I applied for and qualified for a $10,000 grant from the Chronic Disease Fund that pays for my Revlimid. I also qualified for a $10,000 grant from the LLS that pays my Medicare Part B, Supplemental and Medicare Part D premiums. If I had any co-pays or co-insurances for medical appointments and some other medical expenses, the LLS grant would cover those, too.
Talk with the social worker or nurse navigator about programs to help with myeloma expenses. The Cancer Support Community also has a good book about the cost of cancer care that gives the names and contact information for multiple patient assistance programs. It is a free book that you can order online. It has lots of other good financial information in it, too. Well worth sending for.
Nancy in Phila
Forums
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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: Medicare coverage of Revlimid
Nancy;
I am a myeloma patient on continuous Revlimid. From your post about patient assistance plans, I understand it's possible to receive financial help from more than one charitable organization, if necessary to cover both pharmaceutical and Medicare costs. So glad I read your post, as I was informed that it was inappropriate to apply to more than one organization. Currently, I'm waiting to hear back from LLS and see what they will allow me.
Thanks for posting such valuable and helpful information.
Reina
I am a myeloma patient on continuous Revlimid. From your post about patient assistance plans, I understand it's possible to receive financial help from more than one charitable organization, if necessary to cover both pharmaceutical and Medicare costs. So glad I read your post, as I was informed that it was inappropriate to apply to more than one organization. Currently, I'm waiting to hear back from LLS and see what they will allow me.
Thanks for posting such valuable and helpful information.
Reina
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Reina
Re: Medicare coverage of Revlimid
Reina,
There are a lot of assistance programs out there. Your treatment facility and pharmacy should be able to hook you up with the needed help if you qualify. After all, that way they are assured of getting paid.
Some assistance plans cover things that others do not. I currently have one that covers the co-pay on my Revlimid and another that covers the co-pays on other costs of chemotherapy.
Some do not pay for consultation doctor visits or diagnostic procedures while some pay on just about anything. This means you can "sharp shoot" and use a particular plan for a particular purpose that another one will not pay.
I have one grant that will even reimburse my Medicare insurance premiums. I may just take them up on that and use the money to offset my out of pocket expenses on the things that are not covered.
Hang in there and good luck.
Charlie.
There are a lot of assistance programs out there. Your treatment facility and pharmacy should be able to hook you up with the needed help if you qualify. After all, that way they are assured of getting paid.
Some assistance plans cover things that others do not. I currently have one that covers the co-pay on my Revlimid and another that covers the co-pays on other costs of chemotherapy.
Some do not pay for consultation doctor visits or diagnostic procedures while some pay on just about anything. This means you can "sharp shoot" and use a particular plan for a particular purpose that another one will not pay.
I have one grant that will even reimburse my Medicare insurance premiums. I may just take them up on that and use the money to offset my out of pocket expenses on the things that are not covered.
Hang in there and good luck.
Charlie.
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Grizlump - Name: Charlie
- Who do you know with myeloma?: me
- When were you/they diagnosed?: June 2014
- Age at diagnosis: 67
Re: Medicare coverage of Revlimid
I have been on Revlimid for approximately 9 months. When I first started, the costs appeared to be staggering.
I decided to try for a grant. My wife told me I was wasting my time as no one would give me a grant once they saw my financial position. I applied to 4 agencies. I was rejected by 3 but was successful in getting a $10,000 grant from the Leukemia & Lymphoma Society.
Give it a shot. It will only cost you a couple of hours to fill out the forms.
Good luck.
I decided to try for a grant. My wife told me I was wasting my time as no one would give me a grant once they saw my financial position. I applied to 4 agencies. I was rejected by 3 but was successful in getting a $10,000 grant from the Leukemia & Lymphoma Society.
Give it a shot. It will only cost you a couple of hours to fill out the forms.
Good luck.
Re: Medicare coverage of Revlimid
I was diagnosed 7/2010, but just recently discovered that the leukemia society has a "grant" eligible to those diagnosed with multiple myeloma. I think current amount is $10,000. You can go to lls.org to apply and/ or call them for more information. I just applied in the last couple weeks so not sure on how long it takes etc.
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baranski
Re: Medicare coverage of Revlimid
I am a Medicare/Tricare for Life (retired military). Does the Cancer Centers of America or the Mayo Clinic accept any of these for their treatment?
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TheQuill - Who do you know with myeloma?: No one
- When were you/they diagnosed?: Nov 16, 2015
- Age at diagnosis: 68
Re: Medicare coverage of Revlimid
Hello everyone.
I recently started exploring my options when eventually my wife and I transition to a Medicare Supplement program. I have been Medicare-eligible and filed the necessary forms in time when I turned 65, almost 4 years ago, to postpone signing up with a Medicare Supplement program till we do not have the employer coverage through my wife's employment. My wife plans on working for at least 5 more years. She loves what she does and I keep busy with my own activities and I am sure she is not continuing to work to pay any bills or to have this Medical Coverage. At least for now my Revlimid copay is only $20.00 for every 4 weeks.
I went on the various local websites (Northern California) and found that the Revlimid copayments are about the same till one reaches the out of pocket expense of about $4,850. Thereafter, though, some companies would charge as much as $379/month for the copay, whereas Kaiser, in particular, would be charging only $12.00 per month. I did compare the specifics; Revlimid and 15 mg x 15 per month, which is my current dose on the maintenance program.
This is quite a difference! And the monthly premiums for the programs I compared are quite similar. Of course, I would have to get the Part D and whatever else is required to get the best coverage when I sign up for the Medicare Supplement programs.
Am I making some mistake here? Or is this the difference between an HMO and a private insurance?
K_Shash
I recently started exploring my options when eventually my wife and I transition to a Medicare Supplement program. I have been Medicare-eligible and filed the necessary forms in time when I turned 65, almost 4 years ago, to postpone signing up with a Medicare Supplement program till we do not have the employer coverage through my wife's employment. My wife plans on working for at least 5 more years. She loves what she does and I keep busy with my own activities and I am sure she is not continuing to work to pay any bills or to have this Medical Coverage. At least for now my Revlimid copay is only $20.00 for every 4 weeks.
I went on the various local websites (Northern California) and found that the Revlimid copayments are about the same till one reaches the out of pocket expense of about $4,850. Thereafter, though, some companies would charge as much as $379/month for the copay, whereas Kaiser, in particular, would be charging only $12.00 per month. I did compare the specifics; Revlimid and 15 mg x 15 per month, which is my current dose on the maintenance program.
This is quite a difference! And the monthly premiums for the programs I compared are quite similar. Of course, I would have to get the Part D and whatever else is required to get the best coverage when I sign up for the Medicare Supplement programs.
Am I making some mistake here? Or is this the difference between an HMO and a private insurance?
K_Shash
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K_Shash - Name: K_Shash
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: November 2014
- Age at diagnosis: 67
Re: Medicare coverage of Revlimid
Hi K_sash
Briefly, each state has different Medicare supplement policies. HMO in California pays about everything, even though no premium except deduction from social security. HMO without premium in Ohio (where I live) charges way more than if you had straight Medicare, e.g., I paid $150 co-pay for MRI which would have cost about $85 with Medicare alone. A specialist visit is $45, 20% of Medicare cost is about $12. There is co-pay which is way over original Medicare's 20% charge. I have only become aware of this recently and can't wait until I can get out of my Medicare Advantage Policy and return to straight Medicare.
Please, all, consider carefully what you are paying. Read articles on "Do I need a Medicare Supplement policy?" Do your research. I had surgery two years in a row. Even then it cost me more with my supplement policy than straight Medicare would have cost me. Perhaps better to buy the best drug coverage you can.
Sorry for ranting and raving, I missed changing my insurance by one day.
Smarty
Briefly, each state has different Medicare supplement policies. HMO in California pays about everything, even though no premium except deduction from social security. HMO without premium in Ohio (where I live) charges way more than if you had straight Medicare, e.g., I paid $150 co-pay for MRI which would have cost about $85 with Medicare alone. A specialist visit is $45, 20% of Medicare cost is about $12. There is co-pay which is way over original Medicare's 20% charge. I have only become aware of this recently and can't wait until I can get out of my Medicare Advantage Policy and return to straight Medicare.
Please, all, consider carefully what you are paying. Read articles on "Do I need a Medicare Supplement policy?" Do your research. I had surgery two years in a row. Even then it cost me more with my supplement policy than straight Medicare would have cost me. Perhaps better to buy the best drug coverage you can.
Sorry for ranting and raving, I missed changing my insurance by one day.
Smarty
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smarty - Name: Marti
- Who do you know with myeloma?: myself Smoldering Myeloma
- When were you/they diagnosed?: May 1, 2015
- Age at diagnosis: 76
Re: Medicare coverage of Revlimid
Smarty-
When I was switching over to Medicare almost 3 years ago, I did lots of research and attended a seminar specifically for people with cancer who were going to be going on Medicare. The person who led the seminar suggested that the Medicare Advantage plans would not cover a lot of what we as people with cancer would need, especially concerning prescriptions. Each state has different insurance policies available for people with Medicare. I have found that the supplemental policy that I got covers everything that I've needed. So, I only pay my premium and nothing else. It is a little more expensive than some of the other supplemental plans, but I have no co-pays or co-insurances to pay.
When deciding on a Part D plan, I talked with a couple of different insurance representatives. They both said that it wasn't necessary to purchase an expensive plan since I would go through the donut hole and into catastrophic coverage within one prescription of Revlimid at the beginning of the year. What I found is most important to look at is what percentage you would have to pay of the tier 5 drug level cost. For example, if Revlimid costs $10,000 a month and under catastrophic coverage you would be responsible for 5% of that which is $500. Your Part D plan would cover a percentage of that $500. I've seen anywhere from 25% to 65% of that amount that you would be responsible for. So, you need to pay attention to what percentage you would be responsible for.
The other thing that I've learned to pay attention to is what drugs are covered in the formulary for the plan you are considering. This means look for all of the drugs that you take and what ones you think that you might be prescribed for any acute problems that may arise. The first year of coverage in the plan that I chose it didn't cover 3 of the acute drugs that I got prescribed. So, the next year I looked for a plan that did cover more things. I switched plans and was very happy with the new plan.
The third thing that could be really important is which specialty pharmacy the plan uses for prescriptions like Revlimid. The two that I've had to use are Optum Rx and CVS Caremark. Both of those have been extremely reliable in getting my prescription to me on time each month and both have been proactive in getting a new prescription from my oncologist's office each month.
A lot to do to get the coverage that works the best for you, but it is well worth the time and effort that you put into it. You can also use your state insurance help network to assist you in working through all of this. I don't remember what the name of the agency is, but it is in some of the other posts in this insurance part of the forum.
Good luck,
Nancy in Phila
When I was switching over to Medicare almost 3 years ago, I did lots of research and attended a seminar specifically for people with cancer who were going to be going on Medicare. The person who led the seminar suggested that the Medicare Advantage plans would not cover a lot of what we as people with cancer would need, especially concerning prescriptions. Each state has different insurance policies available for people with Medicare. I have found that the supplemental policy that I got covers everything that I've needed. So, I only pay my premium and nothing else. It is a little more expensive than some of the other supplemental plans, but I have no co-pays or co-insurances to pay.
When deciding on a Part D plan, I talked with a couple of different insurance representatives. They both said that it wasn't necessary to purchase an expensive plan since I would go through the donut hole and into catastrophic coverage within one prescription of Revlimid at the beginning of the year. What I found is most important to look at is what percentage you would have to pay of the tier 5 drug level cost. For example, if Revlimid costs $10,000 a month and under catastrophic coverage you would be responsible for 5% of that which is $500. Your Part D plan would cover a percentage of that $500. I've seen anywhere from 25% to 65% of that amount that you would be responsible for. So, you need to pay attention to what percentage you would be responsible for.
The other thing that I've learned to pay attention to is what drugs are covered in the formulary for the plan you are considering. This means look for all of the drugs that you take and what ones you think that you might be prescribed for any acute problems that may arise. The first year of coverage in the plan that I chose it didn't cover 3 of the acute drugs that I got prescribed. So, the next year I looked for a plan that did cover more things. I switched plans and was very happy with the new plan.
The third thing that could be really important is which specialty pharmacy the plan uses for prescriptions like Revlimid. The two that I've had to use are Optum Rx and CVS Caremark. Both of those have been extremely reliable in getting my prescription to me on time each month and both have been proactive in getting a new prescription from my oncologist's office each month.
A lot to do to get the coverage that works the best for you, but it is well worth the time and effort that you put into it. You can also use your state insurance help network to assist you in working through all of this. I don't remember what the name of the agency is, but it is in some of the other posts in this insurance part of the forum.
Good luck,
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: Medicare coverage of Revlimid
Hi Nancy,
Thank you for your detailed explanation of benefits for seniors. As you can probably guess, I am just smoldering and not requiring medication for cancer at this time. Your advice for a very good supplement plan is something I will have to consider. It is not only states that have different policies but even counties. They don't make it easy for us.
I appreciate your advice on drug coverage. I will research that carefully before I make my changes for the new year.
Thanks again for your insight.
Marti
Thank you for your detailed explanation of benefits for seniors. As you can probably guess, I am just smoldering and not requiring medication for cancer at this time. Your advice for a very good supplement plan is something I will have to consider. It is not only states that have different policies but even counties. They don't make it easy for us.
I appreciate your advice on drug coverage. I will research that carefully before I make my changes for the new year.
Thanks again for your insight.
Marti
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smarty - Name: Marti
- Who do you know with myeloma?: myself Smoldering Myeloma
- When were you/they diagnosed?: May 1, 2015
- Age at diagnosis: 76
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