Medicare & TPN... more questions

I just got my medicare booklet in the mail and will can get on it January 2011. So I'm trying to figure out which part I need. I'm mostly concerned with the cost of TPN.

Question: Does Medicare Part B cover TPN? Or do I have to get the drug Part D?

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Don 't take my word for it but...from what I can remember Medicare Part B covered my TPN when I was still on it. I know that I didn't have the Drug coverage thru medicare, so I know that wasn't who did it.
It's been about 2 years ago now though so my memory may be wrong. I know though that it was covered thru Medicare.
Judy

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I have Part A & B...Im fully covered!

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By all means get both A & B; it is the best bargain you will ever get, and will cover TPN--which in my case is over $100,000 a year.

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TPN is covered through Part B, however, be aware that Medicare only covers 80% of anything through Part B. You need to at least try to get secondary insurance for the other 20%. Be aware that the laws for the secondary insurance providers are run by the state. I was denied by three different secondary insurance companies BECAUSE I AM ON TPN!! I am still attempting to try to get secondary coverage for TPN. Most won't take me because I am on SSDI for disability and they only cover people over 55 or 65y/o and there are no laws in Indiana that they have to cover people who are on Medicare via SSDI. TPN can cost up to $5000/wk so this is a pretty serious issue. It is so sad to me that our country can't seem to take better care of people with disabilities and chronic illness. Thank God that by 2014 they will no longer be allowed to discriminate like this based on "pre-existing conditions". Unfortunately that doesn't help me now. I hope that you are able to find a way to get your TPN fully covered. It has not been an easy task for me.

Good luck.

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I agree with JenD - it can be a nightmare! You should get both parts A&B. I'm glad I have both. I am lucky because my former company (from which I am disabled) retired me because I had been there for more than 10 years. So I get the United Healthcare as a secondary medical coverage at the retiree rate. Since I had been on United since before I got sick, I did not have to worry about not qualifying. I thank my lucky stars for that!

Mimi

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What I can add to the previous helpful postings is that even though Medicare is generally good about covering my TPN (within the limits others have noted), Medicare will not pay for plain hydration with electrolytes. Sometimes my TPN is not enough to keep me hydrated in times of lots of unusual fluid loss, so my dr. has given me a prn order for hydration with electrolytes which I can run as needed. My secondary insurance (which I have by virtue of my past employment although I am now on disability) at first wasn't going to cover hydration, either, but I fussed with them enough to get them to override their normal rules, so, to my great relief, they now cover hydration when Medicare won't. I discovered another weird thing about Medicare a year ago when I needed some iron dextran to boost my iron stores. Medicare would not cover it if it was infused at home, so in order to get it covered, I had to go to a local hospital infusion center and sit for about 4 hours while getting it. By that time, I had already gone through the iron dextran sensitivity tests and it was determined that I was not at risk for a bad reaction....So Medicare would only cover the more expensive option!

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What I can add to the previous helpful postings is that even though Medicare is generally good about covering my TPN (within the limits others have noted), Medicare will not pay for plain hydration with electrolytes. Sometimes my TPN is not enough to keep me hydrated in times of lots of unusual fluid loss, so my dr. has given me a prn order for hydration with electrolytes which I can run as needed. My secondary insurance (which I have by virtue of my past employment although I am now on disability) at first wasn't going to cover hydration, either, but I fussed with them enough to get them to override their normal rules, so, to my great relief, they now cover hydration when Medicare won't. I discovered another weird thing about Medicare a year ago when I needed some iron dextran to boost my iron stores. Medicare would not cover it if it was infused at home, so in order to get it covered, I had to go to a local hospital infusion center and sit for about 4 hours while getting it. By that time, I had already gone through the iron dextran sensitivity tests and it was determined that I was not at risk for a bad reaction....So Medicare would only cover the more expensive option!

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I was recently approved for SSD and was wondering how Medicare works. I presently have insurance under my husband but there are so many exclusions for my J-tube feedings and care. When am I eligible for Medicare and how do I find out if I am entitled to benefits? Do I have to apply after a certain period of time now that SSD was approved? Medicare was never discussed when I went thru the SSD process.

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After you are on ssd for two years you are eligible for medicare I am pretty sure about this but you should contact your local social security office for details on your case.

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JenD: Insurance laws do vary from state to state. In Minnesota, the insurance companies are regulated by the Commerce Department, and the
Dept. is very helpful in suggesting coverage for someone in your position. Minn also has a high risk pool that gave me secondary coverage when I was under 65, and on Medicare. Then I was told the private insurance (BC/BS) had an open enrollment period the end of the year so I signed up with them. Good luck!

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Hi,
Just got put back on tpn and medicare is paying 100% for everything I need. talk with your case manager if you have concerns, Glad you got it. Sandy

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