I recently had to add to my multiple myeloma with prostate cancer. Had surgery in January to remove the prostate. Just waiting to do another PSA test and hopefully it's all good. But here's my real situation at hand.
My wife who had neurosurgery last October with multiple complications has not been able to go back to work. She's getting much better, but we are on her insurance, which is 100% paid by her employer. We are about a month away from having to get on COBRA to keep her insurance for both of us. I was ok with that knowing that she will most likely go back to work in about 5 or 6 months.
But I will also be 65 in July, which means that I can not be on COBRA and have Medicare available to me. So I went to a health insurance specialist where I live. The quote that I got for a Medicare supplement was $131.82 per month through Mutual of Omaha. And a Humana Part D Drug Plan at $18.40 per month. The coverage for Revlimid, which is my biggest concern, is that after the donut hole I would pay $500 per Revlimid prescription with the Humana plan. My Aflac cancer policy pays $300 per Revlimid prescription. So I guess I could look at my cost being $200.
I would greatly appreciate getting some feed back on these quotes. And also how well does Medicare pay for a stem cell transplant? I have already done the stem cell harvest and have them waiting for me when I get past the prostate thing.
Thank You, George
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: COBRA and Medicare
The amount that you would pay for the Revlimid per month once you are in the donut hole is about what I pay. I think mine is around $550 a month. Your supplemental quote also is reasonable, but you don't mention which plan you are looking at. I have Plan F which covers all of my expenses with no co-pays or co-insurances. I chose that plan because I see the oncologist every 6 weeks and have a Zometa infusion and multiple blood tests each time, which are all covered 100%. So, all I pay is my monthly premium, which is $216 from AARP.
What's available to you depends on where you live. I know that someone who lives outside of Philadelphia has different plans available to them than I do (I live in Philadelphia). Figure what your annual expenses are likely to be and see which plan would fit your needs the best.
Nancy in Phila
What's available to you depends on where you live. I know that someone who lives outside of Philadelphia has different plans available to them than I do (I live in Philadelphia). Figure what your annual expenses are likely to be and see which plan would fit your needs the best.
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: COBRA and Medicare
Nancy,
Thank you for the reply. I just looked at the packet I brought home. It is the plan F. And the actual cost of Revlimid is $528.00 through one pharmacy. I live in California. I was given a rate sheet that actually shows the rates for the county I live in. I didn't realize there is different costs as far as where a person lives. I also see the oncologist every 6 weeks. My Zometa has been changed from monthly to every 3 months. Also have labs twice per month. 100% coverage sure sounds great. I will bring up the AARP option.
I go back to the health insurance specialist in June to go over everything and set it all up. If you don't mind me asking, could you let me know if you had your transplant done while you had Medicare? If so, was it covered?
Thank you, George
Thank you for the reply. I just looked at the packet I brought home. It is the plan F. And the actual cost of Revlimid is $528.00 through one pharmacy. I live in California. I was given a rate sheet that actually shows the rates for the county I live in. I didn't realize there is different costs as far as where a person lives. I also see the oncologist every 6 weeks. My Zometa has been changed from monthly to every 3 months. Also have labs twice per month. 100% coverage sure sounds great. I will bring up the AARP option.
I go back to the health insurance specialist in June to go over everything and set it all up. If you don't mind me asking, could you let me know if you had your transplant done while you had Medicare? If so, was it covered?
Thank you, George
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: COBRA and Medicare
George-
If the plan that has been quoted for you is Plan F, look at the details of what it covers. It should be the same everywhere. The difference in the different insurance company's Plan F is basically the cost. What you've been quoted is a good price.
When looking at the Part D prescription insurance, look at their formulary to see what the cost is for any other drug that you might be prescribed. You want to make sure that they would be covered. I found in my first year with the plan I had that a couple of the medications that I was prescribed that year for acute illlnesses weren't covered and had to go through the appeal process for them. One never did get approved and it was quite expensive. I switched plans my 2nd year on Medicare for a plan that did cover everything. Now, we want to be sure that our plans cover the new oral myeloma medications, Ninlaro (ixazomib) and Farydak (panobinostat).
I had my transplant while I was still working so I was on my employer's insurance plan. Your question about how much Medicare would cover of a transplant is one to ask Medicare and the financial department of the hospital where you would have the transplant.
I'm glad that you're doing your research now and asking all of your questions. It takes a lot of time, but it pays off in the long run. If in doubt, or have any other specific questions about the policies you are considering, call Medicare, the customer service rep of the company, and your broker.
Good luck in getting the best insurance for you,
Nancy in Phila
If the plan that has been quoted for you is Plan F, look at the details of what it covers. It should be the same everywhere. The difference in the different insurance company's Plan F is basically the cost. What you've been quoted is a good price.
When looking at the Part D prescription insurance, look at their formulary to see what the cost is for any other drug that you might be prescribed. You want to make sure that they would be covered. I found in my first year with the plan I had that a couple of the medications that I was prescribed that year for acute illlnesses weren't covered and had to go through the appeal process for them. One never did get approved and it was quite expensive. I switched plans my 2nd year on Medicare for a plan that did cover everything. Now, we want to be sure that our plans cover the new oral myeloma medications, Ninlaro (ixazomib) and Farydak (panobinostat).
I had my transplant while I was still working so I was on my employer's insurance plan. Your question about how much Medicare would cover of a transplant is one to ask Medicare and the financial department of the hospital where you would have the transplant.
I'm glad that you're doing your research now and asking all of your questions. It takes a lot of time, but it pays off in the long run. If in doubt, or have any other specific questions about the policies you are considering, call Medicare, the customer service rep of the company, and your broker.
Good luck in getting the best insurance for you,
Nancy in Phila
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: COBRA and Medicare
Nancy,
I have to say thank you for your input and advice. I spoke to the health insurance specialist and asked about Ninlaro and Farydak. Both are covered. Also called my transplant hospital and they are going to have their financial / insurance advisor call me back, but it looks like having Medicare and my supplemental will take care of the transplant.
Sure is nice having the Beacon and folks like yourself to help out.
Thank you,
George
I have to say thank you for your input and advice. I spoke to the health insurance specialist and asked about Ninlaro and Farydak. Both are covered. Also called my transplant hospital and they are going to have their financial / insurance advisor call me back, but it looks like having Medicare and my supplemental will take care of the transplant.
Sure is nice having the Beacon and folks like yourself to help out.
Thank you,
George
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Castaway - Name: George
- Who do you know with myeloma?: just myself
- When were you/they diagnosed?: 1/24/14
- Age at diagnosis: 62
Re: COBRA and Medicare
George-
I'm glad that my responses to your questions were helpful. All of the stuff you need to look at when getting ready to switch to Medicare is confusing. It sounds like you have things figured out now.
Nancy in Phila
I'm glad that my responses to your questions were helpful. All of the stuff you need to look at when getting ready to switch to Medicare is confusing. It sounds like you have things figured out now.
Nancy in Phila
-
NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
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