Tracy9
Frequent Contributor (1K+ posts)
Member # 7521
posted
Does anyone know if you have Medicare due to disability, are you unable to get the Medigap plans or HMO plans? I am assuming you are not as we have never gotten anything in the mail.
I'm also wondering how they pay for IV therapy. I've heard you have to go to an infusion center every single day. I have Medicaid so I'm all set but my husband has Medicare ONLY and I'm trying to figure out what we can do for a back up, but it makes sense none of those medigap plans would want to pick up a disabled person.
He is 50 now though, so would that make a difference? But even if he joined AARP he is still on it for disability no matter how you slice it. And he needs IV abx and no way is he willing to go to an infusion center every day. IS that the only way to get them if your insurance is Medicare only?
13 years Lyme & Co.; Small Fiber Neuropathy; Myasthenia Gravis, Adrenal Insufficiency. On chemo for 2 1/2 years as experimental treatment for MG. Posts: 4480 | From Northeastern Connecticut | Registered: Jun 2005
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joalo
Frequent Contributor (1K+ posts)
Member # 12752
posted
Up.
-------------------- Sick since January 1985. Misdiagnosed for 20 years. Tested CDC positive October 2005. Treating since April 2006. Posts: 3228 | From Somewhere west of the Mississippi | Registered: Aug 2007
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
posted
- His age matters not if he has Medicare.
AARP would make no difference. AARP, itself is not a health plan. But, through AARP, there are some options with United Health Care.
Straight Medicare is straight medicare. Any other HMO would have different rules, perhaps, but not necessarily.
I checked about this years age. For lyme, on Medicare, 28 days is the maximum IV time allowed. But, check again. Just don't ask yourself as you have to identify yourself anytime you call with a question. Get someone else to call for you but, first, just search their website, anonymously.
But, I would surely guess that Medicare would not go beyond what the IDSA recommends and, even 28 days on IV, may not be permitted as the IDSA rarely thinks that necessary. It's gotten worse, rather than better.
However, if there is another infection that requires IV of the same medicine (or another) that will also work with lyme, you may be able to get longer times for IV.
Cpn comes to mind. Every lyme patient should be assessed for Cpn, anyway and, if present as IgA, longer IV may be approved. See thread below for where to test for Cpn.
With medicare ONLY, there would still substantial copays for an IV coverage but - if done at an infusion center, they would be far less than home care.
If you have any friends who are in the medical field and could help with home care, that would be so nice.
Going daily to an infusion center was required for the time when I inquired. No home care service on medicare would have covered that for me.
There was absolutely no way I could have gone anywhere then.
The sensory problems for many with lyme cause so much stress that I think it's actually dangerous for someone to be exposed to the stress of infusion centers with all the hustle, bustle, lights and noises. Just getting ready to go and getting there is a huge stress and toll on the adrenal, cardiac and sensory systems.
You say he needs IV, but has he been through an oral protocol with a good ILADS-educated LLMD? Many do get better with oral Rx plus good supplements for support. -
Posts: 48021 | From Tree House | Registered: Jul 2007
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Keebler
Honored Contributor (25K+ posts)
Member # 12673
Cpn Help - more detail in the thread below about testing ---------------------
In addition to the usual coinfections from ticks (such as babesia, bartonella, ehrlichia, RMSF, etc.), there are some other chronic stealth infections that an excellent LLMD should know about: ----------
I would encourage EVERY person who has received a lyme diagnosis to get the following tests.
- at link. -
Posts: 48021 | From Tree House | Registered: Jul 2007
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Abxnomore
Frequent Contributor (5K+ posts)
Member # 18936
posted
This is not a direct reply to your question but keep in mind that with straight medicare you are not in a plan and choose any doctor you want to see, who participates in medicare. You do have to pay the 20% that medicare does not cover but you can buy a supplemental policy to take care of that.
Medicare offers Medicare part D, as the drug plan that you pay for, it's not expensive, and it does have it's issues but the new law has addressed some of them.
If you get a medicare HMO or advantage plan you will be bound to the doctors in their plan. Probably not the best choice with Lyme or IMO under any circumstances. While there are not many LLMD's who accept medicare, there are some out there. It will be harder still to find any in an HMO or advantage plan.
Posts: 5191 | From Lyme Zone | Registered: Jan 2009
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Abxnomore
Frequent Contributor (5K+ posts)
Member # 18936
posted
Yes, if you are on disability and entitled to Medicare you are entitled to purchase a medigap policy. Many insurance companies offer them.
There's a open enrollment period, the same with the Medicare Part D drug plan, but if you are new to it be sure to call and get the information, as I don't think you have to wait.
If you wait too long to enroll you can be penalized and may end up having to pay more.
Contact Medicare. If you get the long recording press 0 several times and it will by pass the recording and get you to a live person.
Posts: 5191 | From Lyme Zone | Registered: Jan 2009
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