Medicare coverage for Belatacept

[Mydaughtermyhero]

I will be transitioning to Medicare next year and wonder if they will cover the cost of the Belatacept infusion. Is there a particular supplement plan I should be considering?

Any advice about Medicare would be appreciated.

[Bassetmommer]

The best advice is to see a Medicare insurance specialist. You do not have to pay them. They get paid by the insurance companies. We have used this one for years and you can speak to her remotely.

Kathy Coler

[LavenderRabbit]

They paid for mine for the first 3 years after transplant.

[Blue-Quilter]

I am approaching 5 years post-transplant in October. I was on tacrolimus the first two years, then Envarsus for a year. No matter what dose we tried, my levels bounced all over the place from way too low to way too high. In those three years, I had over 90 blood draws; 12 were in the target range. Hence the switch to belatacept in October of 2022.

I am on Medicare with an advantage plan. The infusions are approximately $5000 every 28 days. Medicare pays 90% so my share of that is $500. Your costs may be different, so checking with a Medicare specialist might help. Mine couldn't tell me how much my part would be because I didn't know how much the infusion was going to cost.

This wasn't part of my retirement plan to have to pay that every month, so it's coming out of my savings for now. When that runs out (or hopefully slightly before), I will apply for financial assistance that my center has available. I don't know what their criteria is, so I don't know if I will qualify. Unfortunately, I make $58/month too much to qualify for Medicaid, but not enough to pay my bills and still afford my infusions. It's a classic case of being caught between a rock and a hard place. But one thing I know: God has never let me down yet, and I don't believe He's going to start now. He will provide a way or He will take me home, but even that won't happen one minute before He ordained before the beginning of time.

[Bouvierlover2]

I have Standard Medicare with a Part B and Part D plan. Part B plan pays the entire cost of my Belatacept. There is a cost to Part B but is based on income. I definitely would talk to an independent Medicare specialist! It really helps!!!

[Mydaughtermyhero in reply to Bouvierlover2]

Thanks so much for this response. I know the coverages differ from state to state but would you mind telling me which company is covering the Belatacept? I did see this article yesterday. I have had the experience of needing to prove why I require the more expensive option of medication. I know for sure that tacrolimus side effects were unpleasant for me.

kidney.org/atoz/content/faq...

[Bouvierlover2 in reply to Mydaughtermyhero]

It is my part B Of Medicare …. There is no company for “ regular “ Medicare… only for Part D and your supplemental . Yes I know it’s confusing. Medicare is Part A and part B… you need to find a Part D for Medication coverage and a supplemental. I reccomemend a Part G as they cover everything! But are a little more money out of pocket. It has been well worth it for me!

[Hawk12]

It is covered as an inpatient procedure. I have standard Medicare with Blue Cross/Blue Shield Federal as my secondary. I have no copay.

[RavaSpirit]

I've only been on Bela for a few months but so far no additional costs with Medicare plan B as primary and Cigna as secondary

[Mydaughtermyhero in reply to RavaSpirit]

This is good to know. It sounds like most everyone regardless of supplemental plan provider is covered.

[Jepsos]

I’m covered. I have Medicare and Anthem as my supplemental insurance.