Does Medicare pay for all costs for dialysis?

[support member]

Right now my wife who is on dialysis and is on the company health plan with almost no payment for the pd dialysis supplies (however we do pay a lot for medications and medication copays), shortly she may have a choice to move over to medicare. Would Medicare cover all costs, is there anyplace here on this topic? It appears that she at the present time has a choice of continuing to remain on the company plan is there any downside to moving over to medicare?

Thanks folks



EDITED:  Moved to proper topic - Rerun, Admin

[Simon Dog]

Medicare covers 80% of the cost of dialysis, but the provider is also compelled to accept the "medicare rate" (about $245 per hemo treatment, not sure the PD rate), so the patient responsibility is 20% of a smaller number.

If you are under 65, you have to switch to medicare after 30 months on dialysis.  If you have private employer insurance, you will be medicare primary and the private insurance will pick up the remaining 20% subject to whatever deductibles, copays and out of pocket limits of that insurance.

[Rerun]

Support Member,  Welcome!  Please go introduce yourself so we can get to know you.   

http://ihatedialysis.com/forum/index.php?board=14.0

Thank You,

Rerun, Admin

[Tío Riñon]

Hello Support Member:

Sounds like your wife is in a similar situation to me.  I have had to switch from my organization's group insurance with a majority of the premiums being covered as a benefit associated with my job to COBRA, the law that allows continued coverage when you no longer have the job benefit.  I have learned that I can stay with the group insurance for up to 18 months (and possibly 24 with an extension due to disability), but I am expected to cover the full cost of the premium.

The downside is that I now have to pay two premiums:  the group insurance AND Medicare.  The upside, as mentioned by Simon Dog, is that the providers do have to accept Medicare's rate and with the group insurance covering the balance, I have little or no out-of-pocket expenses.  The exception to this is for medication.  Medicare doesn't cover drugs (except for those included in the bundle), so you'll rely on your group insurance's prescription policies.  However, I would also talk to your dietitian and social worker about medication discount cards and Medicare supplemental plans to decrease your prescription expenses.

[obsidianom]

Overall Medicare is the best deal for the money there is.  My wife is on it for dialysis and has a second insurance and so has no copay at all. We only have copay on meds . I wish I were on Medicare but am just 4 years too young. Its much cheaper and better than private insurance.

[iolaire]

Its much cheaper and better than private insurance.

One word of warning for working patients and patients who are part of higher income families is that Medicare has higher premiums for higher income beneficiaries, starting at $85k for single persons and $170k for married couples:
http://www.ssa.gov/pubs/EN-05-10536.pdf
There also are some additional ad-on's for the drug benefits based on income.

[Simon Dog]

Its much cheaper and better than private insurance.

The one exception is when you have a hard time finding a doctor who accepts medicare.   This is most common in primary care, where many practices are closed to new medicare patients.  (most docs seem loyal enough to their patients to keep the medicare patients they already see). 

[obsidianom]

Thats funny because I prefer medicare patients as I dont have to worry about high deductables like the private insurances and I know exactly what is covered and what the rules are. Private insurances have so amny different policies and differnces in what is covered . Many patients have $5000 deducatable plans now so nothing is paid by insurance. Medicare at least desnt have this issue.

[Simon Dog]

Are you a primary care doc or specialist?   I've read the "acceptance issue" is most prevalent with internists and general practice docs as they are underpaid under the "pay for procedure" medicine system in the US.