Can I choose not to apply for Medicare

I am 42 years old and been on dialysis for 2 1/2 years. I have good health insurance coverage through my job. Do I need to apply for Medicare? If I choose not to apply for Medicare… will my health insurance continue to be my primary payer for ever… beyond the 33 months coordination period. Or will my insurance will drop to secondary payer automatically at the end of 33 months.

In general, insurance companies choose to pay secondary when a patient should have Medicare as his/her primary payer. If you wish to use your employer plan indefinitely, I would strongly suggest that you request a letter from that plan that states that it will pay primary indefinitely so if the plan switches to become a secondary payer, you may have some legal recourse.

Some reasons why you may want to consider having Medicare:

  1. Having Medicare does not prevent your employer plan from paying first for any service Medicare does not cover and second for any service that your employer plan covers;
  2. If you are a transplant candidate, you need to have Medicare Part A the month you have the transplant (even if you postpone taking Medicare Part B) to protect your right to have Medicare Part B cover anti-rejection medications any time you still have the transplant and you have Medicare Part B (even if Medicare eligibility is due to age or disability instead of ESRD);
  3. Having Medicare as your primary payer limits the amount of money your insurance company spends per month reducing how fast your lifetime benefits are used
  4. Having Medicare as a secondary payer limits what any provider that accepts “Medicare assignment” can charge you, including requiring the provider to write off any balances that are over Medicare’s allowable if your employer plan paid at least that much–and cost savings could offset the Medicare Part B premium;
  5. If anything happens with your job that makes you eligible for COBRA and you already have Medicare, your company is legally required to offer you COBRA to continue your health coverage; however, if you have the COBRA event before you have Medicare, your employer is not legally required to offer you COBRA.

Incidentally, if you chose to start a home dialysis training program before the 3rd full month of dialysis, you would be eligible for Medicare the month you started dialysis and Medicare would be primary at 30 months, not 33. The 33 months people hear about assumes that patients choose to do in-center hemodialysis, which means they have a waiting period for Medicare until the first day of the 3rd full month of dialysis.