I am recently retired and have applied for Medicare Part A and B. I plan to purchase Medicare supplemental insurance policy F.
I'm looking at Part D drug plans. Are drugs like Revlimid, Velcade, etc covered by Part D?
Any suggestions regarding what Medicare plans are best for myeloma treatment?
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Re: Medicare Part D coverage of multiple myeloma treatments?
Hi, I have been on Medicare since 2010. I have parts A, B, and D. I never saw any advantage to supplemental insurance, but that is a personal decision that everyone needs to make on their own.
My Revlimid is covered by the Part D plan, and the first prescription will take you right through the "donut hole" and straight into the catastrophic coverage. Even with them paying 95%, my copay was still nearly $500.00 per month. Thankfully, I qualified for a grant from Patient Access Network, and they cover that additional costs for me. Your income alone, not your assets, determine your qualification for that assistance.
Velcade is covered by Part B since it is part of an outpatient treatment. I was still on the hook for $337.00 each treatment (400 bucks if I got Zometa too) but, once again, I got help from a Cancer Society grant, and they took care of what Medicare did not pay.
Now for a word about supplemental insurance. They try to scare the hell out of people with their lies. Every ad I have seen on TV tells that Medicare Part B only pays 80%, and I will probably owe the other 20%. Truth is, medicare pays 80% of the Medicare approved amount, not 80% of the original charge. You are stuck with about 20% of that approved amount, not 20% of the original charge. My experience over the years has been that the actual 80/20 figures – the Medicare approved amount – are at least 50% less than the original charge, and usually much lower than that.
Bottom line, I have always been able to cover my doctor visits and outpatient services copays with what was left out of my card playing money. That was a lot less that the supplemental insurance premiums would have cost me. These cancer treatments would have changed all of that were it not for a couple of generous grants that were made available to me. At first, I had mixed feelings about accepting any form of charity, but then I realized that a lot of this funding comes from companies like Celgene (maker of Revlimid). They are, in effect, paying the money back to themselves after getting a tax deduction for their original outlay to the charity. What a country!!
You might also want to look into state programs to help with these costs. I live in Illinois and we used to have a great prescription drug benefit plan for seniors and disabled. It was discontinued when the politicians found out they could buy more votes by spending that money on something else (free cell phones, perhaps).
Best of luck,
Charlie
My Revlimid is covered by the Part D plan, and the first prescription will take you right through the "donut hole" and straight into the catastrophic coverage. Even with them paying 95%, my copay was still nearly $500.00 per month. Thankfully, I qualified for a grant from Patient Access Network, and they cover that additional costs for me. Your income alone, not your assets, determine your qualification for that assistance.
Velcade is covered by Part B since it is part of an outpatient treatment. I was still on the hook for $337.00 each treatment (400 bucks if I got Zometa too) but, once again, I got help from a Cancer Society grant, and they took care of what Medicare did not pay.
Now for a word about supplemental insurance. They try to scare the hell out of people with their lies. Every ad I have seen on TV tells that Medicare Part B only pays 80%, and I will probably owe the other 20%. Truth is, medicare pays 80% of the Medicare approved amount, not 80% of the original charge. You are stuck with about 20% of that approved amount, not 20% of the original charge. My experience over the years has been that the actual 80/20 figures – the Medicare approved amount – are at least 50% less than the original charge, and usually much lower than that.
Bottom line, I have always been able to cover my doctor visits and outpatient services copays with what was left out of my card playing money. That was a lot less that the supplemental insurance premiums would have cost me. These cancer treatments would have changed all of that were it not for a couple of generous grants that were made available to me. At first, I had mixed feelings about accepting any form of charity, but then I realized that a lot of this funding comes from companies like Celgene (maker of Revlimid). They are, in effect, paying the money back to themselves after getting a tax deduction for their original outlay to the charity. What a country!!
You might also want to look into state programs to help with these costs. I live in Illinois and we used to have a great prescription drug benefit plan for seniors and disabled. It was discontinued when the politicians found out they could buy more votes by spending that money on something else (free cell phones, perhaps).
Best of 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 Part D coverage of multiple myeloma treatments?
I also chose Plan F for supplementary coverage and have been very happy with it. I don't have to worry about getting billed for co-insurance or co-pays. And, I don't have to worry about being billed for the amount above what Medicare approves if I see a provider who doesn't accept Medicare assignment. Since I travel out of the country periodically I like knowing that I have coverage for foreign medical expenses if I should need medical care while away. I have a grant from the LLS that pays for my insurance premiums. That means that Part B and D plus my supplemental plan are paid for.
When looking for part D plans, pay attention to the formularies that the different plans have. I was very happy with the plan I had through AARP until I developed a couple of acute medical problems last year and found that my plan didn't have a couple of the drugs that were prescribed for me in their formulary. Also, because of eye problems that I have from having shingles that went into one of my eyes, I use a steroid eye drop every day. My plan didn't authorize 3 of the prescription eye drops that my ophthamologist prescribed. They finally authorized the 4th one that he tried to prescribe. I found that, for 2015, that eye drop wasn't going to be in the formulary any more unless I purchased a much more expensive plan. I went plan shopping again and found one that would cost me less, but had all of the drugs in their formulary that my various doctors had tried to prescribe for me in 2014.
Revlimid has to be pre-authorized before it is dispensed by the specialty pharmacy in all of the plans. But, I haven't ever had any problems with it getting authorized. And, because it is so expensive, you will be in and out of the donut hole in the first prescription. After that first prescription, you will only pay 5% of the cost of any drug at the most for the rest of the year. My co-pay after the initial $2000+ for the year would be about $500 a month. I got a grant from the Chronic Disease Fund that pays the cost of my Revlimid.
A representative at one of the Part D plan companies told me that I didn't need to purchase a plan that was any higher than the lowest cost plan they offered because the cost of the Revlimid would put me into the catastrophic level of payment after one prescription of Revlimid. But, you need to pay attention to the formulary for that level plan and make sure that all of the drugs that you take, or might need to take, are in their formulary.
Do your research. A good webinar that can help you with things to look for when deciding on what plans to purchase is one that is on Oncolink.org. Christina Bach is a social worker with many years of experience in oncology at the Abramson Cancer Center at Penn. She has 3 webinars that she did in November on insurance for people with cancer. One is for Medicare, one for the ACA, and one for medical assistance. I went to one of her seminars a couple of years ago and the information that I learned really helped me in narrowing down the different plans that were available and helped me when talking to the various insurance company representatives.
A long answer to your questions, but I hope helpful,
Nancy in Phila
When looking for part D plans, pay attention to the formularies that the different plans have. I was very happy with the plan I had through AARP until I developed a couple of acute medical problems last year and found that my plan didn't have a couple of the drugs that were prescribed for me in their formulary. Also, because of eye problems that I have from having shingles that went into one of my eyes, I use a steroid eye drop every day. My plan didn't authorize 3 of the prescription eye drops that my ophthamologist prescribed. They finally authorized the 4th one that he tried to prescribe. I found that, for 2015, that eye drop wasn't going to be in the formulary any more unless I purchased a much more expensive plan. I went plan shopping again and found one that would cost me less, but had all of the drugs in their formulary that my various doctors had tried to prescribe for me in 2014.
Revlimid has to be pre-authorized before it is dispensed by the specialty pharmacy in all of the plans. But, I haven't ever had any problems with it getting authorized. And, because it is so expensive, you will be in and out of the donut hole in the first prescription. After that first prescription, you will only pay 5% of the cost of any drug at the most for the rest of the year. My co-pay after the initial $2000+ for the year would be about $500 a month. I got a grant from the Chronic Disease Fund that pays the cost of my Revlimid.
A representative at one of the Part D plan companies told me that I didn't need to purchase a plan that was any higher than the lowest cost plan they offered because the cost of the Revlimid would put me into the catastrophic level of payment after one prescription of Revlimid. But, you need to pay attention to the formulary for that level plan and make sure that all of the drugs that you take, or might need to take, are in their formulary.
Do your research. A good webinar that can help you with things to look for when deciding on what plans to purchase is one that is on Oncolink.org. Christina Bach is a social worker with many years of experience in oncology at the Abramson Cancer Center at Penn. She has 3 webinars that she did in November on insurance for people with cancer. One is for Medicare, one for the ACA, and one for medical assistance. I went to one of her seminars a couple of years ago and the information that I learned really helped me in narrowing down the different plans that were available and helped me when talking to the various insurance company representatives.
A long answer to your questions, but I hope helpful,
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 Part D coverage of multiple myeloma treatments?
Hello Charlie and Nancy
Thank you both for taking the time to answer my Medicare questions. I will begin Part A and B on February 1st, and I have decided to purchase Supplement Plan F.
Charlie, you make some good points for not purchasing a supplemental plan and thanks for detailing your personal experience. I will probably buy a low-end Part D plan knowing I will be through the donut hole with my first Revlimid prescription.
I appreciate your advice and suggestions, thanks.
Thank you both for taking the time to answer my Medicare questions. I will begin Part A and B on February 1st, and I have decided to purchase Supplement Plan F.
Charlie, you make some good points for not purchasing a supplemental plan and thanks for detailing your personal experience. I will probably buy a low-end Part D plan knowing I will be through the donut hole with my first Revlimid prescription.
I appreciate your advice and suggestions, thanks.
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Dano - Who do you know with myeloma?: Me
- When were you/they diagnosed?: Jan 2014
- Age at diagnosis: 65
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