Medicare coverage post transplant

[MrChan]

can you get Medicare if you have insurance thru your employer and are not disabled? I just called SSS and the person was trying to read the policy as he was talking to me. He was as uninformed as me.

[Cabrilla]

my dialysis insurance counselor AND my transplant counselor both agree that you become eligible when you get the transplant or you start dialysis. It’s optional to apply for it.. If you have employer health insurance then Medicare is secondary (means it pays a portion after your first insurance pays its part).

[Gardner-NY in reply to Cabrilla]

Maybe something has changed with Medicare under age 65 and not due to disability rating; but my brother in law had his kidney transplant at age 57 and due to him and his wife had good private employer insurance they said 'no' to Medicare when offered. When he turned 65, Medicare did not pay for his $1200 a month antirejection medications because he turned down Medicare at age 57 when offered. Make sure you check into this or you could be in financial hardship later on. My spouse had his transplant at age 59 and we took the Medicare though we had employer good medical insurance and he paid every 3 mos for Medicare for over 36 months then it dropped, and I paid for the work medical insurance. Please check into this issue.

[LavenderRabbit]

Yes you can. I have employer healthcare and Medicare. Talk to your coordinator, they should be able to help you.

[WYOAnne NKF Ambassador]

Your transplant coordinator and social worker at your transplant center should be able to help you. I am surprised that they didn't' already discuss Medicare with you. You can be on it for 3 years after a transplant, if you are not 65.

[Yankcg70]

It was to my understanding that you are covered up to 3 years on medicare after the transplant. You should already be on it.

[NoCaGirl]

Yes. I did. I had private insurance but got medicare as secondary insurance due to ESRD. You qualify when you get transplant or start dialysis.

[Oceansideup]

My hospital financial coordinator advised that I apply for Medicare even though I had group health insurance through my spouse’s employment - because if I didn’t apply at the time of transplant, Medicare would not pick up my immunosuppressant drugs when I turned 65. That’s the bottom line.

ESRD Medicare entitlements were poorly understood by those at my social security office. And at others for that matter. I applied and spent MONTHS and countless hours on the phone following up about the application, necessary forms and procedures. I couldn’t speak to anyone in person because offices were closed because of covid.

My application was repeatedly mishandled despite my going through the chain of command desperately looking for someone that was knowledgeable about the guidelines and application rules and requirements. I became stressed out about it. I kept a detailed timeline of all of my phone calls, what I was advised and what actions I took. FINALLY I was put in contact with a “technical specialist” who seemed knowledgeable. Even he did not understand some of the complexity of ESRD eligibility but he did eventually help me straighten everything out and fixed all the mistakes that had been made along the way.

If the person helping you appears to be lost with regards to your questions or is giving you conflicting information, request to speak with someone who is experienced in securing ESRD Medicare. It’s what finally resolved it for me after almost a year. I needed one person to review my application and see it through to the end.

If this doesn’t work, you can involve your congress person who can advocate for you. This was the step I was about to resort to when I finally got my issue resolved.

Times are different now with offices opened so hopefully you won’t have the same problems I did!

Best of luck to you!

[Porter20]

My insurance in NC requires you to move to primary as Medicare at 30 coordination period group becomes secondary. You are mandated so yes. ESRD pushes you to the top to get benefits too. So go to a SSA office to get qualified.