u/shutupveena

Hi all,

My mom recently enrolled in Wellcare Value Script prescription plan. We had input her medications and all her medications were $0 aside from one. Well, we went to go pick up one of the medications that is supposed to be $0 but CVS says it's not covered by Wellcare. The Medication is Prednisone and it's a T2 drug on Wellcares formulary list and as mentioned before, was $0 when I input her medication with the correct dosage, quantity on the Medicare tool. I'm wondering if anyone's experienced something like this and what are we supposed to tell the pharmacy, especially because now I'm concerned whether her other medications are covered even though Medicare tool said they were.

Hi,

My mom recently qualified for Medicare due to her disability being approved. We also applied for Medicaid (as well as the Medicare savings program, extra help, etc.) in CA to see if she would qualify for anything. Her app is still in progress but after speaking with the Medicaid people they mentioned she probably won't qualify for any premium deductions, but may qualify for partial medicaid on a share of cost basis. I kind of understand share of cost as in every month, my mom would have to pay a certain amount of medical expenses before Medicaid would start to pay.

If this is the case, would it still be beneficial to have an advantage plan or supplement? Or is partial medicaid eligibility enough?

Hi,

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My mom was approved for Medicare because she got her disability benefits. We are looking at potentially a medigap plan; however, if she were to enroll in a medigap plan and then drop it in say 2-3 years from now (and still be under 65) will she have to go through underwriting when she turns 65 to have a medigap plan? We know that when she turns 65 a new enrollment period opens up, but will that not occur if she enrolls in a medigap plan and drops it before age 65?

Hi,

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My mom has an enrollment period that ends at the end of August. We recently enrolled in a MA-hmo plan but coverage won't start until July 1st. We are wondering if we are still able to disenroll from this plan and return to original medicare? We realized that although the plan says all her doctors are in network, it failed to include that it also ultimately depends on the medical group she is part of and that makes it too tricky when looking and staying with her specific doctors. We went through a broker who submitted the application for us. Would the broker be able to help us disenroll or do we have to call the plan directly or speak with Medicare?

She is under 65 and was approved for Medicare through disability benefits

Wonder if anyone can help me this...

Trying to get a Medicare HMO advantage plan for my mother. When I look up doctors, they say they're all in network with the plan but I noticed that there may be differing medical groups. Even tho they're in network with the plan, from my understanding, if the medical group doesn't match up with the PCPs medical group then my mother won't be able to see the specialist?? Then what's the whole point of UHC saying this doctor is in network with the plan if it ultimately depends on the medical group?

Additionally, when I look at urgent cares in the area, all the urgent cares only accept one medical group. How does this work if you are in a different medical group???? You can't go to any urgent cares in the area???

My mom recently qualified for Medicare bc she was approved for SSDI and navigating it all has been quite a doozy. We spoke with SHIP and an insurance broker and are still confused. We are leaning moreso towards just keeping Original Medicare but keep hearing about how we'll be on the hook for the 20%. However, we are also assuming that Medicare typically charges a set amount for most things and they aren't an outrageous price. We have also looked at Medicare advantage ppo plans because we heard HMOs are awful. But we noticed none of her doctors were in the network for the PPO plans. But the PPO plan we were looking for charges the same copay amount for an out of network provider as an in network provider and details on coverage state that an out of network provider can be seen as long as they accept regular Medicare, so it shouldn't be a big deal right?? And since it's a PPO, I'm assuming we won't have to deal too much with prior authorization?

Wanted to hear people's thoughts on those who have a PPO advantage plan or just straight medicare. Medigap isn't an option right now as it's too expensive for my mom as she's under 65.

Hi, asking this on behalf of my mom. She recently got approved for SSDI and was also enrolled into Medicare Part A and Part B. She has rheumatoid arthritis and takes Orencia. Orencia isn't working for her and her Rheum suggested Rinvoq but she hasn't started yet and probably won't since apparently Medicare won't cover it or Orencia. Looking at the Part D plans, it looks like Medicare doesn't really cover any rheumatoid biologics?? How do people on Medicare afford their biologics?? I've heard some people do in office infusions but still have to pay a bunch for that every month...my mom has been through so many medications and nothing has worked (methotrexate, enbrel, xeljanx, orencia). We're working with her Rheum to figure out what would be the next steps, but would Medicare cover something like Remicade, humira, or simponi ?? We are planning to speak with someone at SHIP and possibly a Medicare broker because this is all so confusing. I've also looked into Abbvie for Rinvoq but my mom may qualify for the extra help program and I've heard Abbvie does not accept Medicare patients who qualify for extra help.

Just wanted to hear other people's thoughts who are on Medicare and have rheumatoid arthritis as well! We are located in southern california, if it matters.