Getting Medicare

One thing unique to End Stage Renal Disease (ESRD) is that dialysis treatments and kidney transplants are paid for by Medicare. In 2017, Medicare spent $11.4 billion on dialysis and dialysis centers lose money on Medicare reimbursements. All the profit is from charging patients with commercial insurance a lot more. Medicare pays about $90,000/year for hemodialysis treatment; my work insurance was charged about $250,000/year. Needless to say, insurance companies do not want to pay for dialysis forever so after 33 months, the primary insurance for dialysis shifts to Medicare.

Here are some statistics from The Kidney Project at UCSF.

I started hemodialysis in July, 2017 so this is month 30. I was told that I needed to apply for Medicare by the end of this month so that there is no interruption in insurance coverage when my work insurances stops paying in April, 2020. There is a lot of information on how to apply but my dialysis clinic suggest that I apply in person at the local SSA (Social Security Administration) office in case documents or files gets lost. No local number is listed online for Social Security offices so I had to start with the national 800 number.

The first call had a wait time of 45 minutes while my second call had a wait time of 41 minutes to speak to someone. I decided to call earlier at 7am and finally got a wait time of only 21 minutes. After speaking to the agent, I was even more confused since they wanted me to file for disability first. I can still work so I’m not sure I want to pursue that route. After sitting around for six week so far recovering from heart surgery, I’m pretty sure I want to work as long as I can.

Anyway, instead of waiting, I decided to just stop by the local office after dialysis. How bad can it be? The office is on the 5th floor of a high rise office building. Parking is expensive ($2.00 for 20 minutes) and the SSA does not validate. When I arrived, there were probably 100+ people waiting already. I stepped up to a kiosk, entered some personal info, and got a ticket with the number C59. There were 9 windows and various letter/number ticket combination was being served. To my surprise, after only 5 minutes, I was called to a window to provide more info on my visit. Then I was told to wait until someone form the inner office called me. After about 20 minutes, I was called and followed a worker to his cubicle. He helped me fill out the application and I was out of there in about 50 minutes. I still need to go back to show them my proof of citizenship (passport) but I should receive my Medicare card within 30 days.