Medicare coverage post Transplant: can one re-enroll?

Posted by nkdonahue @nkdonahue, Jan 21 11:40am

My daughter received a kidney transplant in November of 2019. She has been on disability, but recently was hired as a contract tracer. The job offers private insurance. If she signs up for the private insurance – for just the next 5 months before she enters grad school, can she "re-enroll" to get back on Medicare? She will still be in the 36 month period post transplant. We have been unable to figure this out and would love to hear about others' experiences.

We are also curious to find out if the newly passed law will allow transplant recipients who have already passed the 3 year mark post transplant to be once again covered under Medicare – or if the law will only apply for those who will still be in the 3 year period when the law takes effect, January 1, 2023. My daughter will hit three years in November of 2022….!?

Thank you for sharing your experience or insights.

@nkdonahue Hi and I'm not sure about the 3 year part but for me I had to wait 2 years from becoming on disability due to my transplant before being eligible for Medicare. I do remember them saying when I was applying that most who are younger may get it for a while but once they recover then it drops. So I got the impression that when your younger it's temporary. I'm already retirement age so I'm.not familiar with how it works for younger folks. I'm almost 62 and even tho I'm not Medicare age yet that due to my being on disability I would not lose it. So by your question I'm guessing the period of time is typically 3 years.
Have a Blessed Day
Dana

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@nkdonahue, We are patients, and we are not qualified to answer your questions about drug coverage for your daughter, a kidney transplant recipient. You are asking an important question.

I would suggest that your daughter contact the human resource manager of her place of employment, or her insurance company, or the Medicare Program.

You can read about – “Medicare Coverage of Kidney Dialysis & Kidney Transplant Services”
The information in this booklet describes the Medicare Program at the time this booklet was printed. Changes may occur after printing. This is not a legal document,
Visit Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227) to get the
most current information. TTY users can call
1-877-486-2048.
https://www.medicare.gov/Pubs/pdf/10128-Medicare-Coverage-ESRD.pdf
I hope this leads you to the answers that you are looking for.

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@danab

@nkdonahue Hi and I'm not sure about the 3 year part but for me I had to wait 2 years from becoming on disability due to my transplant before being eligible for Medicare. I do remember them saying when I was applying that most who are younger may get it for a while but once they recover then it drops. So I got the impression that when your younger it's temporary. I'm already retirement age so I'm.not familiar with how it works for younger folks. I'm almost 62 and even tho I'm not Medicare age yet that due to my being on disability I would not lose it. So by your question I'm guessing the period of time is typically 3 years.
Have a Blessed Day
Dana

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Thanks for your input, Dana. In our case, my daughter enrolled in Medicare Part A and B right away. The new legislation that was passed just a few weeks ago will also change things moving forward. As of January 1, 2023, that three year limitation will go away. Folks who have trouble getting insurance (after three years with a transplant) will not have to struggle to afford their immuno suppression drugs.

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@rosemarya

@nkdonahue, We are patients, and we are not qualified to answer your questions about drug coverage for your daughter, a kidney transplant recipient. You are asking an important question.

I would suggest that your daughter contact the human resource manager of her place of employment, or her insurance company, or the Medicare Program.

You can read about – “Medicare Coverage of Kidney Dialysis & Kidney Transplant Services”
The information in this booklet describes the Medicare Program at the time this booklet was printed. Changes may occur after printing. This is not a legal document,
Visit Medicare.gov, or call 1-800-MEDICARE (1-800-633-4227) to get the
most current information. TTY users can call
1-877-486-2048.
https://www.medicare.gov/Pubs/pdf/10128-Medicare-Coverage-ESRD.pdf
I hope this leads you to the answers that you are looking for.

Jump to this post

Hi Rosemary, Thank you very much for your suggestions. I was thrilled to find the booklet that you pointed out. I wish I had found it long ago. It has been difficult to learn all of the ins and outs of Medicare after transplant. We are also talking to our local SHINE counselor. He was extremely helpful and just mentioned the same booklet today.

REPLY

Here's our understanding so far:
In late 2020, the Immuno Bill was passed. This bill will extend Medicare Part B only for the coverage of your immunosuppressant meds for the life of your transplanted organ as long as you pay the required premium (15% of the 65 and over premium – expected to be about $45 a month in 2023). This lower premium is only for Part B immuno med coverage and only after the 3 years posttransplant. The bill does not take effect until January 2023. At this time, it appears that it can be retroactive for those patients who have already lost coverage. You are only eligible for this coverage if you have no other coverage options. Rules are still being drafted for this legislation so more to come on how exactly this will work.

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@pdennis

Here's our understanding so far:
In late 2020, the Immuno Bill was passed. This bill will extend Medicare Part B only for the coverage of your immunosuppressant meds for the life of your transplanted organ as long as you pay the required premium (15% of the 65 and over premium – expected to be about $45 a month in 2023). This lower premium is only for Part B immuno med coverage and only after the 3 years posttransplant. The bill does not take effect until January 2023. At this time, it appears that it can be retroactive for those patients who have already lost coverage. You are only eligible for this coverage if you have no other coverage options. Rules are still being drafted for this legislation so more to come on how exactly this will work.

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Thank you, pdennis for your response. I appreciate the clarification that you have provided regarding the new legislation. My daughter will hit the 3 year mark in November of 22, so it's wonderful to know that the coverage can apply retroactively, should she need it at that time.

When you say that one is eligible only if you have no other coverage options, do you think that if there is a student insurance program in her graduate school, that she would likely be ineligible under the Immuno Bill?

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@nkdonahue

Thank you, pdennis for your response. I appreciate the clarification that you have provided regarding the new legislation. My daughter will hit the 3 year mark in November of 22, so it's wonderful to know that the coverage can apply retroactively, should she need it at that time.

When you say that one is eligible only if you have no other coverage options, do you think that if there is a student insurance program in her graduate school, that she would likely be ineligible under the Immuno Bill?

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The final rules have not been drafted, so we really don't know yet. We'll have to see what the final wording is on the rules and what would be considered a "coverage option." I think it will take at least six months for the final rules to be drafted.

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@pdennis

The final rules have not been drafted, so we really don't know yet. We'll have to see what the final wording is on the rules and what would be considered a "coverage option." I think it will take at least six months for the final rules to be drafted.

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I didn't understand that when legislation is passed, the finer points or the rules of application are not necessarily decided. I'm curious about the process and who is involved.

Thanks again for your helpful input

REPLY

You can find the Final Rule for this benefit at https://www.govinfo.gov/content/pkg/BILLS-116hr133enr/pdf/BILLS-116hr133enr.pdf
CMS has a couple of years to establish rules for how it plans to implement this benefit.

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