Vitamin D and Medicare

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Almost a year ago in February when I started on Medicare my doctor said I was just out of range - low on Vitamin D. He told me to take 5,000 units day. He tested me again 6 weeks later in March and then again in May. I was now in the upper half of the normal range.

Doctor tested me for Vitamin D again last week, just short of my one year anniversary of being on Medicare. Quest’s computer kicked out the test and said “Medicare does not cover this for your condition”. What do you mean? Medicare already paid for 3 of them.

Quest issued an Advance Benefit Notification (ABN) saying that they would charge me $320.19 if Medicare denied the reimbursement. I told them to screw themselves and leave that test out of the lab order.

Fortunately, I knew that no one should be paying more than $40 or $50 for a Vitamin D test. And I’ve since learned that the Medicare reimbursement for the Vitamin D test is $29. Quest would have billed me for more than ten times the cost if I was dumb enough to sign the form and tell them to go ahead with the test as the doctor ordered.

What lesson do we learn from this?

For-profit health care lives for ABNs. Once a patient signs an ABN approving a medical procedure, there’s no limit to what the doctor or hospital can charge for the test. That’s why Private Equity is trying to get into Medicare.

Here’s the Medicare coverage determination for Vitamin D tests. Medicare will pay for 3 per year, but once you’re “in range”, Medicare only pays for one Vitamin D test per year.

https://www.cms.gov/medicare-coverage-database/view/lcd.aspx…

It’s not reasonable and necessary to perform more than three tests per year.

Patients with Vitamin D deficiency that have been supplemented to normal levels are limited to one test per year.

It’s also interesting that Medicare coverage determinations vary slightly by region. It may be different where you live.

intercst

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Intercst,

Years ago my BIL a top endocrinologist recommended vit D to my mom as she aged. He stated she should take about 5000 or even 6000 IU. Mom would then go on to break two bones in her right foot. Then my BIL saw the first studies that were coming out about how much to take and not break bones.

There is no one figure fits all. But not all doctors know about the broken bones. It is a higher incidence of broken bones.

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Here’s the cost for a Vitamin D test at the online lab I used before I went on Medicare.

https://www.ultalabtests.com/partners/ultdirect/testing/cate…

What’s funny is that these guys (i.e., UltaLabs) use Quest to perform the blood draw and do the sample analysis. So the same people are doing the work, just charging you a wildly inflated price for it if you get caught in one of these billing scams.

So let’s check the scorecard.

Medicare reimbursement = $29. And cost-free to the Medicare beneficiary (traditional Medicare pays 100% for most labs.) A Medicare Advantage plan may charge you a 20% co-pay.

Order the test yourself online and pay cash = $39

Dumb enough to sign an ABN = $320

U.S. health care is a fraud and a scam.

intercst

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U.S. health care is a fraud and a scam.

I recently posted that I went in for my annual low dose CT scan to check for lung cancer.

When registering, the registration person asked me to sign my name to three documents / statements which I did not have an opportunity to read or examine. I signed on a digital screen no bigger than an iPhone. I wasn’t about to ask her for the paper copies of what I was signing…

First signature is for us to treat you
Second signature is for us to bill your insurance company
Third signature was for - who knows

'38Packard

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Lawyers

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Vitamin D. He told me to take 5,000 units day

Does your Medicare pay for Vitamin D?

I’m new to United Health Cares AARP Medicare HMO. They provide $85 each quarter for OTC drugs. Vitamin D is on their list of items available. The list is quite extensive including Prilosec, Band Aids and all sorts of stuff. Even special socks for compression or diabetics.

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pauleckler asks,

<<<Vitamin D. He told me to take 5,000 units day>>>

Does your Medicare pay for Vitamin D?

I’m new to United Health Cares AARP Medicare HMO. They provide $85 each quarter for OTC drugs. Vitamin D is on their list of items available. The list is quite extensive including Prilosec, Band Aids and all sorts of stuff. Even special socks for compression or diabetics.

I have traditional Medicare, so no. Vitamin D is an over the counter (OTC) supplement that traditional Medicare doesn’t cover.

A bottle of 400 capsules of D3 5000 units was $12 at Walmart.

United Healthcare is skimming off about $1,800/year in overhead and excessive Executive Compensation from the $12,000 or so of Medicare money that was transferred to them when you signed up. It’s nice that they’re returning some of that to you in Vitamin D.

What I’m doing for Medicare insurance at age 65
https://retireearlyhomepage.com/medicare2020.html

Why are people so hot to sell me a Medicare Advantage plan? Who’s being “advantaged” if I buy one? Let’s look at the numbers.

The actuarial value of your Medicare benefit is somewhere around $12,000/year. It varies a bit from state-to-state and county-to-county. Surprisingly, the lowest Medicare spending is in Hawaii with a value of $883/month or $10,596/year. Unsurprisingly Alaska has the highest average costs of a bit over $14,000/year.

If you choose Medicare Advantage, the Centers for Medicare & Medicaid Services (CMS), transfers that average $12,000/year benefit to the private health insurer you select. In turn, the insurer is allowed to skim off up to 15% of that $12,000 in admin expenses (i.e., $1,800/yr) though in many urban areas competition may limit that skim rate to 12% or so. That 15% figure relates to the so-called Medical Loss Ratio or MLR. Medicare demands that Medicare Advantage insurers spend at least 85% of your benefit on actual medical services and no more than 15% on overhead & profit. For Obamacare, insurers were allowed as much as 20% overhead & profit and an MLR of 80%.

The Gov’t bureaucrat that runs the $1.5 Trillion/year Center for Medicare & Medicaid services earms $165,000/yr and flies commercial. Who’s giving you a better deal?

intercst

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“Does your Medicare pay for Vitamin D?”

Medicare typically does not pay for OTC supplements, vitamins, and such. They do pay for
some drugs that require “nurse-directed instruction” or “use of a machine” to administer -
e.g. albuterol is typically introduced to the lungs via a nebulizer. Medicare will pay for
that medicine through Part B. Similarly, diabetic test strips for blood sugar will be paid
for by Medicare Part B - not Part D. Why this is done is quite beyond my understanding. But
finding out that this is how things work requires your pharmacist and/or doctor to
recognize how the system works. You sometimes have to push a little and keep asking how/why
things are covered.

If you go to Advantage Plans instead of standard Medicare, the plan defines what is covered
and what is not and how and why no longer matter. Other problems can arise - and likely will
eventually. The world tends to generate problems much more efficiently than the world develops
solutions.

Howie52

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Couple of points-

There are two tests for serum Vit D levels, 25-OH and 1,25-OH. The second is wildly more expensive to run for reasons that are opaque to me. Either gives a good indication of body stores of the Vitamin.
There may be reasons to order one over the other but I leave that to the endocrinologist.

5000 U of Vit D may be an ok dose for someone deficient in D to quickly build up stores, but it is possible to become Vit D toxic. For daily long term dosing, no more than 2000 U daily is recommended.

fd

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5000 U of Vit D may be an ok dose for someone deficient in D to quickly build up stores

Not really - they use 50,000 U for that.

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5000 U of Vit D may be an ok dose for someone deficient in D to quickly build up stores, but it is possible to become Vit D toxic. For daily long term dosing, no more than 2000 U daily is recommended.

Absolutely, and one reason why I have such a hard time with the study Leap posted, since they gave mega supplements to people with reasonably high D serum levels and blocked the very people who would have benefitted from the study who had low serum levels. And your blood levels should be monitored annually at a minimum. You don’t abuse fat soluble vitamins, but they can be a great tool. I would not do more than 2,000IUs without talking to my doctor first.

Blood testing is critical. DH and I are out in the sun 2-3 hours a day any day it is over 45F and not raining or very windy. We are considered pretty healthy, yet my D levels when tested came in at 55 and his were in the low 30s, both requiring supplementation that we did not think we would need. (He is much more diligent about using sun screen than I.) I have been for dexa scans twice in my life because of family history of osteoporosis, but after the second scan was told not to come back for a third. Even with low serum D, I have super strong bones, probably because of weight bearing exercise. I don’t supplement vitamin D for bone health.

I upped my existing 1,000 IUs to 2,000 with DH getting the OK from his doctor to increase to 5,000 IUs. He gets his serum D levels retested this week to see if he can cut back on the dosage.

Data is your friend, assuming it was collected correctly and without bias.

IP

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fd,

Are you seeing some of this in your practice?

https://discussion.fool.com/35039878.aspx