Insurance Agent Forum

[Winter]

What are those actually? Are they like chemo and infusion therapy or clinic administered type of drugs or what. Whats the general picture there.

Thank you.

Winter

[GreenSky]

Originally Posted by Winter

What are those actually? Are they like chemo and infusion therapy or clinic administered type of drugs or what. Whats the general picture there.

Thank you.

Winter

You are basically correct. Chemo is covered at 80% with Medicare and let's hope the person has a supplement.

Most MA plans pay 80-90% (usually 80%) capped at your policy maximum. Aetna charges $45 and I've used that as a selling point.

Rick

[MedSuppPro]

Also would include the prostate cancer injectables. They can be very expensive. As well as Chemo for rheumatoid. Also, there may be excess charges!

[Frank Stastny]

Originally Posted by MedSuppPro

Also would include the prostate cancer injectables. They can be very expensive. As well as Chemo for rheumatoid. Also, there may be excess charges!

How can there be "excess charges" on a drug? Do some drugs "accept assignment" while others do not?

Has Medicare changed the rules and not bothered to tell me? The last time I checked excess charges applied to physicians, not drugs, tests, etc.

[retread]

I have the same question as Frank about "excess charges", but while waiting on a good answer, let me toss in a comment:

These Part B drugs can be a two-edged sword. On the one hand, I have had clients with Med Sup plans tell me that getting the same drug injected by the doctor in his office (and fully covered) instead of oral Rx (at huge co-pays ... 33% x $3000 is $1000!!!) saved them big bucks.

On the other hand, I had to disenroll one client from her PPO so she could go on Medicaid, which paid for her immunosuppressive drugs preparatory to a kidney transplant when she developed kidney disease. The PPO had a $1500 co-pay for transplants and did not cover Part B drugs. Medicaid in her state, pays for her Part B drugs, dialysis, transplant, and transportation to/from dialysis clinic, which the PPO does not cover (or only covered part of). Even an SNP that I carry and supposedly designed for this situation, does not cover these expenses at 100% like Medicaid does.

BTW: this client was not on Medicaid when I sold her the PPO last year. She developed ESRD, and those expenses, even though mostly covered under the PPO, coupled with a decreased income due to her disease, put her in a financial state that required Medicaid assistance. She can't afford the $1500 deductible for transplant surgery, much less pay for those Part B drugs.

[MedSuppPro]

Medicare assignment rules are very complex and ever changing. I was up late last night faxing apps in before the AEP deadline and I stand to be corrected. As of July 2006, CAP vendors are required to accept “Mandatory Assignment”.

There are plenty of Part B non-mandatory assignment situations (i.e. Hepatitis B vaccine). That said, there could have been another CMS interim rule announcement that changes everything.

I always advise MedSupp clients to include coverage for Excess Charges.

[retread]

Originally Posted by MedSuppPro

Medicare assignment rules are very complex and ever changing. I was up late last night faxing apps in before the AEP deadline and I stand to be corrected. As of July 2006, CAP vendors are required to accept “Mandatory Assignment”.

There are plenty of Part B non-mandatory assignment situations (i.e. Hepatitis B vaccine). That said, there could have been another CMS interim rule announcement that changes everything.

I always advise MedSupp clients to include coverage for Excess Charges.

I think what you are saying is that if a client goes to a doctor that is not capitated, he may refuse assignment and therefore balance bill for the Part B drug, in which case this would be covered only under plans F, I, & J, and 80% under G. I learn something new every day!

[MAPDJim]

Originally Posted by GreenSky

You are basically correct. Chemo is covered at 80% with Medicare and let's hope the person has a supplement.

Most MA plans pay 80-90% (usually 80%) capped at your policy maximum. Aetna charges $45 and I've used that as a selling point.

Rick

Help me out here. If a MA or MA-PD has a $200 a day for 7 day inpatient hospital coverage where does the part B meds coverage come in? I see some plans with a $45 part B meds copay and some with a 0-20% part B meds coinsurance. I also have one that makes no mention of the hospital part B meds coverage.

So if there is no mention of the part B meds coverage do they have to pay a part B meds copay or coinsurance?