Pegasus on Medicare

[MDI55]

I am retiring in June so I have started looking at my coverage under Medicare . Does anyone have information on how best to cover the cost of Pegasus once I switch. Right now I pay $100 a month but that is under my companies private insurance.

[hunter5582]

It depends on which Medicare Part D plan you sign up for. Each plan is different. I have a $100 max monthly copay for any one medication with a $2,000/year cap.

[Mishie14]

Key to your sign up for Medicare is finding the best part D drug coverage for all of the drugs you take and for sure the ET drugs. Peginterferon is expensive. Part Ds are not the same other than what drugs must be covered. Very few drugs under Medicare are cost controlled. First time this year is insulin is now cost controlled. Medicare pays 80% only of covered services so an add on policy Part C might be helpful. The supplemental policies are generally unique to your location. They vary by premium cost, additional services like dental annd vision, and deductibles and co-pays. There is also pending a new Medicare out of pocket max annual cost that will be kicking in. Having a good Medicare insurance specialist to help you through the sign up is important. You can make annual changes to the providers but we found some changes are harder than others to make. Good luck!

[Mirror368]

You have a decision ahead of you. You can pick either a Medicare Advantage plan, or Medicare/Medigap supplement/Part D drug plan. We chose the latter because it allows you to see any doctor or use any facility that accept Medicare. Of course, it is the most expensive way. With it you are never denied services such as MRI, etc. Anyrhing Medicare pays for then your supplement covers the other 20%. We chose Medigap Plan G.

If you can access it the October 23, 2023 issue of the AARP Bulletin has a very thorough article on both…The Future of Medicare.

One thing to remember that after the first year you would not be able to switch to a Medigap Supplement without passing rigid medical underwriting.

if you go on Medicare.gov you can investigate plans in your area and see actual costs for 2024.

Best wishes, Eileen

[Island-Lady]

my husband and I just went on Medicare and chose the same as mirror 368, above.

it is definitely worth it to go online and look at what the Pegasus will cost on each plan, and with each pharmacy because the cost very vary widely.

[EPguy]

If you have good gov't or post-retirement benefits, things are easier. Otherwise:

Good news is the rules are changing for expensive drugs right now. For 2024 the max drug out of pocket is $3250. For 2025 and later it's $2,000. So starting 2025 you'll go from 1,200 to 2,000/year, but 2024 will likely be at the ~3250.

There has been the "donut hole" which made drug costs very complex. But starting partly in 2024 and fully in 2025 it's no longer a worry:

"2024 is the last year for the donut hole. A $2,000 out-of-pocket cap takes effect for Medicare Part D in 2025."

nerdwallet.com/article/insu...

If there are any better options within medicare it would be good to know, but I can't find.

I currently pay 0 so it is a big jump.

I think the cheapest drug plan works well if one is going to pay the 2000 each year since we will max out the cost anyway. I plan to get a zero cost part D. For example if you are on IFN and get some BP meds, that BP med will be "free" since you already paid the 2000 max.

[Minify in reply to EPguy]

You are right. I just picked up a 12 week supply of Pegasus and paid $3300 out of pocket (my Mecicare supplemental insurance paid the rest $13,400). So I have reached the 2024 out-of-pocket cap and there will be no cost to me for ANY medication for the remainder of the calendar year. And in 2025, that out of pocket cap is set at $2000.