Medicare & Enteral Supplies

JimInVA

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Darcey turns 65 shortly and qualifies for Medicare. As we've been shopping Medicare Part D supplements, I'm told that our agent was unable to find Jevity 1.5 (the formula that she currently uses) listed as a covered item in any of the supplemental choices that he has available. One possibility is that he's considering it as a "drug" when it might be classified as something entirely different. It may, in fact, be covered by Medicare directly. The bottom line is that "I don't know". So I was wondering if any of you more enlightened individuals might shed some light on this for me.

My best...

Jim
 

nona

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Jim, while there may be questions about the specific formula, in my experience the food and supplies are covered by Medicare as long as there's a prescription. I've always had to go through a third party. In AZ the script went from my doctor to Ameritas to the food manufacturer, Kate Farms. In NH the middle man is Coram. I think you'd have the best results if you went through your doctor's office.
 

Nikki J

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It is part b not part d Or C if you are doing MA Are you working with a SHIP counselor? They are volunteers trained to counsel medicare issues. if you are doing regular medicare of course you know you need a supplement policy
 

JimInVA

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Then that explains why he wasn't able to find it. This agent has left me with more questions than answers. And he didn't seem very well prepared when he first saw us. I guess I'll just keep asking questions until I think I understand enough to make a proper decision. Of course the clock keeps ticking... and some things seem very time dependent.

Nikki - as to MA SHIP... I'm not sure if Virginia has anything equivalent, here. And, yes... I absolutely understand the need for the supplemental policies. :)

Thanks nona and Nikki!

Jim
 

Nikki J

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every state has ship. Sorry the MA was referring to medicare advantage. Didn’t punctuate. my friend did the training here recently and found it pretty comprehensive. And she worked in customer service for a health insurance company so explained their benefits all the time. As well as having managed medicare for relatives with extremely complicated needs. Worth a run by them maybe.
 

nona

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I have a Medicare Advantage Plan as well. It includes Part D, so prescriptions are integrated into the plan.
 

JimInVA

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Nikki - Thank you for that additional information. I was going to ask what MA SHIP was, but decided to google it, instead. I found MA (Massachusetts) SHIP (State Health Insurance Program) [Assistance]. Thanks for clearing that up! That's what I get for assuming. And I'll look in the VICAP that you referenced. Thanks again!!! :)

Jim
 

lgelb

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Just to be clear, Part C (Medicare Advantage) covers the whole boat -- what Parts A (inpatient), B (outpatient, including medical foods like tube formulas, and drugs/vaccines administered at the doc's office or in an infusion center), and generally D (including drugs that you take at home), all include. It also avoids the need for a supplemental plan, since out of pocket expenses are capped, as they are not for traditional Medicare.

If you use traditional Medicare, you'll need a Part D plan for drugs, and most PALS would opt for a supplement aka Medigap policy, of which there are several tiers, also confusingly denoted by letters, to cover some level of deductibles, coinsurance and copays that traditional Medicare otherwise requires.

I recommend that anyone enrolling in Medicare first check to see if Medicare Advantage plans are available in their state for them, and if so, shop them first. It is easier to manage one policy than three. If none is available or they are not worthy, e.g. the network excludes physicians on whom you rely, then you can move on to the supplement + Part D selection process.

Above all, start at the Medicare site to see all available plans in any of these categories, because when you use private portals, commercial relationships often constrain what you see.

Best,
Laurie
 

KimT

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Jim,

Carefully consider your state if you are going with Medicare Advantage. The Advantage plans in Florida are terrible and they are being pushed hard. I have the best Part B supplement and a decent Part D drug plan. I've not paid one penny out of pocket for anything except my co-payments for drugs. My supplement picked up where Part B left off. Plus, I can go to any doctor or facility in any state and I'm fully covered.

Also, once Medicare Advantage is elected, it might not be possible to switch back.

Brokers are good resources. They can sort through a bunch of information and present you with options. I used a broker but made my decision, which cost a little more, based on the record of rate increases and financial strength of the company providing the Supplement.

They are doing away with Plan F, so the most comprehensive supplement is Plan G. It has a small yearly deductible of less than $200, then they pretty much cover everything Medicare approves but doesn't cover.

Advantage plans in some States are much better than in other states.
 

KateEmerson

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Jim,

My husband Job had Jevity 1.5 which was fully paid for by Medicare Part B including all the supplies( as Nikki said). He had the original Medicare with the supplement from BC/BS and their Part D( who is considered the best insurer here in MA) . We were very pleased with this insurance package as we did not pay anything out of pocket beyond our premiums . It covered one month at MGH and two months at rehab to start, multiple hospitalizations, VNA home care, vents and all the supplies, etc.

Like all professions, the quality and the knowledge between individuals varies. I spoke with one SHIP counselor who was clueless and a second who was great. The number of options can be mind numbing so finding a really knowledgeable person is key.
 

JimInVA

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I wanted to return here and thank you for all the comments. Ultimately, I think we made good choices on plans. Because my agent keep wavering on what he wanted to recommend to me, I found it prudent to do my own research. That research was aided by links and advice found within your collective answers. When he had his "final" recommendation, I asked him to compare his recommendation against a single "D" plan that I'd located. He soon revised his answer to acknowledge that the plan I'd asked him to compare was better given my individual needs. It saddens me to find that our "trusted professionals" are so lacking. Regardless, I treated him respectfully and thanked him for all of his time and effort on our behalf.

Now.. to flip the coin and to this man's favor... he cautioned that we should probably continue our Anthem Group coverage for another month as he couldn't guarantee there would not be any problems with the new coverage. So I swallowed and agreed that we'd rather pay that $2700 Anthem Nov premium and the new premiums than to be caught with no insurance (I have back surgery on the 12th) should there be any unexpected problems.

Early Friday morning, Nov 1st, I got an email from the agent with an attachment for me to sign and return to him. It was a letter dated Nov 1, asking for Anthem Group Coverage cancellation on Oct 31. To this he added a cover letter that stated it wasn't until 9:41PM on the 31st that he received verification that all applications and coverage had been approved and that his clients (Darcey and me) would sure appreciate the coverage cancellation to be retroactively issued for the day before (the 31st). To my surprise, Anthem approved that request and cancelled all group insurance and billings. For whatever I might have thought about the process of picking insurance, this man went out of his way to help me keep that $2,700 in MY pocket.

Might have to do some steak and lobster before surgery. Just saying...

My best!

Jim
 

affected

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wow Jim, have a drink with that steak too!
 
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