Thank you, @Terry4, for mentioning that a few states do not allow Supplemental plans to reject seniors for pre-existing conditions. There are also a few scenarios when you might once again have the choice—I think moving to a new area or if your Advantage plan goes out of business. I personally don’t know what is the best choice for anyone going on to Medicare, but I strongly feel that each person should understand the choice that they make along with their future options.
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@Will1 I neglected to say that since you are transitioning to Medicare due to disability, you may not have the same choices as those of us who are age 65. And when you reach age 65, my understanding is that you may have more choices than now. So some of what I wrote may not be relevant to you. Hopefully you have gotten good advice about your options. Health Partners is a very good company and You should get good coverage and service.
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What pump do you have please?
My brother has Type 1 and I manage his healthcare. He’s been on disability for several years and has always had an Advantage Plan. My brother has preexisting conditions; therefore a supplement would have been outrageously expensive. He turns 65 next month & I’m ecstatic about him being able to get a supplement. If you have to get a an Advantage Plan, I would advise you to talk to several Sales Reps and really compare the plans. Medicare changed the rules last year & it required people with insulin pumps to buy their insulin under Part B, which means you pay 20% . My brother had Humana last year & they raised his insulin cost substantially. I switched him to Anthem this year & they charged him under Part D with the usual drug co-pay. It saved my brother a lot of money. With all the co-pays & deductibles, the advantage plans were outrageously expensive. My brother didn’ have to see any doctors to sign up for Medicare. The govt told him he had to sign up for Medicare.
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I just crunched the numbers and Humana’s insulin retail price was 5 times what the insulin retail price is for the Medicare supplement I’m getting for my brother in September. 5 times! With the Advantage Plan, there’s less transparency & you don’t know what insulin will cost under Part B. I thought insulin would cost less under Part B for a larger insurance co. I was right. Anthem is bigger than Humana. Keep in mind that you will probably have to pay more for insulin with an Advantage Plan.
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I just started Medicare on July 1st. My Endo explained that I need to be seen every 3 months in order for Medicare to pay for my pump supplies. She said that the appointment interval must be at least 90 days from the last appointment and no more than 2 weeks beyond those 90 days. She always recommends that I set up 2 appointments past the current appointment to be sure I can fulfill this requirement given her busy schedule.
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I am on Medicare and need doctor’s notes every 6 months for my FreeStyle Libre prescription. I don’t see my endo that often so I use my PCP who is a nurse practitioner. I’m on MDI and don’t qualify for a pump due to my C-peptide results. I have LADA and have some residual insulin.
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You can call the Medicare toll free number and ask questions without being on Medicare as did about insulin under Part B and the 90 day requirement.
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Hi Will1, so this is what I believe you will need to do once your Medicare (or Medicare Advantage) kicks in; In order to get T1D supplies and prescription meds you will need to see a Medicare doctor (Primary Care Phys if on Medicare Advantage). So I would suggest you schedule an appt. as quickly as you can. You may need to schedule an appt. with the new Medicare Endo as well. (We’re on Medicare Advantage and the primary care phys. wasn’t all that comfortable with prescribing T1D supplies but in the end did. (this was in part because our first PCP would not allow us to schedule an appt. for 3 months - turns out he was very sick and rather than refer patients, especially new patients his office just acted as if everyone could wait for this guy to recover in 3 months. We would have run out of insulin by then (which I explained to the office workers and phys. assistant) but that didn’t seem to matter!
Anywho, the point is be your own best advocate, you know what you need and by hook or crook you may need to be a little more proactive to get it. We ended up getting what we needed but it was a bit of a headache. Not because of Medicare per say but medical office incompetence (I’m not a fan of Medicare Advantage for this reason).
If you are starting Medicare because of being disabled (you had to wait 24 months I bet? Which really confounds me but just another messed up aspect of our healthcare system) you may have little choice for supplemental coverage because you are not yet 65. I in either case my recommendation is do your homework as much as possible. Find the best doctors you can that fit your needs, etc., etc. We have changed medical groups (IPA’s) several times just to get to the doctors we wanted.
Sorry for the rant about our healthcare but I hope I was somewhat helpful. Medicare can be a really good thing, especially for those of us who may be or have become disabled! Unfortunately a lot of it is figuring out how everything works!
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