Medicare part D late enrollment penalty issue

[xsfxsf]

Must you use kits? (KLD)

Not really but it would be very inconvenient not to. I am in bed for many hours, up to 20, at a time. I cannot cath sitting up anyway. If I did not have kits I’d have to get all the contents separately like gloves, drape, betadyne, lubricant and the biggest issue a container. I found the reusable ones really hard to clean as the colonization is very smelly. I prefer sterile kits too.

By the way not only am I struggling with the $300/mo. cath copay and $80/mo. Part D penalty, but I also spend around $200/month just on chucks. Every time I get in bed I use 6 large chucks, which I absolutely need or the bedding will get soiled sometimes. I highly doubt any insurer will pay that.

[ChesBay]

My Medicare (Part B) only pays 75%. The co-pay for me, using kits, is $300/month or so.

I am guessing you are under 65? If you are 65 or over you can get supplemental insurance for much less than your current $300 monthly equipment copay. Usually, with Medicare and Supplemental insurance, 100% of approved urological are covered.

They are really pounding you with the $80 penalty on Part D sorry to hear that.

[SCI-Nurse]

Must you use kits? (KLD)

[xsfxsf]

If you have Medicare they should be paying for catheters.

My Medicare (Part B) only pays 75%. The co-pay for me, using kits, is $300/month or so.

[Gearhead]

Correct

[SCI-Nurse]

Only if you started Medicare before your 65th birthday. (KLD)

[Gearhead]

I pay a small penalty. I quit working for others & worked for myself for a few years (then got injury). The insurance I had didn't meet ACA requirements. Penalty goes away @ 65 (very soon for me). The amount of penalty is determined by how many months you didn't have adequate or no part D insurance before turning 65.

[SCI-Nurse]

When I signed up for Medicare, there was plenty of information and warnings about this on their website. I am puzzled why more people are not aware of this. (KLD)

[ChesBay]

I'm not eligible for a Medicare supplemental policy according to the insurance agent I talked to. Because the providers are not legally required to offer it, they won't, obviously, for someone who is disabled.

This means I'm paying about $300/month out of pocket for catheter kits and another $250 for Part D (including the $80 penalty). It's becoming unmanageable due to other costs (medical and otherwise) also increasing.

If you have Medicare they should be paying for catheters. I have steered clear of Medicare Advantage plans. I think they suit some, but in our situation, I want to be able to choose my doctors, etc. I just use straight caths and lube covered but if you need kits
I'm pretty sure you can appeal for them if your urologist feels they are a medical necessity and will make a case for you.

Medicare DME Equipment:
https://www.medicare.gov/media/publi...nkit_matcher=1

[rdf]

I have such a penalty, but it's only $5 or so. People new to SSDI and Medicare are not warned of this possible penalty, not that I am aware of. I was surprised when I first was told about it. This is important, $80 is beyond the pale, it can devastate a budget for so many out there.

[SCI-Nurse]

Anyone who has a hard time paying out of pocket for meds (not supplies) should check this out and sign up, as then they will send you e-mails when new meds are added to their formulary:

https://www.markcubancostplusdrugcompany.com/

(KLD)

[xsfxsf]

My Medicare supplemental policy (which I pay partly as a Federal retiree) includes Part D.

(KLD)

I'm not eligible for a Medicare supplemental policy according to the insurance agent I talked to. Because the providers are not legally required to offer it, they won't, obviously, for someone who is disabled.

This means I'm paying about $300/month out of pocket for catheter kits and another $250 for Part D (including the $80 penalty). It's becoming unmanageable due to other costs (medical and otherwise) also increasing.

[SCI-Nurse]

My Medicare supplemental policy (which I pay partly as a Federal retiree) includes Part D.

(KLD)

[Oddity]

I too have a monthly penalty for my Part D. Mine is significantly less than $80, though.

(I took at 2 year “drug holiday” years back during which I titrated off all my prescription meds. I also dropped part D due to not needing it anymore. 2 years later, I wanted to try another bladder med, and when I added part D back I was assessed a ~$7-8 a month penalty fee for not carrying it for the previous 2 years. My insurance rep assured me it was non-negotiable, for my situation, assessed and levied directly through SSA premium deductions.)

(The rationale was/is to prevent Medicare enrollees from only buying into it when they need it, and dropping it when they don’t. Like I did. That’s not how “insurance” works. This program in particular needs everyone enrolled, and paying in, to function. It’s quite a low premium for the program’s total utilization. This was part of the “law making” deal. It only made fiscal sense if everyone was paying the premium, not just those with hefty drug bills.)

[ChesBay]

I haven’t experienced it but here’s some info on it.
https://www.aarp.org/health/medicare...irst-eligible/