Does Medicare Really Pay for Meds?

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scorpio1960
Veteran Member


Date Joined Jan 2009
Total Posts : 914
   Posted 2/5/2009 10:49 AM (GMT -6)   
Hi All,
 
I was wondering if someone knows if Medicare pays for more of the IV medication than typical health insurance.  I'm currently on SSDI but opted to keep my health coverage through my employer and pay a monthly premium which is not too high ($200) as opposed to getting Medicare.  Someone recently told me that it might be worth it to get Medicare also.  I recently received a notice that I have until March to make a decision and I am so totally confused and not well enough to start making phone calls or even comprehend much right now.  I'm having a very hard time speaking today and am not sure it will be much better tomorrow.  lol
 
Anyway, does anyone know if it's possible to get Medicare in addition to keeping my current health insurance which is Empire BC/BS PPO through my employer?  Up until now the coverage has been great and I do not want to give it up unless it will really be worth it. 
 
Will Medicare actually pay for most of the medication as I was told?
 
Right now BC/BS will only cover up to one month of IV antibiotics and I was told that I need a minimum of six months.
 
Any advice or information would be greatly appreciated.
 
Thanks.
 
Valerie

seeingstars
Regular Member


Date Joined Apr 2008
Total Posts : 266
   Posted 2/5/2009 11:08 AM (GMT -6)   
That's an interesting question. I know you don't want to do phone calls but you may need to get someone to do some for you. Some insurances say only one month but actually if the doctor reorders it at the end of the month will let you go again. So it would be renewed on a month to month basis. But others ONE MONTH is it. Since all insurance is different it really would benefit you (or a friend/family member) to call. I also have bc/bs but in a different state and have had an iv 2 times with each time being over 3months. They paid thruout without any problems.

Zenith_Z
New Member


Date Joined Apr 2008
Total Posts : 7
   Posted 2/5/2009 4:47 PM (GMT -6)   

Hi, you might want to check your BC/BS policy and see if it has a paragraph in it that if you qualify for medicare that your coverage will cancel....I had BS/BS but I did not qualify for their regular plan, but had them through the Oregon Health Care plan (for those they consider uninsurable) 

I paid for my prior employer plan as long as was allowed, then when I went to find insurance none would take me so ended up paying them 438 per month until I got medicare.....medicare doesn't pay for drugs....you have to purchase a medicare drug plan to go with....which are not the best at all as in most states there is a "gap" where after you pay and they pay 2500 bucks they do not pay at all until you hit 4500 bucks then pay again.....some pay for generics through the "gap".

Anyway, please check your policy to make sure you have coverage once medicare elegible -- it may not be the same for you as you are in their "regular' plan but worth checking.

Sherri


scorpio1960
Veteran Member


Date Joined Jan 2009
Total Posts : 914
   Posted 2/5/2009 11:13 PM (GMT -6)   
Thanks for all the responses. For some reason my doctor thought I might be better off with Medicare for meds instead of BC/BS and told me to check into it. I've been eligible for Medicare since last year but I decided stay with BC/BS because up until now that have been pretty good. I am allowed to keep my employer plan with BC/BS as long as I am on long-term disability. I was told that Empire BC/BS in NY is horrible with IV meds for lyme and will only approve one month.

So if I went ahead and added Medicare, I would be paying for three plans and still have a gap in the script coverage?

Please bear with me, I'm probably the most challenged (mentally) on here at this point and to think I use to be such wiz, really. lol

I guess if at some point I find I'm having a good day - no make that a few good minutes - I better get on the phone and start asking some questions. I can see it now, by the time someone picks up the phone I will not know what to ask. lol I know, I know I do have lists but at times even my lists confuse me. lol

scorpio1960
Veteran Member


Date Joined Jan 2009
Total Posts : 914
   Posted 2/6/2009 10:45 AM (GMT -6)   
Keephope - Thank you so much for explaining it all in such detail.

Would this all apply to the IV meds also?

scorpio1960
Veteran Member


Date Joined Jan 2009
Total Posts : 914
   Posted 2/6/2009 1:55 PM (GMT -6)   
Thanks!

bucci
Veteran Member


Date Joined May 2006
Total Posts : 1477
   Posted 3/8/2011 5:51 PM (GMT -6)   
Cece,

Are you talking about PATR D ?

that is the medicare coverage you get for medication coverage.
do you have it?
can you email me who you are using and what the plan and the cost.

I have to get part D for all my medications and still haven't done it.

I have no idea if medicare pays for lyme treatment.

I was told they did when I went to a clinic in ariozona and then after a 2 weeks they told me
medicare denied the coverage and I got stuck .

anyone know the real story out there?

Also as far as BC/ BS my Dad has that and I think it was medicAID? (NOW I HAVE TO ASK MY SISTER)
But what happened was he has the BC/BS as his PRIMARY and the medicaid (or could be medicare? which ever you get when you turn 65)
Anyway he could not get into the rehab we wanted after he broke his hip because BC/BS was the primary.

if the medicaid was his primary he would have been able.

The social worker who was handling it told my sister that the insurance companies are cutting back here and there so much that medicaid it actually better IN SOME CASES.

But this is not lyme. lyme IV coverage is not as easy to come by. Does BC/ BS cover IV ???
20 yrs of doctors . DEC. 2009 tested positive for lyme, bartonella, ehrichiosis, HHPV6, chlamadyal pneumonia .
parasites :strongylides, diaoebia fragialis, hook worm.

Hep C ....fibro, rhumatoidal,depression,
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