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Medicare Plan D for someone with NTMs
I am about to leave Kaiser for a traditional Medicare plan and would like to know what plan D people who are being treated for NTMs (MAC, Psudomonas, Aspergillus, etc.) are choosing for 2026. I live in San Rafael, Northern California and will be treated at UCSF. I am wanting to get a plan that contains as many of the possibilities as possible as I don’t know what my treatment will entail.
I can leave Kaiser without undergoing medical underwriting because Kaiser is raising their rates and there is a Guarantee Issue exception for existing members of Senior Advantage plans.
Many thanks in advance.
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@sueinmn Thank you! I'm going to talk to a BPM after I identify the pharmacies that carry Brinsupri. Great idea! I do understand the $2100 cap is for those listed in respective Formulary. Unfortunately, the drugs that I was most interested were either not in the Formulary or not considered a standard treatment drug for MABC. As I previously mentioned, this was an issue with Nuzyra and still denied after 3 appeals. My ID doctor told me that this was pretty std and recommended another medication. Fortunately, I don't need at present but just want to plan ahead-just in case.
@paxmundi Absolutely!
@lulu1944 I may not have read your post(s) correctly and you may have already called your State Insurance Office for help. They can help with looking at the Advantage Plans with the D plan included, built into the insurance plan...meaning you are no longer on Original Medicare when you have Advantage Plan you are basically going right into and directly involved with an Insurance Carrier Plan. They can also help you with the Original Medicare Plan in which you choose a Supplemental Plan (Medigap) where you stay on Original Medicare and add a Supplemental Plan and a D Plan. You then pick and choose your D plan according to what medications the Plan D('s ) cover(s). You can change the D Plan each year during the open enrollment period if you need to change due to a change in mediations etc.
It is much easier to understand the Supplemental Plans because each plan is plainly explained .....Plans G, N, K L and possibly F for example vs the Advantage Plans are very difficult to understand because each insurance company can have differences from one another, somewhat.
Hope I am not repeating what you already know. As you know open enrollment gives you more time yet to grasp all this information. It can be very trying but as you know this decision is so important health wise, financial wise and the long term.
Barbara
@sherrig I spoke to HealthSpring today and learned NJH is not in network with NJH. I will keep looking-and hope I find something prior to December 7th.