Replies to This Discussion

Permalink Reply by KarenInWA on September 8, 2012 at 12:40am

I was always under the impression that Medicare paid 80% and Medicaid will pay the remaining 20%. Is this not true?? I am a kidney tx patient who works a FT union job. Right now, my work insurance is primary, and Medicare is secondary. Then, sometime in 2014, that will flip and Medicare will be primary. At the 3 yr mark of my transplant, if it is still successful, Medicare will terminate for me. At that point, my insurance should become primary again (I hope *that* transition is smooth). All that to say that I don't have personal experience with  Medicare/Medicaid, but I thought it was done in a similar way to mine? Are you a kidney patient?

Permalink Reply by Dennis on September 8, 2012 at 11:17am

As I am unable to work My Medicaid premium is paid by My state DHHR,so I'm not sure if they will pick it up or not . I need lungs .

Permalink Reply by Jay Lackritz on September 9, 2012 at 8:29am

I don't know if you qualify for Medicaid, which is separate insurance that is different in every state, and is essentially a poverty program. Since these benefits are different in each state, you have to inquire from your state as to the coverage, which also depends on your Medicaid insurance company. The ACA, which expanded Medicaid insurance, allows any state to not expand their Medicaid, and the Romney/Ryan plan allows any state to offer essentially nothing, yer still get paid by the federal government for providing poverty insurance.

I don't believe that VA rules prevent you from pretending that you're not a vet and purchasing a Medicare supplemental plan or a Medicare advantage plan, the same as non-vets do.

If you want to save the premiums, you can use the VA benefits, but then you have to adhere to their rules. Other than that, you can do what the rest of us have to do, and that's buy a plan to supplement medicare. If you had medicare and a supplemental plan, you would not be restricted to any particular facility or doctor, as in an HMO or VA insurance. With Medicare and a Supplemental plan F, you could go to any Medicare approved facility in the country, and never have to pay one red cent, other than your monthly premiums. In this scenario, you would most likely need a Part D plan for drugs, but you might be able to get your drugs from the VA. I am not an expert in VA insurance, so I can't help you with VA drug benefits.

Here's info on Supplemental plans:

http://www.medicare.gov/Publications/Pubs/pdf/02110.pdf

You can download a listing of all Medicare approved transplant centers from here:

http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/C...

They are listed separately for each organ types. Here's a direct link to this month's list:
http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/C...

BTW, unlike kidney patients, with lungers, your Medicare will never terminate, unless you lose your social security disability, and are deemed healthy. If you go back to work, you can still keep your Medicare for about 8 years. Of course, if you're over 65, you will never lose your Medicare either, unless congress agrees to end Medicare and turn it into a voucher program.

Permalink Reply by Dennis on September 9, 2012 at 9:11am

Hi Jay, thanks for the info. I have part D for my TX drugs if I am TX'd at a "civilian" Hospital until I can get home and then the VA will pick them up but I'll still pay premium per drug as I make a few hundred dollars more than allowed for free which isn't that big of a deal as I know how expensive they are in the "civilian world"