Medicare Part D with TRICARE

Medicare Part D with TRICARE

Question: If you had TRICARE for Life would you even get a Part D plan of any kind?

Answer: Probably not. With TRICARE for Life your prescription coverage is considered creditable which means it is as good as or better than what you could get with a Medicare Part D plan. There is no reason to get other coverage unless you are unhappy with how TRICARE is covering your prescriptions (which I doubt you will be). In that case, you may enroll in a Part D plan without losing your TRICARE. Medicare Part D would pay first, TRICARE would pay second. I assume you are aware you need to enroll in Medicare Part B at or past age 65 once you are no longer active duty. For more specific questions about TRICARE prescription benefits call the TRICARE Pharmacy Program 1-877-363-1303.

Part D Excluded Medications

Part D and ED Medications

Question: I will be 65 in Oct. Are ED meds such as Viagra and testosterone injections covered by Medicare?

Answer: No. ED medications are not covered by Medicare unless they are prescribed for a medical condition other than sexual or erectile dysfunction. This is known as prescribing "off-label". Viagra is sometimes prescribed for treatment of pulmonary hypertension so if you are taking it for that and your doctor certifies nothing else will work for you then Medicare might cover it, but that’s a long shot because there are so many other drugs available. A few years back a glitch in the CMS system allowed ED drugs to be covered but that has been corrected.

For answers to your Medicare Questions or to request quotes on a Medicare Supplement or Part D Drug plan visit www.MedicareAnswersfromConnie.com.

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What is Medicare

Medicare with VA Benefits

Medicare with VA Benefits

Question: I am 61, on VA disability, and get free health care except dental. When I turn 65 and get Medicare, will I still be able to go to the VA for medical care?


Answer: Qualified veterans may have and use Medicare and VA benefits at the same time.

You're several years away from 65, so bear in mind this answer is for current guidelines and those could change by the time you reach 65.

In most cases you will have your VA benefits and Medicare once you reach age 65. With VA, there are several levels of eligibility so it is important to contact VA as the time nears to find out exactly what your coverage will be.

Typically, to automatically receive Medicare Part A you must have a minimum number of credits earned from employment or receive them under a spouse's coverage. You can find out how your disability effects this requirement by calling Social Security (1-800-772-1213). You likely will need to enroll in Medicare Part B. There is a premium for Part B. Your disability and financial circumstances will effect what you are required to pay. Also, there is a penalty for enrolling outside your initial enrollment period if you are not covered under a qualified plan. VA can advise you on how your VA coverage fits these guidelines.

 Right now VA prescription coverage is considered "creditable coverage" to Medicare Part D -the drug plan for Medicare. This means you are not penalized for failing to enroll in a Medicare drug plan (Part D). You may have both Medicare Part D and VA but may only fill a prescription with one or the other, not both.

 You don't say how long you have been on VA disability. I have talked to some disabled veterans who are under 65 and because they qualify for Social Security Disability they begin receiving Medicare benefits in their 25th month of disability. VA benefits, in general, and disability benefits even more so, are complicated so be sure to check with VA for specifics to your situation.

Medicare Part D waiver

Requesting a Drug Waiver on a Medicare Part D Plan

Question: Why is it that insurance companies have the last say of all meds that we take even if the doctor’s order means that I cannot take a certain med because it causes real severe allergies that can make it more severe for my COPD? My doctor has made a great effort to help me and the insurance company won't listen. Is it because we are old and they don’t care of our quality of what little life we have left?

Answer: Insurance companies participating in Medicare Part D are required to cover drugs in all categories but not every drug available in a category. Generics are used where available. There is always an exception and there is a process for requesting an exception waiver. I have had several clients whose doctors have documented that my clients are unable to take a particular drug and must take a certain other drug, and of course the reason why. Their waiver has been granted. Perhaps your doctor is not providing the documentation required. Has your agent contacted the plan on your behalf? If your case is a documented need and not just a preference you should be able in most cases to get the drug your doctor is ordering. If you've tried all these things, you might want to consider switching plans when annual enrollment comes around (Oct 15-Dec 7, 2011). Some plans are more tightly managed and some are just easier to work with than others.

Part B Penalty

Medicare Part B Late Enrollment Penalty /Appealing the Penalty

Question:  When I turned 65 I did not sign up for Medicare. I was working and paid my own insurance...thought that was a patriotic thing to do....well, 7 yrs later, I signed up for Medicare and they penalized me to pay 70% higher for my premium...my SS check is about 600.00....can't stand this much more since I plan to live to at least 100.  Do you think I can get this penalty cancelled?

Answer: Bottom line, it never hurts to try.

Coverage in an Employer group health plan that has 20 or more employees and is primary to Medicare allows the covered person to postpone enrollment in Medicare Part B until the employment terminates or the health plan terminates. The person then has 8 months to enroll in Medicare Part B without a penalty. Employers of less than 20 people and individual health plans are generally secondary to Medicare. Coverage under these plans usually does not allow postponement of Part B enrollment without a penalty once you do enroll in Part B. In most cases it costs more to stay enrolled with small group or individual plans than it does to enroll in Medicare so people elect to go the Medicare route.

If you believe your situation fits the guidelines for postponing Medicare Part B enrollment, then you may appeal the decision on your Part B premium by contacting Social Security (1-800-772-1213).

I recommend you investigate an appeal. Good luck, it can be frustrating but persevere! Let me know how it turns out and if I can help you please contact me but I recommend you call (512.557.2269)as this could be more complicated than is suited for e-mail.

For answers to your Medicare Questions or to request quotes on a Medicare Supplement or Part D Drug plan visit www.MedicareAnswersfromConnie.com.

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Medicare Beneficiary Advocates

Resolving Medicare Covered Services Complaints

Question:  Connie, my father's doctor prescribed oxygen late in the day Thursday. Home Health called Friday after 5 p.m. to say [the nurse] had worked late to coordinate with the contract provider of the oxygen. HOWEVER, they cannot bring the equipment until Monday, as the battery on the equipment would not last over the weekend and Medicare requires an overnight test to determine that he needs oxygen. It doesn't seem right that my father must wait 5 days (Th-Fri-Sat-Sun-Mon) before getting the oxygen needed. Where do we turn for an advocate?

Answer: You, informed and empowered, are your best advocate. If that fails to resolve an issue, there is The Medicare Ombudsman program through CMS (the Center for Medicare and Medicaid Services). They receive complaints and do take action. It isn’t necessarily punitive. They have a “reeducation” process when mistakes are made from lack of knowledge or understanding. Negligence and fraud are another matter and they do handle this also. There are also Ombudsmen affiliated with local/regional Area Agencies on Aging who advocate for Medicare beneficiaries. These area agencies focus primarily on Assisted Living and Nursing Home facilities. I’m pretty sure they also step in with Home Health complaints. If your dad is covered by an Advantage plan, you must contact the Advantage plan. They have full caseloads so try the informed and empowered route first!


So…How to be informed and empowered. The answers are out there, you just have to know where to look and I’m happy to point you in that direction. Here are 2 links so you understand Medicare’s process for providing Oxygen.
http://www.medicare.gov/Publications/Pubs/pdf/11045.pdf

http://www.medicare.gov/Coverage/Search/Results.asp?State=TX%7CTexas&Coverage=46%7COxygen+Therapy&submitState=View+Results+%3E

You’ll see there are criteria for justifying oxygen (or any other service). I’m guessing your doctor took care of documenting the criteria as being met.


Next, call Medicare 1-800-633-4227, explain what has happened. You’ll need your dad on the phone to give his permission for you to speak to them on his behalf. If Medicare feels the situation is not right, they will help initiate the complaint process. At this point you may want to request a different home health agency and/or different oxygen provider if you aren’t feeling confident in this one. It’s OK for you to do this.

 It does not seem reasonable, based on the information you provided, for it to take 5 days. Your concern is justified.