ESRD Regs/Medicare

It is no bearing that it is the same company. ACA and Medicare are totally different. Medicare sets the rules for the MA plans and not the ACA company. When a person turns 65, it resets everything. That's a fact!

Accidentally, I posted the Spanish version earlier. This is the English one: https://www.medicare.gov/sites/default/files/2018-07/10128-medicare-coverage-esrd.pdf

I'm not challenging anyone, I'm trying to clarify. This is the CMS publication and it seems clear the ESRD (except in limited circumstances) is a different ballgame. Please help me understand.
 
It is no bearing that it is the same company. ACA and Medicare are totally different. Medicare sets the rules for the MA plans and not the ACA company. When a person turns 65, it resets everything. That's a fact!

ACA is a form of government/commercial coverage. Now tell me Medicaid and Medicare are totally different: (Further CMS guidance)

Individuals who develop ESRD while enrolled in a health plan (e.g., a commercial or group health plan, or a Medicaid plan) offered by the MA organization are eligible to elect an MA plan offered by that organization. In order to be eligible, there must be no break in coverage between enrollment in the health plan offered by an MA organization, and the start of coverage in the MA plan offered by the same organization.

And a person doesn't get magically cured of ESRD just because they turn 65. There is no ESRD reset when a person turns 65! Show me that in print.
 
Accidentally, I posted the Spanish version earlier. This is the English one: https://www.medicare.gov/sites/default/files/2018-07/10128-medicare-coverage-esrd.pdf

I'm not challenging anyone, I'm trying to clarify. This is the CMS publication and it seems clear the ESRD (except in limited circumstances) is a different ballgame. Please help me understand.

I'm sorry, I may have confused you. Yes, the ESRD is going to stop him from getting an MA plan unless there is a special one approved in his area.

However, I was originally addressing when he turns 65. None of the ACA stuff, or MA stuff will matter because he will be in open enrollment and you can write him a med supp starting 1/1/20
 
ACA is a form of government/commercial coverage. Now tell me Medicaid and Medicare are totally different: (Further CMS guidance)

Individuals who develop ESRD while enrolled in a health plan (e.g., a commercial or group health plan, or a Medicaid plan) offered by the MA organization are eligible to elect an MA plan offered by that organization. In order to be eligible, there must be no break in coverage between enrollment in the health plan offered by an MA organization, and the start of coverage in the MA plan offered by the same organization.

And a person doesn't get magically cured of ESRD just because they turn 65. There is no ESRD reset when a person turns 65! Show me that in print.

I was not disputing whether or not he can get an MA plan, but I was stating that it won't matter when he turns 65 because he can then pick up a med supp with no questions asked. I never said turning 65 gets rid of ESRD...come on man!

I simply said: When he turns 65 the clock resets. He can get anything he wants, whether it be a med supp, medicare advantage, or even nothing. Treat him just like any other turning 65.

The above still holds true.
 
I'm sorry, I may have confused you. Yes, the ESRD is going to stop him from getting an MA plan unless there is a special one approved in his area.

However, I was originally addressing when he turns 65. None of the ACA stuff, or MA stuff will matter because he will be in open enrollment and you can write him a med supp starting 1/1/20

Thanks for clarifying, Todd. I kept going back and reading and re-reading, thinking I was missing something.

So, now I'm curious about the kidney transplant situation. I know a lady who had a successful transplant but they left her old kidneys in. Her doctor says she is still ESRD even though dialysis is no longer a treatment and she's fine as long as she takes her anti-rejection meds. In such a case, would the MA plan require the diagnosis of ESRD be changed or would they accept her based on the transplant alone?
 
Thanks for clarifying, Todd. I kept going back and reading and re-reading, thinking I was missing something.

So, now I'm curious about the kidney transplant situation. I know a lady who had a successful transplant but they left her old kidneys in. Her doctor says she is still ESRD even though dialysis is no longer a treatment and she's fine as long as she takes her anti-rejection meds. In such a case, would the MA plan require the diagnosis of ESRD be changed or would they accept her based on the transplant alone?
Once a person is flagged in the CMS system as an ESRD patient, they are always flagged even after a transplant.

The MA plan would send a form for the doctor to complete to state she is no longer ESRD/had transplant/regained kidney function. Depending on how the doctor responds, the person may or may not get enrolled.
 
From page 15 of that booklet we're supposed to leave when we sell a Med Supp. :err:

Note: If you’re under 65 and have Medicare because of a disability or End‑Stage Renal Disease (ESRD), you might not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65. Federal law generally doesn’t require insurance companies to sell Medigap policies to people under 65. However, some states require Medigap insurance companies to sell you a Medigap policy, even if you’re under 65. See page 39 for more information. :huh:
 
From page 15 of that booklet we're supposed to leave when we sell a Med Supp. :err:

Note: If you’re under 65 and have Medicare because of a disability or End‑Stage Renal Disease (ESRD), you might not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65. Federal law generally doesn’t require insurance companies to sell Medigap policies to people under 65. However, some states require Medigap insurance companies to sell you a Medigap policy, even if you’re under 65. See page 39 for more information. :huh:

What booklet?

This one?
https://www.medicare.gov/pubs/pdf/02110-medicare-medigap-guide.pdf
 
Accidentally, I posted the Spanish version earlier. This is the English one: https://www.medicare.gov/sites/default/files/2018-07/10128-medicare-coverage-esrd.pdf

I'm not challenging anyone, I'm trying to clarify. This is the CMS publication and it seems clear the ESRD (except in limited circumstances) is a different ballgame. Please help me understand.

Hopes,

Client usually would only qualify for SNP MA if he's currently in ERSD. However, he could also sign with the company his employer insurance is with IF they have an MA.

At 65, he would go to a secondary open enrollment and get a Med Sup without underwriting.

If he went with Medigap currently, he'd fall into under 65 prices, which can be a bitch. Your thinking is correct.
 
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