Medicare drug coverage

Medicare Drug Coverage

Question: Does Medicare cover the cost of Coumadin when it must be taken for the rest of one's life due to a mechanical heart valve?


Answer: Coumadin and its generic Warfarin Sodium are covered drugs under a Medicare Part D prescription plan. You would either enroll separately in a Medicare Part D plan or in some situations prescriptions are included in Medicare Advantage plans. You will pay a copay for the Coumadin in most cases. Original Medicare (Part A & Part B) does not cover drugs except in certain limited situations. Based on the information you provided, your situation does not meet the criteria. You may go to www.Medicare.gov , download Medicare and You 2011 booklet and on page 40 it gives details about situations where Medicare Part B covers drugs.

Medicare and Medicaid

Medicare with QMB and MQMB

Question: I am a retiree living on $800.00 a month from Social Security. I qualify for QMB which is the same as the "extra help" program. I have Medicare and Medicaid. I need glasses, hearing aids and dentures. The lady at the hearing aid store said I didn’t qualify with them because there is not an "M" in front of my "QMB", in others words, it’s gotta be "MQMB" for me to get any help. My glasses need to be replaced. I can barely hear and the one hearing aid I have came from a friend of mine whose mother died. My mouth is sinking in from no dentures.

Can you please give me some kind of information on how I can get these things I need? 

Answer: You would need to contact your local Medicaid office to get information specific to you. Just in general, the extra help offered to Medicare beneficiaries is based on their income and assets and where that puts you in the level of assistance available. You may call 211 and you will be connected to a Medicaid representative. If you have trouble connecting through 211, you may call 1-877-541-7905. You may also go online to www.211texas.org to search for the phone number to your local Medicaid office using your home zip code. Request Medicaid review your qualifications for extra help.

Medicare and Social Security Disability

 

Medicare and Social Security Disability: When Does Medicare Start?

Question: When on Social Security Disability, does Medicare start automatically?

Answer: Medicare Parts A & B automatically start on the 25th month of your disability. If you have ALS they begin right away. There are some options available in Texas for people under 65 without health insurance who are uninsurable given their disability.

Medicare and Durable Medical Equipment Coverage

Medicare and Durable Medical Equipment Coverage

Question: My friend just got an RX for a walker (Rolator). When I took her to the medical supply store, she was told that Medicare does not cover the nice rolator with the seat now. They only cover the silver metal type one. Is this true?

Answer: Medicare has no such policy about the type of walker they cover. Your friend's prescription determines what Medicare will pay for (& I called Medicare just to make sure nothing has changed!) If she needs one with the seat because she can only walk short distances, they cover that, but her doctor has to write the RX specifically. Not sure why you were told that. I’ve heard all sorts of explanations that aren’t based on fact given to my clients. Be sure you are using an approved supplier. Texas is participating in a "competitive bidding" program Medicare has and you are required to use specific suppliers. You can go to www.medicare.gov/supplier and look for a supplier in your area. Confirm they are participating in the program before you buy as things can change!

Medicare and Glucose Testing Supplies

Medicare and Glucose Testing Supplies


Question: How will Medicare pay for my glucose testing supplies?

Answer: Medicare Part B covers test monitors, test strips, lancet devices and lancets. Some blood sugar control solutions and therapeutic shoes, in some cases, are also covered. With original Medicare alone, you pay the deductible then coinsurance of 20% of the cost. Medicare Supplements or an Advantage plan will pay part or all of the deductible and coinsurance.

Medicare Coverage for Dental and Vision Care

Medicare Coverage for Dental and Vision Care

Question: Is there any way Medicare pays for dental work or eye exams?

Answer: Original Medicare does not cover routine dental or vision care. Some Medicare Advantage plans offer some coverage for vision and dental but make sure you know what is and IS NOT covered before enrolling. Read the fine print! Some Advantage plans only cover vision and dental as covered by original Medicare.

Medicare Part A will pay for certain dental services that you get when you are in the hospital. Medicare Part A can pay for hospital stays if you need to have emergency or complicated dental procedures, even when the dental care itself is not covered.

Medicare provides limited vision coverage in some cases such as after cataract surgery or for some cases of macular degeneration. If you are in a high risk category for glaucoma, Medicare will cover screenings every 12 months. It is a good idea to check with Medicare or your Advantage plan rather than assume a procedure is covered. For more information on Medicare coverage go to www.medicare.gov/coverage .

Medicare Supplement ~Medicare Advantage Plan, That is the Question

Medicare Supplement ~Medicare Advantage Plan, That is the Question

 

Question: What is the difference in a Medicare Supplement and a Medicare Advantage plan?

Answer: Day and Night! Control and choice are the biggest differences. You have more control and choices with a Medicare Supplement than you do with a Medicare Advantage plan.

A Medicare Supplement works with your Medicare A and B and pays the Medicare approved charges not picked up by Medicare. You may use any doctor or facility you choose. Plan F is the favorite plan and covers 100% of charges not picked up by Medicare. Medicare Supplements are regulated by the federal government and all plans must offer the same benefits (with a few exceptions in a couple states – not Texas). Insurance companies may charge whatever they choose for the different plans, so costs vary.

A Medicare Advantage plan takes the place of your Medicare A and B. When you enroll in a Medicare Advantage Policy, you assign your Medicare A and B to that plan. As long as you are enrolled in the plan, you do not have the option of using just your original Medicare. Some plans allow you to go out of network for a higher cost share but many plans pay nothing if you go outside the plan network. You are responsible for the total out of network bill except in emergency situations. You MUST use the doctors and facilities in an Advantage plan’s network to see the full benefit in cost savings. If you are considering a Medicare Advantage Plan, be sure your doctor and a convenient hospital are in the plan network. Some Advantage Plans include drug coverage and other benefits like vision, dental and hearing plans. The services of these additional benefits are limited.

Costs of both types of plans can vary. Some Advantage plans do not charge a premium to be enrolled in their plan. If you are old enough to be on Medicare, you probably know by now there is nothing completely free, especially in health care. In many instances a Medicare Supplement Plan N is competitive in premium with an Advantage plan.

I use the analogy of driving your own car – the Medicare supplement option, (you can go when and where you would like) versus taking public transportation – the Medicare Advantage option, (it can get you there often for less money but will be less convenient).

Both Medicare Supplements and Medicare Advantage plans have their place. It is important to do your homework and understand either type of plan before you enroll.

SOURCE:  www.Medicare.gov , Medicare and You, 2011 Handbook