Medicare rules involving kidney failure

Karen – Ohio:  My husband is 66 and is still working. He is covered under his employer’s health care insurance plan. He has stage five kidney failure and is on dialysis, which he started in December 2014. He is on the list to receive a kidney transplant. When he met with the social worker in charge of financial arrangements at the transplant center, she told him that he only has until July 2017 to remain on his employer’s health care coverage. She said there is a 30-month rule that applies to dialysis patients, and after he hits that 30-month mark, his employer’s insurance company will refuse to pay for his dialysis. He will be forced to go on Medicare as his primary insurance. His employer’s insurance would then become his secondary plan. Is this true? We want to be well-educated about all of our options.

Phil Moeller: End stage renal disease (ESRD) more likely qualified your husband for immediate Medicare enrollment. There is a 30-month “coordination period” during which your husband’s private health insurance is the primary payer for covered dialysis expenses. Medicare is the secondary payer of expenses during this period, so you should look into this right away to see if you have any covered expenses that his employer plan did not pay for but which Medicare can help take care of. Of course, when you sign up for Medicare, you may need to pay its premiums, and perhaps this is the reason you haven’t done so to date. At the end of this 30-month coordination period, you will need to have Medicare, because it will become the primary payer for his dialysis and transplant care. However, his private insurance does not need to go away. He can keep it, and it will become the secondary payer. It’s also possible that he would get only Medicare Part A and B coverage and keep his health insurance for drug coverage and other things. This coordination and the best way to proceed with both private insurance and Medicare can get complicated. I suggest you read this official guide: Medicare Coverage of Kidney Dialysis & Kidney Transplant Services. Also, talk to an Ohio Medicare counselor with the State Health Insurance Assistance Program to help you make the right decisions. Best of luck.