I have been told a few times at RUSH and also at the UW transplant evaluation visits that I would become eligible for Medicare if I every went on dialysis or had a transplant. Now that I am at the footsteps of a transplant I trying to understand if I should apply for Medicare. The UW social worker had told me that once the transplant happens the financial counselor would come by me and sign me up for Medicare and that I would benefit from Medicare Part B. Medicare Part B helps cover:
Medicare Part A (Hospital Insurance) helps cover:
Medicare Part B (Medical Insurance) helps cover:
I had good coverage through my employer's plan at CIGNA. I knew that CIGNA would still be my primary coverage after transplant for 30 months and Medicare (if I took it) would be secondary. But then Medicare would only cover for 36 months following a successful transplant. Hence for 6 months (past the first 30 mo) Medicare become my primary insurance and then it flips back to CIGNA. This is my understanding and it very confusing. A great deal of it is explained in in the manual here. However, most of it is irrelevant to me as a majority of the patients go from CKD to Dialysis to Transplant. I have bypassed the need for dialysis due to a living donor. So some questions remain which I will confirm and take action based on my chat with the UW Social Worker at the pre-operative visit on Dec 9th. What I have learnt is that it is prudent to sign up for Medicare Part B and Part A upfront to cover for the out of pocket expenses incurred for the immunosuppressive meds. These meds will be lifelong and so their cost (out-of-pocket, OOP) matters. I spoke to CIGNA Home Delivery Pharmacy and found that the OOP is reasonable as most drugs are available in their generic form. Hence, I need to work the cost angle out- OOP vs. premium for Medicare Part A/B and the long-term impact of declining Medicare coverage. More on this very important aspects in the coming days as I learn more.
Medicare Part A (Hospital Insurance) helps cover:
- Inpatient care in hospitals
- Inpatient care in skilled nursing facilities (not custodial or long-term care)
- Hospice care
- Home health care
Medicare Part B (Medical Insurance) helps cover:
- Services from doctors and other health care providers
- Outpatient care
- Home health care
- Some preventive services
I had good coverage through my employer's plan at CIGNA. I knew that CIGNA would still be my primary coverage after transplant for 30 months and Medicare (if I took it) would be secondary. But then Medicare would only cover for 36 months following a successful transplant. Hence for 6 months (past the first 30 mo) Medicare become my primary insurance and then it flips back to CIGNA. This is my understanding and it very confusing. A great deal of it is explained in in the manual here. However, most of it is irrelevant to me as a majority of the patients go from CKD to Dialysis to Transplant. I have bypassed the need for dialysis due to a living donor. So some questions remain which I will confirm and take action based on my chat with the UW Social Worker at the pre-operative visit on Dec 9th. What I have learnt is that it is prudent to sign up for Medicare Part B and Part A upfront to cover for the out of pocket expenses incurred for the immunosuppressive meds. These meds will be lifelong and so their cost (out-of-pocket, OOP) matters. I spoke to CIGNA Home Delivery Pharmacy and found that the OOP is reasonable as most drugs are available in their generic form. Hence, I need to work the cost angle out- OOP vs. premium for Medicare Part A/B and the long-term impact of declining Medicare coverage. More on this very important aspects in the coming days as I learn more.
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