lupron and Medicare

Hello all,

I have Medicare A and B. I also have federal employee blue cross. My co-pay for Lupron through blue cross is $700.00 per 3 month shot. Does anyone, (i'm sure some do) have any experience with Medicare covering lupron injections? Thanks!

[Haliday]

My husband is on a medicare Advatage plan with Kaiser Permanente here in CA and pays nothing.

[Hidden in reply to Haliday]

thank you for your response.

[bluepacifica]

My husband's Lupron shot is covered by Medicare, 100%.

[Hidden in reply to bluepacifica]

thank you for your response.

[Spitzz]

I have Medicare A/B and a Medicare supplement insurance, + Part "D" drug coverage and I pay $0.00 - / NO CO-PAY and there is no deductible to be met ..

I don’t know the cost breakdown between Medicare and my supplemental insurances but it seems like something is out of whack – Do you have a Medicare part “D” additional coverage?

Is your oncologist giving you the Lupron, or are you getting it yourself from the pharmacy?? My oncologist administers my shot, there could be a difference.

Best of luck / Arnie

medicare.gov/part-d/

google.com/search?client=af...

[Hidden in reply to Spitzz]

thank you for your response.

[rhbishop2]

What a rip-off. A 1-month shot here (UK) is £70 (about $100) and that's the over the counter price.

[Hunt4Fun in reply to rhbishop2]

In US my 6 month (45mg) Lupron shot administered by doctor is billed by Cleveland Clinic to Anthem Blue Cross insurance at just over $18,000.00... no kidding. I see that online I can buy 6 month Lupron from Canadian Pharm for about $2,600.00. Even if I could get Clinic doctor to do prescription, my insurance company will not cover cost. Reoccurring 3 month PSA & T labs cost $690.00.

63 and must retire at end of year. Need go to Affordable Care. Very worried how going to afford medication/healthcare and the future ACA/healthcare until medicare. Thanks for the info on Medicare!

[bluepacifica in reply to Hunt4Fun]

What state do you live in?

[Hidden in reply to bluepacifica]

michigan

[bluepacifica in reply to Hidden]

michigan.gov/difs/0,5269,7-...

[Hidden in reply to bluepacifica]

thank you.

[rowboattom in reply to rhbishop2]

rhbishop2 In California I have been charged $1,000.00 (private Doctor) and 3 other time at UCSF $10,000.00 ( Cancer Hospital). In all cases I paid $0.00

[chascri]

I have traditional Medicare part A& B and a BCBS medical supplement planF. I was on lupron from 2006 to 2012 when I switched to Eligard every 6 months. I have never paid anything for either. I do pay about $250 per month premium for the Plan F Supp .

[bldn10]

I need to figure out what is wrong in my case because I have Medicare w/ the AARP (United) supplement and I paid $1300 and $988 for my 2 3-mo. shots. As I recall the full price was over $3000 each.

Bill/Memphis

[bluepacifica in reply to bldn10]

Which plan is your supplement? Are you getting your Lupron shot in your urologist or oncologist's office? It's not considered prescription when it is given by those doctors. We have Plan F so that we pay nothing. Here in Hawaii the supplement is reasonable, $275 for both of us. There is also a Plan F, high deductible, by the way. We don't have the high deductible.

[bldn10 in reply to bluepacifica]

Rx Preferred (PDP) A, Supp. Plan F

I do not have a urologist, my Lupron was prescribed by my med-onc in Va. and administered by an independent profusion clinic.

[bluepacifica in reply to bldn10]

Perhaps you have Plan F with a high deductible. We also have AARP United Healthcare as a supplement and pay nothing between Medicare and our supplement. I would start by calling your medical oncologist to make sure they have your AARP supplement insurance on file. Aloha.

[David20451]

Never ever paid for Lupron injections.

[DewayneH]

I have been on intermittent Lupron for almost 10 years. Texas Oncology has a contract with Medicare and my co-pay is paid by my supplement with United Health. I have no expense with my injections; of course I do have a monthly premium for the supplement but it has been well worth it.

D. Harris

[herb1]

Here's a little twist on the story. when I got my last Lupron 3 mo shot in Nov 2013, Medicare (I have A+B) paid 80% of the Lupron shot cost, but did NOT pay for the office visit! Now, my new urologist is saying the same is happening again. So I get the shot on a separate day, everyone gets paid [more!], and everyone (EXCEPT ME!) is OK with it!! Sounds like it's really hospital trick to make money.

Herb

[Hidden]

thank you for your response.

[Hidden]

Jakehannam, thanks for the information. Just to be clear, (i have lupron brain fog), your telling me you have fehb bcbs and medicare a and b? I'm a 65 year old retired federal employee and I continue to carry federal employee health benefits which is blue cross, blue shield basic plan. I also have Medicare a and b. therefore Medicare pays 80% and blue cross picks up the remaining 20% for a lupron injection? sorry for sounding like a dunce, but when i got whacked for 700, i lost it. I haven't had a lupron shot since i started Medicare. thanks again.

[bluepacifica in reply to Hidden]

Your supplement plan probably has a deductible, especially since it's called a basic plan?

[Hidden in reply to bluepacifica]

correct, 20%

[Hidden]

thank you sir for spelling it out in simple terms.

[groceries2010]

Hi. I'm on Lupron too. I also have Medicare and a blue cross blue shield Medigap plan. Medigap is a supplemental plan that --after you pay a deductible(160.00) at the beginning of the year and 40.00 per month, Medicare pays 80% and BCBS pays the rest. This year, by far, has been my most worry-free year since I started this journey. I hear that the premiums, in Michigan, are going up some at the beginning of the year. But it still won't be as outrageous as the co-pays I used to pay with Humana Advantage Plan.

gerry

[rowboattom]

Hello nameless9999 I have Medicare A B and United health care and I pay $0.00 for Lupron 3 month shot

[middlejoel]

Medicare pays for the Lupron shots. You have the same insurance combo as I did 2 years back and I had ADT-3 with no copay.

[skateguy]

Did you get the Lupron with a prescription? If not, the Lupron may have been processed under your medical benefits. Call your insurance company and find out which way is less expensive to you. I had a similar experience were I paid $800 for a 3 month Lupron shot and called a pharmacy to see if there was a generic version and found out that with a prescription, I could get the Lupron for $90.00. Call your insurance company and ask

[joeoconnell]

i have the same coverage A and B and while i was getting the shot from my urologist the co-pay was $80. later i switched to the VA and pay nothing. i am a disabled vet service connected i don't know if that accounts for not being charged