Humana, Medicare and insulin

4073 Views 12 Replies 7 Participants Last post by Ronnie, Dec 23, 2021

Greysquirrel

Discussion Starter · Oct 10, 2019

In Jan. 2018 went to pick up my insulin at my pharmacy and was told Humana told them that if it was for a pump it had to be billed under part B. As they don't bill part B so a scrambled around town and found no one will bill part B till I got to Sams club and they would, so since then I have been getting my insulin from them.
Went to pick it up yesterday and it was $70 dollars more than last time. Asked why and was told I was in the donut hole with my insurance. Said I was under part B and should not be there. Druggist called medicare and was told that since I was with Humana HMO that it had to be billed under part D
My questiion is if I go under just Medicare and not Humana will my insulin be paid for?
Tried to call Humana and Medicare but after being on hold for 30 minutes from both of them I gave up and came here to see if anyone can answer.

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moon

· #2 · Oct 10, 2019

I don't know the answer since I'm just Medicare, but it sounds like the problem here is that your private insurer is the primary one and Medicare is secondary so ... coverage from primary rules.

There's a phone number here (scroll down) you might try if it wasn't one of the ones you already did.

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mbuster

· #3 · Oct 11, 2019

I am just looking in to Medicare, I'll be 65 the end of April. My understanding is that just Medicare (Part A and B) doesn't pay for most prescription drugs. You either have to have a Medicare Advantage Plan or carry the supplemental Medicare Part D. I'm not sure what I will do yet other than sign up for Medicare as I will be employed and covered by my company's insurance plan until I retire. Was planning on doing it on my birthday but may go until the end of the year or wait until I'm 66 and 2 month to draw full social security.

I think you need to get up with someone to discuss the options to find what might be best for you. I think it's open enrollment time for next year.

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Greysquirrel

Discussion Starter · #4 · Oct 11, 2019 (Edited)

Moon
Maybe I did not make myself clear. I know if I am on a Humana plan that I have to get my insulin charged to Part D what I am PO about is that Humana told my driggest two kyears ago that inluin for a pump must be paid through Part B so I ran all over town till I got to Sams and they said they could do it, then Humana change my plan to a HMO so that changed things. As you are on Medicaid and I assume on a pump as you are on this forum what I want to know is if I dump Humana and Pard D and just go on Medicar will it pay for my insulin for my pump?

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moon

· #5 · Oct 11, 2019

I have no experience along these lines since I don't use a pump (am on MDI which always falls under Part D) and Medicare is my primary/only insurer (except for MediGap).

How frustrating for you! The only way to navigate this I think is to sit on hold with Humana until you can talk to someone. My experience with Medicare is loaded with getting bad information, or misleading/incomplete at best, which is why I'd start with Humana.

Another option would be to try your local SHIP office. A list of phone numbers by state can be found here if you click on the Find Local Medicare Help button at the top. It might involve making an appointment with them, but they can be enormously helpful.

Please let us know what you find out. Am hoping it can be resolved in your favor and fast! Good luck.

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Greysquirrel

Discussion Starter · #6 · Oct 17, 2019

Finally got an answer that makes sense. When to my local Humana office, 45 minn away and had a video chat with someone at Humana. He looked up my records and checked what I had been paying and found that the last two times I got insulin what my price was and said the reason I paid more was not that I was in the donut hole as I am a long way from that and that it was being paid as part B. The reason is that the cost of my insulin went up to $979.03 so my co pay went up, nothing to do with how it was being billed. If the druggist had just looked at my cost of the previous prescriptions she could have told me that. No what the medicare person told the druggist makes no sense to me or to the Humana rep. Anyhow at least I know why I paid more than the last time. But why a vial of insulin is $326 and change is beyond me.

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moon

· #7 · Oct 18, 2019

How frustrating to go through all that. And the cost of insulin is criminal.

I use CVS and they have made so many mistakes the last couple of months that I'm ready to bail. Last week - 2 mistakes - was the last straw.

Found a local pharmacy that has excellent reviews and ... they deliver! For free! Well, their costs are on par with CVS (which is higher than most other drug chains here) but the service looks to be miles better. Supporting a local pharmacy vs a chain is going to make me beyond happy.

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Ada1mhill

· #8 · Apr 8, 2021 (Edited)

You're absolutely right! Actually online pharmacies have better prices for insulin. The current insulin price in Canada is between 30$-40$. Actually, the price is higher than most canadians afford to pay. Anyway, you can buy it without any prescription, and that's a huge advantage for me. Usually I order all my medicines from www.alaskacenterfornaturalmedicine.com because they have one of the best prices on the market, and the delivery is really fast. If I'm not mistaken, they are shipping to the USA as well. However, you better check that out before placing the order.

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itissteve

· #9 · Apr 8, 2021

Welcome to our site, Ada1mhill! The price of insulin is a huge concern to insulin-dependent diabetics. I'm not sure what the situation is in Canada, but in the U.S. action about the price comes in fits and starts.

It would be nice to get to know you. Would you introduce yourself in our New Member Introductions forum?

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sanjidasan

· #10 · Dec 21, 2021 (Edited)

It's been quite a long time now. Has your situation changed now? Maybe you should try to find another Medicare that will cover your medical bills, and you can choose a Plan that's right for you. I have good health insurance too, and the company found a Medicare Plan that worked for me, and I could pay for my psychotherapy sessions. I used to have big problems with constant anxiety, so these sessions helped me deal with it, but I probably wouldn't have been able to afford it without them. I wouldn't have had the money for two sessions. That's why Medicare is the best solution to my problem.

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itissteve

· #11 · Dec 21, 2021

Hello, sanjidasan! Welcome to our site! Could I interest you in introducing yourself in our https://www.diabetesforum.com/forums/new-member-introductions.4/ ?

How are charges for insulin handled where you live?

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Ronnie

· #12 · Dec 23, 2021

Greysquirrel said:
In Jan. 2018 went to pick up my insulin at my pharmacy and was told Humana told them that if it was for a pump it had to be billed under part B. As they don't bill part B so a scrambled around town and found no one will bill part B till I got to Sams club and they would, so since then I have been getting my insulin from them.
Went to pick it up yesterday and it was $70 dollars more than last time. Asked why and was told I was in the donut hole with my insurance. Said I was under part B and should not be there. Druggist called medicare and was told that since I was with Humana HMO that it had to be billed under part D
My questiion is if I go under just Medicare and not Humana will my insulin be paid for?
Tried to call Humana and Medicare but after being on hold for 30 minutes from both of them I gave up and came here to see if anyone can answer.

Save

Ronnie

· #13 · Dec 23, 2021

Sorry, just be prepared to be on hold an unreasonable amount of time. It is a fact for the Medicare age group. Some days I am on the phone with insurance issues for hours. Mostly on hold. We have a Medicare advantage plan through my retirees group and drug plan through our retirees group and a gap coverage for meds. If we did not have the gap coverage, Ronnie would be in the doughnut hole (gap) and would have to pay the major portion of his meds including novolog, till October. If you do not have an advantage plan, you can have original Medicare, a drug plan, and a supplement. With an advantage plan you can’t buy a separate drug plan. Also once you choose a plan and then decide to switch, your pre-existing medical issues will be used against you and limit the plans that will accept you

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