It looks like I need a Medigap insurance policy. I have 12% renal function and am looking at making decisions on dialysis. I am on Humana Gold Medicare. Any suggestions? Advice? Thanks.
Humana Gold Medicare is a Medicare Advantage plan. People in Medicare Advantage plans cannot use Medigap plans. If you haven’t started dialysis or had a pre-emptive transplant, you can switch to another Medicare Advantage plan with lower out of pocket costs or switch to Original Medicare during the Medicare Advantage Open Enrollment Period which lasts from January 1-March 31. If you start dialysis or have a kidney transplant later, even though you have Medicare now, you will have a new initial enrollment period for Medicare due to ESRD (kidney failure). At that time, you can switch to Original Medicare. WARNING: I’d suggest you only switch to Original Medicare if you can get a Medigap plan in your state at your age. Federal law only gives people 65 and older protections to buy a Medigap plan in all states for 6 months after they get Medicare Part B. Some state regulations require companies selling Medigap plans to people over 65 with Medicare to sell at least one plan to those under 65 with Medicare.
I f you are considering a transplant you should contact a financial coordinator at the hospital you would like to receive a transplant from and ask them for some guidance. I am in Michigan and my Dialysis center has been pushing everyone to get an Advantage plan. I was not sure it was the best decision for me so, I called my financial coordinator at the University of Michigan was told that anyone considering a transplant should think hard before switching from standard Medicare because, most of the Advantage plans are HMO’s and require pre-approvals before most procedures even the transplant itself. I was told that the delays that getting these pre-approvals could cause may delay or exclude me from getting a transplant in some situations. I hope that this helps someone,thanks Rob.
Thank you for sharing this information. I suspect dialysis clinics are pushing Medicare Advantage plans because unlike Original Medicare, MA plans don’t require clinics to cover the cost of for ESRD-related labs and drugs under the rate Medicare pays them for dialysis. Also, if you can get a Medigap plan, you will know from month to month what your out of pocket costs will be in premiums. With MA plans, your coinsurance and copays for Part A and B services could be as high as $7550/year–may be less, but be sure you know what you’re getting. The advertising for MA plans focus on extra benefits but don’t tell you that those extra benefits may have a limit or are only available under certain situations. For example, from what I’ve seen the transportation benefit is limited to a few trips/year…not enough to cover in-center dialysis and home delivered meals may only be for a short time after a hospital stay. Do you due diligence. Read the policy. Know what doctors/hospitals are in network (may not pay out of network and if the MA plan pays, you will pay more for out of network services). Know if your drugs are covered and what you’ll pay for them. The cost of drugs is in addition to the cap I mentioned before. As you can tell, I’m very leery of MA plans.