Medicare payments

[AuntHelen]

Does anyone know if Medicare pays for the Gazyva infusions?

[lankisterguy Volunteer]

Hi AuntHelen,

I have had most of the new targeted therapies but not Gazyva yet. I rely on my CLL Expert and his Physician's Assistant who is fantastic dealing with insurance and Medicare.

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I trust you are referring to traditional Medicare Part A & B and I hope you don't have a Medicare "Advantage" plan = Part C.

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Since it is infused in a hospital or clinic, the cost will be under Medicare Part B. If you also have a Medicare supplement policy type F or G, then there should be no copay at all.

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Len

[AuntHelen in reply to lankisterguy]

We have the original Medicare and the G supplement. Chose G because it takes care of the access fee to Mayo. Thank you for your response.

[cllady01 Former Volunteer in reply to AuntHelen]

Medicare part B pays for cancer treatments that are infused in hospital, clinic, or drs. office.

medicare.gov/Pubs/pdf/11931...

[AuntHelen in reply to cllady01]

CllDy01! Thank you so much. This is a relief! Have a great Day.🌼

[Hidden in reply to AuntHelen]

that booklet was issued in July 2017. Not sure gazyva approved for anything at that time. You need to consult the actual billers/payers.

[lankisterguy Volunteer in reply to AuntHelen]

Since you are under original Medicare- the hospital must advise you BEFORE treatment, if Medicare will NOT pay for any procedure or drugs given in the hospital.

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If they don't give you a written document and get you to sign an agreement to pay out of your own pocket, before the procedure, you will not be liable for the Medicare portion (80%) of the cost.

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Your G supplement usually pays the other 20% if Medicare pays.

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So make certain you don't sign any payment document, until you are certain what it covers.

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Len

[Hidden in reply to lankisterguy]

does the g supplement cover regular prescriptions? Massachusrtts does not use these letter options. Just 2 core and supplement 1

[lankisterguy Volunteer in reply to Hidden]

No

Medicare part A & B and the (Medigap) supplement plans only cover doctors and hospitals (infusions in clinical settings and drugs professionally administered in the clinic or hospital). ( e.g.: Rituxan or Gazyva infusions plus their pre meds) ehealthinsurance.com/medica...

cms.gov/newsroom/fact-sheet...

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Prescription drugs taken at home (self administered) are Part D, those are separate commercial insurance policies and do have copays (e.g.: Ibrutinib/Imbruvica, Idelalisib/Zydelig, Venetoclax/Venclexta)

en.wikipedia.org/wiki/Medic...

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Len

[skunkbay53]

Yes they do and PAN foundation

[Zeit]

Medicare paid for all my Gazyva infusions.

Zeit

[Hidden in reply to Zeit]

medicare part B?

[Zeit in reply to Hidden]

Yes, I have basic medicare with Antheum Blue Cross for a supplement. 100% was covered.

[AuntHelen in reply to Zeit]

It is strange, I have so many checks from Medicare, they don’t pay the facility directly, they send the payment to us. I have been on the lookout for the payment on theGazyva. They may wait until the treatment is complete in order to Bill medicare

[AuntHelen in reply to Zeit]

Thank you🌼