Topic: medicare

i dont know if any one can help me but i thought i would put this out there and see. my sister is having a very difficult time with the oxiliplatin and xeloda chemo treatment. the side effects have been severe and so far oncologist just says it is normal side effects. the day she gets her oxiliplatin is horrible. we have asked if she can stay in the hospital overnight because of the side effects. they tell us no. aside from this what our concern is right now is her health insurance. she has been out of work since december when she had her second surgery. so far her job has been very helpful. she has missed significant amounts of time over the past year and a half since she was diagnosed. she is collecting disability and they are still providing her health insurance. she is worried that sooner or later they are going to tire of this and fire her and she will lose her insurance or she will simply max our her insurance benefits and be dropped. i was reading on the social security website that if you receive disability benefits for 24 months you automatically enroll in medicare. she is going to look into this and see if this is an option. does anyone know what medicare pays for and what are the out of pocket expenses. it is such a mess. you are trying to deal with this horrible disease and than have to worry about the expense. i would appreciate any help.

Re: medicare

Sallypa-Sorry about your sister, adding insurance pressures doesn't help. I am on disability and after 2 years was eligable for medicare automatically. Part A is hospitalization and no charge, Part B is doctor visits, outpatient care... and is deducted from your disability check and I believe is $115.00 a month. You will also need Part D for drugs and then you need a supplement. I was so suprised by the expense, for me it was cheaper and better coverage to keep my personal insurance. The medicare office will help you understand this better, there is a thing called "the donut hole" which involves paying for your drugs and it is not in our favor. I know it took me several calls to medicare and insurance brokers to figure it out.I also found out that I will be penalized for not accepting it when it was first offered!! I wish I could share better news, you have so much on your plate already.
Lots of prayers-Cathy

Re: medicare

thank you jathy for the information. can i ask you about this drug thing. you say it doesnt favor the patient but if you dont take it you are penalized? is that true? are you using both your own insurance and medicare. we are hoping my sisters insurance will continue but we dont know when they will decide to stop it.

Re: medicare

Sallypa, I am starting on Oxaliplatin/Xeloda this Friday.  Now I am worried about the severe side effects you mention your sister experiences.  I will start on Medicare in March, 2013.  So, I guess I will worry about that in a year!

Cindy

Re: medicare

cindy, i hope that you wont have the same reaction my sister does. the good thing if there can be a good thing the severity of the effects lessens a day or two after the infusion and continues to lessen between infusions. wear gloves and try to drink liquids at room temperature. also if it is cool outside stay indoors for a couple days after the appt if you are having the side effects. i wish you all the best.

Re: medicare

Sallypa-I declined PartB(doctors) and Part D(drugs), PartA (hospital)is free and automatic so I have that Part A. I will be penalized when I turn 65 for not accepting PartB when it was first offered. The "donut hole" is way to confusing to understand, it has to do with meeting deductables in a certain time frame. I know that what I took away from this is it wasn't the answer to my prayers, inmy case BCBS was more affordable and better coverage. The toll free medicare number will help and a lot of Senior Centers have advisors. I live in IL. and we have SHIP Offices to help.
Good luck and lots of prayers-Cathy

Re: medicare

Medicare generally has a $250 deductible, then covers 80%.  I would also suggest a good supplemental insurance.  You can do a search on the internet and find sites that will explain what Medicare covers and what it does not cover and how a supplemental plan will cover what Medicare does not.  In the long run with both medicare and a supplement insurance will be cheaper than paying the 20%.  Talk to insurance agents and they will help you figure it out.

And yes, if you do not take Medicare part B when you are eligible you will pay a penalty for the rest of your life.  Many people do not know this or are not aware of it.  Unless you have a 'group' insurance from an employer that they can use as creditable coverage, you will pay a penalty.

Hope this helps.

Margaret

Re: medicare

oncologist has stopped chemo for the time being as the side effects have become too severe. she cant really eat because the xeloda has caused sores in her mouth and than if she does get something down she throws it back up. also she is having a lot of pain in her stomach. she cant go back to work this way and she is worried they will fire her and she will lose her insurance. they have already changed the policy and if she is hospitalized it will cost her 400 per day. we checked with social security and she wont be eligible for insurance until at least august. i am trying to ease her fears about the insurance but havent been able to find too many answers on line so i am putting it out to my friends here. can the job fire her and take away her insurance as she has been diagnosed with cancer while working there and has been being treated for a year and half. i read the insurance company can not drop you unless you reach the max of the insurance but dont know if this applies to being fired.

Re: medicare

Sally, I really know not much about Insurance BUT I am wondering if she gets fired and looses her Insurance could she possibly go on State Insurance? You might look in to that as well as Disability Insurance. Just a suggestion.

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.

Re: medicare

yes we did look into disability insurance but there is a two year wait from the time you apply until the time you are covered. it is a very scary thought of losing your health care while dealing with this disease.

Re: medicare

Well, I would check in to the State Insurance and see what they offer. I am sure every State has it. I had never heard that about a 2 year wait for disability. Guess I would contact a Disability Lawyer for a consultation on what you could do.

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.

Re: medicare

Sally:

Has your sister worked at her company for over a year?  If so, has she applied for FMLA?  That would give her 12 weeks a year for being off work due to her illness.  If she has FMLA she cannot be fired from her job due to her illness.  Her job can also give her personal leave if her FMLA runs out, but at that point they do not have to hold her job for her.  Difficult situation at best.  I was lucky w/my job situation while my husband Tom was ill.  I was able to start working from home and had friends that would take Tom for his medical care at times so I never used all my FMLA.  It's different when you are the patient because you have no choice except to use the time off.

In my last post I failed to mention the 'donut' hole for Part D Medicare.  On part d, the insurance pays for prescrption drugs up to a certain point (don't remember the $$ amount) then the person pays 100% for the drugs (again up to a certain $$ amount) "This is the donut hole" and after that point the part d then starts paying.

Has your sister looked into the possibility into getting into a state group insurance for those with severe medical issues?  I think you have to have been uninsured for 6 months before you qualify though.

It kinda sucks all the way around.  It can be hard to even get medical insurance once you have a cancer diagnosis and life insurance is out of the question!  The so call 'pre-existing' rule where life insurance companies cannot use pre-existing conditions against people is ONLY for those under age 19...at this time.  Eventually the Health Care Reform will encompass everyone but not until year 2014 or some such date.

I wish I had better answers - you need to get in touch with Social Security and ask these question of them.  Sometimes they can 'rush' an application through given the severity of the situation and can get a person on Medicare within 6 months or less.  It's worth a try.

HUGS,
Margaret

Re: medicare

Sally:
I don't see this mentioned. I just started Xeloda last week, and was astounded at MY copay!!! I am on COBRA from my previous job, and it expires in Oct. When I will be eligible for medicare/medicaid. I can't remember. The disability one. I sure hope they cover enough because my hospital and doctor bills are high enough already. One of these days they MIGHT get paid. I need to win the lottery first. smile
Anyway, I digress. For the Xeloda, contact Genentech. As long as you are NOT on state funded insurance and don't make $100K/year, you can get assistance from them. (they make Xeloda). They are covering about 80% of my copay, which brings my copay down to about $30-40/wk, which is MUCH better than it was.
You can look them up online. It was easy. About 20 minutes.

KrisJ
"Don't just have minutes in the day; have moments in time."
Any opinions I give are based on personal experiences, and are not based on medical knowledge. I strongly suggest receiving medical care and opinions.

Re: medicare

Kris..most (if not all) pharmaceutical companies have the compassionate use program you are describing. 
Required income levels may vary though however, the lowest I have found is $75.000. 
Hugs
Marion

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

Re: medicare

I am wondering:  when applying for disability - does it always take two years before implementation of Medicare benefits?  If so is it possible to use original date of diagnoses and thereby speed up the acceptance date? 

This is a very important thread you are establishing on this site.  Please, continue to keep it going.

Thanks and Hugs
Marion

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER

Re: medicare

How interesting:  This seems to fit right in with what you are talking about:
https://www2.gotomeeting.com/register/624373162

Margaret already is aware of this however; is not able to participate in the web conference.

For those of you able to do so please, share with us your findings.

Thanks a bunch,
Marion

THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROVIDER