Mets and on Medicare

Artista928

Anyone here have mets and is on Medicare? I'm wondering if they cover chemo pills. I know they do IV. If not, how do you pay?

TIA

flashlight

Artista928, I don't have Mets, but if you are younger than 65 and have Medicare it will pay 80% of your cancer treatment. From another thread on this site about the ACA I learned that Medigap supplemental insurance is difficult to obtain so most go with a Medicare Advantage plan to cover the remaining 20%. If you don't have Medicare contact your MO and ask what they can do to help you.

Artista928

Thanks flashlight. I'm on social security disability for something else, not cancer. I have AARP plan F supplement too. I'm 55. I thought Medicare pays for IV meds but chemo pills falls under plan D which is for rxs and that's where I heard it doesn't. That's my confusion.

BevJen

Artista928,

I am on Medicare, over 65, and I also have Plan F plus a Plan D prescription plan through express scripts.I also have mets.

Medicare Part B will pay for things that you get at a hospital or doctor's office. This includes IV meds as well as things like faslodex/fulvestrant. That last drug can be given by shot (how I get it) or I believe that some centers now give it by pill (perhaps still in testing?) My understanding of the Medicare rules is that if it can be given in either pill or injection/IV form, then it's covered under Part B.

To find out for sure, you can check at medicare.gov, although I haven't had a lot of luck in calling in to the medicare help number. They don't seem to understand the question about meds. Perhaps your oncologist's staff can help you?

Also, I've found that at this time of year, the Part D people are extremely helpful because they want your business. You could try calling some of the larger Part D programs in your state and see what they say. I'll be they will help

Hannahllrose

Can anyone tell me what "MO" stands for? Thank you.

BevJen

MO means Medical Oncologist (as opposed to a surgical oncologist, breast surgeon, etc.)

MinusTwo

Hanna: Here's the link to the abbreviations. https://community.breastcancer.org/forum/131/topic...

Bev & Artists - I'd be interested in what you find out. I too have a traditional Medigap Supplement & a part D - Drug supplement. It's been my experience that pills come under the "part D" umbrella. But I do believe there are rules that anything has to be administered in a clinic or docs office.

mac5

Arista...I’m 70 and on Medicare A, B, and D for prescriptions. My Part D co-pay for Ibrance is over $2,000 per month.

The Medical Center Social Services helped me get on a Prescription Assistance Program for Pfizer, the manufacturer’s of Ibrance. If I can handle the SEs I’ll be on Letrozole and Ibrance ‘til...

BevJen

MinusTwo,

If a drug is available as both a pill and an infusion, then it's generally covered under Part B, not D. The pills don't have to be administered in a doctor's office or a clinic. The only thing that has to be administered in a doc's office, etc., is something akin to an infusion or a shot (e.g., faslodex) and that falls under Part B then.

I'm shocked by what mac5 writes about 2k a month. My copay for Ibrance is higher until I go into the donut hole then catastrophic, so the first payment of the year is very high. After that, I pay $594 a month. I haven't been able to qualify for any Pfizer or private foundation assistance bc I just retired.

However, you should look around and use the medicare part d tool at medicare.gov. During the open enrollment period each fall (I think Oct 1- to about Dec 1) you can switch your Part D program. I have express scripts, which seemed to work out the best for me, but in other states (I'm in Maryland) it may be different.

mac5

BevJen...my co-pay could be 3xtremely high because I have a low monthly cost Part D. The Plan may have Ibrance on a super high tier. Of course, when I purchased the Plan I had no idea I was going to be taking the drug. I’m not a big fan of Big Pharma, but without the Research where would we all be

candy-678

Just reading along for information for the future. I do not have Medicare yet, yet. I am on Social Security Disability as of January. So in 1 1/2 years I will switch to Medicare. I am now on COBRA and getting my health insurance from my old employer. My co pay for Ibrance is $35.00 a month!!! So, wow, looks like I will go broke when I get on Medicare!!!! I was hoping Medicare, even with a supplement, would be better than COBRA health insurance. Sounds like I was wrong in my thinking. Sigh.....

BevJen

Mac5- I pay very little for my Part D, but I check every fall during open season to see what each plan will do. You should keep that in mind. You are NOT Locked into your Part D program

Candy, I don't know much about this, but if you are willing to forego the choice of a physician and to get referrals, you can always go into a Medicare Advantage plan. In some states, those cover a whole lot more. I'd start trying to look into this now. A lot of people like them, especially when they end up covering the same docs as you already use. Or you can try to get a grant from one of the foundations supported by Big Pharma -- just look at info that Jaycee has posted a number of times on the Ibrance thread.

AliceBastable

I have a Medicare Advantage plan. If you live in a smaller town, they're not so good because of lack of options. In large urban areas, they're great, I even got to keep my primary doctor (although I've switched to another one since because I like her better). I don't pay a Part D premium, and my regular prescriptions (blood pressure, cholesterol, low-level diabetes and a beta blocker) are all free. I don't know about more complicated and expensive drugs - perhaps Google Medicare Advantage Plans and look for information on pharmacy benefits.

Spookiesmom

DH and I both have cancer. Both stage IV. We have Medicare Advantage plans. Neither of us pay for them. Yes, we pay for Medicare, not the insurance. Which is covering all our expensive meds. The MOs office did the paperwork for my Ibrance, I don’t pay anything for it. All my other meds are $3.60 for 90 days.

As was said, you can change during open enrollment starting in October. Do your homework now, talk to various reps to see what would work best for you. Yes, it can be very confusing, start now.