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← Return to Insurance has denied Evenity
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Helen,
I, too, am on traditional Medicare and on Evenity which is 100% covered. The cost - $5,000+ for each monthly set of shots!
I am pretty certain that the Advantage plans do not have to follow the traditional Medicare guidelines. As they are private insurance plans, they have their own rules.
Replies to "Helen, I, too, am on traditional Medicare and on Evenity which is 100% covered. The cost..."
@susanfalcon52 I'll have to check but I thought that if Medicare approves coverage then Medicare Advantage must also cover. The cost will be different but coverage is not supposed to be denied by Medicare Advantage. So, for instance, if Traditional Medicare covers Evenity then Medicare Advantage is supposed to cover Evenity also. But the cost to the patient will be under the Medicare Advantage private insurance company rules. Private insurance does have their own rules but they do contract with the federal government's Medicare program. I'll check on that.
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Evenity is covered by Medicare B even if you have an Advantage Plan because it is given in the office. However, I had to pay 20%. @susanfalcon52 do you have a supplement to your Medicare? That might explain your 100% coverage. Those of us on Advantage Plans get the coverage that you would get without a supplement, which is 80%. Our Advantage plans aren't involved at all.