Hi all,
Being new to Medicare and purchasing a high deductible Plan F supplemental policy, I have the following questions/concern:
What part of my insurance covers my Zometa infusion – Part A, Part B, or Part D?
I believe my billing code is 636.
I receive my Zometa infusion from an infusion clinic in a medical building associated with Baptist Health, but offsite from the hospital. I could go to the hospital and get the infusion outpatient.
I'm trying to plan treatments for the rest of the year and don't know which deductible is affected or whether it might influence my donut-hole coverage.
I guess I should ask about lab work too. I typically have labs drawn locally for CBC and Chem and send vials to my out-of-state clinic for myeloma markers. How is that covered while in remission? All labs are near normal so far?
Any insight would be appreciated.
Craig
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blueblood - Name: Craig
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: March 2014
- Age at diagnosis: 54
Re: Medicare coverage of Zometa & myeloma lab work?
Infusion is Part B, and with Plan F (what I have also), it is fully covered. Likewise with lab work.
It's remarkable. Since my diagnosis, I've had surgery, skilled nursing, chemo, constant labs and tests, and the only expense I have had is gas and valet parking at the hospital. I do get assistance for oral chemo co-pay from a foundation, but the rest was covered by Medicare and MediGap.
It's remarkable. Since my diagnosis, I've had surgery, skilled nursing, chemo, constant labs and tests, and the only expense I have had is gas and valet parking at the hospital. I do get assistance for oral chemo co-pay from a foundation, but the rest was covered by Medicare and MediGap.
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moonscape - Who do you know with myeloma?: me
- When were you/they diagnosed?: 11/2015
Re: Medicare coverage of Zometa & myeloma lab work?
Craig-
I also have Plan F and everything has been covered by Part B and my supplemental. I see my oncologist every 6 weeks, have a full complement of bloodwork done then and have a Zometa infusion, too. None of this has any bearing on your Part D coverage since that is for prescription drugs, not infusions.
If you are taking Revlimid, Pomalyst, Ninlaro, or any of the other oral cancer drugs, those are covered by Part D. You would have to pay a large amount for the first prescription in the year of one of the first 3, and then you would automatically be in and out of the donut hole and into catastrophic for the rest of the year ending December 31. Then on January 1 you would start the cycle again with having one large first payment and then 5% of the cost after that through the rest of the year.
You'll get the hang of all of this quite quickly. I got notification of my monthly premium costs for 2017 for my supplemental plan this week. I thought it was quite early this year, but then realized that October and open enrollment is in a couple of weeks.
Nancy in Phila
I also have Plan F and everything has been covered by Part B and my supplemental. I see my oncologist every 6 weeks, have a full complement of bloodwork done then and have a Zometa infusion, too. None of this has any bearing on your Part D coverage since that is for prescription drugs, not infusions.
If you are taking Revlimid, Pomalyst, Ninlaro, or any of the other oral cancer drugs, those are covered by Part D. You would have to pay a large amount for the first prescription in the year of one of the first 3, and then you would automatically be in and out of the donut hole and into catastrophic for the rest of the year ending December 31. Then on January 1 you would start the cycle again with having one large first payment and then 5% of the cost after that through the rest of the year.
You'll get the hang of all of this quite quickly. I got notification of my monthly premium costs for 2017 for my supplemental plan this week. I thought it was quite early this year, but then realized that October and open enrollment is in a couple of weeks.
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 Zometa & myeloma lab work?
Thanks Moonscape and Nancy,
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blueblood - Name: Craig
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: March 2014
- Age at diagnosis: 54
Re: Medicare coverage of Zometa & myeloma lab work?
In reading Nancy's reply, I have a question about Part D and drug copays/coverage. After the first large payment of the year, does a patient pay 5% of the cost of each drug every month, such as Pomalyst and Ninlaro?
That would be approximately $12,000 a month, unaffordable for those of us on two drugs – at least it would be unaffordable for me. My understanding is that once on Medicare, we are no longer able to accept the generous copay assistance offered by Celgene and Takeda. How are patients handling these large copays, or have I misunderstood?
Thanks to anyone who can enlighten me as it will soon be a concern when I transition to Medicare.
That would be approximately $12,000 a month, unaffordable for those of us on two drugs – at least it would be unaffordable for me. My understanding is that once on Medicare, we are no longer able to accept the generous copay assistance offered by Celgene and Takeda. How are patients handling these large copays, or have I misunderstood?
Thanks to anyone who can enlighten me as it will soon be a concern when I transition to Medicare.
Re: Medicare coverage of Zometa & myeloma lab work?
The specialty pharmacy your prescriptions come from should be able to help you find co-pay assistance. I have been on Revlimid, Ninlaro, and Pomalyst off and on over the last 2 years, and so far my out of pocket drug costs for them have been ZERO.
Medicare has covered all lab work and most of the imaging and doctor visit expenses.
If you are being treated at a major cancer treatment center, they probably have a benefits-insurance person who will help you with these grants and services. Some of the assistance programs even reimburse you for your insurance and Medicare premiums.
I did extensive research on Medicare supplement coverage and found that it was not a good deal for me. The premiums far out weighed any out-of-pocket costs I have incurred over the past 3 years.
Your state may also have a program to help with prescription drug costs. We used to have that where I live, but the politicians found they could buy more votes by giving away free cell phones, so that program got cancelled.
Having Medicare in no way affects your qualifying for one of the co-pay assistance grants, just as long as you are within the income guidelines (500% of federal poverty level). LLS even reimburses me for my Medicare premiums.
Charlie (grouchy German)
Medicare has covered all lab work and most of the imaging and doctor visit expenses.
If you are being treated at a major cancer treatment center, they probably have a benefits-insurance person who will help you with these grants and services. Some of the assistance programs even reimburse you for your insurance and Medicare premiums.
I did extensive research on Medicare supplement coverage and found that it was not a good deal for me. The premiums far out weighed any out-of-pocket costs I have incurred over the past 3 years.
Your state may also have a program to help with prescription drug costs. We used to have that where I live, but the politicians found they could buy more votes by giving away free cell phones, so that program got cancelled.
Having Medicare in no way affects your qualifying for one of the co-pay assistance grants, just as long as you are within the income guidelines (500% of federal poverty level). LLS even reimburses me for my Medicare premiums.
Charlie (grouchy German)
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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 Zometa & myeloma lab work?
I don't know how much Pomalyst and Ninlaro are a month, but Revlimid is about $10,500. My cost is around $560 a month. But as others have said, you can apply for a grant to help you pay for your drugs. My specialty pharmacy would have helped me with that if I hadn't already done it on my own. The social worker with your cancer center also should be able to help you apply for grants.
The LLS grants up to $10,000 a year for people with multiple myeloma. The Chronic Disease Fund, I don't remember the new name, also grants up to that much. I have one that pays for my Revlimid and another that pays my insurance premiums. Yes, there is an income cap but it is fairly generous. Some people are asked to pay a small co-pay with their grants and others don't have to pay anything.
Good luck getting the financial help you need. Cancer is an expensive proposition for us.
Nancy in Phila
The LLS grants up to $10,000 a year for people with multiple myeloma. The Chronic Disease Fund, I don't remember the new name, also grants up to that much. I have one that pays for my Revlimid and another that pays my insurance premiums. Yes, there is an income cap but it is fairly generous. Some people are asked to pay a small co-pay with their grants and others don't have to pay anything.
Good luck getting the financial help you need. Cancer is an expensive proposition for us.
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 Zometa & myeloma lab work?
Hi Nancy.
It's great to read that you have great insurance under Medicare. Can you tell me which carrier you use? I live in Florida, and so far the companies I've found do not include my current doctors.
Thank you so much!
It's great to read that you have great insurance under Medicare. Can you tell me which carrier you use? I live in Florida, and so far the companies I've found do not include my current doctors.
Thank you so much!
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