Medicare as primary and home IV's

[triples15]

Thanks a bunch everybody!
<br>
<br>I heard back from my CF Social Worker and the nurse coordinator at my clinic today. They did a little research and talked to their billing contact at the home health company I use for my IV meds. They said it has been their experience that once they bill Medicare and get an official denial, they then submit it to the secondary who will pick it up if it is a service they normally cover. They feel confident that I could do home IVs, even it took a little wrangling as far as the insurance companies go.
<br>
<br>So for now my husband is enrolling in single coverage with his new plan and I'm going to stay on the COBRA. I spoke to the new company's benefits office today and open enrollment is in November, with coverage then starting Jan. 1 2012. I've decided I'll see how this Medicare/Cobra thing works out in the next few months, and if it's not working as I've planned I can jump onto his pretty quickly. This will at least let us avoid hitting the $3,000 deductible (and perhaps even the $6,400 out-of-pocket max) now, and then already again in January. That would be painful!! And if staying on COBRA does seem to working well over the next few months I will stay on it until open enrollment the next year, as it will coincide with my Cobra coming to an end.
<br>
<br>Phew!! This has been a hard time trying to figure this out and I've seriously been losing sleep over it. Thanks so much to all of you for each of your responses!
<br>
<br>Lauren, yep I'm on Medicare due to being on SSDI. I took the free Part A, plus the part B, which is about $115 per month. I didn't take part D due to having excellent prescription coverage at the time (which is now the Cobra) and I think they will still pay the same for my scripts. I was excited about getting Medicare because I thought it would be secondary and would help pick up some of what my primary didn't pay. At the time I was enrolling in Medicare my husband was still with his previous employer so I was making plans around that being primary. Now that I'm Cobra, making Medicare primary, I'm wondering if I made a mistake and would be better off without it! I still think it should come in handy when I eventually get on the husbands crappy insurance and Medicare is then the secondary. Only time will tell I guess. Sorry, I keep rambling! My mind just races with thoughts.
<br>
<br>So my decision is made for now, and I don't have to live with it for very long if it is the wrong one! <img src="i/expressions/face-icon-small-smile.gif" border="0"> That's what I keep telling myself. Please feel free to offer any further advice tho! This has been such a confusing process and I'm sure I'll have more Medicare questions as time goes by!<br><br>P.S. Lauren, you are right, I suppose what you are doing might be against the law, but to be honest, with the confusion I'm facing I certainly can't blame you for doing it that way!<br>

 

[triples15]

Thanks a bunch everybody!
<br>
<br>I heard back from my CF Social Worker and the nurse coordinator at my clinic today. They did a little research and talked to their billing contact at the home health company I use for my IV meds. They said it has been their experience that once they bill Medicare and get an official denial, they then submit it to the secondary who will pick it up if it is a service they normally cover. They feel confident that I could do home IVs, even it took a little wrangling as far as the insurance companies go.
<br>
<br>So for now my husband is enrolling in single coverage with his new plan and I'm going to stay on the COBRA. I spoke to the new company's benefits office today and open enrollment is in November, with coverage then starting Jan. 1 2012. I've decided I'll see how this Medicare/Cobra thing works out in the next few months, and if it's not working as I've planned I can jump onto his pretty quickly. This will at least let us avoid hitting the $3,000 deductible (and perhaps even the $6,400 out-of-pocket max) now, and then already again in January. That would be painful!! And if staying on COBRA does seem to working well over the next few months I will stay on it until open enrollment the next year, as it will coincide with my Cobra coming to an end.
<br>
<br>Phew!! This has been a hard time trying to figure this out and I've seriously been losing sleep over it. Thanks so much to all of you for each of your responses!
<br>
<br>Lauren, yep I'm on Medicare due to being on SSDI. I took the free Part A, plus the part B, which is about $115 per month. I didn't take part D due to having excellent prescription coverage at the time (which is now the Cobra) and I think they will still pay the same for my scripts. I was excited about getting Medicare because I thought it would be secondary and would help pick up some of what my primary didn't pay. At the time I was enrolling in Medicare my husband was still with his previous employer so I was making plans around that being primary. Now that I'm Cobra, making Medicare primary, I'm wondering if I made a mistake and would be better off without it! I still think it should come in handy when I eventually get on the husbands crappy insurance and Medicare is then the secondary. Only time will tell I guess. Sorry, I keep rambling! My mind just races with thoughts.
<br>
<br>So my decision is made for now, and I don't have to live with it for very long if it is the wrong one! <img src="i/expressions/face-icon-small-smile.gif" border="0"> That's what I keep telling myself. Please feel free to offer any further advice tho! This has been such a confusing process and I'm sure I'll have more Medicare questions as time goes by!<br><br>P.S. Lauren, you are right, I suppose what you are doing might be against the law, but to be honest, with the confusion I'm facing I certainly can't blame you for doing it that way!<br>

 

[JustDucky]

Medicare doesn't cover home IV's, they will cover the nursing part of it, but not the service from an infusion company like Apria. They are my primary and only insurance unfortunately..... I have in a way figured out how to get my IV's at home though, it is a pain in the butt to say the least but this is how I do it.....I use my part D insurance (they cover generics even through the doughnut hole or gap stage) to get the IV meds that are covered under their plan ahead of time. My doctor and I went through the most common antibiotics that I am prescribed and essentially ordered them through my part D company (I can't simply order them when I need the antibiotics, it takes a few weeks to get them in and I can't wait that long for treatment). So now I have a stockpile of antibiotics that I am nearly always on in my home, it really does look like a pharmacy! IV fluids are also covered so I also order enough bags to reconstitute my meds. I have to buy the IV supplies myself (IV tubing, port needles, syringes, etc...) out of my own pocket, but that is a small cost compared to having to stay an entire month in the hospital just for IV's. Of course, there are some IV's that aren't covered, such as tigacyl, so I either stay in house for that or do them as an outpatient at my local hospital (which medicare does pay for, ridiculous as it costs them way more to do it that way than to just cover services from an infusion company but that's the government for you).
So that's it in a nutshell....I am hoping that one day, Medicare will cover IV antibiotics fully at home so that we don't have to jump through hoops just to get them for home.

Jenn

 

[JustDucky]

Medicare doesn't cover home IV's, they will cover the nursing part of it, but not the service from an infusion company like Apria. They are my primary and only insurance unfortunately..... I have in a way figured out how to get my IV's at home though, it is a pain in the butt to say the least but this is how I do it.....I use my part D insurance (they cover generics even through the doughnut hole or gap stage) to get the IV meds that are covered under their plan ahead of time. My doctor and I went through the most common antibiotics that I am prescribed and essentially ordered them through my part D company (I can't simply order them when I need the antibiotics, it takes a few weeks to get them in and I can't wait that long for treatment). So now I have a stockpile of antibiotics that I am nearly always on in my home, it really does look like a pharmacy! IV fluids are also covered so I also order enough bags to reconstitute my meds. I have to buy the IV supplies myself (IV tubing, port needles, syringes, etc...) out of my own pocket, but that is a small cost compared to having to stay an entire month in the hospital just for IV's. Of course, there are some IV's that aren't covered, such as tigacyl, so I either stay in house for that or do them as an outpatient at my local hospital (which medicare does pay for, ridiculous as it costs them way more to do it that way than to just cover services from an infusion company but that's the government for you).
So that's it in a nutshell....I am hoping that one day, Medicare will cover IV antibiotics fully at home so that we don't have to jump through hoops just to get them for home.

Jenn

 

[JustDucky]

Medicare doesn't cover home IV's, they will cover the nursing part of it, but not the service from an infusion company like Apria. They are my primary and only insurance unfortunately..... I have in a way figured out how to get my IV's at home though, it is a pain in the butt to say the least but this is how I do it.....I use my part D insurance (they cover generics even through the doughnut hole or gap stage) to get the IV meds that are covered under their plan ahead of time. My doctor and I went through the most common antibiotics that I am prescribed and essentially ordered them through my part D company (I can't simply order them when I need the antibiotics, it takes a few weeks to get them in and I can't wait that long for treatment). So now I have a stockpile of antibiotics that I am nearly always on in my home, it really does look like a pharmacy! IV fluids are also covered so I also order enough bags to reconstitute my meds. I have to buy the IV supplies myself (IV tubing, port needles, syringes, etc...) out of my own pocket, but that is a small cost compared to having to stay an entire month in the hospital just for IV's. Of course, there are some IV's that aren't covered, such as tigacyl, so I either stay in house for that or do them as an outpatient at my local hospital (which medicare does pay for, ridiculous as it costs them way more to do it that way than to just cover services from an infusion company but that's the government for you).
<br />So that's it in a nutshell....I am hoping that one day, Medicare will cover IV antibiotics fully at home so that we don't have to jump through hoops just to get them for home.
<br />
<br />Jenn

 

[JustDucky]

Medicare doesn't cover home IV's, they will cover the nursing part of it, but not the service from an infusion company like Apria. They are my primary and only insurance unfortunately..... I have in a way figured out how to get my IV's at home though, it is a pain in the butt to say the least but this is how I do it.....I use my part D insurance (they cover generics even through the doughnut hole or gap stage) to get the IV meds that are covered under their plan ahead of time. My doctor and I went through the most common antibiotics that I am prescribed and essentially ordered them through my part D company (I can't simply order them when I need the antibiotics, it takes a few weeks to get them in and I can't wait that long for treatment). So now I have a stockpile of antibiotics that I am nearly always on in my home, it really does look like a pharmacy! IV fluids are also covered so I also order enough bags to reconstitute my meds. I have to buy the IV supplies myself (IV tubing, port needles, syringes, etc...) out of my own pocket, but that is a small cost compared to having to stay an entire month in the hospital just for IV's. Of course, there are some IV's that aren't covered, such as tigacyl, so I either stay in house for that or do them as an outpatient at my local hospital (which medicare does pay for, ridiculous as it costs them way more to do it that way than to just cover services from an infusion company but that's the government for you).
So that's it in a nutshell....I am hoping that one day, Medicare will cover IV antibiotics fully at home so that we don't have to jump through hoops just to get them for home.

Jenn

 

[JustDucky]

Medicare doesn't cover home IV's, they will cover the nursing part of it, but not the service from an infusion company like Apria. They are my primary and only insurance unfortunately..... I have in a way figured out how to get my IV's at home though, it is a pain in the butt to say the least but this is how I do it.....I use my part D insurance (they cover generics even through the doughnut hole or gap stage) to get the IV meds that are covered under their plan ahead of time. My doctor and I went through the most common antibiotics that I am prescribed and essentially ordered them through my part D company (I can't simply order them when I need the antibiotics, it takes a few weeks to get them in and I can't wait that long for treatment). So now I have a stockpile of antibiotics that I am nearly always on in my home, it really does look like a pharmacy! IV fluids are also covered so I also order enough bags to reconstitute my meds. I have to buy the IV supplies myself (IV tubing, port needles, syringes, etc...) out of my own pocket, but that is a small cost compared to having to stay an entire month in the hospital just for IV's. Of course, there are some IV's that aren't covered, such as tigacyl, so I either stay in house for that or do them as an outpatient at my local hospital (which medicare does pay for, ridiculous as it costs them way more to do it that way than to just cover services from an infusion company but that's the government for you).
So that's it in a nutshell....I am hoping that one day, Medicare will cover IV antibiotics fully at home so that we don't have to jump through hoops just to get them for home.

Jenn

 

[JustDucky]

Medicare doesn't cover home IV's, they will cover the nursing part of it, but not the service from an infusion company like Apria. They are my primary and only insurance unfortunately..... I have in a way figured out how to get my IV's at home though, it is a pain in the butt to say the least but this is how I do it.....I use my part D insurance (they cover generics even through the doughnut hole or gap stage) to get the IV meds that are covered under their plan ahead of time. My doctor and I went through the most common antibiotics that I am prescribed and essentially ordered them through my part D company (I can't simply order them when I need the antibiotics, it takes a few weeks to get them in and I can't wait that long for treatment). So now I have a stockpile of antibiotics that I am nearly always on in my home, it really does look like a pharmacy! IV fluids are also covered so I also order enough bags to reconstitute my meds. I have to buy the IV supplies myself (IV tubing, port needles, syringes, etc...) out of my own pocket, but that is a small cost compared to having to stay an entire month in the hospital just for IV's. Of course, there are some IV's that aren't covered, such as tigacyl, so I either stay in house for that or do them as an outpatient at my local hospital (which medicare does pay for, ridiculous as it costs them way more to do it that way than to just cover services from an infusion company but that's the government for you).
<br />So that's it in a nutshell....I am hoping that one day, Medicare will cover IV antibiotics fully at home so that we don't have to jump through hoops just to get them for home.
<br />
<br />Jenn

 

[maryiris]

Wow!! What a crazy mess. I have the large health plan - my husband is employed by Visa. We are not even mentioning the medicare (I am disabled) so we don't end up with a mess - bills going back and forth with no one wanting to pay. HOWEVER - would the medicare as secondary pick up some of the out of pocket limit and deductibles that we pay with my husband's insurance?

Anyone know?

 

[maryiris]

Wow!! What a crazy mess. I have the large health plan - my husband is employed by Visa. We are not even mentioning the medicare (I am disabled) so we don't end up with a mess - bills going back and forth with no one wanting to pay. HOWEVER - would the medicare as secondary pick up some of the out of pocket limit and deductibles that we pay with my husband's insurance?

Anyone know?

 

[maryiris]

Wow!! What a crazy mess. I have the large health plan - my husband is employed by Visa. We are not even mentioning the medicare (I am disabled) so we don't end up with a mess - bills going back and forth with no one wanting to pay. HOWEVER - would the medicare as secondary pick up some of the out of pocket limit and deductibles that we pay with my husband's insurance?

Anyone know?

 

[maryiris]

Wow!! What a crazy mess. I have the large health plan - my husband is employed by Visa. We are not even mentioning the medicare (I am disabled) so we don't end up with a mess - bills going back and forth with no one wanting to pay. HOWEVER - would the medicare as secondary pick up some of the out of pocket limit and deductibles that we pay with my husband's insurance?

Anyone know?

 

[julie]

I can only see like 3/4 of your message because it's cut off on the right side (freaking website, sometimes I swear... LOL) so if you can copy and email it to me services@dafcf.org I might be able to give better info.

However, the main fact here is MEDICARE DOES NOT UNDER ANY CIRCUMSTANCES EVER EVER EVER EVER cover at home IV therapy. NEVER. (soapbox here: people need to do their freaking research before they post absolutes, just saying)

FYI, you CAN decline medicare coverage if you want. And it sounds like that might be best here for you (again, I can't see your entire message so it's really difficult to respond).

 

[julie]

I can only see like 3/4 of your message because it's cut off on the right side (freaking website, sometimes I swear... LOL) so if you can copy and email it to me services@dafcf.org I might be able to give better info.

However, the main fact here is MEDICARE DOES NOT UNDER ANY CIRCUMSTANCES EVER EVER EVER EVER cover at home IV therapy. NEVER. (soapbox here: people need to do their freaking research before they post absolutes, just saying)

FYI, you CAN decline medicare coverage if you want. And it sounds like that might be best here for you (again, I can't see your entire message so it's really difficult to respond).

 

[JustDucky]

Yes, that's it in a nutshell...Medicare doesn't cover home IV's....unless you utilize part D prescription insurance (which is different from Medicare part A and B) and even then, not everything is covered. The new, fancy antibiotics aren't covered at all, but the older generics are for the most part, it depends on your coverage and if you have that coverage through the gap known as the doughnut hole. If you have the most basic part D coverage, you will quickly find out that you will be in the hole after just one order of your IV (they aren't cheap!) Since my hospitalizations last summer, I have successfully administered home IV''s 3 times because I pre ordered them (that's the key, you need to do this or you will wait weeks before it is shipped to you because it is a specialty med) . Supplies for IV's are also not covered under medicare.

Now to answer your question mary: Medicare as a secondary probably would pick up covered services that your husband's doesn't. I would check with his company, speak to HR as they would be able to guide you. I know there are people on this board who have similar situations as you do....I am strictly Medicare original w/medigap as well as Part D insurance.

Good luck<img src="i/expressions/face-icon-small-smile.gif" border="0">
Jenn w/CF

 

[JustDucky]

Yes, that's it in a nutshell...Medicare doesn't cover home IV's....unless you utilize part D prescription insurance (which is different from Medicare part A and B) and even then, not everything is covered. The new, fancy antibiotics aren't covered at all, but the older generics are for the most part, it depends on your coverage and if you have that coverage through the gap known as the doughnut hole. If you have the most basic part D coverage, you will quickly find out that you will be in the hole after just one order of your IV (they aren't cheap!) Since my hospitalizations last summer, I have successfully administered home IV''s 3 times because I pre ordered them (that's the key, you need to do this or you will wait weeks before it is shipped to you because it is a specialty med) . Supplies for IV's are also not covered under medicare.

Now to answer your question mary: Medicare as a secondary probably would pick up covered services that your husband's doesn't. I would check with his company, speak to HR as they would be able to guide you. I know there are people on this board who have similar situations as you do....I am strictly Medicare original w/medigap as well as Part D insurance.

Good luck<img src="i/expressions/face-icon-small-smile.gif" border="0">
Jenn w/CF

 

[scanboyd]

for some reason I am unable to read all the post on this issue, they are cut off on the right side of post, any solution to this??

 

[scanboyd]

for some reason I am unable to read all the post on this issue, they are cut off on the right side of post, any solution to this??