OT: Medicare Advantage Changes

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Setj
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OT: Medicare Advantage Changes

Post by Setj » Sun May 03, 2015 4:39 pm

I received a letter from my eye doctor about changes Medicare made effective April 1, 2015.

Eye glasses, eye glass prescriptions and contact lens have never been covered by Medicare.

If I am understanding this letter correctly, before my eye doctor can provide any one of these three items, I have to present him with a Notice of Denial of Coverage from my Medicare Advantage carrier.

Is that what you understand?

Of course this seems ridiculous - the doctor can not do work for me that I am willing and able to pay for without first the denial. But this seems to be the state of our government these days - not protecting our freedom, but instead requiring us to get permission before we can make a move.
Seth

(I made a typo when I registered the user name. :oops: )

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chunkyfrog
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Re: OT: Medicare Advantage Changes

Post by chunkyfrog » Sun May 03, 2015 4:50 pm

Double check with your carrier. Your doctor's office might be confused.
I have original Medicare, which does not cover glasses, dental care, or hearing aids.

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LSAT
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Re: OT: Medicare Advantage Changes

Post by LSAT » Sun May 03, 2015 5:25 pm

I have a Medical advantage plan that covered eyeglasses through 2013.....They stopped covering them 1/1/2014. Yearly eye exams are covered.

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LSAT
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Re: OT: Medicare Advantage Changes

Post by LSAT » Sun May 03, 2015 5:26 pm

I have a Medical advantage plan that covered eyeglasses through 2013.....They stopped covering them 1/1/2014. Yearly eye exams are covered. What does the Coverage Book you received at the beginning of the year say?

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palerider
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Re: OT: Medicare Advantage Changes

Post by palerider » Sun May 03, 2015 5:39 pm

LSAT wrote:I have a Medical advantage plan that covered eyeglasses through 2013.....They stopped covering them 1/1/2014. Yearly eye exams are covered. What does the Coverage Book you received at the beginning of the year say?
once you get your rx, you can buy eyeglasses online for such low prices, you'll end up getting spare pairs and just for fun pairs, and STILL save money

starting point:
http://glassyeyes.blogspot.co.uk/

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Setj
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Re: OT: Medicare Advantage Changes

Post by Setj » Sun May 03, 2015 5:44 pm

Let me try to express this again because you are both missing the point.

Since I started Medicare Advantage in 2013, the three items (Eye glasses, eye glass prescriptions and contact lens) have never been covered by Medicare Advantage. If I needed them, I just made an appointment, got them and paid for them. Easy stuff.

What this letter is saying is Medicare made a change and now requires the patient present a Notice of Denial from his Medicare Advantage carrier before the doctor can perform the services.

So this means, the next time I need a new eye glass prescription, I first have to get a Notice of Denial from my carrier, present this to the doc's office and then make an appointment for the work. This, of course, means a delay while asking for and waiting for the Notice of Denial.

The letter from my eye doc's office says,
The Centers for Medicare and Medicaid Services has notified all Medicare Advantage Plans that this change is required.
Seth

(I made a typo when I registered the user name. :oops: )

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CowFish
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Re: OT: Medicare Advantage Changes

Post by CowFish » Sun May 03, 2015 5:48 pm

palerider wrote: once you get your rx, you can buy eyeglasses online for such low prices, you'll end up getting spare pairs and just for fun pairs, and STILL save money

starting point:
http://glassyeyes.blogspot.co.uk/

That is not as simple and fun as you think for people who use multi-focals - see - http://glassyeyes.blogspot.com/2007/10/ ... works.html

I've done it. Not so easy.

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chunkyfrog
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Re: OT: Medicare Advantage Changes

Post by chunkyfrog » Sun May 03, 2015 5:54 pm

Your exam will be out of pocket. You only need to go to a provider who will accept cash.
I have been recycling my frames at substantial savings, and I still get the hi-res multifocal.
Still expensive, but the Rx needs to specify pupillary distance. Some don't.

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Re: OT: Medicare Advantage Changes

Post by bwexler » Sun May 03, 2015 6:03 pm

I have a Medicare Advantage Plan in California. I shopped around and determined there are vast differences between different providers. My wife has an eye appointment Tuesday and I have one at the end of May. There has been no mention of the issue you are bringing up. The Advantage plans normally can't change your contract mid year.
I suspect your provider is confused or maybe he is aware that your Advantage plan now provides some coverage for eye care and wants you to verify so you don't feel ripped off after you have paid him.
Either way I believe Obama care mandates some coverages that may not have been common previously.
You may be pleasantly surprised.

The advice about not buying glasses under the insurance coverage is very valid. A couple years ago I bought glasses for myself and my wife at Costco for less than the deductible through the insurance for just mine.

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chunkyfrog
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Re: OT: Medicare Advantage Changes

Post by chunkyfrog » Sun May 03, 2015 6:10 pm

I have done the math, and Eyemed rarely saves you any money. FWIW.

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Krelvin
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Re: OT: Medicare Advantage Changes

Post by Krelvin » Sun May 03, 2015 6:32 pm

chunkyfrog wrote:I have done the math, and Eyemed rarely saves you any money. FWIW.
Agreed. The last 2 times I went in for glasses, the "sale" at the glasses place was a better deal than Eyemed insurance.
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