ESRD treatments begin in prison
Mary, a fully insured individual, was imprisoned on 4/5/ 00. Mary began a course of
dialysis at the State's expense in 1/01 while still in prison. Mary filed for R-HI
and R-SMI in 6/03, upon release from prison. Mary R-HI was awarded as of 6/1/02 (12
months retroactive to the date of filing). Mary elected R-SMI to begin as of the month
of filing (6/03), rather than 12 months retroactive. Thus avoided premium liability
for the time Mary could not take advantage of the Medicare coverage.
If Mary had filed for Medicare when first eligible in 2001, would have had to pay
SMI premiums when there was no possibility of Medicare's paying for care. If Mary
had filed for R-HI but refused R-SMI in 2001, or if had lost R-SMI by voluntary disenrollment
or for nonpayment of premiums, Mary would not have R-SMI upon release from prison
and would be unable to have R-SMI until 7/1/04 based on a 2004 GEP enrollment (unless
withdraw R-HI application, as described in HI 00801.197).
Medicare is secondary payer
Gina is working and covered by employer’s group health plan when begins a regular
course of dialysis in 1/01. Gina is eligible for Medicare beginning 4/01, however
after learning that the group health plan will be primary payer of medical expenses
until 9/30/03, Gina decides to wait to apply for Medicare. In 11/03, Gina files a
Medicare application and elects to have R-HI and R-SMI coverage begin effective 10/1/03,
the first month Medicare is primary payer for medical expenses.