Insurance questions for seniors: Our mother... - Kidney Disease

Kidney Disease

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Insurance questions for seniors

mwilliaus profile image

Our mother is 85 and was recently diagnosed with Stage 4 kidney disease. She lives in the US & has Medicare Part A but stopped Part B a few years ago. It's open enrollment season and I'm wondering if people have any experience with insurance for seniors they'd care to relate. Would re-enrolling in Medicare Part B be worth it?

27 Replies

Yes it would. If you're not sure get in touch with your state's SHIP program. They can help you figure it all out.

Unless she has some other insurance it's a good idea to have Medicare A, B, and D. Be careful about Medicare Advantage vs. straight Medicare as some Dr.'s don't accept Advantage although it offers other great benefits. You can sign up now and still opt out or switch until Jan. I believe. Ask when you call. If she gets straight Medicare she can have that in an HMO like Kaiser. I prefer to have my choice of Drs. I have straight Medicare A, B, and D along with Medi-Cal (Calif. version of Medicaid). I've had those since I was 34 due to being disabled with an autoimmune disease.

Good luck, it can be a bit confusing. Also if you think about the paying 20% of the cost, it's not really 20% of the actual price because Medicare prices are lower. For example if an MRI cost $1500 you don't pay 20% of that amount. Medicare only accepts around $400 so you'd pay 20% of $400. I've always found it to work well even before I had Medi-Cal. And it was wonderful when they started Part D to cover medications.

You're right about referrals on some Advantage plans, but I have Aetna Medicare Prime Advantage and can see most everyone I want without a referral. I did need one for the nephro, and an MRI needed pre-approval, but most are very quick and simple. I love my plan. Tha KS for providing her with good info.

I have that same plan and the cost per month is zero and most of the drugs are zero. And I love being able to take yoga classes on line with Silver Sneakers.

What I don't understand is how does one decline Medicare Part B? I thought you HAD to have it since you have to pay for it. Maybe she has Part B and wants to get the Supplemental Insurance for the leftover 20% that isn't paid by Part B.

Ya, I wondered that too. I don't know how you decline Medicare coverage. I guess I never wanted to NOT take advantage of what is available. I worked many years and paid in lots of $$, so I want all the benefits possible...lol. I love this plan too. I had Select before, and although it was good, it didn't cover nearly as much as the newer Prime plan that came out in 2020. I've been able to get so much better care than I ever believed possible, got diagnoses that I couldn't afford before, have seen a bunch of specialists, etc. and paid very little. I only pay minimal for upper level scripts, which saves me about $80/mo over the previous plan. I haven't taken advantage of Silver Sneakers yet, but I plan to. I'm currently doing P/T 3x/wk and then at home on the off-days, so I need to find some additional energy to do much more than that, but the option of S.S. being free is a great addition. Also, their website is very easy to use, and any time I've talked to a rep I've received good customer service. They also give you a video made specifically for you each year, which is always available on-line, and it outlines all of your coverage. Have a good day PecanSandie (oooh, I love those cookies!)

orangecity41 profile image
orangecity41NKF Ambassador

Did she completely stop part B of just the supplement? Either one, is good idea to contact the state SHIP program as mentioned before. It is now open season.

I have Aetna Medicare Prime HMO and they pay nearly everything, including meds. This is my 3rd year and I'm so very happy with it. I've been able to see doctors, get tests, etc. that I hadn't been able to in years. The only out-of-pocket I had last year was $100 for an MRI and minimal expense for meds, out of nearly $70k in charges. I've been able to go to P/T 3z/wk for nearly 2 years without any co-pay. Wouldn't have been able to afford even one session if I had a co-pay. Good luck on finding a good plan for your Mom. I'm just not sure if the kidney issue will cause issues getting coverage...check into that when you're considering plans. I remember that being a question when I first changed to it, but at the time I didn't have CKD. Good luck on ins. and her health.

Hi! It may be may be possible to return to Part B with chronic kidney issues, particularly if one has end stage renal disease. You'll need to talk to a professional about your mom's options. The ideal arrangement in our opinion is the situation outlined by Sophiebun in the thread above - Medicare Parts A, B, D and a supplemental plan. Of course, Medicare is gov't based and coverage is nationwide whereas Medicare Advantage Plans are largely industry based; hence restricted to doctors "in network" and often limited to certain regions and state control. That can be problem for some folks, not so much for others. My husband suffered kidney failure, went through dialysis, and recently received a transplant. Over the year, he has paid nothing for dialysis and 8 hospitalizations including the transplant and under $1K in drug costs (largely insulin). We've been blessed.

nascar4433 profile image
nascar4433 in reply to Darlenia

Wow, that's wonderful that he's doing well now, and that you had good coverage. Hope things continue to go well for you both....you've gone through a lot.

Best is Medicare Advantage Supplement -- PPO, zero premium with Aetna. I suggest any one just joining now to get Plan G.

Supplemental insurance, includes A, B and C -- called D.

To start B again, may require to pay penalty. Should not have stopped. Unless for financial reasons, in that case dont worry. Apply for Medicaid and state help.

Tissybell profile image
Tissybell in reply to Fatbuddy

Aetna med supp

Tissybell profile image
Tissybell in reply to Tissybell

Aetna Med supp is good. I love the AARP UHC Med Supp Plan G, since all I pay is Part B deductible. When Mom goes on dialysis, she is immediately eligible for Medicare. She needs to re-start Plan B. Iv'e been told by another Broker that one can expect to pay the full max out-of pocket early within a few months if on an MAPD. Look up the govt Medicare book for kidney patients and contact SHIP. Finally, dee a local Broker anout insurance plans.

Fatbuddy profile image
Fatbuddy in reply to Tissybell

Yes, Aetan supplements advantage is good. I had for 5 years. But after heart issue, I had to take insulin. Aetna does not accept Senior Model for Insulin, so i switched to Wellcate.

Yes, Plan G is best. Used to be Plan F was better, but now discontinued last year.

Bet117 profile image
Bet117NKF Ambassador

mwilliaus,

Look into the SHINE program. They often can be found via your local Council on Aging or google them.

Their services are free, the folks are friendly, knowledgeable and will sit down with you one on one to answer questions about Medicare, match you with a supplemental insurance program which will best meet your mother's medical and financial needs based on frequency of doctors visits, services needed and prescriptions taken. They will also provide you with contact numbers.

This includes state insurance as a supplement and VA benefits.

Have been very helpful to both myself and numerous friends.

Highly endorsed by teacher's union.

Give them a call!

mwilliaus profile image
mwilliaus in reply to Bet117

I was looking for SHINE and wondering if you meant SHIBA instead? That's what I was finding before and suggested by someone else as well.

Bet117 profile image
Bet117NKF Ambassador in reply to mwilliaus

Hi mwilliaus, I connected with SHINE via my town's Council on Aging as they have two volunteers who are available on site or phone to meet with people.

Google your Council on Aging and give them a call as they could possibly direct you.

Let me know how you do.

B...

mwilliaus profile image
mwilliaus in reply to Bet117

got it. Thank you. - Mark

Bet117 profile image
Bet117NKF Ambassador in reply to mwilliaus

Mark,

No thanks ever needed. Medicare and supplemental program can be mind boggling; many choices, prices etc. Can't say enough about these folks nor can my friends who recommended them.

Let me know the outcome.

Bet

Bassetmommer profile image
BassetmommerNKF Ambassador

Yes, get the best insurance possible. Get part B, and get a supplement. If you live in NY and she has a lot of drug costs, get EPIC also. There are people who are brokers who do not charge to talk to you and get you the right coverage. They get paid by the insurance companies, but they do not force one or another on you. Look up Health Insurance brokers.

I totally agree with you. Seek a reliable, licensed Medicare company that specializes in all the available plans. Our church found one a few years ago that has a really good reputation. They came out every year at enrollment time (pre-Covid) and told us about the difference in plans between Advantage and others, answered questions, and then if we were interested they scheduled appts. at their office (or your home), where they asked about your specific needs, and then advised which plans best suited you. They were incredibly knowledgeable. One year they told me about the newer plan offered by Aetna that would be better for me than the previous Aetna I had, and although it meant leaving my PCP of 14 years, it opened up a whole new world to me to get the care I had so desperately needed but couldn't afford. As Bassetmommer said, they don't charge anything as they get paid commission by Medicare. My rep called me a couple of weeks ago and we decided my plan is still the best one for me. Don't fall for calling the 800 numbers that are so widely advertised on TV (we all know the spiel by JJ Walker & Joe Namath)...I asked him about that and he said there are a couple of zip codes in Florida that have some of those benefits, but it's a very limited area and very few people. But the catch is that since most won't qualify, they have you on the line and up-sell you other plans, for which they receive commission. He said most people regret the decision and change out of the plans as soon as possible. Don't fall for those ads...even if you like the pitchmen...it's just a paid job to them. Good luck mwilliaus!

KidneyCoach profile image
KidneyCoachNKF Ambassador

Yes, re enroll in part B it is a lifesaver to me.

Hi mwilliaus,You can also always contact NKF Cares and speak to someone about insurance questions and they can also help direct you to additional professional Medicare specialists. NKF Cares is open 9am-7pm Eastern Time and can be reached toll-free at 1-855-NKF-CARES (1-855-653-2273).

Thank you very much to all who've responded. It's very much confusing, especially since my mother did her own thing for so long and kept us out of the loop. I'm worried her pre-conditions related to her kidney as well as other things are going to make it hard to get any supplemental plans, but I'll look into everything that's been suggested here.

This is so sad. If you drop Medicare B and try to sign up later there are penalties. People on a limited budget think it's safe to drop it and save money, but we all get sick in the end and need it. See medicare.gov/your-medicare-...

yeah, she really messed up. But I should've been on top of it more. We have all sorts of problems now.

All good advice. Those off of Medicare may find it difficult to return, stumbling blocks are often in place. So seek help if that's the case. Anyway, simply a consideration for those here...if you think you may need a transplant down the road or very specialized care, Medicare will give you access to likely all centers since it's a federal program. That's huge. So play your cards right, within the constraints of your budget, to achieve the goals and outcomes you desire.

The biggest problem with Supplemental is that if you don't enroll when you are 65, the monthly premiums keep getting higher and higher until they are almost unaffordable. And you still have to enroll in the drug plan (Part D) because that isn't covered by Supplemental.

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