Note: I have altered a much broader message from Medicare since we CLL patients realistically only have the option of changing our Part D drug plan. And that is where the cost of CLL targeted drugs hit our pocketbooks. All the other parts of Medicare are essentially fixed for us, we cannot change them due to our pre- existing condition. - Len
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Mark your calendars — Medicare Open Enrollment starts October 15! It's your chance to review or change your prescription coverage for next year. Get a head start by previewing your 2024 options to see if there's a better fit for your needs and budget. medicare.gov/drug-coverage-...
Note: You may be seeing and hearing a lot of information about Medicare plans. Start at Medicare.gov, your official source for unbiased Medicare information, to find the type of coverage that best meets your needs. medicare.gov/drug-coverage-...
Sincerely, The Medicare Team
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Hi Len, When you’re on Medicare, can you only change your drug plan yearly? I’ll be going on Medicare in a few months. My understanding is to pick the best supplemental at the start because changing would be very expensive due to CLL. Is that accurate information? Thanks, Jeanmarie
Wisely choose your supplement (Medigap) plan (type G) that covers the copay on Part B since you cannot change it. This will mean that any medical procedure administered by a medical professional that accepts Medicare will be covered with no copay. You should enroll in Part A & B Medicare at 3 months before your 65th birthday and then get your supplement plan in place.
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Your Part D insurance for drugs you take by yourself (without medical supervision) are plans you can change once per year, and you can compare the total annual cost of those plans by going to medicare.gov/plan-compare/#... and entering all the drugs you expect to take in 2024. Then review the competitive plan costs each year in Oct to early Dec.
Thanks for adding that important information- I was not aware of that.
I wish I could do that with the Mutual of Omaha plan I bought when I lived in California and then dragged with me when I moved back to New Jersey.
I pay more per month than my wife, who bought the same plan here in New Jersey (she is 10 months younger and age is a factor, but it should not be that much).
I disagree with that statement. The specialty pharmacies all seem to work with the insurance companies, but the drugs are NOT delivered through your local brick & mortar pharmacy. They are usually shipped FedEx overnight.
The drugs are listed in Medicare.gov drug list, but sometimes by the Patented sales name like Imbruvica and some by the generic like ibrutinib.
And in my experience, the specialty pharmacies are very active in helping reduce your copays and work with your CLL expert doctor's staff to control the overall costs.
Mostly for USA but possibly elsewhere, I encourage all CLL patients that are taking an expensive targeted therapy to ask for help navigating payments from their CLL expert doctor, actively work with the specialty pharmacy and enlist organizations like LLS.org to find copay assistance. I have had one of the three come through for me at different times since 2015, and have not paid a copay in 8 years of targeted therapy.
They are part of many drug plans, they just aren't carried by local pharmacies due to expense and monitoring needs. And they are most likely high tier, high copay sections. My Venclexta is covered, but it has a high copay and I qualify for free drug from the company, so don't get it through them. I got it from a specialty pharmacy the drug company has a contract with.
Why are all other parts of coverage fixed because of preexisting conditions? I’ve got a few years to go before I’m forced off my private plan and onto Medicare. Im not looking forward to the switch. I worry about the funding challenges the US government has and what might happen. I think what is playing out in the NHS in the UK today is in store for US seniors. I hope I’m wrong….
Why- it was built like topsy by our congressional representatives and like everything they do it is like a racehorse built by a committee en.wiktionary.org/wiki/a_ca...
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I share your hope that they figure it out in time, but based on the recent events with funding the government, I seriously doubt it.
Of relevance, a recent Wall Street Journal article highlights an alarming trend, many hospital systems in US are dropping, refusing to see patients with Medicare advantage, citing low reimbursement and amnisistrative hurdles to getting paid.
So, i believe(opinion) that we should get, keep Original medicare, with good Medigap coverage( G) as long as we are able.
Stay tuned, things change. But for now, the new luxury in the over 65 group is affording best Insurance coverage.
I think it might be the *type* of Medicare Advantage that plays in to this, there are Medicare Advantage HMO's that try to squeeze like non Medicare HMO's, that places are dropping. I have a Medicare Advantage PPO, so I can even go out of network and get *some* coverage. The big plus, is a Medicare Advantage plan has some sort of cap on out of pocket maximum we have to pay; mine is $6500. If you go with straight Medicare and just add a Part D, there is no cap on amount owed. If you end up with major extensive comorbidities where you utilize services a lot, there is no cap on how much you pay. However, I am reading that a large part of the problem is that in some regions the plan administrators are delaying payments, taking excessive time for Prior Authorization processing, and other administrative problems. So I hope the pushback is temporary and that the plans get their act together, because people won't subscribe to the plan with these problems.
But you still have to sort out among the types of Medicare Advantage plans, because like other US health insurance, they all differ. And the "most expensive up front" payment is not necessarily the most cost effective. I personally have not seen a Medicare Advantage HMO that I would be comfortable with, in my region. All the cancer specialists are a 3 hour drive away. I'll pay a bit to have someone of my choice an hour away. But with these new changes, I may have to select a different, non Advantage plan within my carrier, unless there is no "preexisting condition" clause in my area. I haven't checked recently since it hasn't been a problem. I may have to switch back to original Medicare. We can switch out of a Medicare Advantage from Jan-Mar.
When I got this diagnosis, I realized that many of the things I previously enjoyed as part of a UD middle class lifestyle would go to the wayside, because I needed to put money away for medical expenses.
Thank you, I have worked hard to stay on top of this. The lowest co-pay I can get for Calquence, after all Medicare plan coverages, leaves me still about $11,000 a year out of pocket - and I have tried LLS, American cancer, my two oncologists. They are, at times, a huge help. My question for you and all: of our many fast talking, do nothing, over paid politicians, Biden's minions keep talking about capping total out-of-pocket outlays for drug for seniors to be $3,000 a year starting in 2025. Can you confirm this or give me what you know, and even if so, would we (our drug) be covered by that cap?
I would prefer that we avoid engaging in denigrating political statements (sarcasm excepted).
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There have been announcements about Medicare changes made by bi-partisan legislation that will eliminate the 5% copay on catastrophic drug cost in 2024 and put a $2,000. cap on annual drug copayments in 2025 and allow negotiated drug costs starting in 2025. Ibrutinib / Imbruvica is one of the first 10 drugs listed for negotiation.
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I cannot confirm or even explain how the bureaucrats will interpret or implement either of those two actions. So you will need to get your confirmations or explanations from a source much smarter and more diligent than me.
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I suggest these sources, but struggle to interpret them:
Thanks for the reminder! You are correct saying that we soon will be inundated with thousands of TV ads about Medicare - mostly trying to switch folks to Medicare Advantage plans where the insurance companies make a fortune denying treatments and have poor formularies. I was told the US and New Zealand are the only two industrialized countries that allow drug companies to hawk their drugs on television. It should be made illegal here in the US, too. If you watch network news in the evening, they run drug ads back-to -back-to-back. It's disgusting.
a very important issue. If one can find a really good advantage plan, with a robust system of hospitals and do not travel much, a lot of money can be saved, excellent service obtained. For most, the best, if one can afford it is a solid Original plan with G type medigap.
i am not so sure the issue with hospitals dropping will go away soon. There is little appetite in Washington to take on more expense. We may have to be satisfied with the benefits now on the table and Pray they do not diminish.
The problem with payments for hospitals, providers is not new. This wave of dropping is a desperate reaction to really bad reimbursements and delays in payments. Hard to overstate how terrible the crisis in medical systems in the US is.
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