Reply
Newbie

Part C Coverage Confusion

I have a Medicare Advantage plan but I'm confused about some things associated with these plans. As I understand it, Part C is supposed to cover everything that Part A and Part B covers.

 

However, when I go to get certain vaccinations from my pharmacy like the Flu shot or Pneumonia shot, they insist on using my Medicare card and do not want the Advantage card.

 

So I don't get it. If they want my Medicare card, that means Medicare covers it, so my Advantage plan should cover it too, right?

0 Kudos
2,449 Views
2
Report
Bronze Conversationalist

@cs22653291 MA plans are Medicare Part C . . . but that terminology essentially went away in 2006 with the creation of Medicare Advantage plans.

 

MA plans DO cover everything traditional Medicare (A & B) cover . . . but not in the same way. Your OOP cost under an MA plan may be higher or lower than traditional Medicare . . . especially if coupled with a Medigap plan.

 

Your pharmacy is normally not set up to file claims direct with Medicare (Part B) or Advantage plans. If they can't file claims they can't be reimbursed.

 

SOME pharmacy's can file Part B claims but that is normally used only for insulin.

 

If they are asking for your Medicare card it is possible they are confused as well.

 

This PDF explains a bit more about how Medicare handles vaccines.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Vacci...

 

Hope this helps.

 


Bark less. Wag more.
0 Kudos
2,355 Views
0
Report
Honored Social Butterfly

 Medicare Part B pays for one flu shot in each flu season, which typically runs from November through April, regardless of whether you’re enrolled in the original Medicare program or in a Medicare Advantage plan.

 

If you’re in original Medicare, the shot is free (no deductible, no copay) if you have it administered by a doctor or pharmacist who accepts Medicare assignment — that is, has agreed to accept the Medicare-approved payment as full reimbursement for providing this service.

 

If you’re in a Medicare Advantage plan (such as an HMO or PPO), the shot is still free. But you may be required to have it administered by a doctor who is in the plan’s provider network.

 

So your problem can be solved by going to one of your in-network medical providers - preferably, your primary care physician.  

Pharmacist aren't normally in a medical provider network which MA plans have.

It's Always Something . . . . Roseanna Roseannadanna
0 Kudos
2,415 Views
0
Report
cancel
Showing results for 
Show  only  | Search instead for 
Did you mean: 
Users
Announcements

Ask the Expert: Social Security

Discuss your thoughts about the 2022 Social Security cost-of-living adjustment with AARP experts - and ask a question to earn 50 AARP Rewards points. Join the discussion now.


AARP Make Your Move Contest 2021

Enter Today! Ends 10/22/2021. See Official Rules

Test Your Knowledge, Score Big. New Game Each Day!

AARP's new Right Again! Trivia game - part trivia, part puzzle, all fun! Special opportunities for AARP Members and Rewards participants. Play Now.

AARP Right Again! Trivia

AARP Rewards

Activate AARP Rewards to earn points for games, quizzes and videos. Redeem for deals and discounts. Get started with AARP Rewards now!

AARP Rewards Badge

Music and Brain Health

From soft jazz to hard rock - discover music's mental, social and physical benefits. Learn more.

Music and Brain Health