I need to make the decision to pick a Medicare Supplement Plan & Rx Plan (Plan D) as I lose my private health coverage by May 1st.
I’m on IBrance , Faslodex & Xgeva. Based in Florida.
I have contacted all the cancer centers to find out which insurance plans covers the high costs for MBC patients. None of them could help me. They told me to contact the insurance companies directly.
So I’m reaching out to my fellow (US-based) MBC’ers:
1. If you are on Medicare, which plans are you enrolled?
2. Do you recommend the carriers?
3. In addition to enrolling in Medicare Part A & B, I’m considering Medicare Supplement Plan G as it covers the most out of pocket costs. Also adding a RX plan D. I need a plan that cover Tier 5 drugs like IBrance & other new drugs that become available. Any experience with these plans?
I look forward to your insight, knowledge & advice.
Thank you in advance!
🙏❤️🙏
Written by
hopenowandtomorrow
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Hi! My 65th is in February and I just finished signing up. I have a Humana supplemental coverage and a Part G for pharmacy coverage.
I went to my local insurance agent to told me that in Ohio United Healthcare & Humana supplements are the same— just different carriers. She also recommended supplement rather than an Advantage plan because it will be more flexible with Dr’s. I go to Ohio State which is a certified Cancer Center.
I was worried about Ibrance coverage and this part G will cover Tier 5 drugs…. But not the same as my previous insurance with Aetna. My Ibrance will be 3000 the first month then 700-850 a month after the first month.
Pfizer has financial help for Ibrance— but I don’t qualify. Apparently the government is not “allowed” to negotiate drug prices for Medicare!
I am not currently using the Medicare until Feb so I don’t know how it will be— but I asked a million questions and feel this is the best I can do. Let me know if you have other questions!
Hi BluHydrangea: Thank you for your detailed & helpful response! Given the high out of pocket costs for IBrance, will you meet your max out of pocket or deductible within the first few months so you won’t have that in future months?
unfortunately, you will have big upfront, as explained, and then the rest of the year, it is still hundreds a month. When I took it I would have had to pay $16,000 a year out of pocket. This makes me crazy and it is NOT the way it should be! Some of the other cousin drugs can be covered through different organizations but last I checked it was not Ibrance. I pay zero in any of my medical expense now-other than insurance premiums!
Well, that is not a positive but makes me laugh--not sure why! Once I went on IV meds--then they cover those! Why I have no copays for anything is quite a blessing and somewhat because of lucking out turning 65 in 2015 and Medicare offering this awesome plan that I have. A couple of years back, I think three or four they canceled it. So, Just keep paying premiums and we make out well. Otherwise I would be more of a maniac than I already am--and making a loud voice to what is going on with Medicare and how little they pay for our meds. Now, do keep this in mind---other than these big cancer meds, when you get anything filled at your pharmacy, after they tell you how much you need to pay---ASK them for one of the discount drug programs. I have always found that I then pay less than I would if I used my medicare card.
Okay, definitely get AARP medicare supplement and take their top program--no matter how much more it may be--it is more than worth it. Also, they offer a great dental plan that you can go to dentist three times a year and paid for and you can put your spouse on it as well as any children under 26. Medicare itself!!?? It is a mess. Fortunately for me, I was able to sign up for their top program at the time, in 2015. Unfortunately, they no longer offer it because it covers too much. So, take whatever program is the best and that is all you can do. Now, do call the insurance company that will cover your drugs. Ask them specifically how much they cover of Ibrance, etc. Ibrance get substantially more expensive once on Medicare--as ridiculous as that sounds and is. You can later reach out to Pfzier patient assistance program and fill out multiple papers to qualify. Even if you do not qualify financially, they like to offer a year of free meds just to keep you buying their product. Now, possibly in Florida you will have more luck. But the insurance companies will tell you exactly how much you would pay upfront and through the different stages of expense.
Thank you for the very practical & specific advice! I will do exactly that. The top Med Supp plan in 2022 is Plan G. I will research the insurance company’s offering part D (Rx) plans in FL to see the best payment option for IBrance.
Have you tried contacting Gov. DeSantist office for assistance in finding an affordable means of buying Ibrance. Be sure and cry some while you talk and explain how difficult this is for you emotionally while taking chemo. Let them know that you just don't have the energy to deal with this and that everyone sends you to someone else and what you really need is someone to get the price to something affordable and to be patient with you. Hope this helps. Best wishes and blessings, Hannah
I’m sure he’ll take my calls LOL. I may just stop taking IBrance & see if Faslodex is enough. I’ll check what I can afford with Medicare. Since many of you have done this, I’m hopeful I’ll find a solution.
I didn't mean that the governor personally would help you. He has aids that specialize in various areas like healthcare. Also, the House of Representatives person closest to your home will have aids that specialize in healthcare. Call their D.C. office and tell them how stressful this has been for you and that you need help. Tell them all the things you have done.
When I retired I kept my work insurance which covered my husband and me. It is now a supplement to medicare and costs $900 a month. We don't pay co-pays on medical, but do on drugs. The most we pay on any drug is $60 for a 90 day prescription. My Ibrance is $30 a month. I thought we were paying a lot. Now realizing we are blessed. My friends all think I am stupid for paying that much. I never dreamed my stage 1 cancer would come back. I wanted to keep my insurance because I knew what I was getting and didn't want to have to check for insurance coverage every year.
I truly hope you find an affordable option that is good. I live in North Florida. Are you near here?
Will the American Cancer Society or some other support group help you find a good supplement to your Medicare.
The Ibrance intel is really depressing. I own my own company, and we have great private insurance. Though I am signed up for Medicare Part A, this news is making me rethink a decision I was pondering of going full Medicare. The meds are what I am most worried about. That is over $12k a year...on top of any premiums. I have to do some hard math, esp since right now my company covers the cost and that then moves to cash out of pocket for me. Hate this, as I am sure many of you do.
This actually does make me very angry! Then when I discovered that these new targeted cancer drug companies give ncos a huge monthly award for each payment. Now, there are no other drugs in this country that this is applicable. WTH!!
Ok, do not get me going with this! And yes, you know why it took so long to get test kits! And it would have been nice if when the President said he was going to order them--that someone on his staff would have done that back in September! No order was ever placed--well this goes on and on! And yes, anything the government touches gets screwed up--well some positives. But right now, the negatives are far outweighing any positive. Bonnie
I had Covid in March 2020 and could not get tested as there were not enough tests. So you can imagine how this insanely late rollout is not working for me.
Let's take bets on how the fast the site to order test kits crashes on Wed. It will be like when AOL decided to do flat pricing and there were not enough modems; I predicted that one, too.
But I feel like Medicare feels like universal healthcare. Which will not work for everyone. Like us!
I started Medicare last January with United Health Care/AARP supplemental insurance and their part D for drugs. We recently moved to Florida and I was dismayed at how much the same policy increased just by changing states! I’m still with them though and just switched to the Walgreens drug option to keep that premium low. I was on Pfizer patient assistance last year, but if I can’t get it for this year, I think I’ll have to pay $2,500-$3,000 for the first month and $800-$1,000 every month. It’s outrageous, but who has a choice? I’ve been very pleased with United Health Care. I’m hoping that Ibrance can go generic in the near future and maybe that will lower the price. I’ve never understood how when you get to the “catastrophic “ insurance level these companies think that’s ok. It means it’s a catastrophe and we need help!!!
I know. I almost want to stop treatment over all this. Be sick & bankrupt too? Sorry, that’s my frustration speaking. Thank you for your help! I’ll check out United Healthcare.
I had to start Medicare the first of January. Before hand I was researching and asking anyone willing to talk about it questions. What I realized is it got so complicated because there are differences between states on how things work. So I decided to just talk to people in my state. One big thing I was able to figure out was Medicare Advantage is private insurance . The way I understand it is they have to cover the things Medicare covers but there premiums are not regulated. I had a couple friends who had chosen the advantage plan because it was so enticing at the on set. But over the years the premium cost kept going up. They now struggle with that cost. They could decide to go back to Medicare A B D but would then need a supplement plan . With there pre existing conditions the supplement plans are way to expensive. When you purchase an Advantage plan that is your one time to purchase a plan with no questions about pre existing conditions. If you decide later to drop it the Insurance company can ask all the questions they want. My Insurance agent went through all different drug suppliers for me . Everyone had Ibrance and a lot of the other drugs I named off as tier 5 drugs and all there costs were in the 10,000 range or more. So I felt it truly didn't matter the drug plan I chose I would never be able to afford them without help . I would have to deal with it when I get there. So in the end I chose Medicare A B D and a supplement through Aetna. Time will tell if I sink or swim. All I know is I had an Advantage plan that cost me 400 A month in premiums and every time I had something done I was told I owed this much of it. I figured out with premium cost now on Medicare ill be paying 292 A month. Ill see by the end of this year what extras I pay . last year I paid out 7,000 over and above my premium cost. Ouch!!!!
Thank you, that is helpful! I’ve been told MBC patients should not enroll in Medicare Advantage plans as they are not designed for stage IV cancer claims. I will look at Medicare A, B & D with the G Med Supp & see what I can afford.
Supplement plans are all basically the same. Plan G must cover the same things no matter the company you use. Some might be an HMO vs a PPO. An HMO will be cheaper but have a smaller network. Deductible might also be different. I found insurance companies not helpful at all because they claim you need a policy for them to check on what things cost. The drug plan can be tricky. Pay attention to what tier they put your other meds in. One plan I looked at seemed a good choice but they put my heart meds into a higher tier which cost more than the other plans. The drug plans I looked at were all 3,000 or so for Ibrance in the 1st mo. This puts you into catastrophic coverage which is still 600-800 a month. The PAN Foundation offers Grant's that can help with co pays.
I had no choice but to go on Medicare last month. I have Medicare and Anthem/Blue Cross which has Optima to cover medications. I just reordered my Ibrance and it was a little over $97.00. I had been paying zero as the Oncology clinic got me a no pay card. I can't use that now that I'm on Medicare.
I will be surprised if Pfzier will NOT give you one free year--whether or not you financially qualify. It is just a lot of paperwork--but nothing overwhelming--although most things have become overwhelming these days!!
HelloI am on Medicare plans D and G.For me,the plan(D I think)
does not cover all of the Ibrance cost.I also make too much money to get assistance.I pay about $3000.in January and about $750 in Feb. when I enter the donut hole and catastrophic levels ,from then on til the end of the year.If you make under $60000 or $70,000(I can't remember which)you can get assistance .You can deduct your previous years drug costs to qualify.
My prescription plan is with CVS/Aetna.
I've done lots of research and spent hours on the phone with my drug insurance people and have been unable to get ibrance any cheaper. If anyone knows of a way to do so I would love to hear it. Good luck
That is consistent with what I am learning. Two options for getting IBrance cheaper shared here are:
1. Try to get a free coupon/voucher from your cancer center.
2. Apply on the Pfizer site for a discount or free IBrance. Even if you don’t qualify, fill out the forms anyway. Sometimes Pfizer will give you a IBrance free for 1 year to keep you as a customer.
I haven’t tried either yet but I plan on it after I enroll in Medicare.
I have MBC and a Medicare Advantage plan. It works fine. I don't understand why the plans are different in different states. My plan is AARP Medicare Advantage through UHC. My premium is $0, deductible $0 and max out of pocket $3500, not including meds.
I'm on Verzenio, which runs about $12,000 per month. With my plan, I would have been paying more than $2000 a month. A pharmacist at my cancer center made me aware of Lilly Cares, which is patient assistance. I was surprised that Medicare patients can qualify, and that the income threshold is fairly high. I get it shipped monthly for free!
You can go to the drug company's website and look for patient assistance. You will fill out an application with proof of income. You may be able to see the qualifying income levels before you apply. It's pretty easy!
Great information! Under Medicare Advantage do you have any copays for the labs, scans & radiation? Have you run into any situations where something wasn’t covered?
I do have copays for tests. There have been a couple of meds (not for cancer) that they didn't cover. We appealed and got them to cover them though.I will say that Medicare has terrible reimbursement to the cancer center. If they bill Medicare for $10,000, Medicare might pay $1000 and write the rest off. I then just have to pay my copay, not the $9000 difference.
As an MD, it makes me so angry that they pay so little!!
I don't know how hospitals and offices survive with such poor compensation.
hi. you have many replies already but i will share as well. i am 63 and on disability since 2019 so became eligible for Medicare in 2020. did a lot of research on advantage plans vs supplemental plans and found supplemental plans to be superior. advantage plans can actually be a 'disadvantage'... the premiums may be lower but the out of pocket expenses can be high and they can have a lot of restrictions on which doctors and hospitals they accept...much like an HMO.the supplemental plan that i chose is AARP United Healthcare. it has been great. i have not had to pay any out of pocket expenses. and as long as the provider, (including specialists) accepts Medicare, which most do, you do not need a referral. there is no restriction on who you see or where you go. you can even go out of state if you choose. i highly recommend. i have severe bone mets to my spine and have had to become my own advocate in seeking out specialists to help me as my spine is basically collapsing. i can only stand for a couple minutes and can walk only a few steps at a time. the pain can be unbearable despite the pain meds that my oncologist prescribes (90 mg morphine ER daily and dilaudid 8mg 6 times per day for break thru). however, she was at a loss as how to treat my spine issues. i found a pain management/spine specialist who is a caring person along with his degree. he just performed radio frequency ablation to 3 of my right facet joints in my spine in addition to several steroid injections over the past year and i did not pay a dime. of course i have to pay the monthly premiums for this supplemental plan ($199 monthly) but zero copays and total freedom of choice. for me, it has been a great choice.
as for the drug plan D, none of them cover Ibrance well. however, i opted not to take Ibrance. personal choice. i am on letrozole which i believe to be the 'heavy lifter' in the ibrance/letrozole combo....my opinion and no offense to anyone intended. but i do think that Pfizer should be ashamed of themselves for charging such high prices and taking advantage of our pain and suffering and adding anxiety to MBC patients that cannot afford. perhaps if they spent less money on their fancy, yet totally unrealistic commercials, they could lower the drug price.
wow. didn't realize how long this post would be...lol. sorry about that.
hi again. i remember going through the same research a couple years ago and i don't envy you that... both frustrating and time consuming! but you did receive a lot of good feedback👍! and btw....good that i declined ibrance on my own as i cannot afford it anyways! MBC is a life changer in so many ways as we know. experiences differ but we are all impacted. for me, my 'soulmate' husband divorced me upon diagnosis..did not see that coming. lack of mobility and pain ended my career. my income consists of disability and some assets that are quickly dwindling. the yearly cost of ibrance is actually more than my yearly income!!!. blows my mind. i meant what i said in earlier post about Pfizer. makes me sad that in this day and age and society, your health and life can often be determined by your wealth, or lack of. and not just talking about me at all. and not just MBC patients. i mean across the board.oh boy.....really got sidetracked
Thank you for sharing Carole! My heart goes out to you about the loss of your marriage, health, job, etc when you got this diagnosis. May God comfort & provide for you on all levels. 🙏❤️🙏
I am on United Healthcare. It is a retiree benefit from the University where my husband worked. It is a great benefit.
Years ago I did volunteer work to help people find the best program for their conditions and drugs. It is free information from the SHIP program to help you find the best program for you. They put your health condition and your prescription information into the computer program and you get back the names of the supplements, their price and what copays you would pay out of pocket. The federal government requires each state to make this service available. You will have to google to get the contact information..
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Help needed with Medicare
Changing US Health Insurance with MBC
Ibrance expensive
Questions about Ibrance and Ibrance co-pay card and annual deductible 
