Need Help with Medicare Coverage for Supplies!

I am almost out of supplies and my distributor is telling me I get 5 barriers a month. I told her I have issues with them staying on and I could get by with at least 20 but not 5. Then my Medicare plan Humana said I will be paying 20 and they pay 80. Yikes, do you have to pay part? I do have Extra Care, Medicare so maybe they pick up the 20. I don't know, haven't got my entire first order yet. Linda

Medicare typically pays the first 80...then your private insurance pays 80% of what's left...

BUT...if your Humana is a Medicare Humana Advantage plan, then yes...you no longer use regular Medicare and are responsible for the 20% until you reach your out-of-pocket maximum. Check with your distributor to make sure they are in network with your Humana plan.
I just switched to a different Medicare Advantage plan and will incur the same, but I had to switch suppliers to an in-network one.
Good luck, Ritz

PS...with my ileostomy, my surgeon allows me to change daily, so I'm permitted 30 in a month. I only use about 15, so I order 20 with my new plan.
5 is unheard of...call your insurance and your supplier about that part of your issue.

I have a policy that picks up the 20 that Medicare does not pay.

Hi Linda, according to Medicare, you should be able to get 20 of each wafer and pouch, and like others, I pay $20.

What type of policy? I'd love to save the 20!

Words of Encouragement from Ostomy Advocates I Hollister

Yes, it is open enrollment and I am going to figure this out. I do have extra help with Medicaid. Maybe they will pick up the rest. I have no clue... &zwj

I have ordered 60 of the closed pouches where you bag and throw away, and I got 20 of the open pouches but no wafers. I hate working with new companies.

Thanks, Linda

I think I do also but not sure how any of it works. I get bills on occasion regarding my surgery and when I call, they say never mind, my secondary insurance covered it.

I have called everybody and they are just as confused as me. The last call I made said they need a doctor's order, so he is back in today. I hope to get it figured out. He sent in an order for 30 barriers, so I need to see if that was sent wrong. I can get by with 20 most of the time, but recently my stoma has shrunk so much that the little stream is going under the wafer we thought would work, and it was. So I have used 3 just over the weekend and have 1 left, and then it is back to the back stock of free samples.

Gimo, if you have extra help, you won't have to pay anything. Most insurances will pay the 80. Extra help will pick up all your costs though.

That would be great. I mean, I only got a small bill from the anesthesiologist, but the other surgery and ten days in the hospital were totally covered. I assume it is all taken care of since the surgery was June 5th.

I use Oxford Medicare Supplement. It is also life insurance. It pays anything that Medicare approves, like hospital and doctor visits. Here is a link for it, you can check it out. https://oxfordlife.com/products/medicare-supplement/

I just changed to Comfort Medical supplies and they got in touch with my doctor and got everything approved. I just order online and they did the rest. Here is a link to Comfort Medical https://www.comfortmedical.com/. Hope this helps.

Lovely,

I had used Comfort Medical and loved them, but they are out of network for my new AARP Medicare Advantage plan by United Healthcare. Here in Arizona, they are Optimum, so no choice. In one way, I'll save the $1,315 per month cost for the insurance, and this insurance will cost me $0. So I save no matter what!
Stay well, Ritz

PS... I was thinking, if I stayed home all day, I could just rig up a hose from my stoma to the toilet and get rid of my bag altogether!!! LOL

Any Advantage plan has a large out-of-pocket cost of around $6200-$6500 per year. You pay 20% until you reach that! To pay nothing for your supplies, you can get Traditional Medicare and a supplemental plan. You will have to pay the Medicare deductible of $220, then your supplement would pick up the rest. Unfortunately, you cannot have a supplemental policy if you have an Advantage plan. The give and take of plans are huge. Either pay the premiums for the policies or pay a huge 20% of out-of-pocket cost and maybe in the latter part of the year, if you meet the maximum, you will have your supplies paid for in full. Traditional Medicare does not include dental, vision, or prescription drugs. Having been in the medical field and insurance field, many providers do not accept Advantage plans because they do not pay well. It is open enrollment, so check out your options! It is a "damned if you do and damned if you don't!"
Puppyluv

Yes, Medicaid should pick up your balance on all medical costs!

Puppyluv.... I just switched to a Medicare Advantage plan and my supplier accepts it along with all my specialty doctors. They paid 80 for my supplies and once I pay my out-of-pocket maximum of 2500- then they will cover 100 for my stuff. Plus, I saved 15,000 in premiums for my last plan. I personally love it.

I am also on Medicare, but I have a supplemental with Aetna and I do not have to pay anything for my supplies.

Hi, I have Humana and I pay 20 as well. I have a colostomy and Humana allows 10 barriers per month from my healthcare supplier. And if you happen to use the Hollister two-piece, I have 15 #11703 barriers and about 100 #18003 pouches I can no longer use because I have moved up in size and now use a different part number.

Thanks, Keeper. So very nice of you. I have Humana, and the suppliers say I needed a doctor's order, which he did. I use Coloplast Convatec 2-piece and get 60 closed pouches and 20 open pouches. I get 25 barriers. BUT I have not gotten my first bill, so I could be in for a large amount. Hopefully, I was told the truth. My stoma is extremely hard to keep barriers on as it is under the skin and tiny. I am going to be getting surgery again to fix that or reconnect me. I will have a lot of supplies to share also as I should get a rosebud next time. Nice meeting you.
Linda

I have standard Medicare and no supplement. I order 90 days at a time. I order 20 barriers at a time, but I don't think that's the limit. I order 3 boxes of 60 sealed pouches, because that's the limit, but I use more than that, and buy extras on eBay that I have to pay out of pocket. Sometimes I get a great price, sometimes not so great. Because I generally get almost a week from a barrier, that's generally not an issue.

Under Medicare, I pay the deductible and 20%. I use Edgepark, but not real happy with them. No local alternatives.

It would be great to order a 90-day supply. I shall have to ask about that after my next surgery as I'm not sure what I will need, as they will be fixing my stoma and temporary ileostomy. Just not sure until they open me up.

Linda

Oh, I am so slow sometimes. I was going to mention this the last time I wrote. I was hoping to spend some time in my camper van in Quartzite this winter. But now I have upcoming surgery, and my pharmacy is working on getting my pills synchronized, so maybe by spring but not summer lololo. Arizona has the most beautiful sunsets I ever saw.

My son, who is 50, thinks I am nuts but oh well. I would rather die looking for meteors in the desert than sitting in my easy chair. Although an easy chair is really nice lololo.
Linda

Well, I do hope your camping plans work out. Before moving to Wickenburg, AZ where I currently live, a spot I picked for commuting to Phoenix for the surgery in 2019, I lived 9 years in the middle of the desert about 30 miles NW of Quartzsite which is definitely a mecca for gemstone hunters. I love the Arizona desert. It's so full of interesting life and beauty. Right. Camping in Quartzsite in summer is pretty brutal. Bob

I get 20 a month through Medicare and then I buy an extra 10 or 20 off stomabag.com 21 for 10. And I buy extra deodorant through Vitality Medical or Stoma Bag, whichever one is running the best sale at that time.

I had talked a friend into going to Quartzite and she moaned all the way. Once we got there, I couldn't get her to leave. We had to call our bosses so we could stay 2 more days. I don't know what it is, but I have to say the sunsets were so amazing and the desert is so peaceful. When I was doing Google Earth, I found some BLM land by Ehrenburg right on the Colorado River. Now I love that. I also found some campsites up here in Oregon. Very small, about 10 camps with anywhere between 5 to 15 sites it looks like. It is right on Crooked River. I shall have to investigate the fishing in that area. It used to be you could fish for free once you turn 70. Now I am not sure. Do you have any rivers or lakes around your area? I can't personally message you, but next month I will get the membership.
Linda

Dr. Fields,

I just got my bill and the only thing I was charged for was for two boxes of gloves. Apparently, you are not allowed any. Hmmm, poop and no gloves. Those that make these rules should have to watch videos at least. Apparently, they don't tell everyone that you need a doctor's order and in my case, he verified that I have issues with my stoma so I need more. It seems to work unless they don't bill all at once. But the gloves were on my order.

You have a great plan then. That comes out to about the same as what I have. Paying about $2500 for Medicare and the supplemental plan or paying $2500 for out of pocket up to $2500. A lot of them are not accepted here as well as Obamacare. They don't tell my patients till after the fact and bill them a huge bill! I have had way too many battles with the hospitals for this!

I have Medicare with Blue Cross Garnet Advantage Program. Cost: $0. I get 10 per month and 20 bags. I use 5 ports and 10-15 bags maybe on a pancake month.