Medicare Part D coverage question

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Medicare Part D coverage question


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Old 11-25-2008, 19:21   #1
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Location: Easley, South Carolina
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Default Medicare Part D coverage question

Hi. I just signed up. I don't knwo if this is the right place for a question or not, but I'll start here.

I'm about to turn 65, so I've started researching Medicare supplement plans and Medicare Part D plans. My question here is about coverage under Part D when you hit the infamous doughnut hole.

I take a bunch of drugs, in addition to two kinds of insulin and one diabetes med (Actoplus). It appears to me from browsing just a couple Part D plan formularies that all forms of insulin are considered brand drugs, not generics.

Does that mean that once I hit the doughnut hole, I'd have to pay the full cost of my insulin unless I could find a Part D that covers brand drugs in the hole as well as generics? It sounds to me as if the answer is yes, but I want to be sure.

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Old 11-25-2008, 19:26   #2
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Default Are needles covered under Medicare Part B or D?

I'm about to sign up for Medicare for the first time. I've read the "Medicare and You" book, and I've browsed some websites about some Part D plans as well, but I can't find the specific answer to my specific question.

It appears to me from the "Medicare and You" book that insulin would only be covered under Part B if I took it using a pump. I don't do that right now. At the moment, I use two forms of insulin, both delivered by their manufacturers' proprietary pre-loaded pens. Both pens use BD type needles that I buy by the box at the moment.

I cannot find the word "needle" used explicitly in any of the literature I've reviewed so far. I can see that "syringes" are cited explicitly as items that may be covered under Part D, but not under part B. But I'm a literalist when it comes to language. Since the book did not say needle explicitly, I'm not sure whether to infer that it is covered or it isn't, in either section of Medicare.

I'm sure some readers here are doing what I'm doing. What is your experience with coverage for your needles if you take insulin using prefilled pens and cartridges, not real, traditional syringes and not pumps?

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Old 12-02-2008, 17:45   #3
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Originally Posted by tomseeley View Post
Hi. I just signed up. I don't knwo if this is the right place for a question or not, but I'll start here.

I'm about to turn 65, so I've started researching Medicare supplement plans and Medicare Part D plans. My question here is about coverage under Part D when you hit the infamous doughnut hole.

I take a bunch of drugs, in addition to two kinds of insulin and one diabetes med (Actoplus). It appears to me from browsing just a couple Part D plan formularies that all forms of insulin are considered brand drugs, not generics.

Does that mean that once I hit the doughnut hole, I'd have to pay the full cost of my insulin unless I could find a Part D that covers brand drugs in the hole as well as generics? It sounds to me as if the answer is yes, but I want to be sure.
Hi,

I can only tell you what my own experience has been and I do advise you to contact the supplier of your Part D for verification for yourself on this matter.

I hit the doughnut hole this year and I paid full price for my prescriptions. I am on Plavix and it is very expensive. If you have access to a Walgreens Drug Store they will give the names of many many different insurance carriers that are supplier of Part D and it will tell you on there what they cover, deductable, price per month, etc. It is well worth checking into. Good luck!

Ginny

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