Meds

[Janzian]

This is amazing! so much information. Thank you, all of you.
But I have a sideways question. Are treatments covered by Medicare, Supplemental, my drug plan, or not at all? I'm wondering if I should change my deductible, look for a different plan, or stay put.

Is anyone just avoiding treatment?
There are 2 other options - 1. eat well and hope the body heals itself enough to be comfortable, or 2. live on whisky and chocolate and crash happy.
Anyone trying those?

Thanks,

Jan

[Pete]

Hi Jan,

I have Medicare and an Aetna supplement. They cover the vast majority of my care. I just got my EOB for last month’s rtx treatment. Cleveland Clinic billed my insurance $49,000 for the treatment. Insurance paid $9,750. I paid $26.41. My supplement costs over $500/month, but it’s well worth it.

[annekat]

I don't know if Medicare would cover much Rituxin for me if I needed it. I can't afford a plan like Pete's. I do have a Medicare Advantage plan with most charges about the same as Original Medicare. The main advantage is there is an out of pocket limit of around $5-7000 per year depending on plan, which Original Medicare doesn't offer. So I'm assuming my first infusion of Rituxin, if it was approved, would cost me 20% of the Medicare approved amount, and if I needed another infusion in the same year, it would cost me the same unless it went over my out of pocket limit, in which case it would be either free or less. I am only discussing Rituxin here because it is the only standard treatment I would have trouble affording with Medicare only. The only other issue I've had with the Advantage plans, most of which include drug coverage, is a yearly deductible on drugs which makes it difficult to get my asthma meds. I intend to change this year to an Aetna advantage plan which is the only one I've found that has no deductible on drugs, even with no monthly premium. Another advantage to Advantage plans is some fairly limited coverage toward vision, dental, and hearing care, and free health club membership. You can find out a lot in the back of the Medicare handbook, but it's best to contact the companies on the phone and on their websites before making a decision. And the handbook doesn't give much info on the Supplement plans, which Pete has, and are more expensive, but it will tell you how to find out more. Good luck!
Anne

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[seied]

1. Eat well anyway, but it's not nearly enough to offset the damage caused by the illness.
2. Crash on chocolate and be happy, regardless.

[Janzian]

OK, I'll take your advice!

jan

[Masha]

Anne,
The are NGO’s Non Governmental Organizations to fill in the cost not covered. I wish I knew more details to give you. Ask at your doctors billing office about it.
Masha

[annekat]

Anne,
The are NGO’s Non Governmental Organizations to fill in the cost not covered. I wish I knew more details to give you. Ask at your doctors billing office about it.
MashaHi, Masha,
I know that there are things I need to apply for, such as getting on Medicaid in addition to Medicare, and getting "extra help" from Medicare, which I've been approached by my insurance plan about applying for. I just haven't done either of them because I can't get organized to do so. I did apply for Charity Care when in the hospital overnight last year, and got my entire copay written off. So there are avenues beyond what you mention. But thanks for the tip. Most of my treatments are affordable under my Medicare plan. The only exception is the deductible for my asthma inhalers, and I'm handling that by switching plans for no additional cost to me.
Actually, my whole spiel was to fill in the original poster, Jan, about what I know about Medicare Advantage Plans. Pete had mentioned Medicare Supplements, which are different, and not everyone can afford. It seemed like Jan was embarking on Medicare and wanted to know how to work it for our treatments. I mentioned Rituxin because that is the only one I'm not sure how I'd get if I needed it. But I don't need it, so far! If I ever do, I hear the company that makes it is open to providing to those truly in need. I didn't mention that because Jan didn't give the impression she, or he, was in financial hardship or was asking specifically about Rituxin. But I just surmised about Rituxin under Medicare because it is the main really expensive treatment that many people get. If I ever do need it, I will explore all options with my rheumy's infusion center billing department. Thanks!
Anne

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