Medicare co-pays

GoodbyeGirl,

Reporting from my own experience, I went on Medicare Parts A & B, with a supplemental policy through United Healthcare/AARP plus a Part D drug program. My current treatment is Faslodex (via shots) and Ibrance.

The Faslodex is completely covered by Medicare Part B and my supplemental, because it's administered in a doc/hospital setting. Good thing, because it's over $3000 per time, even with what Medicare pays.

The Ibrance is "covered" under my Part D (I believe that the Part D programs MUST "cover" these drugs.) The kicker is that the copays are high. I believe that this year, Medicare requires an individual to pay $5150 (as you move through the various stages of coverage in the Part D program) plus whatever the deductible is on your Part D program ($400 this year) before you move to the catastrophic coverage and then you only pay about $500-600 PER CYCLE (meaning every 4 weeks). So it's not pretty.

Note that there are many foundations that provide co pay help, but you must have a household income (for 2 people) of approximately $80k or less. That includes any social security $$ that you are drawing as well as pensions, income from investments, etc.

I have a friend who has psoriatic arthritis. The biologics that are used with that are similarly priced to cancer drugs. She signed up for Medicare Part A (which you are required to do or you will be penalized later in your fees -- make sure you check that out) but that's it -- because she's still on her husband's private insurance. She has paid zippo for her biologics, because the drug plan under her private insurance either pays it all (no copay) or in some instances, tells her to get one of those cards that the pharmaceutical companies give out that are drug specific -- you CANNOT use those with Medicare, but if you retain your private insurance, and it has drug coverage, this is important.

Takeaway? I'd call the private insurance company and ask them about the drug coverage for this stuff, and that's how you can compare.

Bev