Choosing a Medicare Part D Plan

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dorimak
dorimak Member Posts: 147
edited November 2019 in Stage IV/Metastatic Breast Cancer ONLY

I qualified for disability with MBC and transition to Medicare on 1/1/20. My insurance agent said for the Part D plans that there are many providers and most people get online and plug in their medications and it gives you the different plans and the estimated out of pocket. The problem with MBC is that we can't predict what drugs we will be on. I am currently on Xeloda. What if I choose a plan and there's a new drug and it's not covered. I was on IBRANCE for over a year thankfully covered by my work insurance, but the retail cost is 10K per month. Had anyone had any experience or advice to give me in choosing a plan? Thank you all.

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  • Cure-ious
    Cure-ious Member Posts: 2,626
    edited October 2019

    Dorimak- Thanks for posting this question! I don't have any experience with Medicare, but I was also wondering what plans people recommend. I heard that the "no pre-existing conditions" protection only applies to the first plan you choose? If so, you would not want to find out later that a different plan would have been better for MBC coverage...

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  • Spookiesmom
    Spookiesmom Member Posts: 9,568
    edited October 2019

    I currently have a Medicare advantage plan. Part D is covered with this. Also currently on ibrance. Getting that covered completely from patient assistance. Suggest you check with MO about that too before making your decision.

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  • vlnrph
    vlnrph Member Posts: 1,632
    edited October 2019

    As long as the pertinent parts of the ACA (affordable care act) are not repealed, the protection against discrimination due to pre-existing conditions remains intact.

    We have chosen different plans 3 times since my initial diagnosis and are happy that this concern is not an issue.

    The political campaign rhetoric a year ago, when a legislative change was threatened, helped inform people that it might be taken away. Pay attention when election time occurs. Know what the candidates propose and, if they don't include a statement of their position in their literature or on a website, ask!

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  • KayaRose
    KayaRose Member Posts: 183
    edited October 2019

    I would really appreciate some input on this also. One of my great fears is that my cancer spreads and I'm put on a drug I cannot afford. I'm currently on Medicare and have a Part D plan that I don't believe would cover any of the MBC drugs. So far I've been fortunate that all my treatments have been totally covered by Medicare and my BCBS supplemental plan but I worry so much about the cost of drugs I may have to take in the future.

    I'm going through all the available Plan D possibilities and am having a hard time figuring out which would be both affordable and provide the coverage I may need in the future.

    This unfortunately also comes at a time when I'm experiencing some swelling and pain under my arm for which my MO is sending me to get an MRI next week. Worried about that, worried about the drugs - seems there's always something to worry about. 5 years out and I still worry. Does it ever get easier?

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  • dorimak
    dorimak Member Posts: 147
    edited November 2019

    So I’ve done a lot of research and still feel like I’m no closer. I talk to the financial counselor at my MO office and she wasn’t really able to help. She did mention patient assistance but I 401(k) savings so not sure if I would qualify, even tho my only income is social security disability. Like IBRANCE is 10 K a month so any new drug is likely to be similar. It’s just sounds like there are a ton of part D plans and each one may or may not cover a particular drug or have a huge copay. The uncertainty we live with is hard enough, without having to worry about whether we may or may not get a life-saving drug because it’s not in the formulary sigh :(. One thing I did learn is that all chemotherapy is covered under the part B plan, but obviously I’m hoping to remain on or off drugs as long as possible.

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