Medicare and Transplant

[zaatar]

First off, ‘Hello’ to everyone. My husband will be having a kidney transplant on March 10. He just turned 60 years old and currently he’s on my insurance. I know that he can get on Medicare for the transplant surgery and three years post transplant. Does he have to sign up himself or is that done at the hospital? Thankfully, he didn’t have to go on dialysis. We were preparing for that and was told the dialysis center would be doing the Medicare paperwork. I’m concerned that we’re going to miss the window of opportunity to sign up. Especially for the cost of the transplant surgery. Any experience with this or advice would be greatly appreciated. Thank you.

[LavenderRabbit]

I don’t know. I got Medicare when on dialysis. I do know you can get your answer from your transplant coordinator.

[Cabrilla]

I’ve been told by both my dialysis insurance counselor and my transplant coordinator that you qualify for Medicare either when you start dialysis or when you get a transplant. You will need to fill out an application. I don’t know if there is a time limit for how long after transplant you can apply. But the application can be done online.

[gardengirl97301]

Talk to your social worker at the transplant center. They will help you figure that all out.

[Hidden]

He will qualify for Medicare immediately upon the transplant if done in an approved facility. He does not have to be on Medicare prior to the transplant. In fact, he has a few months before having to sign up for Medicare. I’m pretty sure that they dropped the three year rule. That is they will pay for the post transplant medication’s indefinitely. You can google search Medicare ESRD and they have an entire booklet on this topic. Personally, I did not find my transplant coordinator helpful.

[DexterLab]

I agree with Cabrilla. I got Medicare early because of my transplant. I had to file with Medicare, but a form from the transplant center made it easy, and they back-dated the Medicare start date to my transplant month. Good luck.

[WYOAnne NKF Ambassador]

Talk with his transplant coordinator regarding Medicare. You can also work with the social workers at the transplant center and they can get him signed up asap.

Best luck with his transplant. I am 23+ years post transplant. LIFE is good!!

[Ynnep]

I'm sorry, I don't know the answer. I would talk to Medicare first. Don't depend on the coordinator or the dialysis center. Medicare/Medicaid issues are not their area of expertise.

[6V53 in reply to Ynnep]

Fill out the paperwork with the Social Worker at the transplant center. That gets the ball rolling. Then research Medicare and read (thoroughly) every letter they send you. Find a copy of the book "Medicare & You 2023". They will send it to you in about 4 months, but it will have answers to many things you have questions about now. If I had this book sooner, I would have done things differently.

Especially look out for anything Medicare sends that is on yellow paper. The initial medication coverage is usually through LInet, so look for those. My pharmacy was billing the wrong place for months.

Good Luck

[Gardner-NY]

Hello, Please don't depend on the transplant center staff to do anything with starting the 36 months of your spouse being on Medicare before he turns 65. My spouse is on my private insurance and had his transplant at age 59 (4 yrs ago), and we both are retired military and what a nightmare things became due to people at transplant knowing zero about retired military members and Tricare secondary insurance to the NY state medical insurance. Call your primary insurance about all that is happening And often they have publications online to read that deal with Medicare for the transplant. So many things went wrong for us due to people that should know what to do did not accomplish their part. Please advocate for yourselves or you could be chasing problems months later on. Glad you asked about this. I wish your husband the best in his surgery.

[Shawj1414]

You can start the application for Medicare by contacting CMS on Monday. Here's the weblink to the CMS site listed below. Remember that you will want him to receive Part A and Part B of Medicare. Part A is free, Part B will have a monthly premium. Keep him under your insurance as well, especially if it is employer sponsored because there will be additional patient responsibility even with Medicare coverage.

medicare.gov/basics/end-sta...

And an excerpt from the webpage:

If you’re eligible for Medicare because of ESRD and you qualify for Part A, you can also get Part B. Signing up for Medicare is your choice. But, you’ll need both Part A and Part B to get the full benefits available under Medicare to cover certain dialysis and kidney transplant services. You can sign up for Part A and Part B by contacting your local Social Security office or by calling Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778.

If you apply for Medicare and are approved because of ESRD, you can sign up for Part B without paying a late enrollment penalty, even if a penalty would normally apply. Also, if you currently have Medicare based on age or disability and you pay a Part B late enrollment penalty, the penalty will stop when you become eligible for Medicare based on ESRD.

[Darlenia in reply to Shawj1414]

^This!^ Also add in Part D if your hubby has other medication needs - insulin, high blood meds, etc. So Medicare Parts A, B, D, and supplemental. And your hubby will be well covered.

[Yankcg70]

Medicare should be first then your insurance 2nd. they should get it done for you but stay on them. Even if not in time for your surgery, it should be retro. Do NOT let him ever go off of your insurance as long as you can keep him on it because it will be a life saver down the road and help with any "preexisting condition" issues. Especially with all that is going on in our government and them trying to overturn what the healthcare reform act put in place. Trust me, it's been a lifesaver for me and I have had mine for 34 years and 1.5 years of dialysis prior to that. I was on my parents insurance because i was only 17 at the time. But i always had to show proof that i had non stop insurance throughout my life.

good luck to you both. I hope it works great for you.

[bluekidney]

Hi I totally agree with Yankcg70, always make sure Medicare is listed as the primary payer. The medical offices will fight you on it at first and they made me call Medicare and my insurance company to get them to change over their status as who would be primary and secondary. My insurance was easy to get a hold of but Medicare usually takes a long time before you can speak to a person. After that if he is admitted to the hospital for any reason always make sure Medicare is listed as primary as we qualify for it that way due to ESRD for 3 years after transplant. I personally had to apply by myself for Medicare. I was told by my dialysis financial coordinator that I had to do it on my own and did not receive assistance with it. It’s an easy application online I would not recommend applying over the phone and possibly maybe walking into your local social security administration to apply in person would be easier.