I’ve been on traditional medicare with supplement. The cost of my part D supplement is doubling which prompted me to look at advantage plans as well. While the low to zero monthly costs are appealing they all have a minimum 20% copay for DME which would include pump and CGM supplies. Plus the rental fee for pump. The coat of that yearly seems to be more than deductible and monthly cost of medigap plan. I’d like to hear people thoughts on this. Also, can anyone tell me how often the distributor bills for pump rental. It doesn’t seem to be monthly. Also has anyone been able to get Lyumjev covered through part b? Humalog?
You can change to a different Part D Rx plan each year. I always consult with my state’s SHIBA (Senior Health Insurance Benefits Assistance) to help me make a cost effective choice. You’ll need to have list of your meds to make a good selection.
Be very careful if you go with a Medicare Advantage (MA) plan. After a year or so following a switch to MA, you will still be able to switch back to standard Medicare but will not be eligible, in 46 of 50 states, to purchase a supplement plan without going through medical underwriting. If you have diabetes or any of a number of other common illnesses, you likely will not qualify.
You may also be subject to high (1,000s of dollars) maximum out of pocket costs. If you receive an unfortunate diagnosis of cancer, for instance, the 20% copays for treatment may be unaffordable.
I found this source of information on the topic to be reliable and educational.
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I have Medicare and a Plan F supplement and like it because no matter what happens I know I am covered and yes it does go up but it’s still within reason for what I get. Last year I had prostate cancer and with surgeries and all the tests along with my pump and insulin, I paid no out of pocket costs and the hospital and lab bills alone were billed over $100,000 to Medicare. I also tried both Lumijev and Fiasp and both were covered under Part B, but I had (and still have) problems with Walgreens putting it in their computer right, so it takes a week for them to fill it correctly (with a lot of phone calls from me). My plan D changes each year depending on what my medications are and what their coverage is. I start checking all of them on Oct 15th.
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There is value to being on Facebook. There is a Diabetes and Politics group that I highly recommend. In fact today, there is a post regarding the issues of Advantage plans. As you said, the attraction of no monthly premiums sounds good (too good?) but the high claim denial rates and the burdensome prior authorization requirements have led me to steer clear. I suggest meeting with an independent health plan broker to see what’s out there where you live (having geography in the criteria makes things even messier). There are supplement or gap plans out there.
Thanks. I got humalog covered through Part B when I first went on Medicare three years ago. Then I switched to Lyumjev and could not get Walgreens to put it through Part B. I gave up because my part D plan had a tier 6 which provided free insulin all year. I did have them try again to put Lyumjev through Part B a few months ago and was told it was not on the Part B formulary. Dont want to pay $35 monthly next year if I. can get it for free. I’m a retired diabetes educator and had several patients who also had difficulty getting Lyumjev covered after I recommended they try it. I am planning on switching part d I’m on Ozempic and that the drug that costs me a fortune after going in the coverage gap. I am definitely sticking with Medicare and not advantage plan
Thanks. I will be sticking with Medicare
Thanks. That was a great article on FB. I’m sticking with Medicare.
Sorry I’m late to the party but my experience with Part C (Advantage Care) was awful. (for my wife) Was able to switch to Orig Medicare with Supplemental or GAP coverage when she turned 65 and couldn’t wait to do so. Won’t go into the details but Advantage care was awful for us as T1D. My 2 cents, although the big insurers are all basically doubling their monthly premiums (might this have anything to do with drug cost negotiations?), you made a good choice.
Never too late. Thanks for the input. Definitely sticking with regular Medicare. On a side note my husband who is not diabetic had an ER visit last week has an advantage plan. Never had much of a problem. But so far three bills have come n and they denied them all.
I have a Medicare advantage policy. There is no copay on my Dexcom G7. No 20%. Not sure about a pump but from what I remember was 0 co pay. Switched to MDI and probably pay more for the InPen and insulin but personal choice. Good luck. I have aarpUHC