This topic is about someone who recently moved to Kansas City and switched their health insurance from Original Medicare to an Aetna Medicare Advantage plan, with Kansas Medicaid as secondary coverage. They are facing challenges in getting their colostomy supplies covered, which were previously fully covered under Original Medicare. Aetna is denying coverage for certain items, claiming they are not included under Part B.

Here are some helpful suggestions and insights:

1. Contact Aetna to get clear information about your plan's benefits, especially regarding "Durable Medical Equipment." Ask why the specific stoma barrier is excluded and find out which alternative products are covered.

2. If Aetna covers only 80% of the costs, Kansas Medicaid should cover the remaining 20% after Aetna processes or denies the claim. Reach out to Medicaid to find out their preferred or in-network supplier for ostomy supplies.

3. Request a list of covered brands and styles. Switching to a different product that fits Aetna’s formulary might help restore full coverage.

4. Appeal Aetna’s denial. If needed, have your supplier provide documentation showing that the barrier is the correct match for the approved pouch.

5. Consider whether returning to Traditional Medicare could help avoid high copays and out-of-pocket costs associated with Advantage plans.

6. For immediate assistance, use the forum’s “Surplus Supplies” thread. Members can donate extra supplies. Post the specific items you need and arrange for shipment through private messages.

7. Remember, insurers must provide the specific coverage rule or code they are using. Request this explanation in writing to help with appeals or to secure Medicaid secondary coverage.