Dialysis and Medicare



Update 10/17/12: Some notes from a recent conference: http://www.nephrologynews.com/articles/109077-where-is-the-esrd-program-going

Update 10/9/12: I found a very good site that does a great job of explaining Medicare.  It’s directed to “seniors” but all ESRD patients will eventually be on Medicare if you aren’t already. SeniorCorps.org  Also, the National Kidney Foundation has begun a magazine called Kidney Living.  Subscribe today at their website.

You might have noticed all the ads recently about Medicare Supplemental Insurance.  The reason is that the sign up period is between October and December for the 2013 calendar year.  Supplemental Insurance usually pays the 20% and co-pays that Medicare doesn’t cover. Now back to Dialysis and Medicare. 

For dialysis patients, our healthcare and coverage is extremely important.  If you have private insurance when you begin dialysis, that will continue for 30 months then it is converted to Medicare so anything that may effect Medicare will effect all of us eventually.  Prior to the 30 month conversion you can remain on private pay insurance which I posted about in “Dialysis and the Money“.

Beginning on day one, you are eligible for Medicare and it will begin paying costs after a three month waiting period.  For the private pay patient this means, you can get Medicare to cover the co-pay that the private pay doesn’t cover and, as most private insurance plans have a 20% co-pay, that can mean several hundred dollars a month for a dialysis patient.  Having Medicare cover the co-pays and deductibles for private insurance at about a hundred dollars a month means a net savings to you.

Once you convert after the 30 months, Medicare will be your primary and you can continue the private insurance as secondary to pay for what Medicare doesn’t (Medicare only covers 80% of the costs, so again, you are stuck with a 20% co-pay).  If you’re working and on dialysis, you can continue your private insurance as the secondary to Medicare for the first 30 months after you start dialysis.

At the center where I started dialysis, the Social Worker didn’t tell me that I was eligible for Medicare when I started dialysis and I continued to be billed for the co-pay and the $2000 deductible not covered by my insurance company through my employer.  After a couple years that quickly amounted to over $5000 that I was being billed by the dialysis center.  If I had signed up for Medicare when I started dialysis, I would have paid a monthly fee of about a $100 and all the charges not paid my my private insurance would have been paid.  So why didn’t the center’s Social Worker tell me that?  Because she is incompetent.  I wrote about her in “Dialysis and the Center from Hell”

On the official Medicare website there’s a question about Medicare eligibility if you’re still working and covered by private insurance. The answer is basically you are eligible for medicare as a secondary insurance to the private insurance.

If you have health coverage through your employer or union, Part A may still help pay some of the costs not covered by your group health plan. Call the Social Security Administration at 1-800-772-1213 to sign up.”  (You can also sign up on-line for Medicare. )

All ESRD patients are eligible for Medicare IF you paid into Medicare while you were working.  (If you didn’t pay into Medicare, you can still get coverage from Medicare through Medicaid but it requires income and resource means tests.)  You need to apply for Medicare Parts A and B by visiting your local Social Security office or by calling Social Security at 1-800-772-1213.  TTY users should call 1-800-325-0778. You can also apply on-line.

When you enroll in Medicare based on ESRD and you’re on dialysis,
Medicare coverage usually starts the first day of the fourth month of
your dialysis treatments.  Medicare coverage can start as early as the first month of dialysis if you meet all of the following conditions: a) You take part in a home dialysis training program offered by a Medicare-approved training facility to teach you how to give yourself dialysis treatments at home or; b) Your doctor expects you to finish training and be able to do your own dialysis treatments.

Important: Remember, you need both Part A and Part B to get the
benefits available under Medicare for people with ESRD. If you don’t
pay your Part B premium or if you choose to cancel it, your Part B
coverage will end. (from Medicare.gov)

Medicare Part A covers hospitalization and costs.  Part B covers out-patient and physician costs.   Part A doesn’t have a monthly premium because you paid into the hospitalization plan when you worked.  Part B covers out-patient costs and has a monthly premium of $99.90 for 2012. (This will probably increase for 2013.)  For dialysis, you need to have Part B.   If you need help paying the Part B premium, there are resources that can assist you like the American Kidney Fund.  Contact your Social Worker for more information about that and others.

That’s about it for Dialysis and Medicare.  You may already know most of this if you’ve been on dialysis for a while but I want to make sure everyone is informed about it because, as I explained, my center’s Social Worker didn’t tell me.  I didn’t find out about it until I was over  two years into dialysis.  This information would have saved me a huge amount of worrying and concern about paying the several thousand dollars in co-pay and deductible not covered by my private insurance.

DevonTexas © 2012

About DevonTexas

I am a person with ESRD (End Stage Renal Disease) which means my kidneys don't work. Forty or so years ago that would have been a death sentence but today there is Dialysis which means I could be hooked up to a machine that would clean my blood as the kidneys should. Three days a week, I went to a dialysis center and had too very large needles stuck in my arm to remove and replace my blood as it passed through a process where it was cleaned and the fluid was removed, a process taking a little over four hours each time. In November 2017, I received a kidney transplant from a deceased donor. My life went into overdrive. With a "new" functioning kidney, I no longer had to go to a dialysis center and my days were not open to be lived rather than recovering from dialysis which meant dialyzing for three days and resting for 4 days a week. I work full-time and often 50 hours per week. It is something I never imagined. I highly recommend it! HeeHee I want to advance knowledge about dialysis and transplant so that others can learn from my experience and mistakes. We shouldn't have to reinvent the wheel, eh? There is so much to be learned and experienced about our predicament. There are vast resources available to support us and enrich our lives but many patients don't know about them. There are also many issues that we have to deal with whether we want to or not. So I blog about them in www.DevonTexas.com All comments are confidential until I approve them. If you don't want your comment public, let me know and I will respect that. So, feel free to leave a comment. I also blog in LegacyTales in WordPress if you are interested in the ramblings of a Old Man. Give a peek and let me know what you think. https://legacytales.wordpress.com/ Enjoy.
This entry was posted in dialysis, disability, ESRD, Medicare, New Patient, Social Work and tagged , , , , , , , , . Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s