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heartless1
Member
Username: Heartless1
Post Number: 5
Registered: 12-2011
| | Posted on Tuesday, December 27, 2011 - 04:42 pm: | 
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I have written earlier about needing a heart transplant and my COBRA policy was going to expire Jan 30, 2012 and had been denied an extension, I would have to be deactivated on the transplant list for 6 months untill medicare kicked in. After contacting my ex employer and the ins co that issued Cobra and others, I sent in my 2nd appeal and recieved a Christmas present on Dec 27, 2011 that my extension had been approved, thanks for all your help and advice, as I looked into other options you have mentioned. If we place God before us, who can be aginst us. Thanks all and have a great and blessed New Year. |
ajs
Forum Leader
Username: Ajs
Post Number: 704
Registered: 03-2008
| | Posted on Wednesday, December 28, 2011 - 10:35 am: |
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What a great Christmas present!!
Double-Lung transplant at Duke on 10/27/08
Pulmonary Fibrosis with traction bronchiectasis
http://healthierlungs.com
Live each day as if you were living forever, and live each moment as if it were your last.
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Rocket Heart
Member
Username: Rocketheart583
Post Number: 610
Registered: 08-2007
| | Posted on Wednesday, December 28, 2011 - 10:46 am: |
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What great news. Thanks for getting back to us with the results.
Rocket Heart
Tom Emahiser
Waterville, Oh
Heart Failure
Heart Txplt 1/26/05 University of Michigan |
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Jay Lackritz
Forum Leader
Username: Jay_ny
Post Number: 490
Registered: 01-2007
| | Posted on Wednesday, December 28, 2011 - 04:39 pm: |
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Congrats on getting the extension. Since Medicare will pay for your anti-rejection drugs for life if Medicare pays for your transplant, I almost hope that you don't need the transplant for another 6 months when Medicare kicks in.
However it goes, happy holidays and I hope everything works out for you.
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Hostess Rise'
Board Administrator
Username: Rise
Post Number: 16997
Registered: 05-2003
| | Posted on Wednesday, December 28, 2011 - 06:00 pm: |
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Congratulations! I love your positive attitude!
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SandyH
Member
Username: Sandy0329
Post Number: 1
Registered: 12-2011
| | Posted on Friday, December 30, 2011 - 09:59 pm: |
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Jay Lackritz
Do you have a reference website at Medicare that says they will pay for my anti rejection meds for life?? Does that mean I would have Medicare for the rest of my life? I am so worried that when I reach the year mark that they would just say you are not disabled anymore and there goes the income and the medicare? Do you know how it works? When I call they are so evasive. I can't seem to get a clear answer. |
Jay Lackritz
Forum Leader
Username: Jay_ny
Post Number: 491
Registered: 01-2007
| | Posted on Saturday, December 31, 2011 - 11:47 am: |
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Hi Sandy,
The Medicare and You booklet that gets mailed to all people on Medicare discusses the anti-rejection benefit in the section on what Medicare Part B covers. On page 51, it states the following:
"Medicare covers immunosuppressive drugs if the transplant was
eligible for Medicare payment, or an employer or union group
health plan was required to pay before Medicare paid for the
transplant. You must have Part A at the time of the transplant,
and you must have Part B at the time you get immunosuppressive
drugs. You pay 20% of the Medicare-approved amount, and the
Part B deductible applies."
http://www.medicare.gov/publications/pubs/pdf/10050.pdf
Just like any other Medicare covered service, you will need some secondary coverage for the 20% that Medicare doesn't cover, such as a Part C (MA) plan, or a Medigap Supplemental plan. My drug store takes care of this for me, and they just fed-ex my monthly supply of Prograf and Cellcept to me for no charge.
Perhaps I shouldn't have said "for life" and instead said for as long as you have Medicare. Obviously, if you no longer have Medicare, then Medicare will not pay for your drugs or any other health coverage.
As to losing Medicare if you lose disability and social security benefits before you are 65, they guarantee that they will not take away your Medicare benefits for a period of 7 years after you return to work and lose your disability payments. So... if they do take away your disability, you can still keep Medicare for an additional 7 years, and at that time, you will need to purchase health insurance from some other channel. Note that you can keep Medicare for 7 years, but not social security payments. The social security payments depend on you still being disabled. Remember that the purpose of disability is that you can no longer work. If your transplant means that you are no longer hindered and can work, then they can remove your disability payments.
I had a lung transplant, and from what I understand, it is rare for them to take away disability from lung transplant patients, and since most get their transplants in their 50's or 60's the issue of losing Medicare is not a concern. If you get a transplant when you are young, and become no longer disabled and can work, then It is assumed that you should be able to get health insurance from your employer.
As for future health insurance if you do lose Medicare, at this point in time, with the Affordable Care Act under question, based on a supreme court case, it is unknown about one's ability to obtain private insurance with a pre-existing condition in the future.
Here is a Medicare page on this 7 year period:
http://www.ssa.gov/disabilityresearch/wi/extended.htm
I hope this better explains my earlier statement of getting your transplant drugs covered for life. And yes, people have been known to get a different answer to ANY question, each time you call Medicare on the phone and ask. Unfortunately, all these folks who man their phones are not well versed in Medicare rules and laws.
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heartless1
Member
Username: Heartless1
Post Number: 6
Registered: 12-2011
| | Posted on Tuesday, January 03, 2012 - 11:05 pm: |
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JAY, you seem to have some medicare knowledge, you earlier stated that medicare would cover the immuno drugs for life if the transplant was done under medicare,or an employer or union plan was required to pay before medicare paid. The COBRA plan is the same ins company that is still being used at my ex employer the only differiance is I am paying the policy not my ex employer. Do I still qualify for the drug coverage. " Thanks Greg " |
Jay Lackritz
Forum Leader
Username: Jay_ny
Post Number: 493
Registered: 01-2007
| | Posted on Wednesday, January 04, 2012 - 12:33 am: |
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Greg,
Not sure I understand.
You say that you now have a COBRA policy. Are you saying that now your COBRA policy is what you are using for health insurance? Do you have Medicare Parts A and B?
Did you have Medicare Part A when you received your transplant? If so, was it primary or secondary to your private insurance?
Now that you have a COBRA policy, do you also have Medicare Parts A & B? Is Medicare Primary payer or secondary payer to your COBRA policy?
Sounds expensive if you have Medicare, to also pay for a COBRA policy. Aren't these more expensive than the Medicare secondary plans (Part C or Medigap)?
Doesn't matter what is the private insurance company that carries your secondary insurance and it doesn't matter who pays for it, but you must have Medicare A & B which you must pay for. However, if you didn't have Medicare at the time of the transplant. then Medicare will not pay for your transplant drugs.
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Jay Lackritz
Forum Leader
Username: Jay_ny
Post Number: 494
Registered: 01-2007
| | Posted on Wednesday, January 04, 2012 - 12:48 am: |
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Greg,
Sorry about that. When I answered your last question, I ignored your first question.
From your first question...
Sounds like you do not yet have Medicare. When Medicare kicks in 6 months from now, it sounds like you will no longer have a COBRA policy, just Medicare. At the time, you will need to either get a Medicare Part C plan, or a supplemental plan and a drug plan to cover what Medicare doesn't.
If you no longer have a COBRA plan when you get Medicare, then the COBRA plan has nothing to do with what Medicare will pay for, no matter who pays for it.
The only criteria is if you get your transplant before you get Medicare in 6 months, then you will be on your own for the anti-rejection drugs. You can buy a drug policy that will help, or get discount coupons from the manufacturers of the drugs.
Note that Medicare Part B will never pay for all your other drugs, just the two immunosuppressives, so you will need a drug policy after your transplant, even if Medicare will pay for your Prograf and Cellcept.
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heartless1
Member
Username: Heartless1
Post Number: 7
Registered: 12-2011
| | Posted on Wednesday, January 04, 2012 - 12:50 pm: |
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Correct, the cobra policy will go away when medicare kicks in, I have to wait 6 months untill aug 1 for medicare to kick in. So if I get a transplant before medicare kicks in I will have to pay for the drugs through other means. Any way you look at the situation its going to get expensive. |
Holly
Member
Username: Holly
Post Number: 524
Registered: 09-2007
| | Posted on Saturday, January 07, 2012 - 06:47 pm: |
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Yeah!!! God really is good.
Holly Mulkerin
Medina Ohio
Heart transplant 1/28/09 I have a Happy Heart
Be kind. Remember that everyone you meet is fighting a hard battle. Harry Thompson
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