Ugh. Not only does the United States seem to have the most complex health insurance system, nobody seems to understand the nuances. When you have more than one insurance provider, the confusion seems to grow exponentially.
As mentioned before, due to ESRD and kidney transplantation, I have Medicare Part A and Part B. However, I do not have Part D for prescriptions because that’s not part of the ESRD coverage, and I have Blue Shield from work that covers prescriptions. All good so far. Well, post-transplant, Medicare is supposed to cover only the anti-rejection medications, but under Part B for services and supplies, not Part D for drugs or prescriptions. At UCLA, since they deal with this everyday, they billed Medicare Part B for the three anti-rejection medications, and Blue Shield for the rest. After transferring the prescriptions to my regular pharmacy (Albertsons) and mail order (Express Scripts), they both billed the anti-rejection medications to Blue Shield. Two problems: 1) there is no copay for Medicare but there is with Blue Shield, and 2) since our work insurance is self funded, my company ends up paying thousands for the prescriptions when they’re supposed to be paid by Medicare. I called both Albertsons pharmacy and Express Scripts and both said they only bill Medicare Part D and not Part B. Luckily, UCLA pharmacy said they will keep filling my prescriptions as long as the prescribing doctor sends the scripts there. I don’t know if this applies after UCLA hands off care to my regular doctors. The copay is not too bad, only $10 per prescription refill. Since I am paying >$500/month for Medicare, I should probably use it.
Post-transplant, Medicare pays for anti-rejection medications for three years. That was just changed to lifetime coverage. I am 52 so I will get regular Medicare in 13 years. If I am done with dialysis and already had a transplant, why do I need Medicare if my work insurance will pay for the anti-rejection medications? That means I have to keep working or buy my own insurance but surely it’s not efficient to pay a lot for Medicare if it only covers the three drugs. I need to find out more.
Life with chronic diseases 