Firmagon cost and what Medicare pays

[Want2no]

My husband has been receiving firmagon shots for about 10 months. He has Part B Medicare only. He has been paying $90ish a month until the deductible is met and then it goes down to $10ish each month. We are both very new to all the different plans and how things work in the health industry. We were told about the patient advocacy network. The billing office where my husband gets his firmagon shots did all the work basically and he was approved for a grant to be used towards the shots or to help with Medicare premiums. After doing my own research, it turns out that the grant, which will be administered, for treatment they provide, by the cancer facility will not necessarily help my husband with the cost of his treatment as much as it will help the cancer facility recoup the difference between the cost of the drug—firmagon, and what Medicare allows. So my question is: if we choose to use the grant to pay for Medicare premiums and/or other things associated with his illness, can the facility turn around and charge us full cost for the firmagon shots even though I believe they have accepted assignment from Medicare?

[Bdale]

Want2no if the provider accepts Medicare they can only charge you the 20% that part B doesn't pay. But your part should be 20%of the Medicare approved amount. Does your husband have a Medicare supplement or a Medicare Advantage plan? A Medicare Supplement would pay the 20%,after a $266 annual deductible. A Medicare Advantage plan would still have you pay the 20%, but the premium is very low or $0. You can private DM me if you need any help.

[Want2no in reply to Bdale]

Thank you. He does not have a supplemental or an advantage plan. Those are things we might look into next fall though.

[Concerned-wife in reply to Want2no]

I recommend that you don’t wait until fall to study Medicare supplements or MA plans. Accept BDake’s offer to DM. Go to Medicare.gov. Or call the free SHIP counseling in your state.

[j-o-h-n in reply to Bdale]

Bdale.... You're cool..... Thanks..

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 03/09/2023 6:47 PM EST

[maley2711 in reply to Bdale]

You are certain that all Advantage plans require the 20%?????? some are $0 premium, but others can range in the $100-$200 area, and have much greater coverage.

[Hidden]

Yeah, 20% of all Part B injections.(Except vaccines) And yes, it has to be 20% of the Medicare negotiated cost.