Dialysis and Medicare (for those under 65) (medical, plan, doctor, coverage)

[Mr. Rossi]

My wife, a long-time type 1 diabetic, is about to start dialysis due to kidney failure brought on by her diabetes. She is 50 years old. Medicare will cover dialysis and a kidney transplant even if you are under 65. She is currently covered under my employer insurance. I am having trouble figuring out if we'll be better off financially with the Medicare coverage or whether we should stick my our employer insurance. Has anybody dealt with this issue? (I'm going to post this in the diabetes forum as well.)

[Inquring81]

Mr. Rossi:

First of all, your wife is getting Medicare, you aren't.

Even if you decide to stop her coverage from your employer, you'll need to keep your employer related coverage to pay for your own medical costs. And you need to keep in mind that while Medicare is a huge help financially, it is not free -- your wife will have some significant out of pocket expenses associated with Medicare. For some things, you might find that the insurance picks up some or all of what otherwise would be out of pocket expenses.

If there is a social worker at your wife's clinic or doctor's office who can advise you both on the financial costs you should anticipate with her kidney and diabetes care, make an appointment to go get some advice about this decision. I'd also suggest asking for an appointment with the HR staff at work, to find out how the costs for your wife's care will be coordianated between your insurance coverage and Medicare. If there is a support group at your wife's nephritis center for spouses/family members, it would be a good idea to talk to them as well, for "things I wish they had told me about the cost of this/how to pay for this" as they have all had to face this decision, and may have additional tips to give you that the SW and the HR person either can't discuss or don't know about.

Hope that's helpful.

[Mr. Rossi]

I know I'm not getting Medicare, and I wouldn't take my wife off my employer insurance (although I can see how you would think that from my poorly worded post). I'm just not sure if it makes sense financially, at this time, to pay for Medicare premiums when we are close to meeting our our of pocket maximum for this fiscal year.

I appreciate the advice about seeking out info from those who have been through this.

[Inquring81]

One point I'm not certain about, (but I'm sure someone else knows), is a question about possible penalties if your wife does not enroll in Medicare Part B at this point. I'm hoping Querty or one of the others more versed in some of the details about Medicare will chime in here.

Someone who is covered by employer provided health insurance that is "creditable" with Medicare Part B has the option to delay signing up for Part B while they are still covered by the employer-provided plan, without incurring penalties for the delay. A person who isn't covered by employer-provided coverage, who delays signing up for Part B will be penalized by a 10% higher premium for every 12 months that they delay signing up. Even if they have health insurance that they have purchased themselves, and/or Medicaid.

What I"m not certain about, and what I'd welcome hearing about, is whether someone who is a dependent of a worker with employer-provided coverage, like your wife, will also be spared the increased premium costs if she delays signing up for Part B. Can anyone else speak to this point?