[Greysquirrel]

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.

 

[moon]

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.

 

[mbuster]

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.

 

[Greysquirrel]

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?

 

[moon]

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.

 

[Greysquirrel]

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.

 

[moon]

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.

 

[Ada1mhill]

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.

 

[itissteve]

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?