has anyone here on SSDI (for 2 plus years) had their Medicare cover the cost of IV's for any period??
$5,000 out of pocket per month for 9 plus months is flat out unaffordable.
dilly
Posted by Diva (Member # 12128) on :
I would like to know the answeer to that question as I will be on medicare pretty soon/
Posted by minoucat (Member # 5175) on :
In my direct experience, yes.
Choosing plans is a bear. Whatever you choose, get supplemental insurance. We found that AARP enhanced worked well for everything Lymie--all the drugs were on their formulary.
Talk to your doc about what IVs and other drugs will be used, and make sure whatever supplemental insurance you choose has those on their formulary. It can save you a HUGE amount of money.
AARP signed up one person in our LD group who is in their 40s, but has SSDI, so age isn't a limiting factor for AARP if you have SS disability. (I am in no way affiliated with AARP--we've just found them to be good to deal with, knowledgeable and quick)
One does hit the donut hole very quickly on IVs -- that is, you pay the usual copay until you have spent reached your coverage limit -- about $2400 total costs (your copay, and the medicare coverage).
Then you pay out of pocket until you hit the other side of the donut hole, usually about $3400. You pay only a minimal copay after that until the donut hole clock rests in January.
So there is a big financial hit at the beginning.
Because the donut hole goes from Jan to Dec., you can have a problem if you're on IVs for, say, 7 months. If you join a program in September, you could hit the donut hole in November, and then again in March of the following year when the clock starts over in January.
thanks very much for that info. it hadn't even occurred to me that AARP was a possible route too.
with some help from family i think i can figure out the donut hole part of the puzzle, but it sounds like i should speak with someone who knows the ins and outs of the Medicare/supp insurance system as a whole.
Like, if i start the IV's before i have signed up with medicare, can i be turned down for a pre-existing condition? it sounds like planning ahead is everything.
do you know where to look for an informed advocate? is this enough of a legal thing that an atty is required?
thanks again
Posted by sometimesdilly (Member # 9982) on :
MC- sorry. just saw the list of links you put together about insurance resources.
FYI- i've contacted the Pt Advocacy group before on someone's behalf, 1/2 year ago or so, and was told they do not advocate on behalf of Lyme patients.
another group must- i'll keep looking.
Posted by map1131 (Member # 2022) on :
Dilly, I don't know the answer on SS/Medicare and IVs. But I wanted to wish you the best on finding your treatment.
I hope you are doing better than you were a couple months ago. Have you been able to take care of you lately?
Pam
Posted by sometimesdilly (Member # 9982) on :
thanks, Pam.
yes, i just went to my new llmd who is here in town, which i think will make an ENORMOUS difference.
I really don't know how anyone can pull off long distance drs- i could not, which throwing in all the major upheavals of the past year meant i wasn't being particularly compliant.
IV's are a certainty, by April 10th at the latest (her deadline for me to get everything lined up). From most accounts I've read here, i can look forward to having my brain back for at least the time i am on the IV's.
The thought of that, after going on 6 years of dense fog and having a stranger inhabit my body, is nothing short of joyous.
hope you're sailing in calm waters yourself- and thanks again.
dilly
Posted by map1131 (Member # 2022) on :
Calm waters? Not today or the last several days. But I will be there again, no doubt about it.
My GI issues are totally out of hand. I made the mistake of going to New York City last week for a few days. NYC when you are in the thick of it, is all walking.
Walking is my enemy today. My colon is in a rather bad mood, which leads to other issues. I have to be close to a restroom at all times.
Darn ticks!!!!!!! That's putting it nicely.
Pam
Posted by jentytib (Member # 14375) on :
I don't have Medicare but I do have military insurance. As far as I know, my insurance covers what medicare covers.
I have been approved for 90 office visits and 30 days of IV and a PICC line.
So far, so good. I'm seeing an ID though not an LLMD.
Posted by cantgiveupyet (Member # 8165) on :
I had a great medicare insurance specialist help me with my supplemental. He came to my house, so I didnt even have to get in the car!
I found him thru the insurance agency I use for my car insurance.
I think I have read on here that Part B with medicare covers IV??
I wonder if a home infusion company would be able to assist you with your questions?
Posted by herbalfrog (Member # 12711) on :
Hi, I may be able to answer some of your questions as I am on Medicare, with Blue Cross/Blue Shield as secondary and Humana for drugplan. I have been on IV Vancomycin for 8 weeks with in-home care. Was just notified that I reached my donut,and future care needed to be picked up by me. But, when I did some investigating I was told by Medicare that they would pick up my care under part B if I went to the hospital infusion department daily for treatment. They approved three months of IV therapy.