I received the same email today from Medicare.gov encouraging me to compare Medicare coverage options.
I have had the same Medicare Plan D coverage since signing up in 2011, and haven’t ever considered switching plans. However today, since I was finished with today’s chores, which included shredding a huge zucchini with a yield of ~8 cups, making a zucchini crust herb quiche, and making ~ 2 quarts of unpeeled (😉) applesauce out of some fast over ripening Winesaps, I decided to bite the bullet and see what the Medicare site had to offer.
I logged in to my Medicare account and clicked on ‘Compare Plan Details’ which opened another page comparing my Plan D "Estimated total drug + premium cost" for 2023 and 2024. As you might imagine I was shocked! My 2024 drug + premium cost would be $230,645.24! The only reason that could be possible would be if their formulary of covered drugs had changed for 2024, dropping coverage for ibrutinib.
After some searching, I found the 2023 and 2024 formularies for my Plan D insurer, and sure enough, my 280mg/day ibrutinib tablet was no longer in their list of covered drugs, as shown below. I tried calling a couple of customer service numbers, and even after long waits on hold, was not able to speak with a human. I have sent an email asking for an explanation of the change. Is it a mistake? If intentional, what is the rationale? Are they trying to get rid of me because I am an expensive customer?
I’ll post again if I get an explanation. Meanwhile, let this serve as an additional reminder that you Medicare folks need to check your 2024 formularies and compare drug plans!
I get Ibrutanib, through Wellcare part D plan. So far called and was reassured that it is covered, but there is "Pre authorization" . Have had this previously and all went well, but just wonder if there are plans which cover without Preauthorization?
Lenny123, it is my Wellcare Part D plan that dropped the 280mg ibrutinib dose from their formulary, so please make sure that your specific dose is covered.
Streessful, i need to go through the options carfully. I did call and was reassured that the 420 mg. dosage is covered. Mostly concerned about the Prior approval.
I trust you are seeing one of our CLL expert doctors. You should ask for help with this step from the doctor's staff. Some call it a patient navigator, some other have a PA or NP do the prescribing, but in most cases they have handled the issue for several other patients in the same week and can deal with it effortlessly.
The drugs are sourced from a specialty pharmacy that works with your hospital and NOT from your corner pharmacy. Let the pros handle it.
Thanks for the reminder. I did this yesterday and switched plans due to some changes in my current plan. The new plan works much better for me. And, as you mention, it is very easy to make the comparisons and switch plans, if desired.
I dread comparing the Part D drugs. I did it last year and immediatley got a head ache. LOL, my final conclusion was the bottom line was not tot different with the different plans. Some plans charge a higher premium but copay was lower or others had a higher deductible. One plan the drug is cheap and another plan the drug was more expensive. As I said a headache. This year I am thinking of using the free service that will do the work for me. Has anyone used this free service?
It will list the total annual cost of each plan and arrange them with the lowest total annual cost on top. No headaches- just fast accurate calculation done by the computer.
Thank you for this information. I will be eligible for Medicare in 3 years and I’m already thinking about it. I have the impression that Medicare is very good coverage for most healthcare costs, but not for new expensive cancer drugs. The drug company’s patient copay discount that I used was not available for patients on Medicare
Medicare is complex to set up, and it consists of 4 different parts with different rules.
It is suggested that about 6 months before your 65th birthday you contact your SHIP shiphelp.org/ and if they have classes or volunteer consultants to help you learn about the government run Parts A&B, you should get that training. Then sign up 3 months BEFORE your birthday, since it takes time to process and will be in effect before your birthday (first day of your birth month).
This covers all the hospital, doctors, and other medical professional services that "accept" Medicare. This works differently than the health insurance you have had in the past, so the training focuses on the differences.
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Then you should purchase a Medicare supplement / Medigap policy from a commercial insurance company - this is the one you should choose carefully since once chosen you will not be permitted to change policies or companies, due to your CLL. All the companies have type G coverage, but the annual cost and states they cover can vary (if you plan to move to a different state after retirement, this can be important).
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Finally you will need a different commercial insurance - Part D- for the drugs you take at home. This is where the big cost issues have been with the targeted CLL drugs. This area is changing significantly in 2024 & 2025, so by the time you are on Medicare the costs and coverage will likely be all different. This is the only part of Medicare you will be able to change once each year.
Great information Len! Thank you. I've been fortunate that at the age of 69 I am still under my husbands insurance plan as he hasn't retired and I plan on keeping them as well after I do start on Medicare B, tho not quite sure how to do it as I get different answers from Medicare, Social security, the health insurance plan, and the Human Resources person at his office.
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