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Brinsupri follow-up

MAC & Bronchiectasis | Last Active: 58 minutes ago | Replies (131)

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Profile picture for kathyjjb @kathyjjb

@rmoore901 I actually have a PPO with my Humana. It's called Humana Choice PPO. At first it was great! But then after my NTM diagnosis, I started seeing the denials for equipment (Volara) and medications that my doctors were telling me that I should take. Someone mentioned to look at different drug plans. I need to do more research for sure.

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Replies to "@rmoore901 I actually have a PPO with my Humana. It's called Humana Choice PPO. At first..."

@kathyjjb thanks for clarifying that. Good to know. I just found this article which is informative so sharing the info.

Medicare Advantage. This is a private insurance alternative to original Medicare. These plans provide Part A, Part B and usually Part D benefits. They also may offer some benefits that original Medicare doesn’t, such as dental or vision care.

Medicare Advantage plans generally have a provider network, like the health maintenance organization (HMOs) and preferred provider organizations (PPOs) offered in many workplaces. They may charge more or may not cover care for out-of-network doctors and hospitals, except in emergencies.

Some Medicare Advantage plans require a referral from a primary care physician before they will cover specialist care. The plans are required to limit the amount of money you pay in copayments, deductibles and other out-of-pocket expenses, not counting premiums, each year. In 2024, the maximum out-of-pocket limit is $8,850 for care in your plan’s network, excluding prescription drug cost sharing, but some plans have lower caps.

You are not allowed to have a Medicare Advantage plan and a Medigap policy at the same time.