Need thoughts about paying for dialysis--I'm in the USA

Posted , 4 users are following.

Okey, I'm turning 65 this week on Friday. My nephrology gist has also made it clear that I could find myself on dialysis fairly suddenly any time now.

So I've been looking at insurance and thinking about how I'm going to pay for dialysis. Key points:

1. I am still working as a university professor. I plan to work for another 6-8 years.

2. I receive health insurance from my job. I'm on Blue Cross Blue Sheild of Kansas, Plan C (This is a high deductible plan with a health savings account.)

3. It's my understanding that Medicare will serve as the secondary insurance (after my work insurance has paid what it will toward dialysis) for the first 30 months I'm on dialysis. Then roles reverse with Medicare being the primary insurer with my work insurance picking up the remainder of it is eligible for coverage.

4. Once I retire Medicare will only cover 80% of the cost of dialysis. I will be responsible for the remaining 20%, which could be between $20,000 and $30,000 a year. 

5. A supplemental insurance policy may pick plus much of the remaining 20%--like a medigap policy; however, the medigap providers do not have to offer coverage if it is outside the open enrollment time period.

So my questions:

1. Would open enrollment for the medigap policy happen at the time I initially enroll in Medicare Part B when I am initially placed on dialysis?

2. If so, am I further ahead to enroll in both Medicare Part B AND a medigap policy as soon as I know I will be placed in dialysis to ensure that I'll have medigap coverage at a reasonable price? (This would negate the need for my work policy/benefit.)

Basically, I'd appreciate any words of wisdom you may have. I'd also appreciate contact people and phone numbers I can use to get some accurate and quality information about all of this.

Thanks soooo much!!

Marj

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  • Posted

    Hi Marj, unfortunately I can't answer your questions regarding insurance, but I have a question of my own:  how long as you planning to be on dialysis?  Or maybe a more apt question is, are you able to get on a waiting list for a transplant and if so, what is the estimated waiting period? It sounds to me like you are planning to be dialysis for a good long while, and I'm hoping this doesn't need to be the case.

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    • Posted

      I don't see my nephrologist again until November. He hasn't yet referred me in for transplant eligibility testing. I'm trying to pull some weight off now as I'm sure that will need to happen. But it's proving to be pretty challenging on the weight management front. I know I'm not interested in a living donor kidney so even if I do qualify I'll have to wait for a deceased donor kidney match which could take up to 3 years, I guess. I'm 65 on Friday do my age becomes a factor that may be against me for the transplant too. I'm inching closer to 70 years of age without even being tested for a transplant--so I'm realizing that a transplant may well not be in the cards for me. And, frankly, if I'm understanding this insurance thing accurately, I won't have enough funds to pay my 20% of dialysis expenses. Do I may end up selecting no treatment other than "comfort care" simply because that's all I can cover financiAlly. When I do fully retire I will have to have a medigap policy in addition to Medicare to cover this. With that being the case I should maybe go ahead and enroll in both right now when I can't be turned down on the medigap policy AND they have to offer it to me at the same price they charge others.

      I'm trying to find some accurate and individualized financial guidance on all of this but have just been going in circles when reaching out to various agencies like Medicare.gov. Clearly this is a critical financial decision for me. And I definitely need some help--but where do I go to get this help????

      Marj

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  • Posted

    Open enrollment for Medicap occurs when you go on Medicare. There are many policies. I have plan G. It's cheaper than H. My deductible is 187.00 per year. You should enroll in Medicare A and B. Please get a professional to help you with your decision. God Bless you!

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    • Posted

      Thanks, Glenda🐶

      Thankfully I was able to talk with a person from the local SHIP office today. I had spoken with my work insurance person yesterday.  Martha, the person from SHIP, was tremendously helpful!

      As it turns out I'm fairly fortunate. My work insurance (BCBS of KS) does cover dialysis. I am on Plan C. This is a high deductible plan with a health savings account. So I have to pay the $2850 deductible. I then pay 80% and NCNS of KS pays 20% of my medical costs until I reach a total of $5500. At that point everything is paid in full.

      This is the same coverage I have for any other covered medical expense. So I've been in the habit of putting the entire patient responsibility aside each year so it's there for medical care should I need it.

      Martha confirmed that I don't need to enroll in Medicare right now; I can wait until I'm ready to retire or I start drawing social security, whichever comes first. And, if I choose to keep working as I start receiving my social security I can still defer or postpone Medicare enrollment as long as I have coverage through work.

      She did confirm that I need to apply for medigap at the same time that I start medicare plan B. That is the period when I can't be turned down for medigap coverage and I can't be charged a higher premium than anyone else is charged. If I choose to wait and enroll in Medicare at age 70 there will be no penalty and I would still have to be awarded a medigap policy without questions, etc.

      Because my health insurance is paid in full through work and my employer contributes $2500 into my health savings account annually at no cost to me, I'm actually further ahead to continue with my work policy and postpone starting on Medicare. In short, I'm responsible to pay $5500 a year out of pocket for medical care but my employer contributes $2500 to my HSA. So I'm really paying only $3000 out of pocket annually for my medical stuff right now. If I was to switch to Medicare with a medigap policy Part B and the medigap policy would run me close to $280 a month for a total of $3360 a year. And I would have to add a Part D plan as well. So I'm definitely saving money by staying on my work plan.

      I was relieved to learn that I won't be penalized by waiting to mentoll in Medicare until I'm 70 years old. That was my primary worry.

      But what a run around to find the right agency with the right people to help me verify all of this. I kept being sent to the federal Medicare people. I was told to ask for an ESRF specialist with Medicare. Every time I asked for that type of person they literally hung up on me--they didn't even say goodbye. They just abruptly hung up all three times.

      I will say, they were very consistent🐶

      Anyway, I've got everything in writing from my insurance company. And Martha is sending me stuff in writing for my files too.

      And she did verify that medigap Plan G is the better medigap plan since there are changes being planned for Plan F and one other medigap plan.

      Well, thanks for reading this lengthy saga--maybe this will help someone else.

      Marj

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  • Posted

    Hi Marj,

    I'm so glad you got this insurance issue sorted out before starting dialysis--the whole Medicare/Medigap/Advantage maze of choices is overwhelming. And, it's the last thing you want to be thinking about. You are fortunate to have your insurance plan and HSA with your employer and then when you retire, you can switch to the medigap option. 

    My PCP required his patients to sign up for his Medicare Advantage HMO network, so we just did that without even considering other options. Only now do I see the long-term advantages of a medigap policy and the disadvantages of doing it after the initial enrollment period. If we switch during the next enrollment period, our premiums will be higher and the insurance companies can turn us down. I've also learned that if we move out of state, we can sign up for a medigap policy without penalty--just as if we had signed at the initial enrollment time. Same rates with no pre-conditions considered and they can't turn us down. So, at least there is an option to get that coverage. I just want to have a full range of choice of doctors and hospitals.

    Good to know Plan G is now better than F. I heard F was the way to go. May I ask...what is SHIP?

    I send all good wishes your way. I hope you are enjoying what's left of the summer.

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    • Posted

      Thanks, Grace!

      I did double check with BCBS of KS today just to verify what I thought I heard them say earlier this week. They did verify it. Dialysis is covered as long as it is medically necessary--I can't fathom anyone going through dialysis for whom it is not medically necessary🐶

      And it has to be provided by a preferred provider. I'll need to double check to see which dialysis centers in my area are preferred providers. I'll do that over the next few weeks.

      I feel incredibly fortunate to have this quality of medical insurance. I'm also fortunate to have a job that allows me to work from home 4 days a week or all 5 days of the work week. This is a job I can easily manage as I deal with my medical issues.

      So, I plan to work until I'm 70. I'll then need to enroll in Medicare. I'll also enroll in a medigap policy at that same time. And, yes, it does sound like Medigap Plan G is the preferred plan. The premium is lower and the deductible is only $187 annually. So Plan G has been a better medigap option than Plan F according to the SHICK person I talked to yesterday.

      By the way, SHICK stands for Senior Health Insurance Counselors of Kansas.

      Marj

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