medicare and mds

[marylinda]

I was reading that a patient has to pay the cost for the first 3 units of blood during a transfusion. Does that mean my transfusion when needed (procrit doesn’t seem to be working very well) will be my responsibility to pay for? Right now everything is very tiring,
Any knowledge about medicare anyone is willing to share with me would be appreciated. I cannot get medigap until 65 from what I have read.

[Suzanne]

You can get medigap as long as you have medicare A & B irrespective of how old you are. I do know that the provision you mention about paying for the 1st three units is part of the medicare regulations. Don’t know if a gap policy will cover it-might be individual to different policies. Maybe someone else knows. I have medicare A (under disability),medicare B, a gap policy and have now applied for one of the new medicare approved drug policies and I am not 65 yet. Did have to deal with planning how I would get insurance if I become disqualified for medicare because of earnings or medical review before I am 65. Most of this stuff is just way more complicated then anything should be-so don’t get discouraged if you find it confusing.

[patti]

Mary,

You might consider getting a medicare HMO type of policy. My MIL has one and she never pays anything for transfusions. She pays a $15 copay when she’s sees the doctor once a month. Otherwise, she never pays for anything (except prescriptions) having to do with shots, transfusions, etc. Most insurance companies sell the medicare HMO’s. Blue Cross/Blue Shield, Providence Plans, Secure Horizons, etc. It might be something to look into. It’s the one thing our doctor told us to do the first thing after mom was diagnosed. It doesn’t matter if you have something pre-existing. You just have to be qualified for medicare. Mom pays the usual payments from her SS for medicare and then she pays $86 a month for the HMO. But a lot more stuff is covered and in the end the $86 is pennies compared to what she would have had to put out.

Hope this helps.

Patti

p.s. the only disqualifying factor for a medicare HMO is end stage renal disease. Anything else won’t disqualify you.

[marylinda]

Thank you so much for your input. I have checked the medicare site and for my state, New Hampshire. It said I do not qualify for medigap so I called and they are sending me info on supplemental insurance. I think the whole rx plan makes things much worse for many people as free rx become unavailable and rx benefits are not part of supplemental plans. I’m sure they’ll get things worked out maybe next year 2007. I am hoping to be able to pick up something extra but NH doesn’t seem to have much available. Again thank you so much.

[Suzanne]

what I have is a supplimental policy.Thought that term and medigap was one and the same-ie picks up the expenses that hit “gaps” of coverage in medicare. Watch out for the HMO medicare. There is a couple on here from Florida, I believe, thatsaid they could not go to a Mayo clinic or get to a specilaist on MDS until they transferred off of that type of coverage because no one that knew anything about MDS was a member of the HMO where they were.

[patti]

Mary,

Suzanne is right about HMO’s on one point. It can be difficult to get referred out of the HMO group for a specialist (although not impossible). If you currently have a good doctor you can look (or ask) for a Medicare HMO that he is already accepting and then you wouldn’t need to worry about getting referrals to him or another specialist (if he is an MDS specialist already).

Patti

[Neil]

Hi Marylinda,
Medicare Supplements can be confusing. To compound matters each state has their own set of rules and regulations pertaing to “Gap Insurance”.
What applies in other states may or not be the situation in New Hampshire.
Would contact organizations such as AARP, Blue Cross Blue Shield, Humana, Medica etc. Would also contact a local organization dealing with seniors. They often have volunteer counselors who
will visit with you and provide very accurate, usefull info on how to select a gap provider that will suit your particular needs.
One of my primary objectives was to have gap health insurance that would permit me to select any doc I wanted to treat me. I did not want an accountant involved in the selection of my docs.
I did not want any copays. There were situations with copays that limited my options.
This was the situation in Minnesota at the time I made my selections. Could be different in New Hampshire, but get all the assistance, information, education you can absorb. There is almost an infinite number of plans available. The cheapest premium is not always the least expensive on an annual basis. All of those copays can add up. I was going in 3 days a week for 3 months at one point. That could really run up the copay amount and inflate the annual cost.
The health insurance counselors can provide an unbiased view of your options.

[Author]

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