Any meds covered by Medicare?

[anonymous]

I am new to Medicare and wondered if any CF medications are covered by Medicare. I assume not, but wanted to check with others. I am aware of the drug assistance program offered in Jan '06 but don't qualify because of family income.
Also I have CFRD and assume that test strips and other diabetes care items are covered by Medicare?

 

[wallflower]

Diabetic items are covered, as are <b>ANY</b> nebulizer meds you take. Medicare will also cover your nebulizer compressor and equipment needed to run it (tubing, cups, filters).

My neb drugs that are covered are: albuterol, cromolyn sodium, acetylcysteine, amikacin (neb antibotic), and brono saline.

Your pharmacist may not be too smart (like my Walgreens pharmacist), and tell you only diabetic items are covered, but insist and tell them to run your card anyway.

Medicare also rents my Vest for me.

I've found the Medicare people to be pretty friendly - if you have any questions, give them a call and ask if they cover your list of drugs. I once called them and read my whole list to the poor lady on the other end who couldn't spell any of them. They also used to have a list buried somewhere on their website that said what drugs they covered.

 

[julie]

A link I found about some medicare prescription stuff: <a target=new class=ftalternatingbarlinklarge href="http://questions.medicare.gov/cgi-bin/medicare.cfg/php/enduser/std_adp.php?p_faqid=1688&p_created=1125686923&p_sid=x53-Y8Rh&p_lva=&p_sp=cF9zcmNoPSZwX3NvcnRfYnk9JnBfZ3JpZHNvcnQ9JnBfcm93X2NudD0zMzYmcF9wcm9kcz0mcF9jYXRzPSZwX3B2PSZwX2N2PSZwX3NlYXJjaF90eXBlPWFuc3dlcnMuc2VhcmNoX25sJnBfcGFnZT0x&p_li=&p_topview=1">link</a>

Specifically, read this portion a few times as it might apply if they deny your TYPE of medication..... "...However, if you are currently stabilized on certain specific prescription drugs (like drugs for depression, cancer or HIV/AIDS), you don?t have to switch to a different prescription drug. Please talk to your doctor or pharmacist to see if your prescription drugs qualify."

 

[luke]

Anonymous,

Keep in mind that even though Medicare does cover inhaled meds and diabetic testing supplies they only pay at 80%. So if you have the ability to get another insurance (commercial or Medicaid) it is a very good idea. Your co-pays and deductibles ($110 annually) can definitely add up.


Luke

 

[JazzysMom]

It depend on the company & if they accept assignment in full. I havent had to pay anything for the actual supplies so far. I have used the company for a few things & havent had to pay anything. I keep all the paperwork from the company as well as my explanations of benefits because I worry that some day they will come back & say differently.

 

[anonymous]

Thank you for your responses. I did see on their website that Medicare Part B covers drugs used in nebulizers if they "are considered reasonable and necessary". I wasn't aware of this<img src="i/expressions/face-icon-small-smile.gif" border="0">
I don't take TOBI or Pulmozyme but wondered if these are covered by Part B for any of you that take these drugs--I would think they would be reasonable and definately necessary.

 

[JustDucky]

Hi there...I take TOBI, not pulmozyme yet and Medicare is going to cover it. Medicare covers those drugs if you have CF or broncheistasis, not for any other conditions. I have had Medicare since June, and boy, reading all of this stuff can be overwhelming. I called the TOBI support and I was told this before I persued it. So far , no problems. As mentioned before, remember that medicare only covers 80% of the drug's cost, which with TOBI and Pulmozyme, that could run into some serious cash. So....I have a medigap insurance plan that picks up the other 20% that Medicare doesn't cover. My social worker is trying to get Medicaid before January, so that I ccan have home IV's instead of going to the hosp every time (which is frequent) and also, if I have Medicaid before the Medcare changes in January, I won't have to go through their restrictions on income, I will automatically qualify for extra help with my meds. With all that I have read, it can be confusing still. Hugs, Jenn (Cepaciagal)

 

[luke]

melissa,

companies really aren't allowed not to bill you , it is against the law. The only way legally companies can not make you pay is that is if you qualify and the company wants to; medicare will allow the comany to "waive" your copay. But if you haven't filled out the approriate paper work then that company is commiting fruad. Good for you, bad for them. I quess what I am saying is I wouldn't tell to many people about that.


Luke

 

[JazzysMom]

All doctors or companies have the option of accepting Medicare as payment in full. If a provider accepts the Medicare assigment it means that they can not bill the patient more than the co insurance or deductable is for that service &/or what Medicare says is the patients responsibility. If they do not accept Medicare assignment, they may charge your more than the Medicare approved amount. Most of the time they do not. They do need to be "contracted" with Medicare to accept assignment because some patients look for such providers. If they do & a patient hasnt met their deductable then it screws the patient up. I am by no means saying that it should or will happen. I am just saying it can happen. When I worked at our local hospital there are many times that we wrote off balances because a patient could not pay for it & there were even times that it got wrote off just because a patient didnt want to pay for it. Every provider has a cushion to play with either under a charity care type program or a certain percentage of losses. Medicare only dictates the most that a provider can bill a patient after Medicare reimbursements. Medicare doesnt give a hoot if they do bill or if they get paid. They just care if the patient gets billed & therefore pays more than they should. I personally have been on both sides of it & if I can pay I prefer to do that. You never know when things come back to bite you in the a--.

 

[anonymous]

Does anyone know if Pulmicort is covered by Part B?

 

[luke]

Melissa,

Not to split hairs but you are incorrect. When a provider agrees to accept "assignment" they merely agree two things.

1. The provider agrees to accept the Medicare fee schedule
2. That the patient does not have to pay the entire amount up front.

Companies that accept assignment agree to bill Medicare for you. If the company is only a provider and does not accept assignment then the patient must pay up front and then get reimbursed by Medicare themselves. The other kicker is that "non-assignement" providers are allowed to charge you 15% over the allowable amount. Say for example the hospital you worked at charged $3000 for a CT scan but Medicare only pays $1000. Then the provider agrees to accept the $1000. Medicare will then only pay 80%, or $800, the patient is responsible for the rest. If the company does not accept assignment they would require you to pay the $1000 plus 15 % up front. It is true that companies can not make a patient pay and many times can not get payment (that is where bill collectors come in), but.... That is considered bad debt and is accounted for as such. On the other hand, if the company has an indigent program and the patient qualifies to Medicare ?standards? that company can "write off" the 20% and is accounted for differently, "good will" or "charity" for example. But make no mistake about Medicare does care if the company doesn?t bill the patient that 20%. That is one if Medicare guidelines and is fraud if not done

I am posting two links that also illustrates my point in the home care world.

http://homecaremag.com/mag/medical_decisions_decisions_decisions/index.html

http://www.gbls.org/map_old/brochures/medicare_assignment.htm


anon,

To answer your question, yes medicare does cover pulmicort but is very expensive for provider and patient

 

[anonymous]

Yes nebs and meds. (albuterol, duoneb, ipratropium, xopenex etc. )are covered by Medicare B plan, but it does not cover anything under a MDI (metered dose inhaler) or DPI (dry poweder inhaler) Spiriva, Advair, Serevent etc. Those are around $130-180 a pop.

Chuck father to Avery 2 years with CF and Rhett 8 months no cf