Private Insurance, Medicare and IVIG or other tretments

June 8, 2011 at 8:46 am

Those are all good questions.

As a somewhat valid option, go get the Stem Cell Transplant in the next three years. Then, MAYBE, the existing private insurance covers it. Ba Da bing- you are all done, no need to worry about Medicare covering IVIG.

I do have ‘on good authority’ the following “facts”:

1. Your husband’s Medicare will not cover you…..

2. Most private Insurance reserve the right to modify the terms, conditions and prices charged at will and without notice at any time. Given that small print somewhere in everybody’s coverage, we are all at risk at any moment of losing coverage.

3. Most private Insurance require that a Medicare eligible client apply for, and accept, Medicare as soon as eligible. Then, and only then, they may offer secondary coverage. Government, or ‘Cadillac’ Plan workers need not offer a rebuttal….

However, in this case, you only mention the husband and Medicare. How about you? Will his private Insurance continue to cover you, if it even does now?

4. Medicare will not pay for IVIG at home.

5. Medicare probably will pay, but only 80% of approved charges, for IVIG infused at any approved location. But, only for a Medicare Client. Will you also be on Medicare?

6. If you have insurance now which then becomes secondary, it will probably pay some, or most, of the 20% difference depending on your co-pay, deductible, out of pocket and other limitations.

I couldn’t guess (well, yes, I can guess) what happens if you retire, lose the current health coverage, if any, and then apply, with a known pre-existing condition such as CIDP. Maybe someone who has been down this road will respond.

Of course, the option already mentioned is to purchase an appropriate Medicare Supplemental Plan. My neighbors pay about $900 month for a supplemental plan for husband and wife. Presumably, no pre-existing conditions, however.

Other treatments? Some doctors associated with the GBS-CIDP foundation allegedly prefer steroids because they are as effective and much cheaper.

Everyone on this forum is either dealing with this now, or is going to deal with it…..Hide the head in the sand.