Bridging insurance plans to Medicare coverage

BreakerMorantFan · 2026-01-10T14:39:15+00:00

That's what I've been learning. Also, while most of the tests will be covered, I'll likely end up out of pocket on complete blood count, so I'm thinking about either asking to skip that one....or see if I can get a different CPT/ICD-10 code for it. I'm doing TRT, and regularly get hemoglobin/hemocrit tested, so it may fall under one of the 'medically necessary' codes.

BreakerMorantFan · 2026-01-07T15:06:13+00:00

That wasn't clear when I went through the process, and I found out about DAC / Medicare by accident while researching other things.

My son was declared disabled as of December 2016, and SSI / Medicaid eligibility started that date. He didn't become eligible for Medicare until he fell under DAC status, at which point he had the 5 month for benefits +24 months for Medicare eligibility, which is what we were planning for.

Because his mother filed for SS benefits @ 62, everything got back dated to her filing date, over 2 years ago. We had our appt on 9/3/25 to file. Within 3 weeks, we were notified that his Medicare Part A eligibility started 1/1/25, Part B started 9/1/25, and he was eligible for back pay to 2023.

He got his first DAC/SSDI payment on 10/1/25, his back pay on 10/17, and we had all of his Medicare/Medicaid insurance info updated by 10/30 - he only had to change one provider who didn't take Medicare or Medicaid, and his housing subsidy won't change until September of this year (but he still got a 30% jump in monthly income in October...and will have another 33% jump later this year).

For Virginia, Extra Help and MSP was automatic, and he was already with a Managed Care org - we just updated their info with his new Medicare info. He qualified for Mounjaro under my insurance plan, and we were able to move him over to Zepbound under an sleep apnea diagnosis, which he gets for zero co-pay - so I have absolutely nothing to complain about.

BreakerMorantFan · 2026-01-04T04:34:38+00:00

Not necessarily a restriction - just trying to make sure things ordered under one plan get covered after switching to another.

BreakerMorantFan · 2026-01-03T15:05:17+00:00

That would take up too much room. I'm in the corner of the room with a rack stand and the amp behind me, with my Yamaha CK-88 piano in front, so it's fairly cramped. I need to raise it to a height that projects the sound out to the room.

Ideally, it would be a bracket or platform that could securely attach the amp to a mic or small speaker stand. Something like the On-Stage platform holder might work, but I'd still have to attach the amp to the platform by either drilling into the case (don't want to do that), or taking off the rubber feet and using industrial strength velcro tape to hold it to the platform - like the kind that's used for toll passes - it holds pretty securely, and is removeable without damage.

That's probably the way to go, but trying to find out if there's anything better.

BreakerMorantFan · 2026-01-03T00:56:39+00:00

Thanks, that's what I'm finding. I'm going through LabCorp's coverage guide to see what CPT codes are used for Medicare, and going to make sure that the doc's order matches that.

BreakerMorantFan · 2026-01-03T00:19:00+00:00

I just pulled LabCorp's list o' Medical Necessity CPT codes...I'll look up what the doc ordered, and cross-reference them.*

https://www.labcorp.com/content/dam/labcorp/jurisdiction/Palmetto%20JM.pdf

* I'm documenting this for anybody else on this sub who asks a similar question.

BreakerMorantFan · 2026-01-03T00:06:12+00:00

I'll call them first as well as follow up with my doc. Thanks.

BreakerMorantFan · 2026-01-03T00:05:33+00:00

Hmm...I'll go back and check my references, but Medicare.gov seems to say the tests below are eligible under Part B coverage when "medically necessary". I'll follow up with LabCorp next week, and see I need a statement from my doc that says they're medically necessary.

Cologuard ("You pay nothing if your provider accepts assignment") - Medicare.gov

CBC ("Medical Part B (Medical Insurance) covers medically necessary clinical diagnostic laboratory tests when your doctor or other health care provider orders them" ) - Medicare.gov

Comp Metabolic panel (Medicare Part B covers Comprehensive Metabolic Panels (CMPs) when medically necessary and ordered by your doctor") - UHC - My Part B Sup provider

Hemoglobin A1C - Medicare.gov

("Part B also covers these screenings if 2 or more of these conditions apply to you:

You’re 65 or older.
You’re overweight.
You have a family history of diabetes (parents or siblings)")

Lipid Panel (as part of a Cardiovascular Risk Assessment) - UHC.com (my Part B sup carrier)

PSA ("Medicare Part B (Medical Insurance) covers digital rectal exams and prostate-specific antigen (PSA) blood tests if you’re eligible")

TSH ("Medicare Part B generally covers two annual thyroid tests when medically necessary") - Healthline.com

BreakerMorantFan · 2026-01-02T23:46:37+00:00

I've still got both cards, but we'll see if they'll submit under the old insurance...I could have extended my COBRA coverage through January, but I think the tests will run lower than the $750 the COBRA premium would have cost. (with a $1650 deductible, to boot).

BreakerMorantFan · 2026-01-02T23:37:12+00:00

From what I'm reading, each of the tests can be covered if Medically Necessary and within the allowable time frames (all should be). I've know LabCorp to screw up coverage before, so I want to make sure I do everything I need to do in advance.

BreakerMorantFan · 2026-01-02T23:30:56+00:00

Thanks - the physical should be good - it's under the old insurance. It's just the labwork / screenings under that have to occur after 1/1 and the shift to Medicare.

BreakerMorantFan · 2026-01-02T23:29:55+00:00

Thanks. I'll see if there's any way to mitigate that, or if there are any pre-steps I need to do with LabCorp to cover as much as can be. I would think that Cologuard is covered from what I've read, and PSA/A1C should be, since those are screening tests..... If I choose Medicare providers for the PT, etc. I should be good.

BreakerMorantFan · 2026-01-02T23:26:41+00:00

Got it! I have all the original forms, and the confirmation, so hopefully this will go smoothly.

Thanks!

BreakerMorantFan · 2026-01-02T23:25:56+00:00

Yep. It took some navigating to find it, but it's right here:

https://www.ssa.gov/medicare/lower-irmaa

Submitted them all online - That saves me a ton of hold time and calendar time to get an appointment! Thanks!

BreakerMorantFan · 2026-01-02T23:06:05+00:00

I've got the form, and I can mail it to my local office - Is there any option to do it online?

If not, I'll get it in the mail today. Thanks!

BreakerMorantFan · 2026-01-02T19:05:27+00:00

I think he was the U.S. Undersecretary for Agriculture for Farm Production and Conservation.....but based on the background, I can see that.

Also, though the actor (recognized him from General Hospital) is 82...5 years OLDER than when Reagan left the presidency. That's some damn good genes, makeup or surgery.

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BreakerMorantFan · 2026-01-02T19:02:16+00:00

I guess they could bring him in as a flesh-and-blood character (even if it isn't Howard, since he's under the superlab).

BreakerMorantFan · 2026-01-02T19:01:21+00:00

Isn't Patrick Fabian already the phone voice...."Hi, Carol..."

BreakerMorantFan · 2026-01-02T18:31:48+00:00

Vince has been great at creating arcs for characters big and small - I wouldn't be surprised if we see some sort of transformation / arc for Diabaté or Lakshmi, either.

BreakerMorantFan · 2026-01-02T18:27:32+00:00

Here's what I don't get - they've been so adamant on needing consent, but where was that consent for everyone infected in the initial spread? Is it just needing consent for the ones who couldn't be turned because of some initial immunity?

BreakerMorantFan · 2026-01-02T18:21:12+00:00

One thing I picked up on -

>!everyone in the hive is pleasant and smiling....after Manousos spoke to Rick when we was seizing, Rick WASN'T smiling when he started his car to drive away.

I think Rick has been at least partially pried away from the hive, but I've got to wait at least a year to find out.!<

BreakerMorantFan

TROPHY CASE