So here we are, as Dad's 18 months of COBRA come to an end, and his 2 year period on Social Security Disability approaches- which means Medicare coverage.
Actually, it means pure confusion.
COBRA can not be used with Medicare, as they are both federal programs. Ok, that I understand.
So we drop COBRA and Dad is automatically enrolled in Medicare Part A & B come April 1st. Ok. That sounds fine.
But apparently with Medicare, you need a supplemental insurance or a secondary insurance.
And with Medicare there is a Part D- Prescription drug portion.
So I've got Part A, Part B, Part D, Supplemental....and now my head hurts and I'm beyond confused.
Dad's treatments are expensive. VERY Expensive.
When you're talking about $25,000 a month (without Insurance), which doesn't include blood work or doctor's appointments, or MRI's- you're talking expenses that just aren't feasible for anyone!
So financially, we are trying to figure out our best option- as us Glenz girls are searching every possible document on Medicare website for information. Have I mentioned that the government does a wonderful job of laying out everything for us?...Yeah.
AND to make things even more confusing- Dad's chemotherapy is done via oral pills. Which we receive via prescription and they are administered at home. Which you would think would fall under Part D (Prescription Medicine).
Yeah, it's not. Apparently ALL chemotherapy drugs (oral and IV) are considered Part B.
Ok. So we figured that out. NOW, can you tell me the percentage of payment? Maybe a medical policy document Medicare has, similar to other insurance companies?
I asked this question and the billing ladies at Dad's office just laughed. Sorry, I forgot we are talking about the government here.
So our next plan is to sit down together, write down what we know, what we are confused on, and what questions we have, and then....I hate to even say it...schedule a meeting with Medicare to figure it all out.
We are stressed. We are confused. Any and all help that ANYONE has with Medicare (via disability) and supplemental insurance will be GLADLY accepted by our family. At this point, we really need all the help we can get.
But on a positive note, we have until April 1. We do not have to figure it all out tomorrow or the next day or even next month. We have a little bit of time to make some decisions.
Here I am, trying to figure it all out- stressing over each and every thing I don't understand, and forgetting to be so thankful in what I do understand about this process and insurance. So thankful that these last 2 years threw me into a "sink or swim" course when it comes to insurance companies and disability.
So as thankful as I am, at at the same time stressing about it all- I pull out my devotional and how perfect it was:
"Trust is a golden pathway to heaven. When you walk on this path, you live above your circumstances...The low road is circuitous: twisting and turning in agonizing knots. There the air hangs heavy- and dark, ominous clouds predominate. Relying on your own understanding will weigh you down. Trust in Me absolutely, and I will make your path straight."
Trying to take this all one step at a time, TRUSTING in this path (although at times a very confusing path), and reminding myself that it will all work out just fine.
Still fighting hard to BTHO Brain Cancer- one insurance change at a time!
Dad Update: Dad is finishing up another round of chemotherapy and he had an Avastin treatment on Wednesday. Another MRI is scheduled in a couple of weeks and we continue to be so thankful for how well Dad continues to feel. Thank you all for the continued prayers!
There are some rules related to disability where COBRA can be extended up to an additional 6 months I think to bridge the period between COBRA and Medicare. I had to do this for my sister who had GBM. However there are some specific rules and timing which I don't recall exactly and I'm not sure if you're already past that time. In my sister's case, we found that traditional Medicare (part A and B) with a supplement and drug plan (part D) was best once she was Medicare eligible after COBRA. When she had a recurrence, her temodar was covered under her supplement. It seemed to be much easier with less approvals needed before providing services, etc. Good luck navigating the complex world of Medicare! The patient liaison or social worker at the hospital should be able to answer some of your questions too as they've dealt with Medicare before. They also have "competing" interests. They want the patient to get the treatment needed but they also want their facility to get paid for providing the treatment.
ReplyDeleteYou may also want to look at this website. http://tonisays.com/ She publishes a column in my local area newspaper and answers readers questions about Medicare and Social Security, eligibility, etc. Good luck!
ReplyDeleteThank you Martha! Any and ALL advice we can get at this point is very helpful. Just want to make the best decision possible to help with the financial burden placed on my parents.
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