Treatment cost what to expect?

Claire_in_Seattle

This discussion has been an eye-opener. I missed all the financial worry as was treated in what is now part of the Kaiser Permanente system.

I had a lot of nominal co-pays, but all of my treatment and tests were covered. Because I was part of a clinical trial, there was no question about the Neulasta shots. They were covered as well because they were part of the treatment protocol. Two months after I got the Arimidex prescription, it went generic with the co-pay dropping from about $130 to $10 per month. So all in all, no more than about $2,000 per year for 2 years. Afterwards, it was more like $200 for treatment.

I was, of course, paying for medical insurance - something like $7,000 per year.

Now the dentist was another story. I spent about $25k over 3 years getting the neglect of my former incompetent dentist straightened out. I just didn't know. All is just fine on that front, and I now get my money's worth out of the dental plan I now have. BTW - this includes a reduction of about 25% for the out-of-pocket required for the third cleaning I need per year. This year, I think I came out even with dental, but over the past several years, I definitely came out ahead.

And, oh by the way, the mammogram I am getting in two weeks is completely covered as part of my wellness screening. And so are the shingles shots for the same reason. KP is extremely focused on prevention (because it's cheaper to treat healthy people) and they do a lot of public education around nutrition.

The downside of KP is that you need to stay within their system (other than for tertiary care), but I am just fine with that. Not everyone is, I have learned. So the trade-off (as in Canada and the UK) is that you give up choice. - Claire

DivineMrsM

It's been almost nine years that I've been dealing with medical bills due to mbc. I was covered by dh's employers insurance and each year I was juggling different health care changes. Coverage changed, companies changed, deductibles went up, copays went up. I learned as I went along.

This month I had to go on medicare and my prescription copays for Verzenio may be astronomical. On private insurance, the Verzenio company has a copay card that picks up the tab. So I paid nothing, What I don't understand is why there isn't a cap on how much money a person pays for prescriptions on medicare. Makes no sense. Why is there no out of pocket max at $7500 or $10,000. But no, you just keep paying and paying. No cap.

BCBS PPO insurance is pretty good. I had it before. My deductible raised each year, but I think the last time it was $750. Once I paid that, I paid 20% of all bills up to an out of pocket max of $5,000. Then no more payments. The insurance company whittles the bills down. If my onc charges $250 for an office visit, the insurance and the onc agree to a lower fee, and I only end up paying about $15 for the visit. Same with scans. If they cost $8,000, the insurance has an agreement with hospital to pay a lower cost, usually much lower, and if my deductible is met, I may end up paying about $500 copay instead of $1600. Many years, I never reached the out of pocket maximum.

No one likes paying these huge bills. But it is the cost of staying alive. I have to realize that I'm worth spending money, a lot of money, on my health. Still, the bills suck and I sometimes wonder what else I could have done with the tens of thousands of dollars I paid on health care over the last nine years.

Proverbs312b

does anyone have Cigna insurance and take ibrance? Do you typical have a copay? Around how much? Thank you!

DivineMrsM

Proverbs, if you have private insurance, the company that makes Ibrance offers a copay card. You can go online to get it, it’s pretty easy to do. You will end up with a $0 co-pay. Whatever your insurance doesn’t cover, the copay card takes care of. As long as its private insurance. Not the case for Medicare, no copay card for that.

DivineMrsM

This is what I want to see regarding Medicare prescription prices: a cap on what Medicare recipients pay. Democrats propose a cap at $2,000 a year. Republicans suggest $3,100. Next year I may be paying close to $10,000 for Verzenio because currently there's no cap on Medicare drug copays.

It sounds like it has a while to push something through, but both political sides seem to have understood that voters are demanding something be done with drug prices.

**Part of the NPR article:

Practically everyone is frustrated by high prescription drug prices. Voters have made clear they want Congress to do something about them.

On Thursday, the House of Representatives passed a bill that tries to deliver on that. It was a mostly party line vote — all Democrats voted to pass it, along with two Republicans.

The bill, HR 3, titled the Elijah E. Cummings Lower Drug Costs Now Act, is highly unlikely to get through the Senate, and the White House has announced that President Trump would veto it if it came to his desk.

But it does have several components that are reflected in other proposals in Congress, including a bipartisan bill in the Senate that might have better prospects.

"Obviously, Speaker Pelosi's proposals are the most ambitious — they're also the furthest from becoming actual law," says Benedic Ippolito, an economist at the American Enterprise Institute, a conservative think tank in Washington.

The bill lays out a vision for how Democrats would like to remake prescription drug pricing in this country, which could be seen as a promise to deliver on a bill like this if voters choose Democrats in the upcoming election.

Ippolito says he is glad to see some real proposals to address this issue. "It's not every day that we see both parties actively proposing legislation to meaningfully reduce drug prices," he says. "Whether one loves HR 3 or not, I think it's still a good thing that we have both parties taking this issue seriously."

******. Limit out-of-pocket costs for Medicare enrollees

Right now, there's no limit for how much seniors and others on Medicare spend on drugs out of pocket — unlike in most insurance plans. This bill would set a limit for Medicare patients at $2,000 a year.

It's not just seniors who get a break here. Right now, after enrollees have spent several thousand dollars on drugs, they're on the hook for 5% of ongoing costs, their prescription drug plan pays 15% and Medicare pays 80% — drug companies don't pay any part of it. Under the bill, that splitting gets changed around: Patients pay nothing after they hit the new cap, drug companies pay 30% and Medicare and health plans pick up the rest.

Stacie Dusetzina, a health policy professor at Vanderbilt University who has written extensively about Medicare Part D, says that drug prices were overall "much lower" in 2003, when Medicare Part D became law. (Before that, Medicare didn't cover drugs at all.) And, she says, many new, high-cost treatments have entered the market since then.

"In areas like cancer or multiple sclerosis or hepatitis C, all of these treatments are very, very expensive," she says. "So even if you only have to pay 5% of the drug's price, it gets incredibly expensive for the patient, and there's just no limit."

There's widespread agreement in Congress that this needs to be fixed. The bipartisan bill in the Senate has a similar redesign of who pays for expensive drugs, and it has an out-of-pocket cap for enrollees, although it's set a bit higher — at $3,100 per year

DivineMrsM

The House Just Passed Its Prescription Drug Plan — Here's What's In It

https://www.npr.org/sections/health-shots/2019/12/12/787190604/how-the-house-prescription-drug-plan-would-try-to-lower-drug-prices

pingpong1953

flashlight, I haven't done a formal survey, but I think if you'd poll the Canadians on this forum the vast majority of them would not trade our universal health system for the system in the US. I used to live in Cleveland, which has two huge competing hospital systems (The Cleveland Clinic and University Hospitals) and even then I had to wait for specialist appointments and tests and had to deal with doctors who blew me off. I feel sorry for people who are facing crippling deductibles and co-pays. If I would have stayed in the US and gone through all of the medical issues I've had in the past 6 years (BC being just one of them) I would be bankrupt, and my treatment would not have been better or more timely than the treatment I've gotten under Canada's universal health care system.

Murfy

This conversation has been enlightening since I am starting on Medicare this year and actively looking for an advantage plan that provides capped drug prices, affordable deductibles, and will fund the anti-cancer drugs I may need in the future. Have read other threads where some StageIV ladies have trouble getting the drugs they need. Am astounded by the differences between plans! Have narrowed down to a plan with excellent medical and so-so drug costs to a plan with very good drug prices and availability and so-so medical benefits. Does anyone have a Medicare advantage plan they are very happy with and can recommend?

Thanks!

MinusTwo

Murfy - don't know where you are in Texas, but I have friends who are on the Memorial Herman plan and others who are on Texan Plus. Both are pleased.

Personally I do not want an advantage plan. I like my own docs that I've gone to for years & want to pick the hospitals depending on the issue. For BMX, then reconstruction, then a BC recurrence with 5 months of chemo, ALND surgery, more chemo, rads for 5 weeks, Herceptin for year, all continuing blood work, many extensive & ongoing imaging/scans, physical therapy, all doc appointments, lymphadema treatment, etc - so far everything has been paid in full. The only exception is a deductible of around $185 at the first of the year and a deductible for hospital stays of around $1000. No co-pays. No other deductibles.

You are correct, that does not include drugs. Since I am not on any regular drugs, I buy the cheapest drug policy available. But my cancer drugs were all given and covered by the hospital or clinic.

I am very grateful for the wonderful care I have received.

Remember - ALL medicare plans, advantage or traditional, change EVERY year. Yes the drugs under both plans are capped, but FOR THAT YEAR only. Everything changes every fall - prices, rates, availability, what docs are accepting what plans, etc. It's sooooo annoying to have to re-evaluate the choices every year.