Medicare Part B

[RonZone]

My question today is, I'm still on my employer provided Blue Cross/Blue Shield, but a lady at the local dialysis clinic said it would also be beneficial to sign up for medicare part B (I'm already on part A as I am 66 years old). What possible charges will Medicare part B cover that my Blue Cross Blue Shield might not fully cover?

[LutherPDX]

This question is one of bones that is best left up to the experts. Your clinic probably has an insurance person who can talk to you. I assume you are on dialysis, If so your Group insurance from your employer only has to pay so many months of dialysis before have to resort to Medicare anyway. The rest of the equation that involves what state you're, how old you are,If you're allowed to Medicare policy or if your group health insurance can become secondary to Medicare. There's just a lot of variables that you will not be able to get answer properly over the internet.

[BigBilly in reply to LutherPDX]

Ron Zone. My wife and I are on Original Medicare plus Anthem "medigap" insurance (covers the 20% Medicare co-pay). My wife also has the Medicare Part D (prescription coverage). Our premiums are high, but we can see just about any doctor, choose any hospital (if needed), and not have a co-pay. Medicare Advantage plans are advertising on TV everything but free tickets to the movie theater, in some cases for zero monthly premiums. Be careful. Medicare Advantage may be OK if you only have a few medical issues. Participating doctors and hospitals are limited, and co-pays can be high (particularly if admitted to a hospital). Plus, to see a specialist (such as a nephrologist), you must first get a referral from a general practitioner. Not sure about dialysis coverage since I am not on dialysis. Good luck!

[RonZone in reply to BigBilly]

Billy, thanks a bunch for the info. I'll look into Anthem as an option. That is good info about those Medicare Advantage plans I see ads for on tv. That's the kind of info I will need as I make all these decisions.

[RonZone in reply to LutherPDX]

Luther, Yeah, I know there are a LOT of variables with all this stuff, that's why I'm looking at as many options as I can. I'm 66, in Alabama. I will talk to the clinic again and see if I can talk directly to the insurance person if they have one. I start dialysis this summer or fall, so I am trying to get all my ducks in a row before I start, so we're not suddenly hit by a bunch of bills to pay. I'll check on the primary/secondary status of Medicare coverage (parts A and B) and my Blue Cross Blue Shield to see where each stands on that. I'm obviously trying to max out my coverage to reduce out of pocket without paying an arm and a leg in premiums each month. I'm going to keep my employer provided Blue Cross Blue Shield as long as I can but have Medicare A and B in place should that suddenly go away if I have to stop working. I hope that doesn't happen, but who knows. Thanks again for the thoughts, I'll post what I find out in a later comment.

[cs65 NKF Ambassador]

I had Blue Cross Blue Shield for about 3 years as a secondary plan to my Medicare( a Medigap policy) and I have never had to pay a copay since that is covered by the BCBS plan. It was actually recommended to me by my transplant hospital that I get a Medigap plan instead of a Medicare Advantage plan to make sure that when I get a transplant everything, including immunosuppressive drugs and post op care for a living donor, would be covered. I recently switched to another Medigap plan since the BCBS premiums were getting out of hand, but I have had no complaints with the BCBS coverage and it has helped cover several fistulagrams on my dialysis fistula.

[RonZone in reply to cs65]

Hey cs65, good info as well. What Medigap program are you using, if you don't mind saying (if you don't want to say, that's absolutely fine as well). I would like to explore all the options. And yeah, my company covers my Blue Cross plan, it is very expensive these days. I've used it very little in all my 40 something years of employment, so you think Blue Cross would've been putting some of it in the bank for me to use in the future, right?

[cs65 NKF Ambassador in reply to RonZone]

Well, I'm in Massachusetts, so I now have Health New England as my Medigap plan, but if you're in Alabama you can check the Medicare plan finder on the Medicare website for your state. That will list all the plans available for your area.

Love your sense of humor - that will help you out while on dialysis!

[KidneyCoach NKF Ambassador]

There are a lot of variables but private insurance remains primary for 3 years then Medicare is required to become primary and if I recall part B covers clinic charges. Yes it may be worth a discussion with insurance/billing personnel at your clinic. Blessings

[RonZone in reply to KidneyCoach]

Kidney Coach. I was not aware that private insurance remains primary for 3 years. Good to know as I work all of this out. And good to know Medicare part B covers clinic charges. I've got my paperwork filled out for part B, just need to take it to my social security office and have them send it off. Will set up an appt with the clinic billing/insurance folks and see what medigap program they recommend on top of part A, part B and Blue Cross Blue Shield.

[savethewildmustangs]

I work for healthcare (admin for a hospital) in the insurance authorizations area. The Medicare B will augment any outpatient services allowed by Medicare, you have and also will be there until sometime after you get a transplant, if that is your choice. It pays after your primary of BC/BS. It will cost about $138 dollars a month and they collect 4 months at a time, but had to pay more the first time I paid. I know that my primary is charged over $15,000 a month for me doing my own manual dialysis at home. But if you ever lost your job, due to health, your outpatient would be covered up to 80% of what Medicare allows for care. Hope this helps. I just joined this group right now....

[RonZone in reply to savethewildmustangs]

Hey, this is really good info from someone actually in the know! I went to my local Medicare office last week and signed up for Medicare Part B. So I'm good to go with my BCBS and Medicare Part A and Part B, that is until I lose my BCBS one of these years when/if I start working, then I guess I'll need to look into Medigap policies to fill in what Medicare A and B do not pay. My next research needs to be into whether my BCBS will pay for all the medicines, or do I need to supplement my BCBS prescription coverage with Medicare part D? The medicare office said they don't actually offer Part D, that I would need to get that through a third party. They gave me a number 1-800-AGELINE to call for info. I didn't know that you couldn't get part D through them. Interesting. $15,000 a month. Holy cash cow Batman.

[cs65 NKF Ambassador]

Your Medicare Part B covers your dialysis center meds, along with your Medigap policy. You will need a Part D plan to cover your meds you take at home. I don't know the particulars if you have home HD or home PD. Of course, your BCBS is primary now while you're working.

[RonZone in reply to cs65]

Ahh, so Part B doesn't cover the meds I will need for PD? Ok, I'll start looking into Part D policies and see if the cost of the policy is less than what I will pay for the cost of the meds after my BCBS pays. I need to find out who handles all the financial stuff at the dialysis center where I will get all my stuff and have a nice heart to heart with them about all this. The nurse I met with briefly there say "ah don't worry about that, you can take care of that when the time comes". yeah, right. I'd like to know how much this process is going to pull out of my pocket every month, either through paying for policies or paying for meds/services. I really appreciate this input.

[cs65 NKF Ambassador]

I don't know who covers at home dialysis, I get it in center. Check with your dialysis social worker - she should know all the financial stuff. We also have an administrative person who handles insurance questions, too. You can get a Part D insurance fairly cheaply - apply for that on the Medicare plan finder. However, be prepared to find out that some meds you need at home like phosphorus binders can have expensive copays. My nephrologist allows me to take Tums 500 mg as my phosphorus binder. It's very cheap and over the counter. and doesn't have the side effects some of them do.

[RonZone]

Yeah, I'm going to set up an appt with the financial folks at the center to go over all his. Ahh nasty co-pays. Great. I'm adding to my notes for my doc to ask about the Tums 500.