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@rjd

Hi Windy. Now I am really confused. The only terms like "catastrophic" and "donut hole" I know about suggest payment for a prescription medication under your Part D coverage, not as a Part B outpatient medical procedure. How certain are you it is being treated under Part B rather than as a Part D drug?

When I received a Prolia injection in my doctor's office, it was processed under Part D. When I received a Prolia injection at an infusion center, it was processed as Part B medical service.

Does anyone else feel we are living in a Medicare Alice In Wonderland situation?

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Replies to "Hi Windy. Now I am really confused. The only terms like "catastrophic" and "donut hole" I..."

I was asked to provide a link for the Medicare Rights Center. Here it is. https://www.medicarerights.org/ They do offer counseling and advocacy to individuals but the demand for those services greatly exceeds their staffing capability.

I am much more comfortable with information from this organization than what is provided by insurance agents trying to help you decide about Medicare options. I cannot shake my concern about an agent's commission based income.

I was embarrassingly remiss in failing to provide a POTENTIALLY excellent source of individual counseling about Medicare. Each state receives federal money to set up and operate a SHIP office (State Health Insurance Assistance Program.) Link is https://www.shiphelp.org/ to find contact info about your state's program.

Why did I emphasize the word 'potentially?' Because the staffing is by volunteers who receive training. Some state SHIP offices undoubtedly do a good job. Others perhaps not so much.

My sense is that in a state where there is a general interest in consumer protection, the volunteers in SHIP offices are likely better trained and supported. I referred a friend in Illinois to the state SHIP office and she received excellent counseling assistance about a very thorny situation. On the other hand, I presently reside in the state of Texas and would be shocked to receive any decent counseling.

Nonetheless, SHIP is likely better than nothing and folks with Medicare questions about coverage and payment should consider giving it a try. And if you do, would you be so kind as to report back to this forum on your experience?

@rjd I am confused too. I think my Evenity will be in the doctor's office, not an infusion center, but was told by my Medicare Advantage plan that it is covered by Medicare Part B. I expect to pay 20%. I"ll let you know. It's in a week and a half.

I thought donut hole terminology applied to both regular Medicare and Advantage plans but maybe someone can confirm or deny this!