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medicare advantage entyvio coverage

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Ulcerative Colitis
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Killjoy123
Regular Member
Joined : Oct 2017
Posts : 51
Posted 3/10/2023 6:23 PM (GMT -8)
I m getting forced into medicare advantage aetna from senior care (regular medicare) does anybody have medicare advantage aetna who gets entyvio infusions knows the coverage
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Old Hat
Veteran Member
Joined : Feb 2007
Posts : 5865
Posted 3/10/2023 7:30 PM (GMT -8)
You can look up EnjoyGolf's posts toward the end of 2022 because he was facing an issue of Medicare/M.Advantage/Employer's retiree coverage while on Entyvio, and got many replies here on the forum. / Old Hat (40 yrs with left-sided UC; in remission taking Colazal)
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Killjoy123
Regular Member
Joined : Oct 2017
Posts : 51
Posted 3/10/2023 9:35 PM (GMT -8)
thanks i did look at the thread kind of confusing
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straydog
Forum Moderator
Joined : Feb 2003
Posts : 19420
Posted 3/11/2023 4:55 AM (GMT -8)
I am not understanding how you are being forced to go with an Advantage Plan, those plans are not affiliated with Medicare.

Why not apply for regular Medicare & pick up a supplemental plan that pays the 20% that Medicare doesn't.
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FlowersGal
Veteran Member
Joined : Feb 2017
Posts : 1699
Posted 3/11/2023 10:23 AM (GMT -8)
Ditto stray dog. I would switch to regular Medicare PLUS a supplement. If possible. I have Medicare along with a plan F supplement and my infusions are covered 80% by Medicare and plan F picks up the other 20%. so my costs are zero for every infusion.

But Plan F is no longer available I don’t think, and I don’t know the coverage of the other plans. I would get with a licensed Medicare advisor to discuss — they are paid by Medicare and not insurance providers so are impartial to specific companies. Personally I prefer blue shield as my supplement provider because it includes gym membership. Fees and prices of the supplements are set by Medicare, not private insurance so all prices are the same.
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Sara14
Veteran Member
Joined : Mar 2007
Posts : 7776
Posted 3/11/2023 11:20 AM (GMT -8)
Off topic, but wow--your insurance covers a gym membership?! Thats awesome.
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Faithmac
Veteran Member
Joined : Apr 2008
Posts : 1605
Posted 3/11/2023 12:34 PM (GMT -8)
Reg Medicare and a supplement is the way to go. I have a stand alone prescription plan silver script. Pays for everything. My Emgality is $ 30 copay good Rx is $600
I pay for my gym membership and i don't need referrals for doctors.
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CCinPA
Veteran Member
Joined : Dec 2014
Posts : 2613
Posted 3/11/2023 12:39 PM (GMT -8)
Flowers -- I was looking at Plan G supplements and not all the prices are the same. They ranged in price from around $100/month to about $400/month. I don't know what the difference is between the plans.

Killjoy -- I am not understanding how you are being forced to go to an Advantage plan either. Like Straydog said -- those are a choice instead of Medicare. You have the right to Medicare plus a supplement, If this is somehow related to your employer insurance you should still be able to have the right to Medicare and drop your work insurance entirely.
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FlowersGal
Veteran Member
Joined : Feb 2017
Posts : 1699
Posted 3/11/2023 1:03 PM (GMT -8)
CC — Medicare can be confusing. Prices go up every year depending on your age. My initial plan cost was $125 my 1st year on Medicare. Am now paying $376 for both my husband and I (we get a discount if we both have the same plan/company. As far as different companies having different prices — I thought it was set for all. I know I get a worksheet each year showing all the plans and a set cost for each. Maybe it differs by state? I tried to look in the website but it wouldn’t give general cost info without inputting your zip code so maybe prices are regional? I haven’t changed from blue shield since I signed up because it’s worked so well that I didn’t want to rock the boat since it pays for my infusions!

I probably don’t know as much as I think I do!!! 🤣🤣🤣
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FlowersGal
Veteran Member
Joined : Feb 2017
Posts : 1699
Posted 3/11/2023 1:06 PM (GMT -8)
Also OT: yes some Medicare supplements include a Silver Sneaker program. Not all gyms accept it nor do all the plans cover it. I know blue shield does and I think AARP also. And my gym accepts it so yes it’s a great added benefit!
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Killjoy123
Regular Member
Joined : Oct 2017
Posts : 51
Posted 3/13/2023 5:46 AM (GMT -8)
i m on regular medicare as of now but in september I will be forced on medicare advantage in september all nyc employes who worked for nyc will be forced into medicare advantage atnea i know part b covers 80 percent what plan is the best to help with the other 20 percent
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straydog
Forum Moderator
Joined : Feb 2003
Posts : 19420
Posted 3/13/2023 6:54 AM (GMT -8)
I just read an article about NYC workers & the Advantage Plans & none of it sounds good. The plans are denying treatment to individuals that Medicare covers. No where did I read that an employee had to switch.

In all honesty I do not know how anyone can be forced off of Medicare onto an Advantage Plan. Does your employer pay for any of your Medicare premiums? When my husband retired he was offered an Advantage Plan through his employer with cheaper rates. We opted for him to go with regular Medicare with a Supplement Plan. Both he & I have regular Medicare with United Healthcare for a supplemental. United HealthCare writes policies across the country.

By the way, your Medicare premiums come out of your Social Security check every month. I suggest that you contact an independent insurance broker, I think your employer is trying to pull something over on you.
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Killjoy123
Regular Member
Joined : Oct 2017
Posts : 51
Posted 3/13/2023 12:58 PM (GMT -8)
nyc is saving money forcing nyc retirees who worked for the city off medicare to medicare advantage we were promised one thing and in one week they change a law to do this from what i understand theres nothing we can do about it nyc needs money for the migrants people who worked and risked there lives for the city gets the shaft
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CCinPA
Veteran Member
Joined : Dec 2014
Posts : 2613
Posted 3/13/2023 3:45 PM (GMT -8)
So you are retired, but NYC still pays insurance as part of your retiree benefits? Is it possible to opt out of them paying and you just get your own medicare and supplements?
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FlowersGal
Veteran Member
Joined : Feb 2017
Posts : 1699
Posted 3/13/2023 5:03 PM (GMT -8)
I have no personal experience with advantage plans but have heard that they are not good for those of us with chronic diseases. Personally I would opt out and pay for a supplement myself.
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enjoygolf
Regular Member
Joined : Jan 2012
Posts : 230
Posted 3/13/2023 5:55 PM (GMT -8)
I have done a lot of research on this and I would suggest going to a person that specializes in Medicare plan selections. They will be able to go over the plan you are being offered and compare the cost vs Medicare plus a Supplemental Plan. There are so many plans being offered now it can be confusing. Concerning Entyvio -They will be able to see what the cost will be for the Advantage Plan including MOOB compared to the cost of the Supplemental Plan (Including any deductible plus CO-Pay). Do you know what the Maximum Out Of Pocket is on the advantage plan you are being offered. Like everyone said it is your decision. Hope this helps.
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Killjoy123
Regular Member
Joined : Oct 2017
Posts : 51
Posted 3/14/2023 5:29 AM (GMT -8)
Thank you for all the info thats what Im going to do opt out of aetna and get a supplement plan with medicare its going to cost me more living in ny but its worth it. Im looking at plan G looks they would help me cover the cost of the infusion
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straydog
Forum Moderator
Joined : Feb 2003
Posts : 19420
Posted 3/14/2023 5:42 AM (GMT -8)
Plan G is the one to pick. Yes, the supplemental plans costs money, however, with Medicare & a good supplemental your treatment options are much greater. Advantage plans can be problematic for people with health issues. Every person I know that went that route had one headache after another in getting care, some were denied.

My husband & I both have quite a bit of health problems & not once have we been denied care or had a medical bill denied.

Good luck.
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clo2014
Veteran Member
Joined : Feb 2015
Posts : 1909
Posted 3/14/2023 8:30 PM (GMT -8)
On the Medicare Advantage plans... One of the ladies in my support group.. (I'm in TX).. her doctor will no longer use her advantage plan AND the place she gets her durable medical equipment will not be servicing people that use certain Medicare advantage plans. She's trying to see if she can switch back to regular Medicare. She said both places would accept that with supplements.

I didn't ask which one or any questions. I could have misunderstood.... But she told me that when I have to decide to not ever go on an advantage plan.

I did read an article relating to NYC doing this and the possibility of people opting out.

Please let us know how it goes. The whole Medicare and advantage plans is so confusing for me.

Clo
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