Good for people to know about the Hepatitis shot series. DH got them through work as he traveled through Asia and when he was employed with Motorola they made sure he had everything. Later with another company, we made sure with his PCP - who followed CDC on immunizations for foreign travel. Working as a RN, I got the hepatitis series through work for free.
See PM.
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It looks like Part D pays for immunizations that are not covered by Part B. According to Medicare.gov: Medicare prescription drug coverage (Part D) covers all vaccines that the Advisory Committee on Immunization Practices (ACIP) recommends, including the vaccines for Tdap, Respiratory Syncytial Virus (RSV), shingles, and more. Your Part D plan wonāt charge you a copayment or apply a deductible for vaccines ACIP recommends.
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Iāve been on Medicare for a whileā¦and have never paid for any immunization.
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I have a Medicare Advantage plan which usually covers most of everything. A few weeks ago I had a routine mammogram followed by sonogram. The mammogram was free but the sonogram had a copay of $1000! The healthcare network through which I had them said that Medicare doesnāt cover breast sonograms. I was planning to appeal to the network and to my insurance plan.
The sonogram showed some ambiguous stuff, no emergency, new mammo/sono in a month. And voila! The sonogram copay was reduced to $127.
For what itās worth, part B covers my whole MA premium and all the healthcare networks in NYC accept it in full. I am low-income. I had several heavy-duty healthcare years and my expense never approached the cost of a supplement.
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you mean TDAP? Tdap is the booster shot that protects against tetanus, diphtheria, and pertussis (also called whooping cough).
Covered under Part D. I obtained a booster with no injury.
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Thatās why osteoporosis drugs are considered infusions. So that Medicare covers them.
Enbrel is on the list for the government to negotiate with the drug manufacturers so relief may be coming.
My husband was on Enbrel, heās now on Humira. Once he go on Medicare, he will transition to Remicade which is an infusion.
Itās too bad because what heās using works really well.
He goes on Medicare in a year and a half. We will be researching his options.
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Iām assuming that the sonogram is the same as an ultrasound. According to Medicare.gov, āMedicare only covers medically necessary breast ultrasounds when your Medicare-enrolled health care provider orders them.ā So they are covered if properly ordered. But you have an Advantage plan, and they may have their own hoops to jump through to be able to get one covered. $1,000 is a huge surprise! Itās good that it ended up being reduced.
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Shots that are not vaccines have always been tricky with insurance coverage. I remember when I was receiving hormone shots which had to be administered by a nurse (medically required not infertility treatment), I had to pay 2 copays - one for the medicine and one for the āvisitā. It made no sense to me, as there was no other way for this particular medicine to be administered.
My understanding is the same as yours. I know several people who do both, and several people who have only their federal retiree insurance, and only Medicare part A (the free part).
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Secondary is BC/BS FEP about $600 per month for a plus one. I have medicare part B with the medications with a copay. There was a choice last year to switch to medicare part D which would I think be good if your meds are high- Part D and Part B are means tests. Cheaper by far for us to keep at no extra cost the BC/BS FEP medication coverage and pay a small amount of copay on meds. All this part changed in the past year. Who knows what next year will hold. I had to opt out for part D which would have been a lot because of the means test.
We went with traditional Medicare A and B (means test) and BC/BS FEP which includes meds. I was on BC/BS FEP after retirement until I was 65 and on Medicare.
Things seem to change and you really donāt know the full picture until you are there. Confused? I was.
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H is a fed employee. We are leaning towards both GEHA and Medicare. My copay with my oral chemo is $150/mo on GEHA, but would be $325/mo on Part D plus deductible. That doesnāt even count the other ten prescription meds (Entresto, Eliquis and Mounjaro are also pricey, though not at the level of my chemo meds). H is almost 63 and doesnāt plan to retire til at least 67.5, so we have some time still in hand. I turn 65 in 1.5 years, but can continue on his plan as itās creditable coverage. Currently GEHA is $540/mo for retiree & spouse coverage, and Iāve read itās subject to IRMAA adjustments. We pay less than that in premiums now, but hit the OOP maximum almost every year.
I keep records on my medical expenses, so when the time comes, we have some actual expenses to crunch and can model some scenarios.
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Iām really hoping that the $2000 cap on medication that goes into effect on 2025 is going to be a lifesaver for those of us who have many medications, some of which are very expensive.
It really stinks to have to change something that works for you. Millions are in the same boat.
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Thanks all for the lively contributions on this topic.
For 40 years Iāve had Tricare, while part of that time Iāve had other coverage in the Primary position. I can get vaccines and such at Walter Reed but the wait times can be long. (Non-rush hour it is a 45 minute drive).
I still see oncology at WR but if I were to have another serious illness, I would probably choose care thatās closer to home. Without a spouse, I would need to count on others to transport and assist.
When the 65 comes, I will have Medicare + Tricare (which becomes Tricare for Life). I understand that āincludesā the Part D prescription coverage and also allows for overseas travel.
Thanks all!
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Tricare for Life was all my mom ever needed, including when she had breast cancer at 84. We are all thankful for Dadās service, which made dealing with their medical issues in their later years less of a worry.
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It depends where you live, but certainly after age 65 with Medicare, Tricare works well. I know several people who proudly say they have Tricare for life.
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Yes, some pricey meds. Eliquis is similar pricing to DHās Xarelto.
Looking forward to seeing how the out of pocket drug cap in 2025 will affect our part D prescription coverage costs. DH has a higher cost plan with higher cost out of pocket for his Xarelto - his other meds are cheap. I have two nasal sprays which have my overall costs be a little more than āthe bottomā.
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That is the way things work with insurance and classifying medications; a med may eventually be administered a different way, but they code so that they approve various things and automatically add the administration code for injections as well. If the medication is ānot approvedā then the administration fee is also not approved.
There are many times I just donāt want to figure out how various systems āworkā - and really big systems often have patchwork fixes, so understanding the overall is not really logical. How Social Security and Medicare have their computer systems integrated and why they have various rules due to the patchwork ways of computer software.
Yes I meant TDAP. They may have changed their rules. DH needed the booster in 2022 and we had to pay, but it was not a huge charge (we get all our immunizations now at Walgreenās, which has up to date info and has the auto filing/approval on insurance coverage). I did write a letter/email complaining to CDC - but these big government systemsā¦like Medicare is going to change some thingsā¦ But it totally doesnāt make sense. Immunizations covered under other insurance. CDC did respond back to me. Medicare - I didnāt see where one could really post a complaint where one would really get attention.
To me, not paying on TDAP but paying out with other necessary immunizationsā¦
I obtained my tdap in ā21 with no copay. Perhaps yours was a system issue? (Iāve run into that before, when the pharmacist comes back with a price, and I say, huh, it was only a couple of bucks last year. Pharmacist re-enters into computer, and voila, correct price pops up.)