[lifetimemeds]

On June 1, a new Medicare rule goes into effect. Most people won't even notice it in their 2015 Medicare book and will suddenly find out when it is too late. It covers prescriptions under Part D and durable medical equipment under part B.

The rule says that Medicare will NOT COVER any prescription for drugs or medical equipment unless the prescription is written by a doctor that PARTICIPATES in Medicare.

So if you see a doctor that doesn't take Medicare but is seeing you on a reduced fee or other arrangement, any prescription that doctor writes will NOT BE COVERED by Medicare Part B or D. If you are getting care at a university or local mental health center, your prescriptions will not be covered if that doctor does not participate in Medicare.

So now that you know about the new rule, you can plan ahead. It might mean you have to find a new pdoc but at least you will be ready. The worst case scenario is to not know the rule and show up at the pharmacy with prescriptions as usual. But then you are told Medicare won't pay for them. You have to pay all the costs yourself. What can you do then? Horrible scenario. I'm betting this will take a lot of seniors by surprise.

I have already written my congressman and representative protesting this new rule. I received form letters back that were about something totally different.

http://www.cms.gov/Newsroom/MediaRel...014-05-19.html

Require that prescribers of Part D drugs enroll in Medicare: Section 6405 of the Affordable Care Act requires that physicians and eligible professionals who order durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) or certify home health care for beneficiaries be enrolled in Medicare. The statute also permits the Secretary to extend these Medicare enrollment requirements to physicians and eligible professionals who order or certify all other categories of Medicare items or services, including covered Part D drugs. Accordingly, CMS will require that physicians and eligible professionals who write prescriptions for covered Part D drugs must be enrolled in Medicare, or have a valid record of opting out of Medicare for their prescriptions to be covered under Part D. This requirement will help CMS ensure that Part D drugs are only prescribed by qualified individuals. This provision is effective June 1, 2015.

[UpHill]

This is so sneaky. I will write my congress critters too.

[Angelique67]

This is bad, but it's part of the Affordable Care Act. There's a lot that goes wrong with Medicare I heard.

[Yoda]

I had no idea. Thank you for sharing this.

[JoeS21]

Ugh. I wish they would just make Medicare optional. (I almost said, "make Medicare go away," but I guess it MIGHT benefit someone.)

In my state, poor non-disabled people get free or very low cost health insurance. If you are disabled on SSDI, then you have to pay a whopping $104 a month for insurance. If you are like me and cannot afford $104, you don't get health insurance at all (other than for hospitalizations).

Thanks for the warning!!!!!

[unaluna]

I dont think this is exactly true. The point is to deter fraud; if you are on disability, you are already on part d and probably already seeing a medicare doctor, arent you? If you are at university, does part d even apply to you?

Eta - it also says says drs can have a valid opt-out on record.

Yes Hankster, thats what I came away with.
2014-05-19 - Centers for Medicare & Medicaid Services

Require that prescribers of Part D drugs enroll in Medicare: Section 6405 of the Affordable Care Act requires that physicians and eligible professionals who order durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) or certify home health care for beneficiaries be enrolled in Medicare. The statute also permits the Secretary to extend these Medicare enrollment requirements to physicians and eligible professionals who order or certify all other categories of Medicare items or services, including covered Part D drugs. Accordingly, CMS will require that physicians and eligible professionals who write prescriptions for covered Part D drugs must be enrolled in Medicare, or have a valid record of opting out of Medicare for their prescriptions to be covered under Part D. This requirement will help CMS ensure that Part D drugs are only prescribed by qualified individuals. This provision is effective June 1, 2015.

There is also this article that looks closer at this:
Medicare Won't Let Massage Therapists Prescribe Drugs Any More - Businessweek

[lifetimemeds]

So typical of law makers who want the government to control everything. $186,000 is a tiny drop in the ocean and does not mean there is widespread fraud in Part D Medicare. It is the Drug Enforcement Agency's job to monitor the prescribing of controlled substances. If Florida had pharmacies that filled prescriptions for hydrocodone written by provider without valid DEA number, does that mean Medicare is the problem? It is an indictment of DEA failure. So to save a tiny drop, law makers pass a rule that shifts the responsibility of the DEA to the huge, inefficient bureaucracy of Medicare. In the process, the rule makes it a lot harder for Medicare recipients to have access to the better care from good providers.

The doctors I know that have withdrawn from Medicare participation have done so because they are FED UP with the Medicare bureaucracy and shrinking reimbursement. They are not going to bother filing a "opt-out" request. They don't anything to do with Medicare. It has nothing to do with their qualifications to write prescriptions.

Very few psychiatrists in my area take Medicare patients. The few that do are some of the worst doctors in the state. Their practices are mostly Medicare and Medicaid patients because anyone with insurance or cash won't go to them. So now Medicare will no longer allow us to select a good pdoc to see 4 times a year for medication management with our own money because their prescriptions won't be covered.

So disgusted with Obamacare. They make a rule that essentially amputates a leg to treat a little pimple.

I must have missed the part about the DEA involvement. Personally I can't think of anything wrong with preventing dietitians, athletic trainers, massage therapists, veterinarians, unlicensed doctors and anyone else w/o proper training and qualifications from writing prescriptions. If a psychiatrist values money ahead of people then I'm not sure I'd want to be his/her patient.

[unaluna]

$186,000 was one person, so its not a drop in a bucket.

If a dr opts out of medicare, then he has a valid record on file and you can get your prescription filled. Its for people who have never been drs, who sell "durable medical equipment" and bill medicare up the yin-yang. Havent you seen those reported in the news? There is at least one big one per month. I really dont think its about coming between old people and our heart medicine.

[lifetimemeds]

Originally Posted by hankster

$186,000 was one person, so its not a drop in a bucket.

If a dr opts out of medicare, then he has a valid record on file and you can get your prescription filled. Its for people who have never been drs, who sell "durable medical equipment" and bill medicare up the yin-yang. Havent you seen those reported in the news? There is at least one big one per month. I really dont think its about coming between old people and our heart medicine.

No, the biggest fraud in medical equipment is electric scooters, hover crafts, etc. There was a kickback scheme in my state. The scooter company paid doctors $500 for each one they ordered. When investigators went to visit those that got their scooters through that vendor, they found most of the scooters in corner of a room being used as a potted plant table or clothes hanger like many treadmills and steppers.

How many of you who think this rule is a great idea are ON Medicare? That's what I thought. You have no idea what it's like to have a bunch of lawmakers make it hard to get good medical care.

Originally Posted by lifetimemeds

No, the biggest fraud in medical equipment is electric scooters, hover crafts, etc. There was a kickback scheme in my state. The scooter company paid doctors $500 for each one they ordered. When investigators went to visit those that got their scooters through that vendor, they found most of the scooters in corner of a room being used as a potted plant table or clothes hanger like many treadmills and steppers.

How many of you who think this rule is a great idea are ON Medicare? That's what I thought. You have no idea what it's like to have a bunch of lawmakers make it hard to get good medical care.

What is what you thought? You're just going to make the assumption? At least two respondents here are on Medicare. If you want to really know what it's like to have a bunch of lawmakers make it hard to get good health care then you ought to move to Texas.
The real problem here seems to be that you misinterpreted what you read. Two of us have tried to explain it to you. That is all we can do.

[ringtailcat]

George, make it three people.....

[~Christina]

Make that 4 people

Thanks for this

[Rose76]

Thanks for the heads up on this. I hadn't heard.

[Rose76]

Originally Posted by JoeS21

Ugh. I wish they would just make Medicare optional. (I almost said, "make Medicare go away," but I guess it MIGHT benefit someone.)

In my state, poor non-disabled people get free or very low cost health insurance. If you are disabled on SSDI, then you have to pay a whopping $104 a month for insurance. If you are like me and cannot afford $104, you don't get health insurance at all (other than for hospitalizations).

Thanks for the warning!!!!!

Check out if you're eligible for your state to pay that $104 for you. Lots of states do. It's a special form of Medicaid. I'ld be very surprised if Massachusetts didn't do this also. You have to apply through your Health and Human Services, Income Support Division (at least in some states.) No one really lets you know about stuff like this, if you don't ask. I was refused general Medicaid, but got approved for this.

Until I got this to kick in, I was paying that $104 out of my SSDI, which was a great hardship on me. Now the feds are refunding me what I paid over the past few months. I know cost of living is high up where you are, but I'ld think twice about going without that Part B coverage. You might regret that.

[dillpickle1983]

Originally Posted by JoeS21

Ugh. I wish they would just make Medicare optional. (I almost said, "make Medicare go away," but I guess it MIGHT benefit someone.)

In my state, poor non-disabled people get free or very low cost health insurance. If you are disabled on SSDI, then you have to pay a whopping $104 a month for insurance. If you are like me and cannot afford $104, you don't get health insurance at all (other than for hospitalizations).

Thanks for the warning!!!!!

Originally Posted by Rose76

Check out if you're eligible for your state to pay that $104 for you. Lots of states do. It's a special form of Medicaid. I'ld be very surprised if Massachusetts didn't do this also. You have to apply through your Health and Human Services, Income Support Division (at least in some states.) No one really lets you know about stuff like this, if you don't ask. I was refused general Medicaid, but got approved for this.

Until I got this to kick in, I was paying that $104 out of my SSDI, which was a great hardship on me. Now the feds are refunding me what I paid over the past few months. I know cost of living is high up where you are, but I'ld think twice about going without that Part B coverage. You might regret that.

I live in PA and they pay the 104.00 for me because I can't afford it.