans by zip code.

I assume your BCBS will be your supplemental coverage so you don't need Part C. If you lose your job, you'll be allowed to sign up then for Part C. Otherwise you have to wait for open enrollment if you want to change. That happens in Oct with coverage beginning Jan. You can also search on Medicare for Part C plans if you want to compare with your BCBS. Just remember if you are under 65 you do not qualify for Advantage plans.

Good luck! Read all you can and ask questions.

[nursey66]

You can go on Medicare AB&C and D also if you want while still on your private ins.  My hubby was on my work ins, as well as Medicare A&B. Then whan I started to plan to retire, I wanted to be sure to get him on a part C plan, applied in Oct, got him enrolled in Nov. I also kept him on my work ins. till the end of the year, because we were getting Procrit for 35.00 a month, I knew the Part D would be way higher. He is only 60 years old. Then when I retired in Jan, I enrolled him in part D, it was the only option at that time, or work forever !!! I am 67 and worked as a nurse.The AB & C are working out real well, cheaper than my work ins, and they paid everything.  His bills this year alone are over 220,000.00 . But the Part D!!!!!! He went in the donut hole with a drug foe Aspergillios that cost 4000.00 dollars a month !!!Our copay was 2,230.00 . If I still had him on my work ins. the copay would have been 10.00 !!!! I am finding the drug costs to be awfully high without private ins. He has since went on dialysis, so we don't have to buy Procrit or calcitriol , or anti rejection drugs anymore, those were high, with Part D. But now we have to buy Renvela and a couple other drugs & in the donut hole, you are basicaly without insurance. There are some Plans you can get on when it's not open enrollment, and Cost Plans are a combo of straight Medicare & Advantage Plans , you can get on some of those under age 65.

[jeannea]

I agree the donut hole sucks although I think the amount is changing. For me it was Valcyte for CMV that put me right through the donut hole. You have to study plans carefully to compare. I had great coverage for drugs on my last work plan but the copays for ER visits and hospital admissions were killing me. In the 4 months before dialysis while my transplant failed I had 7 ER visits and 4 admissions. It was close to $3000 in copays. So your work plan may be better or worse. Study the plans and ask questions by calling companies if you need to.

[obsidianom]

What I did for my wife when she went on medicare was add a "group companion "plan as she used to work for me almost full time and now is "retired" as she only works a few hours per week. The group companion plan is for retired workers from a group plan at work. It doesnt have a donut hole at all. It has a $1000 out of pocket max per year. Basically it covers 80% of everything after medicare, including drugs. So we pay 20% of the drug cost up to $1000 out of pocket  yearly, then after that they pay 100%.
It is a bit more costly then reg. part c and d coverage but it is far better than the donut hole. I think it costs about $450 per month for the full coverage , but it is also a write off on the business as I can deduct it as an employee expense. Anyone self employed with group insurance may want to check out this option, or if you retire frtom a business that offers this option , it is a good one.

[marlinfshr]

This is something I really need to start thinking about now. My current plan has been excellent and affordable (believe it or not) though it has a 4000 max out of pocket that I used up my first day in the the hospital with my heart attack. Everything else has been covered. Though I only have a $500 prescription allowance in which I  just sent in my claim. Perscriptions haven't been bad ------- yet.

Now that I'm on the transplant list I really need to find something with a prescription plan if anything is available other then Part D and the doughnut hole.

Am I right in thinking that once I get medicare (that will only pay 80%) my other insurance policy would cover the deductible and any copays up to my out of pocket as well as the 20% that medicare will not cover? Or will I still be responsible for paying everything up until my out of pocket max.

BTW, I don't have any work policy as when I did work (and when I go back) I've been/will be self employed so I've been on my own as far as insurance.

[duncan reamhiar]

i already have medicare A and B and D... my prob is i haven't stareted PD (at home) yet... nor the training.. i don't have a social worker assigned to me yet as the dialysis center told me i had to start dialysis 1st... i need to choose  by the end on the month.. yet the plan i already have isn 't enough for my probs now (diabetes hypertension etc... insulin alone is killing me) i reach my donut hole by the end of MNarch/start of April...  i read on my new booklet form medicare that there's these "special programs for kidney failure/dialysis pts... b ut it's all so confusing to me... and where i can't get a social worker til i start dialysis... (maybe next month) i have to choose blind i guess.. and be stuckl with what i choose for the yr... i have no idea what these Special programs from medicare are or if i'm even eliglible for them BEFORE i start dialysis... as it stands now i had the PD tube site put in 3 weeks ago and it's still infected... and where they placed it seems a bit odd.... making it difficult to bend and such... hope3fully when i go for my "flush in a few hrs (2nd one so far)... i can corner someone to help me

[Shaks24]

I think what you are referring to are Medicare Advantage SNP or Special Needs Plans. You can research them online at the medicare website. They are comprehensive medicare plans that offer coverage for specific special needs groups be it a particular health condition or even a particular financial situation. Fresenius has one specifically for kidney patients but it is limited to certain locations. You would have to dig into the details to see if these types of plans would be better for you than original medicare.

[nursey66]

Since you already have Medicare, you should be able to get a suppliment/ or additional policy to cover all the $ original Medicare leaves behind, and believe me, it's a lot. Best bet is to contact an Agent in your area that sells Medicare stuff. I was hesitant to do that because I hate Ins. Agents, but they are really able to help you and are well trained. I thought my Hubby couldn't get additional Ins. since he had Medicare for a number of years, and did not sign up for a part C plan.Even the Social Worker at the TX clinic couldn't help us. I finally called an Agent who got a policy for him at a very reasonable cost and between the A,B,&C  all his bills have been covered 100 %, and he has had over 250,000 this year alone. !!  Part D is anouther matter. He fell into the donut hole so basically we pay for his meds. But Brand name is discounted 57% so his Renvela is 125.00, the rest are pretty cheap anyway. He had to take vorconizol for a lung fungle infection that cost over 4000.00 a month, that used up all his part D $ , but in the long run, I still feel fortunate not to have to pay the 20% Medicare leaves behind. He was on my work policy along with original Medicare, untill I retired. I hope the Part D gets better soon, Meds can be high.We were spoiled with my work ins. All drugs had a 10.00 copay, no matter what they cost or how many you used. Good Luck !!!!

[Shaks24]

I do not think a medigap or supplemental policy will help with prescriptions.

[nursey66]

You are correct !!  Unless your income is low enough to qualify for 'exra help'  once you hit the donut hole, and for kidney patients it doesn't take much, you are on your own ,until you have spent about 4,750 dollars out of pocket, does Part D kick back in. It seems like there is no way around it. It feels like Seniors and people on Disability are supposed to limit their drug cost to the 2,950 dollars per year that part D offers. Obama Care is going to eventually get rid of the donut hole, if the Republicans would only leave it alone !!!  Sorry, didn't mean to get into Politics here.

[Shaks24]

Amen on that!

[marlinfshr]

Doing some calculations and checking as I've since been pulled off the transplant list due to my current policy not covering enough for it, even though they said it was OK during the evaluation.

So, I currently have a policy through BCBS that has been covering everything since my out of pocket was reached within the first 5 minutes in the ER back in April. But it's pharmacy program sucks and it doesn't have enough for transplant coverage (only 50,000) so I'm not going to continue with it for next year.

So, even though I qualify for medicare due to my ESRD disability, does that mean I HAVE to go with medicare? I'm 45 so my choices for medigap here in MD are limited. I can only get medigap Plan A to go with medicare A,B & D.

I priced the new platinum plan and it has a 0 deductible and a 2000 out of pocket max in which pharmacy/prescription drugs are included in, according to the lady I talked with on the phone today. But she stated that I might not be able to go with one of these new plans because I "qualify" for medicare due to my illness so I may have to go with medicare. The only way I can access those plans on the BCBS site is if I don't check the box stating I qualify for medicare. If I check that box it takes me right to the medigap sign up page.

I really hope that isn't the case as adding everything up it seems that my total expenses for the year including premiums, deductibles, and prescriptions I'd pay considerably more with medicare. It may not be much of a difference at first but when looking ahead to post transplant with all the anti rejection drugs and the donut hole with the part A deductible being applied for each hospital visit, it just seems going with the platinum plan would be better for me---even though the premium is higher.

Come to think of it the premium would not be higher with the platinum plan because with medicare I'd have to pay premiums for Part A, Part D as well as Medigap A.

I'm just trying to see if I could go with one of those plans even though I qualify for medicare.

[duncan reamhiar]

spoke to the SW on Monday when i went for the weekly flush she said she would see what might be available for Special Needs Programs for me and let me know when i come back next week for the evidently weekly flush.. so you were right it's a special needs program... thanks for the help... they also told me like you did on here... it doesn't help with the meds but she will see if i can qualify for something else to help there as my insulin alone is over 1k a month once i reach my donut hole which happens by March/ April leaving most of the rest of the yr to try and get out of it.. unsuccessfully

[jeannea]

I just assume the donut hole is like my deductible for the year. My Part B and Part C don't have deductibles so the $2700 or so for donut hole plus my drug copays are my deductibles for the year. Of course I also pay about $500/month in premiums total for B, C, D. There are programs to help pay for some drugs through the manufacturers but you don't qualify if you have Part D. So you could also compare costs that way.

[Shaks24]

Does anyone recall how long it takes to get your medicare card after your dialysis center sends in the form and you complete your application process?

[Deanne]

My Medicare card arrived on Friday. I started dialysis on Labor Day and the social worker filled out the paperwork for me in mid-September, so it took about a month.

[Shaks24]

Thanks Deanne. Some pretty big bills are rolling in and I am waiting to get my card. Its gonna be interesting. lol My worthless junk policy actually did some good as far as discounts for the fistula and PD catheter surgeries. It reduced my costs from over 13000 to about 4000 out of pocket. It sucks having pre exsisting conditiond and trying to purchase decent coverage pre Obamacare. Thank goodness for ESRD medicare.