What's new
By:
Filters
Cystic Fibrosis Forum (EXP)

This is a sample guest message. Register a free account today to become a member! Once signed in, you'll be able to participate on this site by adding your own topics and posts, as well as connect with other members through your own private inbox!

Medicare "Advantage" Insurance Plans

A

adhocergo

New member
I'm specifically looking for anyone who might have (or have experience with) an Aetna Medicare plan? Aetna Golden Choice specifically.

I'm an advocate/friend for a Cystic Fibrosis patient (30/Female) and it's open enrollment and I'm currently reviewing plan choices and wanted to know anyone else's experience?

I currently have her in a Health Net plan but I'm looking through the Aetna literature and it appears that Part B Medicine is only a $45 co-pay as opposed to every other plan I've ever seen where it's 20% of the cost.

All inhaled medicine is considered a "Part B" service (not Part D) and the cost of Tobi and Pulmozyme is through the roof so a $45 co-pay for 12 months would save thousands and thousands of dollars per year.

I talked with Aetna and they confirm it's $45 for Part B meds, but I'm just speaking with some low level call center employee so I don't trust their answers since it sounds too good to be true.

Anyone else have a Medicare Advantage plan where you DON'T pay a % of the cost for Part B medicine?
 
A

adhocergo

New member
I'm specifically looking for anyone who might have (or have experience with) an Aetna Medicare plan? Aetna Golden Choice specifically.

I'm an advocate/friend for a Cystic Fibrosis patient (30/Female) and it's open enrollment and I'm currently reviewing plan choices and wanted to know anyone else's experience?

I currently have her in a Health Net plan but I'm looking through the Aetna literature and it appears that Part B Medicine is only a $45 co-pay as opposed to every other plan I've ever seen where it's 20% of the cost.

All inhaled medicine is considered a "Part B" service (not Part D) and the cost of Tobi and Pulmozyme is through the roof so a $45 co-pay for 12 months would save thousands and thousands of dollars per year.

I talked with Aetna and they confirm it's $45 for Part B meds, but I'm just speaking with some low level call center employee so I don't trust their answers since it sounds too good to be true.

Anyone else have a Medicare Advantage plan where you DON'T pay a % of the cost for Part B medicine?
 
A

adhocergo

New member
I'm specifically looking for anyone who might have (or have experience with) an Aetna Medicare plan? Aetna Golden Choice specifically.

I'm an advocate/friend for a Cystic Fibrosis patient (30/Female) and it's open enrollment and I'm currently reviewing plan choices and wanted to know anyone else's experience?

I currently have her in a Health Net plan but I'm looking through the Aetna literature and it appears that Part B Medicine is only a $45 co-pay as opposed to every other plan I've ever seen where it's 20% of the cost.

All inhaled medicine is considered a "Part B" service (not Part D) and the cost of Tobi and Pulmozyme is through the roof so a $45 co-pay for 12 months would save thousands and thousands of dollars per year.

I talked with Aetna and they confirm it's $45 for Part B meds, but I'm just speaking with some low level call center employee so I don't trust their answers since it sounds too good to be true.

Anyone else have a Medicare Advantage plan where you DON'T pay a % of the cost for Part B medicine?
 
A

adhocergo

New member
I'm specifically looking for anyone who might have (or have experience with) an Aetna Medicare plan? Aetna Golden Choice specifically.

I'm an advocate/friend for a Cystic Fibrosis patient (30/Female) and it's open enrollment and I'm currently reviewing plan choices and wanted to know anyone else's experience?

I currently have her in a Health Net plan but I'm looking through the Aetna literature and it appears that Part B Medicine is only a $45 co-pay as opposed to every other plan I've ever seen where it's 20% of the cost.

All inhaled medicine is considered a "Part B" service (not Part D) and the cost of Tobi and Pulmozyme is through the roof so a $45 co-pay for 12 months would save thousands and thousands of dollars per year.

I talked with Aetna and they confirm it's $45 for Part B meds, but I'm just speaking with some low level call center employee so I don't trust their answers since it sounds too good to be true.

Anyone else have a Medicare Advantage plan where you DON'T pay a % of the cost for Part B medicine?
 
A

adhocergo

New member
I'm specifically looking for anyone who might have (or have experience with) an Aetna Medicare plan? Aetna Golden Choice specifically.
<br />
<br />I'm an advocate/friend for a Cystic Fibrosis patient (30/Female) and it's open enrollment and I'm currently reviewing plan choices and wanted to know anyone else's experience?
<br />
<br />I currently have her in a Health Net plan but I'm looking through the Aetna literature and it appears that Part B Medicine is only a $45 co-pay as opposed to every other plan I've ever seen where it's 20% of the cost.
<br />
<br />All inhaled medicine is considered a "Part B" service (not Part D) and the cost of Tobi and Pulmozyme is through the roof so a $45 co-pay for 12 months would save thousands and thousands of dollars per year.
<br />
<br />I talked with Aetna and they confirm it's $45 for Part B meds, but I'm just speaking with some low level call center employee so I don't trust their answers since it sounds too good to be true.
<br />
<br />Anyone else have a Medicare Advantage plan where you DON'T pay a % of the cost for Part B medicine?
 
J

JustDucky

New member
Medicare

I don't have Aetna but I am familiar with medigap policies as I currently use one as well as the original Medicare to cover the 20 percent that the original medicare does not pay. Advantage plans are HMO's, am I correct? With most of the Advantage plans, you have to see docs that are in your network for the most part. Of course, there are exceptions which you might want to ask about.

As far nebulized medications such as TOBI and pulmozyme, they have always been covered under part B of Medicare regardless of whatever plan you chose because it is delivered via a DME device. I have been covered from day one with part B, my medigap policy picks up the remainder of the cost (20 percent as medicare alone pays for 80 percent). Yes, medigap insurance is usually more expensive than the Advantage plans but I like knowing that I can see any specialist anywhere in the country and not have any co pays to pay for office visits. I have many other not so common problems that have required traveling to three different states so I have gotten plenty of usage from my insurance.

As far as IV medications, I have run into snafus with that one...it seems that Medicare does not cover home IV therapy. The existing part D (prescription plan)covers you to an extent depending on what policy you have (Advantage plans usually incorporate prescription plans into their policies) but the supplies aren't covered at all such as central line kits or port needles. All of that is out of my own pocket. I also have a part D plan that covers through the "dough nut hole" but only generics so I take mainly generics. Any other meds my doc scrounges up for me (such as insulin) because I am on a very fixed income. My meds would eat a huge part of my budget if I paid for everything.

I hope this helps some...just let me know if you have anymore questions. I am considering changing over my part D insurance to another company, it would save me 50 bucks but I am making sure that I get the same coverage or similar as I currently do. Do the research before you decide, once Dec 31st is done and over with, you are pretty much locked in unless you move out of state.

Jenn <img src="i/expressions/face-icon-small-smile.gif" border="0">
 
J

JustDucky

New member
Medicare

I don't have Aetna but I am familiar with medigap policies as I currently use one as well as the original Medicare to cover the 20 percent that the original medicare does not pay. Advantage plans are HMO's, am I correct? With most of the Advantage plans, you have to see docs that are in your network for the most part. Of course, there are exceptions which you might want to ask about.

As far nebulized medications such as TOBI and pulmozyme, they have always been covered under part B of Medicare regardless of whatever plan you chose because it is delivered via a DME device. I have been covered from day one with part B, my medigap policy picks up the remainder of the cost (20 percent as medicare alone pays for 80 percent). Yes, medigap insurance is usually more expensive than the Advantage plans but I like knowing that I can see any specialist anywhere in the country and not have any co pays to pay for office visits. I have many other not so common problems that have required traveling to three different states so I have gotten plenty of usage from my insurance.

As far as IV medications, I have run into snafus with that one...it seems that Medicare does not cover home IV therapy. The existing part D (prescription plan)covers you to an extent depending on what policy you have (Advantage plans usually incorporate prescription plans into their policies) but the supplies aren't covered at all such as central line kits or port needles. All of that is out of my own pocket. I also have a part D plan that covers through the "dough nut hole" but only generics so I take mainly generics. Any other meds my doc scrounges up for me (such as insulin) because I am on a very fixed income. My meds would eat a huge part of my budget if I paid for everything.

I hope this helps some...just let me know if you have anymore questions. I am considering changing over my part D insurance to another company, it would save me 50 bucks but I am making sure that I get the same coverage or similar as I currently do. Do the research before you decide, once Dec 31st is done and over with, you are pretty much locked in unless you move out of state.

Jenn <img src="i/expressions/face-icon-small-smile.gif" border="0">
 
J

JustDucky

New member
Medicare

I don't have Aetna but I am familiar with medigap policies as I currently use one as well as the original Medicare to cover the 20 percent that the original medicare does not pay. Advantage plans are HMO's, am I correct? With most of the Advantage plans, you have to see docs that are in your network for the most part. Of course, there are exceptions which you might want to ask about.

As far nebulized medications such as TOBI and pulmozyme, they have always been covered under part B of Medicare regardless of whatever plan you chose because it is delivered via a DME device. I have been covered from day one with part B, my medigap policy picks up the remainder of the cost (20 percent as medicare alone pays for 80 percent). Yes, medigap insurance is usually more expensive than the Advantage plans but I like knowing that I can see any specialist anywhere in the country and not have any co pays to pay for office visits. I have many other not so common problems that have required traveling to three different states so I have gotten plenty of usage from my insurance.

As far as IV medications, I have run into snafus with that one...it seems that Medicare does not cover home IV therapy. The existing part D (prescription plan)covers you to an extent depending on what policy you have (Advantage plans usually incorporate prescription plans into their policies) but the supplies aren't covered at all such as central line kits or port needles. All of that is out of my own pocket. I also have a part D plan that covers through the "dough nut hole" but only generics so I take mainly generics. Any other meds my doc scrounges up for me (such as insulin) because I am on a very fixed income. My meds would eat a huge part of my budget if I paid for everything.

I hope this helps some...just let me know if you have anymore questions. I am considering changing over my part D insurance to another company, it would save me 50 bucks but I am making sure that I get the same coverage or similar as I currently do. Do the research before you decide, once Dec 31st is done and over with, you are pretty much locked in unless you move out of state.

Jenn <img src="i/expressions/face-icon-small-smile.gif" border="0">
 
J

JustDucky

New member
Medicare

I don't have Aetna but I am familiar with medigap policies as I currently use one as well as the original Medicare to cover the 20 percent that the original medicare does not pay. Advantage plans are HMO's, am I correct? With most of the Advantage plans, you have to see docs that are in your network for the most part. Of course, there are exceptions which you might want to ask about.

As far nebulized medications such as TOBI and pulmozyme, they have always been covered under part B of Medicare regardless of whatever plan you chose because it is delivered via a DME device. I have been covered from day one with part B, my medigap policy picks up the remainder of the cost (20 percent as medicare alone pays for 80 percent). Yes, medigap insurance is usually more expensive than the Advantage plans but I like knowing that I can see any specialist anywhere in the country and not have any co pays to pay for office visits. I have many other not so common problems that have required traveling to three different states so I have gotten plenty of usage from my insurance.

As far as IV medications, I have run into snafus with that one...it seems that Medicare does not cover home IV therapy. The existing part D (prescription plan)covers you to an extent depending on what policy you have (Advantage plans usually incorporate prescription plans into their policies) but the supplies aren't covered at all such as central line kits or port needles. All of that is out of my own pocket. I also have a part D plan that covers through the "dough nut hole" but only generics so I take mainly generics. Any other meds my doc scrounges up for me (such as insulin) because I am on a very fixed income. My meds would eat a huge part of my budget if I paid for everything.

I hope this helps some...just let me know if you have anymore questions. I am considering changing over my part D insurance to another company, it would save me 50 bucks but I am making sure that I get the same coverage or similar as I currently do. Do the research before you decide, once Dec 31st is done and over with, you are pretty much locked in unless you move out of state.

Jenn <img src="i/expressions/face-icon-small-smile.gif" border="0">
 
J

JustDucky

New member
Medicare

I don't have Aetna but I am familiar with medigap policies as I currently use one as well as the original Medicare to cover the 20 percent that the original medicare does not pay. Advantage plans are HMO's, am I correct? With most of the Advantage plans, you have to see docs that are in your network for the most part. Of course, there are exceptions which you might want to ask about.
<br />
<br />As far nebulized medications such as TOBI and pulmozyme, they have always been covered under part B of Medicare regardless of whatever plan you chose because it is delivered via a DME device. I have been covered from day one with part B, my medigap policy picks up the remainder of the cost (20 percent as medicare alone pays for 80 percent). Yes, medigap insurance is usually more expensive than the Advantage plans but I like knowing that I can see any specialist anywhere in the country and not have any co pays to pay for office visits. I have many other not so common problems that have required traveling to three different states so I have gotten plenty of usage from my insurance.
<br />
<br />As far as IV medications, I have run into snafus with that one...it seems that Medicare does not cover home IV therapy. The existing part D (prescription plan)covers you to an extent depending on what policy you have (Advantage plans usually incorporate prescription plans into their policies) but the supplies aren't covered at all such as central line kits or port needles. All of that is out of my own pocket. I also have a part D plan that covers through the "dough nut hole" but only generics so I take mainly generics. Any other meds my doc scrounges up for me (such as insulin) because I am on a very fixed income. My meds would eat a huge part of my budget if I paid for everything.
<br />
<br />I hope this helps some...just let me know if you have anymore questions. I am considering changing over my part D insurance to another company, it would save me 50 bucks but I am making sure that I get the same coverage or similar as I currently do. Do the research before you decide, once Dec 31st is done and over with, you are pretty much locked in unless you move out of state.
<br />
<br />Jenn <img src="i/expressions/face-icon-small-smile.gif" border="0">
<br />
 
You must log in or register to reply here.
Top