What To Do ESRD?

[Bob_The_Insurance_Guy]

Here's the situation:

64 year old female (will be 65 Dec. of 2011) has ESRD and is currently on COBRA (her husband's group plan). Including the 36 month extension, her COBRA will be running out January of 2011.

That leaves her with a 10 month gap to cover.

Two questions:

1. can she get another extension of COBRA to fill in the 10 month gap?
2. are there any Medicare Plans for people with ESRD? I know that SNP Plans exist, but that's for Chronic Illnesses ie Diabetes.

 

[somarco]

Sman (Scott) posted something a few days ago about the GA Gen Assembly passing a law requiring Med supp carriers to cover ESRD starting 11/1/2010 for under 65.

Georgia General Assembly - SB 316

 

[DS4]

Does this woman currently have part A & B of Medicare? I'm assuming yes?
Does Georgia have a state COBRA extension that can trailer Federal COBRA?

 

[Superchief]

There's something there I don't get. 10 month gap? She turns 65 in December. Eligible for Medicare A & B in December too right?

Get her a med supp during open enrollment.

 

[Fisher]

There's something there I don't get. 10 month gap? She turns 65 in December. Eligible for Medicare A & B in December too right?

Get her a med supp during open enrollment.

Wrong year, SuperC... read it again.

 

[VaDwayne]

Here's the situation:

64 year old female (will be 65 Dec. of 2011) has ESRD and is currently on COBRA (her husband's group plan). Including the 36 month extension, her COBRA will be running out January of 2011.

That leaves her with a 10 month gap to cover.

Two questions:

1. can she get another extension of COBRA to fill in the 10 month gap?
2. are there any Medicare Plans for people with ESRD? I know that SNP Plans exist, but that's for Chronic Illnesses ie Diabetes.

She will qualify for disablity social security with ESRD, even though she's not 65(tell her to look into this now, don't wait until the last minute, it is the government).* When she gets social security, she will get part A and can enroll in part B, Now that she has parts A and B, she will qualify GI for a Medicare supplement 3 months before the month of her 65th birthday.

* to get social security benefits she will still have to qualify by paying into SS for 40 quarters, a spouse paying into SS for 40 quarters, or be a railroad retiree(or spouse), maybe something else, it's been awhile.

 

[Frank Stastny]

I'm not sure about GA but in MO once the person is approved for SS Disability there is a two year waiting period before that person is eligible for Medicare. However, if their disability started two or more years before applying for SS Disability they may have their Disability back dated by two years and be eligible for Medicare when approved for SS Disability. (They will also receive two years of disability payments.) She may have just been diagnosed with it.

The following is from the bill that passes:

(g) Insurers offering medicare supplement policies in this state to persons 65 years of age or older shall also offer medicare supplement policies to persons in this state who are eligible for and enrolled in medicare by reason of disability or end-stage renal disease. Except as otherwise provided in this Code section, all benefits, protections, policies, and procedures that apply to persons 65 years of age or older shall also apply to persons that are eligible for and enrolled in medicare by reason of disability or end-stage renal disease.

There is still a question regarding when they will be "eligible" for Medicare. The bill does not state which Med Supp plans insurance companies will have to offer or when they must begin offering them. We can make a WAG but until it is spelled out that is all that it will be.

I believe in OK companies must offer Med Supps to those under age 65 but they only offer Plan A. I believe that is a state regulation. I assume all of these and many more questions will be answered once the Dept of Insurance writes the rules and regs as to what all of that means.

This language is also in the bill but does not clarify when they will be eligible for Medicare unless it is specifically addressed somewhere else in the bill that I missed. It only talks about when they can enroll in a Med Supp.

(h) Persons may enroll in a medicare supplement policy at any time authorized or required by the federal government, or within six months of:
(1) Enrolling in medicare Part B, or by May 1, 2011, for an individual who is under 65 years of age and is eligible for medicare because of disability or end-stage renal disease, whichever is later;

 

[VaDwayne]

I'm not sure about GA but in MO once the person is approved for SS Disability there is a two year waiting period before that person is eligible for Medicare.

This does not apply to ESRD, maybe that's in all states but Missouri though.

 

[Frank Stastny]

ESRD MEDICARE GUIDELINES

Effective Dates (of Medicare)
The effective date of ESRD Medicare is dependent upon the type of treatment the individual is receiving:
1. Hemodialysis (Most common.)
Medicare is effective the fourth month of treatment, i.e. if hemodialysis is begun in May, Medicare becomes effective August 1.
2. Home/Self Dialysis (not as common)
Medicare is effective the first month of treatment if:
• The individual takes part in a training program through a Medicare certified training facility,
• Home/Self training is begun within the first three months of treatment and
• The individual is expected to finish home training and self-dialyze at home

It just doesn't automatically happen immediately for everyone.
I wasn't just addressing ESRD but Somarco's posting of SB 316.

People with ESRD will only comprise a small percentage of people who are on SS Disability. The bill applies to all on SS Disability.

I was simply breaking down the provisions in the new bill. I was simply pointing out that it doesn't mean that as of the effective date everyone on SS Disability will be able to sign up for a Med Supp immediately.

 

[midwestbroker]

Just take all this info, tell her to go to the local security office (I would go in person rather then call, my clients always have better luck that way) and inform them of the situation.

If memory serves right, ESRD and ALS (Lou Gehrig's) are 2 chronic conditions that you do not need to wait the customary 2 years for Medicare to start.