Yikes, Monty!

Please do as Daisy said.

Last year, when we were coming up on a prospective knee surgery date, I got an automated message (pretty much 10 years from my LAST shot) that I was due for a tetanus booster. Since I'm forever getting scratched/pinpricked out in the garden, I told the surgeon I was getting that booster NOW (so that was one of the many delays last year).

Tetanus is nothing to risk.

I had a tetanus a couple years back, so here's hoping

Last year at my physical exam, I requested a Tetanus shot as it had been a very long time since I've had one, and being around horses is a risk, so they gave me one, and my insurance refused to pay for it saying I was too old for one. How special is that!

What the HECK?!!!!!

I hate, no, LOATHE, health insurance companies with a passion, but THIS is a new low!

Well, they have to make their trillions of dollars each year, don't you know.

BlueRidgeGardener23 said: I had a tetanus a couple years back, so here's hoping

Monty, as long as it was 5 years ago or less, you're covered. If you don't get a potentially dirty cut or a puncture wound after 5 years, you can wait until 10 years from the last booster to get your next booster. I'm glad you didn't have a worse injury.

Polymerous said:

What the HECK?!!!!!

I hate, no, LOATHE, health insurance companies with a passion, but THIS is a new low!

on all counts.
I never heard of an age limit on tetanus boosters before. Sounds fishy to me.

tveguy3 said: Last year at my physical exam, I requested a Tetanus shot as it had been a very long time since I've had one, and being around horses is a risk, so they gave me one, and my insurance refused to pay for it saying I was too old for one. How special is that!

What, they think older people can't contract tetanus? or the shot will be bad for you? Very strange. I hope you appealed that decision.

I agree. Appeal that decision, and your doc may need to explain medical necessity to them better than he has.

Here's what I just read online: "Medicare parts A and B do not cover the shot, but Medicare Part D will pay for the Tdap." You DO have part D, don't you?

Hmmm, does that mean I'll have to get part D if I want my pneumonia vaccines to be covered? I'll be on Medicare by the time I'm old enough to qualify...

Diana, here's a quote from Medicare.gov :

"Medicare Part B (Medical Insurance)
covers pneumococcal shots (or vaccines). You can get the pneumococcal shot as a single dose vaccine or a 2-dose series.

In most cases, Part B covers the single dose vaccine or the 2-dose series once in your lifetime."

But I think that everyone should try to avoid medical bankruptcy by paying for part D. As people get older some of the meds can run multiple thousands yearly, just for one individual drug. Once you are enrolled at age 65, you are allowed to switch plans if a new medicine isn't being covered in the formulary of your current plan. However, if you wait past 65 to enroll and then have a need for an expensive medication, I think they can deny you enrollment based on a pre-existing condition. Or at least that was the case when I enrolled.

Once you are enrolled in part D, there is an open enrollment every fall, in which you can compare your out of pocket costs plus annual premium total between plans, and switch to the one that's best for your own list of prescriptions and dosages. I do it every fall for both Hubby and me. He and I have different part D plans because we have different meds. So what is the optimal plan for him is not the same as the plan optimal for me.

I'm glad the pneumonia vaccine(s) are still part B, but that makes the exclusion of the Tdap by part B all the more bizarre and irrational.
I agree that having part D on board in case you might need something is the best way to go. Newer antibiotics, antifungals, antiparasitic and antiviral meds can cost hundreds of dollars. I recall my mom getting socked with an $800 Rx. There was no cheaper option. She paid cash on the spot and had to wait for Medicare Part D paperwork to go through before being reimbursed, but at least by then she was almost recovered.

The alternative to Part D is a Medicare Supplement Plan, which is what we have (as an HMO with our medical provider's group). (I have to say that on the upside, THEY gave us no grief about immediately approving my knee replacement, whereas we had to force an appeal with our old insurance company, pre-Medicare.)

The Medicare Supplement HMO covered my Tdap shot without any hassles.

That said, they don't seem to like a med that I have taken for decades for tension headaches, so I may have to switch for something else for that.

As for antifungals being $$$$ expensive, yeah, tell me about it. I'm still battling that infection (which got out of control down in the hospital), and when I went to get a refill on one of the antifungal creams, the pharmacist told me that insurance wouldn't cover it because it would be "too soon". (Never mind the huge area that I have to cover, every day.) I asked the doc for a new prescription, got it, but so far as the pharmacy/insurance company was concerned, same thing - too soon, you can pay for it out of pocket, yada yada.

What REALLY burns me, is after talking to the pharmacist some more, was her "Well, this prescription will cost you (something like, I forget the exact amount) $545 if you pay for it out of pocket, but (reluctantly on her part, after I all but screeched at the cost) I can give you a coupon so it will only cost you $45..."

What The Bleep.

(Yes, we took the coupon.)

Marilyn, part D IS a Medicare supplement plan. Your HMO sounds more like an advantage plan.

FYI, Clotrimazole 1% is a pretty effective OTC cream for fungal skin infections. You can get two BIG (4 oz.) tubes of it on Amazon for about $9.00. Total 8 oz. Half a pound.

Yes, you're right, it's an HMO Advantage plan. Sorry, all this Medicare stuff is STILL confusing to me. (God help most people trying to figure this stuff out!)

Thanks for the antifungal info - I'll add it to the list. (My dermatologist also sent me an email which I just saw, telling me about an OTC antifungal.)

Marilyn, the 1% Coltrimazole is effective for under-boob intertrigo, jock itch, ringworm, and athlete's foot.

Thanks, Daisy!

You're welcome!

@Polymerous
Clotrimazole is pretty good, but topical Terbinafine OTC (Lamisil) has a broader coverage (that is, Terbinafine kill some fungus species that are resistant to Clotrimazole). Terbinafine costs a bit more than Clotrimazole, but far less than the Rx creams. Without a fungal culture and sensitivity to confirm that clotrimazole will be effective, I would go with the Terbinafine. I hope your doctor's recommendation has taken all that into account.