medicare and diabetes

[mbuster]

As I approach the Medicare age, I am wondering what tidbits of knowledge have others discovered about what Medicare does or doesn't do in regards to your management of diabetes. What things are great? What things are bad? Is there one plan that is leaps and bounds better than others? What would you do differently from the get go? Are there things that they do that are not widely known, that you have to ask for? I'm sure other will be interested as well and may have questions of their own.

[moon]

For me,

GREAT:

1. Covering my Dexcom G6 under Part B DME (durable medical equipment vs pharmacy) and because I have a Medigap Plan F, it is 100% covered (Medicare 80%/Medigap 20%)
2. Endo and all doc visits are also 100% covered
3. Can see any doc I want (Original Medicare)

NOT SO GREAT:

1. They allow so few strips. Diabetics not on insulin, 1/day - on insulin, 3/day.
2. Outrageous price of insulin and being thrown into the Donut Hole.
3. Evaluating pharmacy plans annually for formularies, cost, etc.

I chose Medicare Original (govt) over Medicare Advantage (insurance) in order to see whatever docs I wanted. Advantage is more like HMO or PPO.

The month of my 65th birthday I got both a Medigap Plan F (which covers the 20% copay) and cancer. I had surgery at a well-known teaching hospital, noted physicians, 2 months in rehab, in-office chemo (still do), stem cell collection, other surgeries, another one in 2 weeks, seemingly constant procedures and tests. I have not paid a penny for any of this. My Plan F has averaged about 150/month - a bargain!

Prescriptions is another issue. There are more and more oral chemos, taken at home, and those can bankrupt a person because Medicare cannot negotiate those prices and drug companies are not allowed to assist Medicare patients. I have relied on foundation grants for that (copays can be thousands/month) but those can be elusive. There is an effort to get oral parity laws passed so oral chemo would be treated like infusion chemo, thus falling under Part B vs Part D (pharmaceutical). That part is a crisis.

For someone without health issues, Advantage would be cheaper. But a health crisis can arrive on a dime, as mine did, and that's important to factor in when trying to make a decision. I don't know when/if one can switch between them, if there is a penalty, but it's something I'd want to know as I evaluated the choices.

[mbuster]

I'm thinking medigap as the supplemental, not advantage, because of less or no restrictions attached for things like referrals or in/out network. I hear it is more expensive, but there is some truth to 'you get what you pay for'. Not sure about swapping from one to the other without penalty or potentially being refused coverage at lower prices.