I will be turning 65 in January and face decisions regarding options for supplemental/drug/advantage plans.  I am leaning towards an advantage plan, but would like to draw from the collective experience of this group.  I use a pump, so pump supplies must be included.  [I understand the basic differences between traditional pay-for-service and advantage (PPO or HMO) plans.]

Have you tried both?  What are your experiences

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Hi Gerry- Let me be the first to wish you a HAPPY BIRTHDAY. Check the medicare website and look for the approved plans for your state. You may already have done that. I live in PA and have a Medicare Advantage plan from Humana that I really like. It includes RX and medical coverage. I just met with an agent from Humana the other day, he told me about the changes for 2011. I have had the plan since turning 65, 2 1/2 years ago. The premium is dropping to $80/ month next year, and the deductible is being dropped. That's right, NO deductible. ( This year it was $ 1000.) There is a network for docs and hospitals, but you can go out of network if you want to use a doc you are already using that is not in the network. Your best bet is to gather all the info you can until your birthday, then choose.
Regarding D supplies, my test strips are no cost to me at all. Insulin is on their formulary, as a Tier 2 drug ( higher co-pay than a generic) I don't have a pump so I cannot say regarding that, but I would think supplies would be covered. Medicare coverage is different than regular ins. you have before 65. Some things are mandated by Medicare to be covered and others depend on the coverage of the particular plan. I hope this info has been a little helpful to you, you are entering the confusing "Medicare Zone." Good Luck !
Thanks, catlover, for the info! I am currently studying my options and will continue to do so -- probably right up to the end of December. I talked to my former employer (my pension and insurance source) today, and they explained that I will lose my current coverage the first day of the month I turn 65 -- January. So I have a timeline now.


Gerry
Hi, Gerry--I am in New York and I have original medicare and AARP (United Healthcare) supplemental. I am on the pump and my pump and all supplies, including insulin, are covered 100% by Medicare and AARP. (To get the pump, I have to have several blood tests, and only by failing them was I successful in getting the pump.) The costs for medicare A, B, AARP, and my Part D prescription coverage is about $400. a month. I have no deductibles and no co-pays for anything.
When I investigated changing to an HMO, medicare advantage plan, and/or a PPO, I discovered that I would have to pay a 20% co pay on my pump supplies and insulin. I receive the supplies every three months and the bill is usually $3,000-$4,000 each time. Medicare always cuts the bills. One insurer advised me that they do not cut the bills but would require me to pay the 20% of whatever was billed. I met with two advisors from two different companies who each advised me to stay with what I have. The lynchpin behind all of this is the pump.
I don't know if this helps, but Happy Birthday! and good luck with your choices.
Best, Judith
My husband is a diabetic and was recently taken off all oral meds and put on Novolog and Lantus. This has increased our drug bills by about $6500 this year. His Advantage plan is closing in December so I am now looking for another plan. I will be happy to share anything I learn and am anxious to know of other people's experience. Let's keep sharing! Also -- thanks for the suggestion to join the medicare group.
I live in California and have experienced that most pumpers that are on Medicare don't know that if on traditional Medicare pump supplies and the insulin that goes into the pump is covered under part b benefits as well as the part d prescription plan. The advantage to some with tradition Medicare with a supplement is that the insulin  should have no copayment and does not go toward your cost of medication in your part d which can get you to your donut hole quicker on the part d plans. Check the Medicare website or speak with your plan administrator. Happy early bday Gerry
Be careful about insulin for the pump vs. inject able insulin. I'm researching this right now but I believe the reason pumpers are covered under traditional medicare is that they are using a "medical device". Medical devices and supplies are covered under the regular part of traditional medicare. This is becoming clear to me as I talk with other diabetics -- some are 100% covered and some are not. The covered ones are all using a pump. Leave it to our government to encourage a more expensive (albeit better) treatment. Why should diabetics for whom a more traditional treatment applies have to pay? I'll let you know what I find out when I do more research.

My experience with Medicare and the pump was a bust. My C-peptid did not meet Medicare's qualifications, so they would not pay for the pump. DME has nothing to do with it. As you begin to drop in the amount of insulin you secret, they may consider paying but, only if C-peptid meets Medicare Qualifactions.

Thanks to all for your comments. I appreciate your sharing. At this point I am simply ready to scream: my former employer has yet to provide me with the options I can get through them. Last time I called, they said their package would be mailed very early in December. I hope that's accurate. Then I can compare - but based on my coverage prior to retiring, I need to consider their options before looking elsewhere. I'll keep you all posted!

Gerry

Sunny,

You are absolutely correct re AARP endorsing United Health Care supplemental insurance plans; however, one calls AARP to see whether United Health Care has taken care of the cross over costs from Medicare; AARP has the date when Medicare submitted the cross over amount, and when the supplemental insurance paid/will pay that amount.  It appears that AARP does more than just endorse the supplemental health care policy.  

Best, Judith

Gerry,

If you haven't received the official 2011 medicare book, you may want to get one.  It will help you evaluate the plans. In New york, one can pick up the book (in English or Spanish) in any social security office.  You could also call medicare on their 800 number (I have found the representatives very helpful but l--o--n--g waits to get one on the line) and request a book.  You may also want to meet with a representative from a medicare advantage plan, I found when I did so, I learned a great deal. Good luck.

Judith

Thanks, Judith.  I finally received my literature from my former employer, but I didn't know there is an "official" medicare book.  I will certainly look into it!

I applied for parts A and B Medicare middle of last week.  I talked to a Medicare worker and she explained that I would need parts A and B whether I took the traditional route or the Advantage option.  So my enrollment is in the  works -- I applied online (Medicare only - no Social Security yet!).  I was really pleasantly surprised by how quick it was and how well the website worked.

Gerry

 

One of the things that I found helpful was contacting my senior center.  They referred me to someone who could explain all the options to me including supplemental plans.

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