The World of Medicare

At the advice of my social worker from my dialysis center, I enrolled in Medicare although I already have private insurance through my job. I will start paying the premiums this month. I wanted to know from those who have been in this longer, what has been your experience with a Medicare Advantage plan vs straight Medicare? Im debating on which way I should go. I appreciate your thoughts and input.

People who are on dialysis cannot enroll in just any Medicare Advantage (MA) plan. Dialysis patients can only enroll in MA plans that are designated as “special needs plans” that agree to accept people who are on dialysis. MA plans that accept dialysis patients must be able to provide coverage for services that dialysis patients need, including referrals to specialists.

Patients have told me that they have had unexpectedly large copays with their MA plan. Unless someone has Medicaid (limited income and assets), the patients must pay these copays, which are charged for every service and may be charged for every dialysis treatment.

If someone signs up for Original Medicare, he/she may be able to buy a Medicare supplement. Federal regulations require insurance companies to sell supplement plans to people who get Medicare at 65 for the first 6 months that they have Medicare with no risk of denial and no pre-existing waiting period. State regulation governs whether people under age 65 can buy a plan once they have kidney failure and need dialysis. One the person pays the monthly premium for Part B and the Medicare supplement, he/she may not have to pay much if anything for any Medicare covered service he/she receives.