Section 7: Other Kinds of Health Insurance
There are other kinds of health insurance coverage that may help pay for the services you need for the treatment of permanent kidney failure. They include:
■ Employee or retiree coverage from an employer or union
■ Medicare Supplement Insurance (Medigap) policies
■ Medicaid
■ Veteran Administration benefits
Employee or retiree coverage from an employer or union
If you have group health plan coverage based on your or your spouse’s past or current employment, call your benefits administrator to find out what coverage they might provide for your permanent kidney failure. If you’re eligible for coverage under the group health plan, but haven’t yet signed up for it, call the benefits administrator to find out if you can still enroll.
Generally, employer plans have better rates than you can get if you buy a policy directly from an insurance company. Also, employers may pay part of the cost of the coverage.
See here for an explanation of when your employer will pay first, and when Medicare will pay first with your employer providing supplemental coverage.
If you lose your employer or union coverage, you may be able to continue your coverage temporarily through COBRA. This Federal law allows you to temporarily keep your employer or union health coverage after your employment ends or after you lose coverage as a dependent of a covered employee. Talk to your benefits administrator for more information.
Medicare Supplement Insurance (Medigap) policies
A Medigap policy is health insurance sold by private insurance companies to help fill the “gaps” in Original Medicare coverage, like deductibles and coinsurance. Medigap policies help pay some of the health care costs that Original Medicare doesn’t cover. Medigap insurance must follow Federal and state laws that protect you. All Medigap policies are clearly marked “Medicare Supplement Insurance.”
Not all insurance companies will sell Medigap policies to people with Medicare under 65.
If a company does sell Medigap policies voluntarily, or because state law requires it, these Medigap policies will probably cost you more than if you were 65 or older. Medigap rules vary from state to state. Call your State Health Insurance Assistance Program (more info) for information about buying a Medigap policy if you’re disabled or have ESRD.
When you turn 65, you will be guaranteed an opportunity to buy a Medigap policy.
For detailed information about Medigap policies:
■ Visit www.medicare.gov/publications to read or print a copy of “Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare.”
■ Visit www.medicare.gov/medigap to get information about Medigap policies in your state. When you use this Web site, you’ll get a personalized summary page with general information to help you compare plans. You can get detailed information about all the plans available in your area, or just the ones you’re most interested in.
This Web site has the following information:
■ Which Medigap policies are sold in your state
■ Comparing Medigap policies
■ What each policy covers
■ Your out-of-pocket costs
If you don’t have a computer, your local library or senior center may be able to help you look at this information.
Medicaid
This is a joint Federal and state program that helps pay medical costs for some people with limited income and resources. Medicaid programs vary from state to state. Most health care costs are covered if you qualify for both Medicare and Medicaid and see providers who accept both.
States also have Medicare Savings Programs that pay some or all of Medicare’s premiums and may also pay Medicare deductibles and coinsurance for certain people who have Medicare and a limited income. To qualify for these programs, generally you must have:
■ Medicare Part A.
■ A monthly income of less than $1,277 for an individual or $1,723 for a couple in 2012. These income limits are slightly higher in Hawaii and Alaska. Income limits can change each year.
■ Savings of $6,940 or less for an individual, or $10,410 or less for a couple. Savings include money in a checking or savings account, stocks, and bonds.
To get more information on these programs, visit www.medicare.gov. You can also call 1-800-MEDICARE (1-800-633-4227), and ask for information on “savings for people with Medicare.” TTY users should call 1-877-486-2048.
Veterans’ benefits
If you’re a veteran, the U.S. Department of Veterans Affairs can help pay for ESRD
treatment. For more information, call the U.S. Department of Veterans Affairs at 1-800-827-1000. TTY users should call 1-800-829-4833. If you or your spouse is active duty or retired from the military, call the Department of Defense at 1-800-538-9552 for more information. TTY users should call 1-866-363-2883.
Other ways to get help
In most states there are agencies and state kidney programs that help with some of the health care costs that Medicare doesn’t pay. Call your State Health Insurance Assistance Program if you have questions about health insurance. More info.