Medicare

Medicare is a federally funded insurance program available to people who are 65 years of age or older. Medicare also offers coverage for people with certain permanent physical disabilities as well as people who are living with end-stage renal disease (ESRD).

There are four different parts to Medicare:

• Part A offers coverage for in-hospital costs
• Part B offers coverage for outpatient medical costs as well as coverage for some prescription medications, including anti-rejection medications
• Part C (also referred to as Medicare Advantage) offers coverage for both medical and prescription costs but is offered through private insurance programs
• Part D is a prescription medication program

Medicare can be confusing, particularly when it comes to coverage for medications. Medicare provides lifetime coverage for anti-rejection medications to those who are receiving Social Security Disability Insurance (SSDI) or those over the age of 65. But, for people whose Medicare eligibility is based on having ESRD, coverage only lasts for 36 months. In addition, coverage varies depending upon which part of the program you are enrolled in.

Part B provides coverage for anti-rejection medications if you had Medicare Part A when you had your transplant, you had your transplant in a Medicare approved transplant program, and you have Medicare Part B. However, if you didn’t have Medicare Part A when you got your transplant or if you didn’t have your transplant in a Medicare-approved transplant program, your anti-rejection medications will not be covered by Part B—but they may be covered under Part D.

Part D can also be confusing. It is an entirely optional program, but to be eligible, you need to:

• Be enrolled in either Part A or Part B
• Pay premiums and deductibles in addition to the premiums and deductibles you may be paying for other parts of Medicare

One of the most notable aspects of Part D is the gap in coverage, known as the “donut hole.” Once you have received the maximum coverage benefit offered by the program, you become responsible for the full costs of your medications while also continuing to pay the Medicare Part D premiums. Fortunately, there is a limit on how much money you will have to spend out of your own pocket. When you reach this limit, you may be eligible for catastrophic coverage and you will only be responsible for 5% of your medication costs. This cycle repeats each calendar year.

For additional information about Medicare and prescription medication coverage, visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to speak with a representative about your specific needs.

This is a general summary of Medicare coverage, and is not a substitute for individual advice. This information may change, and you should always verify what information is applicable to you and your particular situation.

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