I am scheduled to begin training for home dialysis on 11/11. I began dialysis on 10/15. When I start a home dialysis training program, I am eligible for Medicare starting the first day of the first month of the home dialysis program ( instead of waiting 3 months). I must start the program before my third month of dialysis, which I can. Additionally, my doctor must state that he expects me to complete the program and will continue home dialysis after the program ends. However- I am currently scheduled for a kidney transplant on 12/6-the same date as the last day of my home training. Is there any way around having Medicare cover my out of pocket expenses without physically starting the training since I may not use it at all?
When you start a home training program during the 3-month qualifying period (ends December 31 since you started dialysis in October), you can request to have Medicare start October 1 (the month you started dialysis). Or you could enroll in Medicare based on the transplant. Medicare would start December 1 if you get your transplant 12/6. If you have no other insurance, the sooner you can have Medicare in effect, the better.
If you have a job-based health plan, having Medicare as a secondary payer limits what any provider can charge you if it has “accepted Medicare assignment.” This means the provider has agreed to accept Medicare’s allowed charge as full payment. So if your job-based health plan pays 100% or more of Medicare’s allowed charge for the services you get, the provider that accepts assignment can’t bill you anything. Those savings could more than offset the cost of the Part B premium.
When you get a transplant, it’s important to have Medicare Part A the month you get your transplant. Having Part A in effect then protects your right to ever use Part B now or in the future to cover anti-rejection drugs for this transplant.
Thank you but still wondering if there is any way around having Medicare cover my out of pocket expenses without physically starting the training since I may not use it at all?
The only way to get Medicare backdated to October 1, the month you started dialysis, is to start a home training program before January 1. Unless you do that, getting a transplant in December would allow Medicare to start December 1, the first day of the month you get your transplant. If you can move your transplant up to November 30 or before, Medicare could start November 1.