LymeNet Flash: ON MEDICARE seeing non-Medicare docs: you are losing rx coverage, what will you do?

This is topic ON MEDICARE seeing non-Medicare docs: you are losing rx coverage, what will you do? in forum Medical Questions at LymeNet Flash.

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Posted by northeast ohio (Member # 20555) on :

Effective June 1, 2016, patients who are on Medicare with a Part D prescription drug plan will lose coverage of their medications and have to pay out of pocket unless they are prescribed by a health care provider who participates in Medicare. None of the top LLMDs participate in Medicare. For those of you faced with losing drug coverage, what will you do?

Posted by TerryK (Member # 8552) on :

If the participating provider has opted out with medicare the prescriptions will be covered. They must file the paperwork with medicare. My guess is that most LLMD's are already opted out or would be willing to do so.

To find the .pdf where this is outlined go to google and enter the string
mln matters se1434

T

Posted by northeast ohio (Member # 20555) on :

Hi TerryK and thank you so much for replying:

This is what I thought, too, but I spoke earlier with my Part D provider (Blue MedicareRX) who told me that the doctor must be enrolled in Medicare. And when I spoke with Medicare directly a few days ago, she told me that the doctor had to be enrolled in Part D and could be enrolled in Part D only. ...

Can you tell me the source of your information? Because I would really like you to be right!

EDIT: Oh, so sorry, I see now that you told me what to search. Doing that now.

Suzanne

Posted by northeast ohio (Member # 20555) on :

Yes, I do believe you are right, in spite of what my Medicare Part D provider told me.

From https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/SE1434.pdf

<< Together, these rules require virtually all physicians and other eligible professionals, including dentists, who write prescriptions for Part D drugs to be enrolled in an approved status or to have a valid opt-out affidavit on file for their prescriptions to be coverable under Part D, except in very limited circumstances. >>

Posted by TerryK (Member # 8552) on :

You are welcome. [Smile]

In my experience it is not unusual to get incorrect answers from medicare or an insurance company. [Frown]

Makes it very hard to make decisions.

Posted by northeast ohio (Member # 20555) on :

I was once told to call three times and hope that the answer that I got 2 of the 3 times was correct.

Posted by susank (Member # 22150) on :

I am hoping to see a doctor that does not take insurance.
For her to be able to prescribe things that my Medicare Advantage plan would cover - she said she needs to be registered with Medicare.
Something called PECOS?
I am waiting for her to complete her paperwork.
I assume this is for Parts B and D.

Posted by northeast ohio (Member # 20555) on :

I'm sorry, I don't know much about Medicare Advantage plans, but I thought that doctors have to be registered for Part C for that. But it is possible that she just needs to enroll for Part D.