What options for those with no insurance

[jambo101]

Are there alternatives to dialysis cost for those with no insurance?

[Michael Murphy]

Yes several, Medicare, Medicaid, these are minimum cost insurance plans that dialysis makes you eligible for.  In addition  you are  eligible for SS disability.  If you are young without a work history this should be calculated based on parents SS earnings, this may require a lawyer.  Finally if thr Medi insurance is too costly speak to clinic social worker there is a plan that you dialysis company will donate the cost of your payments to a kidney. Charity and the Charity will pay your insurance payments.

[Mr Ken]

Yes several, Medicare, Medicaid, these are minimum cost insurance plans that dialysis makes you eligible for.  In addition  you are  eligible for SS disability.  If you are young without a work history this should be calculated based on parents SS earnings, this may require a lawyer.  Finally if thr Medi insurance is too costly speak to clinic social worker there is a plan that you dialysis company will donate the cost of your payments to a kidney. Charity and the Charity will pay your insurance payments.

Speak with a worthless clinic social worker huh........... Good luck with that one..

[Simon Dog]

Yes several, Medicare, Medicaid, these are minimum cost insurance plans that dialysis makes you eligible for.

Dialysis makes you eligible for Medicare after 30 months of treatment if you have private insurance, and at the 4th month if you do not.  You can be eligible immediately without private insurance if you do home dialysis (PD or Hemo).

Dialysis does not per-se make you eligible for Medicaid.  You have to be indigent, which means no cash or cash equivalent assets (investment vehicles, gold, etc.) in excess of $2000.  There is a 5 year lookback period for which you must provide all bank statements and any large expenses (typically over $1000) have to be justified to prove they were not a disbursement of assets to avoid a Medicaid spend down.

I do know Fresenius will hound you and threaten collection action for the 20% balance Medicare does not pay.  It took two years to finally get my insurance company to pay a bill for travel dialysis, during which I was threatened with collection action.

[PrimeTimer]

Day of all days, interesting this subject is being brought up. My husband was just fired from his job. And no joke, he was rated their #1 top employee nationwide. Also no joke, Fresenius has their own collection agency. That ought to do them a lot of good now. Now excuse me while I go throw up.

[iolaire]

Day of all days, interesting this subject is being brought up. My husband was just fired from his job.

Sorry to hear that. I wish the best for you.

[Michael Murphy]

Prime Time,  it sucks to be laid off however find a ada lawyer check on viability of a suit.  Consider if your husband is old enough to file for SS Disability and many companies have disability insurance with fixed payment.  I filed for disability when I was 62.  My SS was exactly what I would have received at 66 plus my companies disability coverage paid 60% of my salary for the first 6 months and since then has paid me 1000 a month till iI am 69.

[PrimeTimer]

Thanks iolaire and Michael Murphy for your thoughts and suggestions. My husband might get a lawyer to help. Seems so fishy and such a cheap shot on his employers part. Funny how they thought he was such an amazing employee but then suddenly kicked him out the door like this. Just the other week they were telling co-workers that they needed to clean up their act and reminded them of how highly rated my husband is in the company. But gee, suddenly now he's not ? Yeah, they are going to miss him tomorrow. 


jambo101: sorry to have gotten off track. You probably qualify for Medicare. Please ask for a financial coordinator or social worker at your clinic once you start dialysis. They probably won't discuss it with you until then. But...when the time comes to do the paperwork, it is best to visit your local Social Security Admin office -they are the ones to handle signing up for Medicare. A financial coordinator at Fresenius really screwed up my husband's paperwork and it has cost us dearly. Don't let that happen to you.

[Michael Murphy]

When I applied for SS disability I thought I would be turned down since every one at my clinic was turned down in the 4 years preceding my application.to speed up the process I applied on line figuring it would be faster then I would do what every one else did get a attorney.  However I was shocked when my application was accepted the first one at my clinic in years.  Then I realized that like most people questioned about the effects of dialysis on my life minimized the impact.  We thought when asked everybody said what would have at a interview it’s not so bad. Since I didn’t have a interview my case was decided on my medical records.

[jambo101]

 While the actual dialysis apparently gets covered what about all the prelims,the myriad of blood tests,the frequent visit to nephrologist,the dietician, the fistula surgery/s etc. do people with no healthcare insurance get fully covered?

[iolaire]

While the actual dialysis apparently gets covered what about all the prelims,the myriad of blood tests,the frequent visit to nephrologist,the dietician, the fistula surgery/s etc. do people with no healthcare insurance get fully covered?

Medicare pays 80% on almost everything but you are responsible the rest plus the monthly Medicare premiums. If you are at the lowest income level I think it’s just over $100/month for Medicare.  I think there are Medicare gap insurance plans which help pay the 20% Medicare copayments. With most insurance plans there is some copayment level you have to hit before everything is paid at 100%.

[Simon Dog]

When I applied for SS disability I thought I would be turned down since every one at my clinic was turned down in the 4 years preceding my application

This should not be happening.

Dialysis is on "the list" of per-se disabilities.  If you are on dialysis, you are disabled according to SS.   The only thing you need is paperwork that proves you are actually on dialysis and you get approved.  When I was on D, I was approved without any interview - though SS did contact the clinic directly and needed some forms filled out directly by the dialysis provider.

If you are claiming disability because of kidney failure but are not on dialysis, you have to prove an actual inability to do work.  Big difference - it is this sort of claim that is frequently turned down.

[PrimeTimer]

So, if you ONLY have Medicare for primary and lost/lose your secondary (such as in my husband's case), who do you tell at the clinic? The neph, the social worker, the financial coordinator or should he just directly call Fresenius himself to let them know he was fired from his job? His former employer said he gets to keep his insurance with Aetna for 2 more weeks and then that's it. After that, we'd have to purchase COBRA and well, that's not affordable.

So will Fresenius force him to buy a supplemental now? Bill him the 20% that Medicare doesn't pay? He hopes to be employed again real soon so we don't know if we want or even should mess with buying a supplemental if he can get insurance again thru an employer. Of course we can't pay 20% out of pocket tho either. What a mess! Seems so unfair that a man on dialysis who is able to work and help himself gets fired. Other than being off for dialysis, he never even called off sick. Anyways, I basically have the same question that jambo101 does...what are the alternatives? Swim in debt and hope to stay afloat? 

[PrimeTimer]

I did an online search and found some answers. So yeah, Medicare will continue paying 80% but without a secondary insurance plan, we will have to pay the remaining 20% out of pocket. Some people can get what they call "Extra Help" with payments by contacting their local Social Security office. We're screwed.


The link is a 60-page pdf but people can read about it by searching "Medicare Coverage For Kidney Dialysis & Kidney Transplant Services".

[Simon Dog]

So will Fresenius force him to buy a supplemental now? Bill him the 20% that Medicare doesn't pay?

Fresenius will bill for the balance and is relentless.  I was hounded for two years for the 20% for two treatments while traveling until insurance finally coughed up the $143.

[Shaks24]

Look into a supplement that will cover the 20%. It may be a challenge though as you only have 6 months from the date you became eligible for medicare to purchase a supplement without underwriting. If he is under 65 that will create even more challenges getting a supplement depending on the state you live in. Supplements can be pretty costly though. Specially if you are under 65. My Plan F started at 280 a month in 2013. Currently its 470 a month and about to go up again.  But if you can get one like the F plan you will have virtually no dialysis bills. For dialysis alone I would be out of pocket about 700 a month in copays for the clinic and the nephrologists monthly billings and I do PD at home so it may be different for hemo. Every state has different rules for supplements so it may be worth a consultation with a SHIP in your area as to what your options are.

[Mr Ken]

Yes several, Medicare, Medicaid, these are minimum cost insurance plans that dialysis makes you eligible for.

Dialysis makes you eligible for Medicare after 30 months of treatment if you have private insurance, and at the 4th month if you do not.  You can be eligible immediately without private insurance if you do home dialysis (PD or Hemo).

Dialysis does not per-se make you eligible for Medicaid.  You have to be indigent, which means no cash or cash equivalent assets (investment vehicles, gold, etc.) in excess of $2000.  There is a 5 year lookback period for which you must provide all bank statements and any large expenses (typically over $1000) have to be justified to prove they were not a disbursement of assets to avoid a Medicaid spend down.

I do know Fresenius will hound you and threaten collection action for the 20% balance Medicare does not pay.  It took two years to finally get my insurance company to pay a bill for travel dialysis, during which I was threatened with collection action.

Not for medicaid...... There is no min asset requirement for medicaid. Goes by income not what you have.

[Simon Dog]

Not for medicaid...... There is no min asset requirement for medicaid. Goes by income not what you have

I was not referring to a "minimum asset" requirement but a "maximum asset requirement".

I think I may have over-generalized.   I am certain that (at least in MA) there is a $2000 maximum asset requirement in order to have Medicaid pay for a nursing home.   This is why you hear the terms "Nursing home spend-down" and "lookback period".   Digging a bit deeper, it appears that this only applies to nursing home payment and not to general Medicaid health insurance which is income based.

So, if I let disability expire, do not get a job or pull a job, and do not cash in any IRA/401K/403B accounts, I could probably get my income down to near zero and qualify.

[Mr Ken]

Not for medicaid...... There is no min asset requirement for medicaid. Goes by income not what you have

I was not referring to a "minimum asset" requirement but a "maximum asset requirement".

I think I may have over-generalized.   I am certain that (at least in MA) there is a $2000 maximum asset requirement in order to have Medicaid pay for a nursing home.   This is why you hear the terms "Nursing home spend-down" and "lookback period".   Digging a bit deeper, it appears that this only applies to nursing home payment and not to general Medicaid health insurance which is income based.

So, if I let disability expire, do not get a job or pull a job, and do not cash in any IRA/401K/403B accounts, I could probably get my income down to near zero and qualify.

Thank you for clarifying that as the case

[Michael Murphy]

This is a problem the clinic (should be Social Worker, but in Fresinius for example each clinic has a insurance specialist assigned) should help you solve,  if you are not eligible for Medicaid then they will help you find and some cases I have seen arranged payments to cover the cost of the insurance to provide coverage.  There is see other options and the insurance specialist can help you find one.  Cobra, Medigap come to mind.  You need to get to a insurance mavin ASAP to resolve these issues.  I know that the period of time after being laid off is very stressful but this is something that when resolved will diminish a large part of the stress.  Getting this resolved quickly is critical right now Incase the current republican congress guts the preexisting condition provision of the Obama Care.

[Mr Ken]

This is a problem the clinic (should be Social Worker, but in Fresinius for example each clinic has a insurance specialist assigned) should help you solve,  if you are not eligible for Medicaid then they will help you find and some cases I have seen arranged payments to cover the cost of the insurance to provide coverage.  There is see other options and the insurance specialist can help you find one.  Cobra, Medigap come to mind.  You need to get to a insurance mavin ASAP to resolve these issues.  I know that the period of time after being laid off is very stressful but this is something that when resolved will diminish a large part of the stress.  Getting this resolved quickly is critical right now Incase the current republican congress guts the preexisting condition provision of the Obama Care.

Wishful thinking but if you have a worthless piece of crap social worker that does not help patients then you have a problem. Social workers are in a world class all by themselves.... Needless to say I do not give them much hope...
 

[Michael Murphy]

Mr Ken not all social worker are useless discouraging people from contacting the clinic social worker is removing what could be a valuable resource in the hunt for coverage.  In my experience SW’s have strengths and weakness’s but condemning them all as useless is throughing the baby out with the bath water.  Dialysys clinics have a complaint procedure if a social worker proves to be useless speak to the clinic manager and file a formal complaint.

[Mr Ken]

Mr Ken not all social worker are useless discouraging people from contacting the clinic social worker is removing what could be a valuable resource in the hunt for coverage.  In my experience SW’s have strengths and weakness’s but condemning them all as useless is throughing the baby out with the bath water.

I have seen many useless social workers and you have to be careful in dealing with them because they will take notes and exaggerate concerns they may have with you. play nice or get burned. Bad experiences....

Dialysys clinics have a complaint procedure if a social worker proves to be useless speak to the clinic manager and file a formal complaint.

Does not due any good to speak with higher ups. I simply say I do not want to see his face in the facility ever. Keep him away from me or there will be trouble. The staff knows it too!!! They have earned title for being worthless.....
 

[Michael Murphy]

After speaking to the manager as a courtesy you the inquire to CMS complaint procedures since Social Workers are mandated by CMS.  In fact most of the inane questions asked by Social Workers are in reality dictated by CMS required forms the Social Worker is required to fill out on every patient.

[Mr Ken]

After speaking to the manager as a courtesy you the inquire to CMS complaint procedures since Social Workers are mandated by CMS.  In fact most of the inane questions asked by Social Workers are in reality dictated by CMS required forms the Social Worker is required to fill out on every patient.

Trust me CMS does not care...... A social worker helping a patient through issues has nothing to do with CMS. It has to do with being a decent human being. In my case this social worker is crap out of luck because I am not going to engage in any conversation with him. He won't be filling out forms on me.... In fact the dialysis center has to do a care plan. Dietician spoke to me so I am waiting for the social worker to attempt to pop in.... He will be popped out quickly...... I can take a lot from people but this piece of crap really pushed my buttons the wrong way and he is not going to get away with it unscathed. He is not doing a service to any patient in fact he is doing a disservice.  You do not need people like that....