Does anyone know the particulars of getting ESRD Medicare prior to the start of dialysis? Medicare’s guidelines say that you qualify in the month that you receive a kidney transplant, but they don’t say what day of the month or if you start your application after you have already received the transplant. This is significant because Medicare states that the anti rejection drugs are not covered unless you already have Medicare part A &B at the time of the transplant. But if you can’t even apply until after you have the transplant, how is it possible that you would have coverage prior to the transplant?
Up till now, I had planned for my insurance through the affordable care act to pay for the transplant and anti rejection drugs. Now I am concerned that this will cause a problem down the road because Medicare won’t cover the anti-rejection drugs if they did not also pay for the transplant.
Your insights and advice will be most appreciated.
If you're not eligible for medicare — other than being ESRD — medicare lasts for 3 years after your transplant. That is my understanding at least. However, congress passed legislation this past year that — that starting in 2023 — prescription coverage for imunosuppressants will be included for transplant patients. "The legislation ensures that Medicare covers the cost of immunosuppressive drugs if no other coverage is available."
In my own case, I had a living donor transplant just over a year ago when I was 50 years old. I was eligible for medicare due to ESRD and, obviously, not my age. I was on dialysis 5 weeks prior to transplant. I believe once one has been accepted for Medicare, coverage begins the month you start dialysis (e.g. PD catheter placement and first use/flushing during training in my case). However, since I have BCBS (e.g. they are the ones who covered my transplant) and didn't opt for prescription coverage via Medicare, I recently dumped medicare. They really didn't pay a dime pre/post transplant. Actually, I didn't even receive my Medicare card until I returned home after surgery.
I know HMOs get a bad rap overall. In my case, BCBS HMO paid for just about everything in my a) stage 1 cancer surgery, b) PD catheter, and c) very expensive robotic kidney transplant. Also, I have little to no co-pays for my monthly labs or pharmacy visits. Cool!
Congratulations on your transplant. I’m glad to hear that BCBS paid well. Will you be able to keep them for the rest of your life or will you switch back to Medicare at some point?
What type of plan is your BCBS HMO? privateMedicare advantage plan?
Private? Employer? Obamacare?
Do you know the exact name of the plan?