Transition (forced) to Medicare – who pays for IV medication?

[iolaire]

I have a question about who pays for IV medication for things like EPO and Iron when on Medicare as primary and work insurance secondary? 

I don’t have Medicare part D drug insurance and for some reason thought I didn’t need to because my work insurance is as good as or better than that plan.  Does that sound right?

So once I move to Medicare as primary does that include the IV medication like EPO or will that be billed separately to my work insurance?

Also am I correct in thinking that my work insurance will continue to pay for my pill based medication?

[PrimeTimer]

Good question, iolaire! We were wondering the same thing when the time comes for my husband. Would be a shame if he has to get a supplemental plan to cover meds....that would mean paying for THREE insurance plans! (Medicare, Employer and a Supplemental).

[Michael Murphy]

I just started Medicare I didn't get the plan d because of the donut hole, my secondary is my wife's plan, not good but reduces my total cost to about 200 a month since any thing over 2500 deductable is paid for by the insurance company. Because I am on my wife's plan and I don't have part d it covers prescriptions.

[iolaire]

I just started Medicare I didn't get the plan d because of the donut hole, my secondary is my wife's plan, not good but reduces my total cost to about 200 a month since any thing over 2500 deductable is paid for by the insurance company. Because I am on my wife's plan and I don't have part d it covers prescriptions.

Thanks, does the Medicare's dialysis payment of $200-$300 per treatment include the drugs or are those billed separately?   

Is lab work billed separately and then paid by Medicare?

It probably doesn't really matter since like you I'll pay up to my deductible limit each year, but I'm wondering.  Also just wondering if the Medicare payment is for less than my bundled $1500 payment for dialysis under my current insurance.  The only thing that is not covered are some of the lab tests where DaVita labs gets about $10 for each test from my insurance.

[nursey66]

Medicare pays for all the medications given during dialysis, including Epo, if it is given at dialysis. I believe if you give yourself the Epo at home, it would go through your private insurance. Medicare pays a set amount for each dialysis run, including meds, labs,  it's a " bundle" deal. Your private ins should pick up the remaining 20% Medicare doesn't cover, if you don't have a supplement.  If your private drug coverage is as good as Medicare part D, you can get it at anytime without penalty. Be sure to keep the notice in the front of your work insurance book that states " this coverage is as good or better than Medicare" in case you need that . We had to send it with the application , when switching to part D , when I retired and the work ins went away for my husband who was on Medicare as well as my ins.

[Michael Murphy]

Actually my secondary plan pays 85 of reasonable.  They interpret that since Medicare pays 80%they will pay 5% leaving me with a 15%payment per treatment.  Some companies will pay the full 20% since on Medicare the payments are less however not all companies are that tfair.  It still pays me to use my secondary since there is a 2500 dollar cap on deductible expenses the way I figure that's a little over 200 a month everytime year th at meant I Will be payong 500 a month form the fiesta 5 months off the year And they Will pay rhe rest.  I a.m putting 2500 ni a account And Will deposit 200 a month so it's like having complete coverage.

[iolaire]

Thanks for the responses.