Medicare as Secondary Payer

Skye

New member
Wheezie....that is awful!

I have been able to find some information about Part B.....not sure how accurate it is. Apparently Part B will cover diabetic supplies including insulin if you have an insulin pump because it is DME. If you deliver via syringe it has to be covered by Part D. I also read that anyone considering a transplant in the future should opt for Part B because a lot of the immunosuppresants are covered under Part B. How CONFUSING for everyone. I feel sorry for all the old folks trying to understand all of this and make decision for their care. At least we have young sharp minds to try and make sense of this.....well somewhat sharp<img src="i/expressions/face-icon-small-smile.gif" border="0">
 

Skye

New member
Wheezie....that is awful!

I have been able to find some information about Part B.....not sure how accurate it is. Apparently Part B will cover diabetic supplies including insulin if you have an insulin pump because it is DME. If you deliver via syringe it has to be covered by Part D. I also read that anyone considering a transplant in the future should opt for Part B because a lot of the immunosuppresants are covered under Part B. How CONFUSING for everyone. I feel sorry for all the old folks trying to understand all of this and make decision for their care. At least we have young sharp minds to try and make sense of this.....well somewhat sharp<img src="i/expressions/face-icon-small-smile.gif" border="0">
 

Skye

New member
Wheezie....that is awful!

I have been able to find some information about Part B.....not sure how accurate it is. Apparently Part B will cover diabetic supplies including insulin if you have an insulin pump because it is DME. If you deliver via syringe it has to be covered by Part D. I also read that anyone considering a transplant in the future should opt for Part B because a lot of the immunosuppresants are covered under Part B. How CONFUSING for everyone. I feel sorry for all the old folks trying to understand all of this and make decision for their care. At least we have young sharp minds to try and make sense of this.....well somewhat sharp<img src="i/expressions/face-icon-small-smile.gif" border="0">
 

Skye

New member
Wheezie....that is awful!

I have been able to find some information about Part B.....not sure how accurate it is. Apparently Part B will cover diabetic supplies including insulin if you have an insulin pump because it is DME. If you deliver via syringe it has to be covered by Part D. I also read that anyone considering a transplant in the future should opt for Part B because a lot of the immunosuppresants are covered under Part B. How CONFUSING for everyone. I feel sorry for all the old folks trying to understand all of this and make decision for their care. At least we have young sharp minds to try and make sense of this.....well somewhat sharp<img src="i/expressions/face-icon-small-smile.gif" border="0">
 

Skye

New member
Wheezie....that is awful!
<br />
<br />I have been able to find some information about Part B.....not sure how accurate it is. Apparently Part B will cover diabetic supplies including insulin if you have an insulin pump because it is DME. If you deliver via syringe it has to be covered by Part D. I also read that anyone considering a transplant in the future should opt for Part B because a lot of the immunosuppresants are covered under Part B. How CONFUSING for everyone. I feel sorry for all the old folks trying to understand all of this and make decision for their care. At least we have young sharp minds to try and make sense of this.....well somewhat sharp<img src="i/expressions/face-icon-small-smile.gif" border="0">
 

Shaunessy

New member
My husband and I are also trying to figure out the secondary coverage thing. He'll be switching from Medicaid + Medicare to employer-based + Medicare. I think we'll pay for parts B & D unless it turns out that my new employers insurance covers enough.

Wheezie - Did you find out that Medicare won't cover drugs that your primary will by trial and error? Do you know if this is true for all part D plans or is this plan specific?

With part D as a secondary, is it necessary to have a plan with gap coverage or perhaps a separate gap coverage plan? By that point we might have already hit our primary's out-of-pocket prescription max anyway...
 

Shaunessy

New member
My husband and I are also trying to figure out the secondary coverage thing. He'll be switching from Medicaid + Medicare to employer-based + Medicare. I think we'll pay for parts B & D unless it turns out that my new employers insurance covers enough.

Wheezie - Did you find out that Medicare won't cover drugs that your primary will by trial and error? Do you know if this is true for all part D plans or is this plan specific?

With part D as a secondary, is it necessary to have a plan with gap coverage or perhaps a separate gap coverage plan? By that point we might have already hit our primary's out-of-pocket prescription max anyway...
 

Shaunessy

New member
My husband and I are also trying to figure out the secondary coverage thing. He'll be switching from Medicaid + Medicare to employer-based + Medicare. I think we'll pay for parts B & D unless it turns out that my new employers insurance covers enough.

Wheezie - Did you find out that Medicare won't cover drugs that your primary will by trial and error? Do you know if this is true for all part D plans or is this plan specific?

With part D as a secondary, is it necessary to have a plan with gap coverage or perhaps a separate gap coverage plan? By that point we might have already hit our primary's out-of-pocket prescription max anyway...
 

Shaunessy

New member
My husband and I are also trying to figure out the secondary coverage thing. He'll be switching from Medicaid + Medicare to employer-based + Medicare. I think we'll pay for parts B & D unless it turns out that my new employers insurance covers enough.

Wheezie - Did you find out that Medicare won't cover drugs that your primary will by trial and error? Do you know if this is true for all part D plans or is this plan specific?

With part D as a secondary, is it necessary to have a plan with gap coverage or perhaps a separate gap coverage plan? By that point we might have already hit our primary's out-of-pocket prescription max anyway...
 

Shaunessy

New member
My husband and I are also trying to figure out the secondary coverage thing. He'll be switching from Medicaid + Medicare to employer-based + Medicare. I think we'll pay for parts B & D unless it turns out that my new employers insurance covers enough.
<br />
<br />Wheezie - Did you find out that Medicare won't cover drugs that your primary will by trial and error? Do you know if this is true for all part D plans or is this plan specific?
<br />
<br />With part D as a secondary, is it necessary to have a plan with gap coverage or perhaps a separate gap coverage plan? By that point we might have already hit our primary's out-of-pocket prescription max anyway...
 

JustDucky

New member
Wheezie, I was actually transferred to a nursing home (sub acute facility) a few times for chronic IV therapy, IV's that would last more than 3 weeks. Another problem for me is that I need "specialized" care because I am a vent which narrows my choices dramatically. My last run in with a nursing home facility damn near killed me, they poo poo'ed my complaints and requests for further tests and to just be more aggressive (they sat on me being febrile with temps of 102 without doing anything!! Trust me, I was foaming at the mouth even to the director demanding something be done before they killed me!) and I wound up being transferred to a hospital where my care was much better. After 10 days there, I finally went home...weak but alive and with my lungs intact. In all, between the first hospital visit, the nursing home visit and the run in with the second hospital, I spend nearly 12 weeks away from home!! GAhhhh!!! You are so right...nursing homes don't know whether to fart or go blind when it comes to CF care. These days, I refuse going to nursing homes, my hospital that I go to now does everything in their power to keep me and so far it has worked.

You were so lucky to have a home company donate their supplies, I can't tell you how much I pleaded with Apria to figure out some way to get me home to no avail. On that hospital visit, I was down to one IV twice a day which I was able to complete as an outpatient at my local hospital...I just had to go their twice a day, wait for the drugs to come (took up to a hour), be hooked up, after a hour be flushed and go home. I did that for nearly three weeks...I think I was more tired from going back and forth than I was from the IV medications and my lungs! Incidentally, do you know what the hospital charged Medicare daily for IV services? $800 a DAY! Still insane....

Yes, part B covers some IV infusions...such as IVG for immunodeficiencies and insulin only if it is delivered by a pump. Some chemotherapy also falls under that coverage. Those who are transplanted under Medicare do get coverage for their immunosuppressants.

Shaunessy, as far as I know, most part D plans (at least in NY) will cover IV drugs until you hit that coverage gap (doughnut hole) and then no coverage until you hit the catastrophic stage (after you have vested $4050 total in out of pocket costs) unless your plan has coverage during the doughnut hole (mine covers generics only in this phase, at one time, the company covered everything including specialty drugs like IV's but they have since tightened their belt). Maybe it will be different for you, some states may still have better coverage through that phase.

Because medicare is your secondary, your husband's plan should pick up your meds first (I think) anything else would be submitted to medicare. Check out what your hubby's insurance will cover as far as meds go...I don't have much experience with medicare being secondary insurance, just primary.

I could literally write a book on this...hugs, Jenn <img src="i/expressions/face-icon-small-smile.gif" border="0">
 

JustDucky

New member
Wheezie, I was actually transferred to a nursing home (sub acute facility) a few times for chronic IV therapy, IV's that would last more than 3 weeks. Another problem for me is that I need "specialized" care because I am a vent which narrows my choices dramatically. My last run in with a nursing home facility damn near killed me, they poo poo'ed my complaints and requests for further tests and to just be more aggressive (they sat on me being febrile with temps of 102 without doing anything!! Trust me, I was foaming at the mouth even to the director demanding something be done before they killed me!) and I wound up being transferred to a hospital where my care was much better. After 10 days there, I finally went home...weak but alive and with my lungs intact. In all, between the first hospital visit, the nursing home visit and the run in with the second hospital, I spend nearly 12 weeks away from home!! GAhhhh!!! You are so right...nursing homes don't know whether to fart or go blind when it comes to CF care. These days, I refuse going to nursing homes, my hospital that I go to now does everything in their power to keep me and so far it has worked.

You were so lucky to have a home company donate their supplies, I can't tell you how much I pleaded with Apria to figure out some way to get me home to no avail. On that hospital visit, I was down to one IV twice a day which I was able to complete as an outpatient at my local hospital...I just had to go their twice a day, wait for the drugs to come (took up to a hour), be hooked up, after a hour be flushed and go home. I did that for nearly three weeks...I think I was more tired from going back and forth than I was from the IV medications and my lungs! Incidentally, do you know what the hospital charged Medicare daily for IV services? $800 a DAY! Still insane....

Yes, part B covers some IV infusions...such as IVG for immunodeficiencies and insulin only if it is delivered by a pump. Some chemotherapy also falls under that coverage. Those who are transplanted under Medicare do get coverage for their immunosuppressants.

Shaunessy, as far as I know, most part D plans (at least in NY) will cover IV drugs until you hit that coverage gap (doughnut hole) and then no coverage until you hit the catastrophic stage (after you have vested $4050 total in out of pocket costs) unless your plan has coverage during the doughnut hole (mine covers generics only in this phase, at one time, the company covered everything including specialty drugs like IV's but they have since tightened their belt). Maybe it will be different for you, some states may still have better coverage through that phase.

Because medicare is your secondary, your husband's plan should pick up your meds first (I think) anything else would be submitted to medicare. Check out what your hubby's insurance will cover as far as meds go...I don't have much experience with medicare being secondary insurance, just primary.

I could literally write a book on this...hugs, Jenn <img src="i/expressions/face-icon-small-smile.gif" border="0">
 

JustDucky

New member
Wheezie, I was actually transferred to a nursing home (sub acute facility) a few times for chronic IV therapy, IV's that would last more than 3 weeks. Another problem for me is that I need "specialized" care because I am a vent which narrows my choices dramatically. My last run in with a nursing home facility damn near killed me, they poo poo'ed my complaints and requests for further tests and to just be more aggressive (they sat on me being febrile with temps of 102 without doing anything!! Trust me, I was foaming at the mouth even to the director demanding something be done before they killed me!) and I wound up being transferred to a hospital where my care was much better. After 10 days there, I finally went home...weak but alive and with my lungs intact. In all, between the first hospital visit, the nursing home visit and the run in with the second hospital, I spend nearly 12 weeks away from home!! GAhhhh!!! You are so right...nursing homes don't know whether to fart or go blind when it comes to CF care. These days, I refuse going to nursing homes, my hospital that I go to now does everything in their power to keep me and so far it has worked.

You were so lucky to have a home company donate their supplies, I can't tell you how much I pleaded with Apria to figure out some way to get me home to no avail. On that hospital visit, I was down to one IV twice a day which I was able to complete as an outpatient at my local hospital...I just had to go their twice a day, wait for the drugs to come (took up to a hour), be hooked up, after a hour be flushed and go home. I did that for nearly three weeks...I think I was more tired from going back and forth than I was from the IV medications and my lungs! Incidentally, do you know what the hospital charged Medicare daily for IV services? $800 a DAY! Still insane....

Yes, part B covers some IV infusions...such as IVG for immunodeficiencies and insulin only if it is delivered by a pump. Some chemotherapy also falls under that coverage. Those who are transplanted under Medicare do get coverage for their immunosuppressants.

Shaunessy, as far as I know, most part D plans (at least in NY) will cover IV drugs until you hit that coverage gap (doughnut hole) and then no coverage until you hit the catastrophic stage (after you have vested $4050 total in out of pocket costs) unless your plan has coverage during the doughnut hole (mine covers generics only in this phase, at one time, the company covered everything including specialty drugs like IV's but they have since tightened their belt). Maybe it will be different for you, some states may still have better coverage through that phase.

Because medicare is your secondary, your husband's plan should pick up your meds first (I think) anything else would be submitted to medicare. Check out what your hubby's insurance will cover as far as meds go...I don't have much experience with medicare being secondary insurance, just primary.

I could literally write a book on this...hugs, Jenn <img src="i/expressions/face-icon-small-smile.gif" border="0">
 

JustDucky

New member
Wheezie, I was actually transferred to a nursing home (sub acute facility) a few times for chronic IV therapy, IV's that would last more than 3 weeks. Another problem for me is that I need "specialized" care because I am a vent which narrows my choices dramatically. My last run in with a nursing home facility damn near killed me, they poo poo'ed my complaints and requests for further tests and to just be more aggressive (they sat on me being febrile with temps of 102 without doing anything!! Trust me, I was foaming at the mouth even to the director demanding something be done before they killed me!) and I wound up being transferred to a hospital where my care was much better. After 10 days there, I finally went home...weak but alive and with my lungs intact. In all, between the first hospital visit, the nursing home visit and the run in with the second hospital, I spend nearly 12 weeks away from home!! GAhhhh!!! You are so right...nursing homes don't know whether to fart or go blind when it comes to CF care. These days, I refuse going to nursing homes, my hospital that I go to now does everything in their power to keep me and so far it has worked.

You were so lucky to have a home company donate their supplies, I can't tell you how much I pleaded with Apria to figure out some way to get me home to no avail. On that hospital visit, I was down to one IV twice a day which I was able to complete as an outpatient at my local hospital...I just had to go their twice a day, wait for the drugs to come (took up to a hour), be hooked up, after a hour be flushed and go home. I did that for nearly three weeks...I think I was more tired from going back and forth than I was from the IV medications and my lungs! Incidentally, do you know what the hospital charged Medicare daily for IV services? $800 a DAY! Still insane....

Yes, part B covers some IV infusions...such as IVG for immunodeficiencies and insulin only if it is delivered by a pump. Some chemotherapy also falls under that coverage. Those who are transplanted under Medicare do get coverage for their immunosuppressants.

Shaunessy, as far as I know, most part D plans (at least in NY) will cover IV drugs until you hit that coverage gap (doughnut hole) and then no coverage until you hit the catastrophic stage (after you have vested $4050 total in out of pocket costs) unless your plan has coverage during the doughnut hole (mine covers generics only in this phase, at one time, the company covered everything including specialty drugs like IV's but they have since tightened their belt). Maybe it will be different for you, some states may still have better coverage through that phase.

Because medicare is your secondary, your husband's plan should pick up your meds first (I think) anything else would be submitted to medicare. Check out what your hubby's insurance will cover as far as meds go...I don't have much experience with medicare being secondary insurance, just primary.

I could literally write a book on this...hugs, Jenn <img src="i/expressions/face-icon-small-smile.gif" border="0">
 

JustDucky

New member
Wheezie, I was actually transferred to a nursing home (sub acute facility) a few times for chronic IV therapy, IV's that would last more than 3 weeks. Another problem for me is that I need "specialized" care because I am a vent which narrows my choices dramatically. My last run in with a nursing home facility damn near killed me, they poo poo'ed my complaints and requests for further tests and to just be more aggressive (they sat on me being febrile with temps of 102 without doing anything!! Trust me, I was foaming at the mouth even to the director demanding something be done before they killed me!) and I wound up being transferred to a hospital where my care was much better. After 10 days there, I finally went home...weak but alive and with my lungs intact. In all, between the first hospital visit, the nursing home visit and the run in with the second hospital, I spend nearly 12 weeks away from home!! GAhhhh!!! You are so right...nursing homes don't know whether to fart or go blind when it comes to CF care. These days, I refuse going to nursing homes, my hospital that I go to now does everything in their power to keep me and so far it has worked.
<br />
<br />You were so lucky to have a home company donate their supplies, I can't tell you how much I pleaded with Apria to figure out some way to get me home to no avail. On that hospital visit, I was down to one IV twice a day which I was able to complete as an outpatient at my local hospital...I just had to go their twice a day, wait for the drugs to come (took up to a hour), be hooked up, after a hour be flushed and go home. I did that for nearly three weeks...I think I was more tired from going back and forth than I was from the IV medications and my lungs! Incidentally, do you know what the hospital charged Medicare daily for IV services? $800 a DAY! Still insane....
<br />
<br />Yes, part B covers some IV infusions...such as IVG for immunodeficiencies and insulin only if it is delivered by a pump. Some chemotherapy also falls under that coverage. Those who are transplanted under Medicare do get coverage for their immunosuppressants.
<br />
<br />Shaunessy, as far as I know, most part D plans (at least in NY) will cover IV drugs until you hit that coverage gap (doughnut hole) and then no coverage until you hit the catastrophic stage (after you have vested $4050 total in out of pocket costs) unless your plan has coverage during the doughnut hole (mine covers generics only in this phase, at one time, the company covered everything including specialty drugs like IV's but they have since tightened their belt). Maybe it will be different for you, some states may still have better coverage through that phase.
<br />
<br />Because medicare is your secondary, your husband's plan should pick up your meds first (I think) anything else would be submitted to medicare. Check out what your hubby's insurance will cover as far as meds go...I don't have much experience with medicare being secondary insurance, just primary.
<br />
<br />I could literally write a book on this...hugs, Jenn <img src="i/expressions/face-icon-small-smile.gif" border="0">
 
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