TPN and Medicare

I've been on disability for 1 year now, and they say I'll qualify for Medicare after 2 years on disability. Does anyone know if Medicare covers the cost of TPN? Right now my insurance covers it, but I have a $4,000 deductable, and I'm hoping Medicare will cover that.

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Medicare paid for my TPN. I had to pay About $25 dollars each month out of pocket to help cover the cost of the home health nurse but the actual TPN/supplies were covered by medicare.
Judy

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Yes Medicare will cover all TPN expenses!

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again to echo,, yep. but why do you have to wait 2 years? i got mine in like 6 months, and that was just the time it took to approve it.. there was no waiting period.

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I was going to ask the same thing...why 2 years? My medicare coverage was almost immediate too.

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Thanks everyone, I'll have to look into it again. I wonder if it varies state to state, I live in Arizona.

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OK, I just called Medicare and they're telling me I have to wait 24 months since date of entitlement of recieving disability.... one more year.

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The way Medicare works for insurance is if you get your Medicare approved but your date of disability is current then there is a 2 year waiting period for insurance, but sometimes Medicare will give you your disability based on when it started and if that was 2 years of more ago then you qualify immediately for insurance. That is how it worked for me. My date of disability they took it back 2 years so I was eligiable immediately for insurance, but a friend who was a cancer patient they didnt give her disability based on when her cancer started but on her current date and she had to wait 2 years to be eligible for insurance. I hope this helps.

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Thanks Velvetkiss, Yes, that's pretty much the way Medicare explained it to me.

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yes, medicare does cover the cost of tpn, which should be a relief to you.
much luck to you!

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As far as I know, Medicare covers the cost of TPN, but NOT enteral formula.

I don't have TPN, but found out after I got my feeding tube put in that Medicare doesn't cover enteral feeding stuff unless you are in a hospital or nursing home, so right now, Medicaid covers all of my stuff for that.
If Medicare won't cover it soon enough for you, you might want to talk with you case worker about having Medicaid cover the cost of your TPN.

Plus, you might want to check into how the TPN can be administered. Some insurances will only let you have TPN at a hospital infusion center, not at home.

Jessie

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I have enterral feeding through my nJ-tube and my medicare supplement insurance covers all the expenses and aso TPN when I get started on it in a week. I have United Health insurance and they have been really good. All my J-tube supplies and the formula are totally covered. My insurance also said that there will be no out of pocket expense for the TPN supplies also.

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Hi there:

If you are under 65, and are qualifying for Medicare due to disability, the gov't requires a 24-month waiting period. This is true of all states. The basic rules of Medicare eligibility do not vary from state-to-state as it's a national program. Just so you can verify what you're being told by your eligibility worker, I found this Q&A on the official Medicare site (www.medicare.gov)
http://tinyurl.com/yfzdzcu

For those of you who said that Medicare kicked in immediately, all I can imagine is that either you are 65 or over, *or* you are referring to Medicaid instead of Medicare. Medicaid has more variability from state-to-state. It's partially federally funded, and partially state funded, and each state can modify the program a little (or a lot if they have an approved waiver from the Feds). In fact, some states even have a different name for the program (e.g., Medi-Cal in California). Both provide health coverage. But Medicare is meant for the aged and/or disabled. Medicaid is meant for low-income. It's all very confusing, but that's the overall way to conceptualize the programs.

As for TPN coverage through Medicare, this is something that I've done a bit of research on and still find a bit confusing. My advice to you is that you make a call to your home care company that currently provides your TPN. If you ask them, I'm sure they'll describe how coverage works generally, or will work specifically in your situation. They are the experts; they have to be to get the money due to them by the various payors. However there is an interesting part of the Medicare site that allows you to search specific coverage rules. On this page, you can select your state and 'parenteral nutrition.'
http://tinyurl.com/yguvf77

Good luck.

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i have a g-j tube and medicare covers everything, including the costs for the supplies and my enteral nutrition. whatever is not covered by medicare medicaid pays, which acts a my supplement to medicare. the same was true when i was on tpn briefly in '08.

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I also have United Healthcare and pay for the top tier plan from my former employer ($368/month) and they don't pay for my tube feeding formula. They also had huge copays with TPN that I'm still trying to pay. Medicare kicks in in a couple of weeks and I will get a different secondary insurance.

Mimi

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I have medicare disability since 1983 for my MS. I pay 273 a month on there Plan J and we have been happy with that. I am 58 years old

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thanks Frantik, that helps a lot!

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