Medicare vs Cobra: Good morning... - Advanced Prostate...

Advanced Prostate Cancer

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Medicare vs Cobra

Survivor1965 profile image

Good morning

Wondering if anyone who is on Medicare can tell me what coverage they get on Xtandi, Lupron on part d? I’ve been riding Cobra for 3 years (MN state Cobra has no limit) but it’s crazy expensive. And Med Part D scares me because there is no out of pocket limit, with ongoing 5% copays.

Many thanks

34 Replies

My Lupron is covered in full. It is not a Part D drug. It is an in office procedure. Xtandi is a part D drug and others taking it will chime in later. Depending on your income you may qualify for copay assistance from the Patient Advocate Foundation. Prostate Cancer funds become available every couple months or so.

Survivor1965 profile image
Survivor1965 in reply to GoBucks

Thank you. Didn’t know Lupron was covered. It’s my understanding that part d is the same whether your on standard Medicare or an Advantage plan. We would never qualify for any low income assistance because my wife still works. Assuming My Xgeva would also be covered too since it’s office administered. Incidentally, Suns are favored by 4 😎

GoBucks profile image
GoBucks in reply to Survivor1965

Yes, Xgeva is covered in full. Don't know anything about Advantage plans except that they limit your Doctors. Re : Suns; I'm an Ohio State Buckeye. 😀

Echotango51 profile image
Echotango51 in reply to GoBucks

I have a Medicare advantage plan with Humana. I can see any doctor that takes Medicare.

dhccpa profile image
dhccpa in reply to Echotango51

I didn't know any Advantage plan worked that broadly. What state are you in?

Echotango51 profile image
Echotango51 in reply to dhccpa

I live in SC, my Humana is a PPO coastal, covers coastal SC and GA, however if I want to go to any other location, I just call Humana and they will put me in that network.

dhccpa profile image
dhccpa in reply to Echotango51

I decided to go with a Plan G supplement. More complicated but I'd heard bad stories about Advantage plans in general.

Echotango51 profile image
Echotango51 in reply to dhccpa

So far I haven’t had any problems. They pay all the claims with out question. My plan doesn’t cost me anything. I get dental, vision , drug plan and gym. What does plan G cost? If I have problems I will go on Medicare. I have been on advantage plans since I turn 65, 70 now.

dhccpa profile image
dhccpa in reply to Echotango51

$350/month for my wife and me. Plus we have separate Plan D drug plans that each cost $14-18/month.

Echotango51 profile image
Echotango51 in reply to dhccpa

Thanks, I’m going too look at plans when the open enrollment comes this year. My wife turn 65 next year, we will see works for us both.

Survivor1965 profile image
Survivor1965 in reply to dhccpa

Right but do you take Xtandi? Trying to get an idea of someone on Med that takes it.

dhccpa profile image
dhccpa in reply to Survivor1965

I don't take Xtandi. I believe it is very expensive even on Medicare unless the manufacturer cuts you slack.

The xgeva is nor fully covered, cost me 459.00 a month under united AARP advantage plan, the lupron is covered in full.

Survivor1965 profile image
Survivor1965 in reply to GoBucks

Do you know if the chemos’s would then be covered because they are technically in office/lab?

GoBucks profile image
GoBucks in reply to Survivor1965

I don't know but would guess so.

dhccpa profile image
dhccpa in reply to Survivor1965

I believe so but double check that. I may face the same situation soon.

Office and hospital procedures are covered. Mine and my wife's chemo were covered. Lupron covered because its done in a doctors office. Drugs however that fall into tier 5 have a large co-pay. In NY we have EPIC, a state coverage that helps immensely with drugs. Also my Xgeva is covered because its an office procedure.

Xtandi is stupid expensive, Medicare won’t pay for it and my part D has a $10,000 deductible plus a out of pocket of $668.00 a month. Can’t do without it so I pay up. Xtandi does have a zero cost assistance program if you qualify. Apply and see ,can’t hurt. Been on it now for4 1/2 years. Fighting the monster 🙏🙏🙏

So you didn’t qualify for the assistance?

No. My dad was on social security. (Low income ) he did qualify for zero with zytiga.

Because of my income(or lack of it) i get my Xtandi through the manufacture for free. They also have a co-pay system. Worth looking into.

We are in Michigan and Medicare pays fully for my husbands Lupron. His Zytiga is paid by an assistant grant through the University Hospital where he is treated. Don’t be afraid to try applying for financial assistance . He is retired and I work full time. They look at our income and savings . It helps us greatly.

Medicare part D plus a supplemental has been working fine for me, I have the Humana drug plan and Humana supplemental as well. Xtandi has a patient assistance program that’s pretty easy to qualify for, call them, the phone number is on the website. I haven’t paid for Xtandi for years. If you are disabled due to advanced prostate cancer you should qualify easily. If Xtandi turns you down at first you can appeal, everything is pretty easy.

Ed

Survivor1965 profile image
Survivor1965 in reply to EdBar

NiceNice to hear someone is winning on the med front. My concern is my wife is still working making pretty good money and with my dis income I wonder if we’d qualify for the xtandi assistance?

Medicare/Humana pays for mine, plus I get extra help through Medicare so I have no out of pocket expenses. In fact, just got statement in for last month. So far $79k has been paid out for Xtandi.

Your saying your xtandi is fully paid for thru Medicare??

EdBar profile image
EdBar in reply to Survivor1965

It is paid for through the xtandi patient assistance program, they bill your Medicare drug plan and pick up the cost of whatever your plan doesn’t pay. You have to contact Xtandi and apply, it’s pretty easy to qualify especially if you are currently on disability due to your cancer dx.

Ed

ppulatie profile image
ppulatie in reply to EdBar

My Medicare is paying fully. It is "extra care" due to my income situation. Never had to contact Xtandi.

So I think I got my answer on the Xtandi question. Huge Part D expenses with no out of picky max with the 5% copays. Maybe have to stick with the COBRA

There are SHIBA advisers in most states. They can plug the medications into their databases and help you make the decision. Here is a contact for them: seniorsresourceguide.com/di...

Thank you. I will make that call

When I first had Xtandi my copay if I retired was to be $6,000 for xtandi and other meds.. I worked an extra 1 1/2 years for med coverage before retiring and getting VA to pick up all meds acct being service connected disabled vet. Retirement income has been good, but not $6000 a month out of pocket good.

So your saying now that you retired VA picks up the costs of Xtandi?

Yes, $11/month. Not bad.... Disability from service finally pays off. Don't think you have to be disables, but never hurts. Well, maybe pain everyday for 49 yrs.

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