Hi all, I'm having a kidney transplant on Dec 20th. I know I'm eligible for Medicare; but I do already have health insurance through my work. I'm trying to decide if there's any reason to get on Medicare if I already have employer insurance.
If I quit my work sometime in the new year, I can see having Medicare as well as the Medicare Advantage plan being useful. My doctor recently said she thought the Advantage plans were limiting and didn't think they would be good for me.
In a nutshell, I'm curious to know about what your experience has been with Medicare and Medicare Advantage plans.
Thanks in advance for any feedback you may have.
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wonderingjen
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Hi. I have a Medicare advantage plan and my transplant hospital says the benefits are great vs my old private insurance. More covered at less cost for me. Have you spoken with an insurance broker as they can run all the options for you and tell you what would be best for you(cost/coverage etc). Also NKF has a webinar they recently completed on this topic- you might find some valuable information by watching the recording.
Hi, could you possibly provide a link to the NKF webinar on Medicare please? I've been searching for it online and on their site and not turning up anything. Thank you.
Hi. Congratulations on your upcoming transplant. You must have an amazing donor!
When I had my kidney transplant 6 years ago (also a living donor), I chose to stay with my employer sponsored health insurance because I had great coverage. I am still with the same employer and continue to have great coverage. There may be some benefits to signing up for Medicare. In my case it seemed as though I wouldn’t benefit because I was going to continue to have the same medical coverage for at least 10-12 years because I was not going to be changing my job.
Talk to the hospital finance people. They should be able to give you some direction.
congrats on your upcoming transplant . Do you also have a great prescription plan through your work cause the transplants meds can be expensive. I just have regular Medicare and a supplement with good prescription coverage I know the finance team of my transplant center went over all my cost that was covered but one med would not be covered it would be like 99 she said so I would suggest you talk to your finance team at your transplant center
When I began the transplant process, I was initially declined for inclusion on the transplant list due to insufficient prescription insurance coverage. At the time, I had Medicare and an Advantage plan. However, the transplant center's finance coordinator explained that they did not believe I would be able to afford the co-pays for the necessary anti-rejection medications. With the support of my dialysis finance coordinator, I was able to cancel my Advantage plan, enroll in a supplemental plan, and obtain a prescription plan that would cover the medication costs. After three years short of two days on dialysis, I was finally added to the transplant list. Nearly four years ago, I received my transplant, for which I am incredibly thankful. I just celebrated my 60th birthday and am feeling great.
Congrats to you, Xoniprocs, on a successful transplant! When you said you cancelled your Advantage plan and enrolled in a supplemental one, what is the supplemental one (as I thought Advantage was considered supplemental)?
Anyone with a kidney transplant can get straight Medicare Parts A and B. Generally speaking you'll also need to get a supplement plan (aka a Medigap plan) to cover whatever Medicare doesn't cover. (Immune suppressants are covered by Medicare so that's good) The problem is getting a supplement plan if you're below age 65. Some states force insurance companies to offer them to the younger folks, others do not. So consider doing this if you're younger than 65...call your insurance plan representative. Tell him you'd like to switch to Medicare and would they lower the premium, serving instead as your supplement.
So why do many prefer straight Medicare and a supplement and not so much Advantage Plans? With Advantage Plans, Medicare largely shuffles over a large pot of money to the insurance company and steps back, letting the advantage plan company handle (with some oversight) your care. While Advantage Plans do meet Medicare standards, each State decides the region/hospitals they can cover and so on. So you're limited to that. Then, often not many doctors want to participate so there's not much choice for you there either. On the other hand, straight Medicare is recognized nationally and has many doctors participating. So, my husband, with many health considerations, can travel anywhere domestically and get care. If he should now get cancer, he can go most anywhere. Things to think about. So that's it in a nutshell. Btw, the National Kidney Foundation has a nice write up on insurance matters.
Medicare Advantage and Medicare Supplement plans are two distinct types of coverage. Medicare Advantage plans typically have lower premiums, sometimes even $0, but they often come with higher out-of-pocket costs. On the other hand, Medicare Supplemental plans tend to have higher initial premiums, but they generally have minimal additional expenses. In my case, a Medicare Supplement plan was the better choice. Although a Medicare Advantage plan includes prescription, vision and dental coverage, it is usually limited. For prescription medications—especially my anti-rejection meds—the Medicare Supplement plan proved to be the best fit for me, even though I had to purchase separate vision and dental coverage.
Agree with all responses. Check with your center. Seems like you have somewhat of a short time to make a decision. I was 70 when I had my transplant and was still under a previous employer using medicare as a secondary . I had just decided to work part time before my transplant. I chose traditional medicare with a supplement. My daughter worked with the major hospital in my area in the billing department and recommended that option. Advantage programs are really private insurance programs and function as such with limitations and prior authorizations. When it came to the transplant my work insurance covered the transplant and medicare became my only insurance afterwards. The nice thing about medicare is that medicare sets the price of health care fees and covers most of the cost of rejection meds under part b and the supplement picks up the difference. I am not certain but it seems my center told me that after a certain number of years your company insurance has to be considered secondary if you have medicare. Either way, my bills were far easier to deal with under medicare.
It's helpful to hear you've had a good experience with Medicare, Eyak1971. I really appreciate your input. Thank you! And hope you have continued good health with your transplant!
Hello: I had the exact question as I am having a transplant on January 7th! I’ve spent about 40 hours talking to the hospital, BCBS, SSA, Medicare, and my company health advocate. I have a “clause” in my group health care that says if I’m eligible for Medicare I could be billed as such if I didn’t enroll. Ie; based on CMS and SSA sites my group health care is primary for 30 month coordination, but after the coordination period moves to secondary for 6 months of the remaining 36 months of eligibility. Medicare sites also talks about in order for Medicare Part B to cover immunosuppression drugs for ‘life’, you had to have Medicare Part A at the time of transplant. So for my situation for these medicines to be covered during the 6 months where my company group health care won’t be primary, I need to have Medicare part B in place to get these covered. Talk to your social security administration local office. The 1-800 # wasn’t helpful, but the local office shared memos with me that weren’t even on their website talking about my situation and when to enroll. Also, Part B is based on income, so it didn’t make any sense for me to pay 36 months of part B as I’d be paying more than my out of pocket maximum from my group health care, but I will need to enroll before the coordination period is over. The piece that’s been the most confusing is when to actually enroll. Ie: during a general enrollment period (jan-mar), but I was told from the SSA I could enroll based on a special enrollment. This is critical for me so I don’t have a lapse after the 30 months. Check with your SSA and get things in writing! Good luck. I felt very deflated and beat up on this whole process as no one could get me a straight answer, but at least I know I have time to enroll in B during the general period of 2027 if I can’t enroll during a special period.
Congrats on your upcoming transplant as well, tennisskip! You certainly put a lot of time into researching this! I really appreciate your input - thank you! I will definitely reach out to my SSA office (local as I agree the 800 number isn't helpful). I appreciate your help!
Congrads on getting your transplant! Usually your transplant requires 2 forms of insurance & if you have a group plan, Medicare is 2ndary. Not sure you need a supplement until you leave your job & Medicare becomes primary. Check with your financial person at your transplant center.
My situation is a bit different as I was on dialysis waiting for a transplant I also had insurance through my employer. I called the insurance and they stated they would pay dialysis indefinitely and no need for Medicare. However the financial coordinator at the dialysis clinic pointed out it is a requirement for ESRD patients to enroll in Medicare within the 30 month coordination period. I also heard that if you decline Medicare at this time you may be denied or penalized when you become eligible at retirement. If you qualify for Medicare solely based on ESRD then Medicare should always be primary and your employer insurance is secondary. You also always have to point this out because then billing becomes a nightmare. Based on my experience both Medicare and my group insurance covered most of my bills and copays I only had to pay $3-$10 copays for my transplant medication. Now that my 36 months are up and I am on my work insurance only I have seen the bills pouring in and I wish I still had access to Medicare. Even though I always thought that Medicare premiums were high now I see the benefits of having both. Every person’s situation is different so it’s nice to do your research and get informed. Good luck with your upcoming transplant!
That's interesting about potentially being denied or penalized later--thanks for mentioning that. I really appreciate your input. Thank you, bluekidney!
congrats on the transplant. I read all the comments and it’s so crazy to me . Fortunately I live in Ireland , I have no health insurance and I didn’t have to pay anything and still don’t 5 years on . Everything is covered by the government. I know we are a tiny country compared to the States. Good luck in December.
Hello, I know quite a bit on why you need to take Medicare when offered for a kidney transplant and the ramifications if you say no b/c you have other medical insurance. My spouse had his transplant at age 59 and we have very good medical insurance with my job at a university plus we both are retired military and have a medical benefit too. Our transplant clinic financial people dropped the ball 'big time' but not know zero about how we needed to handle all this. Before I write back, how old are you now? THanks. I don't want you to have the problems we experienced for over 3 yrs due to not having someone who knew the right advice to give us at day 1. Not trying to scare you.
I really appreciate your help, GardnerADK! I'm 58. I do have insurance from my job; but I'm getting burned out and am considering quitting at some point in the new year. Any advice you have to offer I welcome! Thanks!
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