changing insurance

[okarol]

We are considering changing our health insurance. Currently we have Blue Shield that covers Jenna, plus she has Medicare. Is anyone familiar with BS Silver? I cannot determine if it would cover dialysis and a transplant.

[Shaks24]

If Medicare is primary you could look into if your state of residence offers medigap policies for under 65's. A number of states require medicare insurers to offer these policies to ESRD under 65 patients. They are usually pricey but I got medigap F in Tennessee and with medicare everything is covered with 0 out of pocket except for the premiums. My gap policy is 375 a month but its worth it. So in total I got Medicare A and B, medigap F and medicare D for drugs. I spent 0 last year besides the premiums and I take 6 meds twice a day. My D plan is Wellcare PDP Extra and I get all my meds by mail. All tier 1 and tier 2 meds are 0 copay by mail.

[okarol]

Thanks for the info Shaks! 

[Michael Murphy]

Mediigap plan f may seem pricey until you look at similar coverage with private insurance.  Medigap insurers know they will only be paying 20 % of medicare rates that are much lower than private insurance rates.  Where I go my current insurance company pays 1500 per treatment and medicare pays less than 300 for the same treatment. 

[Shaks24]

I think if you are under 65, the states that offer medigap for under 65 only offer guaranteed issue within 6 month of your medicare enrollment date. After that you may have to go through underwriting which would complicate things. Every state is different though with medigap for under 65 so it is important to research the policies of your state of residence. I wish the feds would step in to this insurance segment and unify it with policy that makes sense for ESRD patients. Its really quite confusing.

[iolaire]

I cannot determine if it would cover dialysis and a transplant.

Are insurers legally able to sell plans that exclude coverage of certain lifesaving treatments?  I know they can choose to not allow unproven treatments.  Also I'd think the network and where treatment would be provided would be the highest concern.

Otherwise have you consulted with your dialysis center's financial coordinator and the financial coordinator at the transplant center?  They should know how/who to contact to help you make the decision.  But of course that advice is only as good as the coordinator.

[Michael Murphy]

I just recently went out on disability and Fresenius sent a Insurance coordinator to see me to insure I new about insurance rules.  I had spent considerable time researching options since I have to go on medicare January 2016.  It turns out if I had spoken to the social worker she would have put me in touch with the insurance coordinator and saved me considerable time and effort.  To avoid extra expense when I go on medicare I need to also start a medigap policy.
The hard part will be coordinating the end of my current policies with the start of medigap medicare coverage.

[Shaks24]

Be sure to research medigap for your state if you are under 65. Its a hit or miss mine field. The one thing that may be in common in all states is the guaranteed enrollment within 6 month of starting medicare. Talking to an insurance specialist from your dialysis provider is probably a great move. Hope it goes smoothly for you.

[thegrammalady]

I was told that "F" policies are the only policies that cover dialysis. Mine is through State Farm. Jenna's Social Worker should have information.

   hi friend

[Shaks24]

I do not think that is the case. Dialysis is largely covered by medicare B and a number of the medigap policies cover the 20% that medicare B does not pay. What is true is that medigap F is currently the most comprehensive of the medigap policies currently available. It also costs the most. Specially if you are under age 65.

http://www.ehealthinsurance.com/medicare/compare-supplement-plans