Insulin Archives | Georgia Medicare Plans

What Are Part B Drugs? – Why is the List Limited?

Bob Vineyard · February 9, 2022 · Leave a Comment

Most prescription drugs are covered by Medicare Part D, but SOME are Part B drugs. What’s the difference? Where is the list of Part B drugs? GA Medicare Plans. Do Advantage Plans include Part B coverage for insulin?

Medicare Part B Drugs

When you have original Medicare and a supplement plan (Medigap) your drugs are covered under a separate Part D plan. Even if you have an Advantage plan (MAPD) drugs are also Part D baked into your plan.

What is a Part B?

Medicare Part B is normally limited to outpatient HEALTH CARE. Part B will cover doctor visits, labs, X-rays, MRI, CAT scan, ER (Emergency Room), Ambulance (when it is a medical necessity), physical and occupational therapy and so forth.

Part B also covers certain medications and durable medical equipment like diabetic test strips, nebulizers, and wheelchairs.

Part D pays for drugs you take regularly for chronic conditions such as: heart disease, high cholesterol, or asthma. It also covers medications you take for a short period of time, such as antibiotics.

But why are SOME Drugs Covered by Medicare Part B, yet Others are not?

For certain medical conditions some of your medications are covered by Part B. For example, Medicare covers flu vaccination once every fall-winter season under its Part B benefit. Also, insulin may be covered if you have a CGM pump, but it falls under Part D if you self inject.

Medication for a nebulizer is another example of a drug that may be covered by Part B.

Most pharmacies cannot bill Part B Medicare prescriptions referred to as Part B drugs) or medical equipment.

If you need Part B drugs or medical equipment, ask if your pharmacy is able to bill your medical plan directly.

Specialty DME (durable medical equipment) providers that may be approved by Medicare include:

Wheel chairs and walkers

Hospital beds and transfer devices

Infusion pumps

Oxygen

Compound and specialty pharmacy

Mail order pharmacy

Does Part B Cover Vaccines?

There are two vaccines for pneumonia that protect against different types of the infection.

Medicare B (Medical Insurance) covers 2 different pneumococcal shots. Part B covers the first shot at any time and a different, second shot if it’s given at least one year after the first shot.

PCV13 helps protect people from 13 of the most severe types of bacteria that cause pneumonia.
PPSV23 protects against an additional 23 types of pneumonia bacteria. Neither can prevent every type of pneumonia, but they work against more than 30 common, severe types.
People who need a pneumonia vaccine should get both shots: first, the PCV13 shot and then the PPSV23 shot a year or more later.

For most people, one of each shot should be enough to protect them for their entire lives.

Does Medicare Pay for Shingles Vaccine?

Shingles vaccine, including the new Shingrix formula, is included in your Medicare Part D benefit.

Will Medicare Pay For Shingles Vaccine?

Shingles, or herpes zoster, is a skin rash that is caused by the same virus that causes chickenpox. Symptoms include blisters, burning, itching, fever, and pain. It usually takes about two to three weeks to clear up.

According to Mayo Clinic:

The signs and symptoms of shingles usually affect only a small section of one side of your body. These signs and symptoms may include:

Pain, burning, numbness or tingling
Sensitivity to touch
A red rash that begins a few days after the pain
Fluid-filled blisters that break open and crust over
Itching

How Do Most Vaccines Work?

Most vaccines start with some form of the virus which is injected. The idea is your body will detect the intruder and generate anti-bodies to attack the virus.

Older vaccines such as Zostavax use a weakened form of the virus. Shingrix, approved in 2017, uses inactivated (dead) virus. Vaccines containing dead virus cells eliminates the risk of transmission.

Is Insulin Covered by Medicare B or Part D?

If you have an insulin pump your insulin and other diabetic supplies may also qualify for Part B coverage.

Many retail pharmacies cannot bill a medical plan for Medicare medical prescriptions (commonly referred to as Part B drugs) or medical equipment.

WALGREENS has a specialty pharmacy that can help with your intravenous medications (including insulin) and other specialty medications

https://www.walgreens.com/topic/pharmacy/specialty-pharmacy.jsp

Many Part B Drugs are Administered in a Clinical Setting

Part B drugs are often administered by a health care provider (i.e. vaccines, injections, infusions, nebulizers, etc.), or through medical equipment at home.

Some pharmacy’s administer vaccines without a prescription. Shingrix and flu vaccines do not require a doctor’s order and may be free at your local pharmacy.

What are examples of drugs covered under Part B?

Examples include:

Injections for osteoporosis
Some transplant medications
Immunosuppressants
End-stage renal disease (ESRD) medications
Flu, pneumonia, and Hepatitis B shots
Medicare Part D may cover medications that aren’t covered under Part B, and vice versa.

Who is Georgia Medicare Plans and What Do They Do?

Medicare information. Our videos help you understand all about Medicare. You have questions, I have answers.

What is Medicare and how does it work? What is Medicare Part A, Part B, Part C and Part D? What is a Medicare Advantage plan and why is it free? What is the difference in Medicare Supplement and Medicare Advantage? Which is better? Why do I have to pay a premium for Part B Medicare? Why is Part A free but Part B is not? How can I pay my Medicare premiums? Can I use a credit card? Can the premiums be deducted from Social Security?

GA Medicare expert Bob Vineyard takes the time to LISTEN then offers ANSWERS in plain English Medicare supplement plans, Medicare Advantage vs Medicare supplement. Medicare Part A, Medicare Part B. Which Medicare plan is BEST? How to change Medicare plans? Medicare supplements plan G information and rates. Which Medicare options are best? What is original Medicare? What are Medicare basics? Turning 65 Medicare? Medicare explained.

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#DoesMedicarePartBCoverPrescriptionDrugs #WhenCanIusePartBforDrugs #IsInsulinCoveredByMedicarePartB

Georgia Medicare Plans. An offer you can’t refuse.

Medicare Drug Plan Finder

Bob Vineyard · October 19, 2016 ·

Using the Medicare Drug Plan Finder can be challenging. You can do it yourself, ask an agent, ask the Medicare drug plan carrier or call 1-800-MEDICARE (1-800-633-4227).

We will show you

step by step how to navigate the Medicare Plan Finder site
how to compare drug plan results side by side
eliminate plans with deductibles
choose plans where all your drugs on on the formulary
find pharmacy’s with the lowest drug costs
where to find the estimated drug copay’s
how and where to enroll in a Medicare drug plan
compare prices using a discount drug card
finding prices at Canadian pharmacy’s

The entire process is more frightening than filling out your taxes but with a little practice you will figure it out. By the time you do it again during the next open enrollment you will have forgotten everything you learned.

So bookmark this page when it is time to renew your plan and you can fly through the process like a pro.

We are happy to run reports for our existing Medicare supplement clients.

We collect your drug information
Run reports for you based on all 24 plans in Georgia
Send the reports to you by email complete with a recommendation for the lowest combination of drug plan and pharmacy

Or you can call Medicare.

OK, this may not be as fun as talking with Jake from State Farm but it can still save you money.

Medicare Drug Plan Finder 2018 Update

As challenging as this process was for 2017, it is even more difficult for 2018 plans.

Drugs on Medicare may show as not on the formulary. Call the carrier and get a different response.

To maximize savings you may need to change pharmacy’s. One client will save almost $4,000 in 2018 by using a different pharmacy!

MAJOR discrepancies in results on Medicare.gov and carrier sites. Calling the carrier can be more confusing. Each time you call you get a different answer.

Good luck!

Medicare Drug Plan Finder for the Do It Yourself Person

For those who like to do it themselves here is a step by step guide to using the Medicare Drug Plan Finder.

Click this link to go to the plan finder.

https://www.medicare.gov/find-a-plan/questions/home.aspx

You can also click the General Search image below.

Enter your zip in the box Search. Click Find Plan.

Select how you get your Medicare coverage.

Most people will select Original Medicare and I Don’t Get Any Extra Help.

Click Continue to Plan Results.

Now the fun starts.

Have all your medicine bottles lined up before moving to the next section.

Prescription Drugs You Take

Enter the name(s) of each medication, click Find My Drug.

Choose the drug name and dosage you take. Also check off how often filled, quantity and whether you get your drugs at retail or mail order.

Repeat the process for each drug.

Note you can change the dose, add or remove the drug from your list using the buttons.

Make a note of your Drug List ID and Password Date. You will refer back to this in the future.

Then click My Drug List Is Complete.

Choose your pharmacy(s).

If you want to compare prices by pharmacy, pick any two.

Click Continue to Plan Results

Check off Prescription Drug Plans with Original Medicare

Click Continue to Plan Results

The next page should look like this. If it doesn’t you have done something wrong. Go back.

Make sure the results (below) are for the correct year. The image below was taken in October, 2016 so the default is to illustrate the 2017 plans. If you need to view the current year, click that button.

You will notice your Drug List ID and Password Date follow you through the process.

When you get to the Medicare drug plan page (above), scroll down until you see the options (below)

Select two or three plans that appeal to you, the click Compare Plans

The plans you want to compare will appear side by side.

You should use your browser setting to print this page. If you know how to print and save as a PDF you should do so and save it on your computer where you can find it again.

Notice I chose the plan with the lowest drug cost (Envision). The Envision plan has a deductible, so I picked the next lowest cost plan (Silver Script) that does not have a deductible.

Some (but not all) plans do not apply the deductible to tier 1 and tier 2 medications when using a preferred pharmacy. Be sure you know the difference.

Often, but not always, plans that have a deductible will have lower copay’s than plans that do not have a deductible.

View Monthly Drug Plan Costs

Scroll down until you see the Estimated Monthly Drug Costs

The monthly costs include your premium plus the estimated cost of your drugs. If you go into the donut hole that will appear in the monthly printout (above).

If you want to see the estimated copay for each of your medications, click the View monthly drug cost details by selected drugs link.

Note the drug copay’s are estimated and do not reflect higher costs due to deductibles or increased costs when you are in the donut hole.

Dig Deeper

If you want to really take this drug plan report for a test drive, check out some other neat things you can do.

Go back to the browser frame where the monthly drug costs are shown side by side. Scroll down until you see this section (below).

Note the tier level for each of your drugs. It won’t always be the same from carrier to carrier.

Click Print My Drug List.

Click Print Comparison Report.

The Drug List shows all the drugs you have entered by name, dosage, etc.

The Comparison Report can be customized to show only information that is relevant to your situation.

Finding the Lowest Drug Prices

Sometimes you have to work a bit to find the absolute lowest drug costs. There are times when you want to purchase 30 or 90 day supplies at retail. Maintenance drugs may (or may not) be cheaper by mail.

Current clients of Georgia Medicare Plans can stop right now.

If you purchased a Medigap plan through us do this.

Email me your Drug List ID and Password Date. Give your current zip code and county of residence. I will run your report (based on your Drug List ID and Password Date) then search for ways to cut your drug costs using mail order and discount cards.

Not a current client? Shameless plug here. Let us help you find the best Medigap plan that fits your needs and budget.

For next year plans I will only do this from October 1 through November 7. After that date I may not have time to perform this service, so no guarantees.

If you are not a current client, proceed as follows.

Your Medicare Drug Plan Finder will show you which plans save money when you order by mail.

But wait, there’s more.

Consider ordering drugs from Canada. We have personally used and recommended Blue Sky for years.

You can also save money by using a drug discount coupon from GoodRx. You have the option of going online and printing out a coupon, downloading an app for your smartphone, or requesting an ID card you can carry in your wallet.

Decide How You Want to Purchase Your Drugs

Get a piece of paper.

Make 4 columns
Write down each drug in column one
Enter the cost of the drug using your drug plan – See call the carrier (below)
Repeat this process for each drug from Canada and again using GoodRx
Go back to your Medicare Drug Plan report and remove the drugs purchased from Canada or using GoodRx
Run the report again

If you use insulin, most Canadian pharmacy’s will not ship it to you. Insulin prices in the US, even with a Medicare drug plan or discount card are crazy expensive. We have found one Canadian pharmacy that stocks and ships insulin direct to you.

https://rxcanada4less.com/

Check insulin pricing before enrolling in a Medicare Part D plan.

Now you are ready to sign up for a drug plan.

Almost.

Before you enroll in a plan, call the carrier you think you want to use.

Give them a list of all your drugs including dosage
Ask them for their preferred pharmacy’s – Compare that to your Medicare report
Which drugs (if any) are subject to the deductible (if the plan has a deductible)
Ask for the initial coverage copay for each drug
If a deductible applies, ask for the cost with and without the deductible
Ask for your cost if/when you are in the donut hole
Write all this down
Do NOT enroll yet – You are still not done

Now that you have the copay for each drug from the carrier you think you want to use, go back to your piece of paper with the drug prices.

Enroll in a Medicare Drug Plan

Now that you have all your information it is time to enroll in a drug plan.

You can enroll direct with the carrier by clicking the Enroll button on the Medicare site
Better suggestion is to call 1-800-MEDICARE (1-800-633-4227)
800 MEDICARE is open 24/7 except federal holidays – You can even call at 3AM
You can also enroll direct with a carrier by phone or on their site

I have been advising clients to enroll via 1-800-MEDICARE for years and have had no complaints. When you follow my step by step instructions you can be enrolled in a drug plan in less than 15 minutes.

No hassle. No sales pitches.

Finding a Medicare Drug Plan

It will probably take you longer to read this post than it will to use the plan finder. With over 400 clients spread all over the state of Georgia, I don’t have the time to help everyone the way I would like to. By asking you, my client, to do the front end work I can still help others find a Medigap plan that fits their needs and budget without totally abandoning my existing clients.

Here are the steps you need to take to use the Medicare Drug Plan Finder

Go to the plan finder
Enter your zip and check off how you get your Medicare benefits
Input your current medications
Choose a pharmacy
Review the results

If you take fewer than 5 medications it will take you about 15 minutes to get results. More than 5 will take a bit longer.

If you find this helpful, share this link with your friends. Thanks, and have a great day!

#MedicareDrugPlanFinder #GoodRx #MedicareOpenEnrollment #DrugsFromCanada #GeorgiaMedicarePlans #GAMedigapRates

Medicare and Diabetes

Bob Vineyard · September 14, 2015 ·

Does Medicare pay for diabetes treatment? How about diabetic supplies? Will my Medicare plan pay for insulin? How can I save money on my diabetic prescription drugs?

If you have diabetes, you need a good Medicare plan that will cover most of your out of pocket costs for care and allows you the freedom to choose your own doctor. Once you find a doctor that can help you regulate your sugar levels, you don’t need to be forced into changing doctors every few years.

This means finding a good Medicare supplement (Medigap) plan you can keep as long as you live. With over 170 different Medigap plans in Georgia, we can help you find the one that fits your needs and budget.

Instant GA Medigap quotes online. No waiting. We never sell your information.

Shop and compare now.

Medicare and Diabetes

If your diabetes has been under control for most of your life, consider yourself fortunate. I have friends that are diabetic, both type I and type II. Some have lived most of their life without major issues. Others have not.

Consider this. According to the Diabetes Care Project

26 million people in the US have diabetes
79 million have “pre-diabetes”, 7 million have UNDIAGNOSED diabetes
More than 90% of diabetics are type II and obesity contributed to most of those cases
The US spends $174 million each year to treat diabetics; $119 million in direct health care costs
$1 out of every $3 spent by Medicare is to cover the cost of care for diabetes
Diabetics have medical expenditures that are more than 2x that of non-diabetics
The average annual cost of care for diabetics is $13,700 with $7,900 of that tied directly to the disease
The costs of treating diabetes rose 41% from 2007 to 2012

The longer you have diabetes, the greater chance you have of incurring high medical costs and complications. This is not the time to manage your illness and out of pocket costs with a Medicare Advantage plan.

Medicare Coverage forDiabetes Treatment

Original Medicare Part B covers the cost of testing equipment and supplies, insulin pumps and therapeutic shoes.

Part B also covers regular screening, diabetes self management training, nutrition therapy services, A 1c and glaucoma testing and much more. Check out Publication 11022 for more details.

Oral medication and self injecting insulin (not for a pump) are covered by Medicare Part D.

Don’t get sucked into the deals that promise free diabetic supplies. If you get an unsolicited call offering FREE diabetic supplies, hang up. Diabetes Health has this to say.

Scammers often pose as federal employees or workers representing legitimate diabetes associations. They’re looking for Medicare and Social Security numbers, as well as other financial information, that they can use fraudulently on their own behalf or sell to criminal syndicates.
Fraudsters that actually do send diabetes supplies send supplies that are inferior in quality, and then turn around and fraudulently bill Medicare for the order. “Free” supplies offered include glucose meters, diabetic test strips, and lancets, as well as such items as heating pads, lift seats, foot aids, or braces.

If you get such a call, immediately hang up and call the fraud hotline (1-800-HHS- TIPS, 1-800-447-8477)

Medicare and Prescription Drugs

The weakest link in the Medicare program is Part D, the prescription drug plan. Nowhere is it more obvious than when it comes to covering the cost of diabetic drugs.

Insulin can be very expensive, especially if you use a pen instead of a needle. The NovoLog patient assistance program can be a financial lifesaver for those who qualify.

Other PAP’s (Patient Assistance Programs) are another option.

We will review PAP’s in more detail in a future post.

Don’t Pay Too Much for Your Medicare Supplement Plan

Almost every day we talk to people who have bought the wrong Medicare plan for their needs, are paying too much, or both.

We recently compared plans for a lady who lived in zip code 31630, was turning 65 and going on Medicare. After talking with her friends she had decided to buy plan F from either Blue Cross or United Healthcare (through AARP). She was told that plan F “pays everything” (which is true) and that she should go with a big carrier that will pay all her claims.

Of course no one told her that ALL the carriers pay 100% of the contractual claims approved by Medicare. The normal claim process is your doctor files with Medicare, Medicare approves the claim, your supplement plan pays their portion.

A routine claim will take a couple of weeks with Medicare and about another week with the Medigap carrier.

Any doctor that participates in Medicare will also accept ANY Medigap plan, regardless of the issuing carrier.

Blue was going to charge this woman $168 per month. She could save a few dollars with the AARP/UHC plan F for $166.

But she can save even more by using a carrier I represent that will pay her claims in the same manner as Blue and UHC but with a monthly premium of $126 per month. That $40 per month savings adds up quickly!

Maybe she should consider new friends.

Better yet, introduce me to her friends so they can save money too.

Diabetes can be expensive. Let us show you a number of ways to minimize your out of pocket costs.

#MedicareDiabetes #Insulin #DiabeticSupplies #MedicareSupplement #MedicareAdvantage