I am under 65 and will be eligible for Medicare in a few short months. I never thought I would get a Medicare card at the age of 51. Anyone out there under the age of 65 (taking Ibrance and Letrozole with Zolodex injections) that would be willing to share the supplemental coverage that they are on? OR if they went an alternative route (i.e. not choosing Medicare.)
I have read on previous posts that you lovely humans suggested going with Original Medicare (yes I know it's more expensive) and choosing a plan G from United over the Advantage Program. I live in NJ and my Oncologist is in PA so I need the flexibility to see a doctor wherever. My issue is Ibrance. I am not eligible for plan G , under 65, but United mentions plan D (not to be confused with Part D.) The out of pocket costs for Ibrance are just crazy (5k + a year.) I did reach out to my Onc. team and they are sending information about assistance.
The anxiety is kicking in as there is a ridiculous amount of information out there. I don't mind paying the upfront costs, I just don't want to receive loads of bills in the mail after each one of the countless scans I do.
Thank you in advance for any responses.
Blessing in health and life to each of you.
Tara
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Ski2sea
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I'm still on private insurance but I'd recommend speaking to an insurance broker. They can usually lay out your options and don't cost anything upfront.
I have United and get my medication through the program at Pfizer. I won't qualify next year but Medicare prescription deductibles continue to go down over the next few years, so Ibrance will be much more affected,
There is also some new law coming into effect in 2025(?) that Biden passed which states that the maximum out of pocket is to be maxed out at $2000. Don’t quote me, but check it out. I hope it’s true and that we can all benefit from it.
I am under 65, and the cost for a supplement plan is just not worth it for me at this point. I am able to switch when I reach 65. I have had an Advantage plan and have not had any issues up to this point, but I understand you want freedom. I have a PPO through Humana. I do get my med, Orserdu, paid for through the manufacturer, but if I didn’t, this year it would have cost in the $3,000 range. I agree about talking to a broker. I did. It really helped.
I had a high deductible plan with Humana which put the premiums at 300+. Otherwise it was 500+. We did the math and out of pocket costs were about the same. The deductible was 2400 I think. You can switch to a no deductible plan when you turn 65 and of course premiums are much cheaper. I usually hit the deductible toward the end of the year. If you travel or want to go to the doctors of your choice original Medicare is the best option.
I thought plan D (not confusing with part D was not available anymore. In any event I will be going on Part G (not high deductible) soon. I spoke to a SHIP counselor and they were quite helpful. You can get a general number for them and then you make an appointment with someone from your State. They will cover 100% of what original Medicare does not cover. No matter how often we bañarse with radiation.
As for part D, I’ve taken some of the AARP courses where I learned that catastrophic amount is changing from 8K per year to 2K per year for drugs in 2025 which should help. It is my understanding that WellCare and Aetna are two of the best to cover cancer drugs. After the first month or two you should reach max out of pocket amount and all will be $0 thereafter.
Good luck and I’m so sorry you have to look at all this stuff so prematurely. Be well.
Sorry,this is going to be a long post.I am on Medicare and have part D prescription benefit.I just switched from United Health with a higher monthly cost to WellCare where the prescription monthly premium is $.50 /month.I qualified for Pfizer assistance for Ibrance for 3 of the last 5 yrs.This year is one of them.At the other times,I had to pay $700+/month for Ibrance,alone,out of pocket.I never reached any level that reduced my monthly out of pocket for Ibrance.I take diabetes meds that are costly ,even after reaching deductable:Jardiance,$140+/ month and Ozempic,$170+/month
This year,on WellCare ,after reaching a $2000+,the costs for those drugs went down to almost nothing a month( I've had so much trouble figuring all this out,and talked to WellCare so often,I can't remember the exact amount,but know it was absurdly low maybe $11.00)
BUT,as soon as I reached the $5000 level I was moved up to stage 3,Catastrophic level so the cost for Jardiance and Ozempic
went back up into the $150+ range.My copay will not lower now until I reach $8000 out of pocket.This will never happen!!!!
I find everything about initial deductable,co pays,levels and prescription levels impossibly difficult to understand.I didn't have many conversations with United Health prescription folks but I've had to talk with WellCare several times .Their agents do not seem to be familiar with plan info and have given me confusing information several times. All of the agents have not been native English speakers either and often were difficult to understand.
It almost seems that paying more monthly with United Health might be worth not having to struggle with WellCare!!!
I think different companies place drugs on different tiers,so if you can find the difference costs on different tiers of the plans you are considering,it might be really helpful.
I know that my mom was able to get manufacturer’s assistance for Ibrance when she was on it. The hospital reached out to the company and were able to help her apply. She is over 65, so I don’t know if that makes a difference.
hi— glad you are getting Medicare! I have original ( not advantage plan) and a G supplement that includes prescription coverage!
For the prescription coverage of our specialty meds is not total coverage. However, I found out this year that the Inflation Reduction Act limits our cost per year. It’s 5000 this year and 2500 next year. That may not help you with Ibrance— or you could get coverage from the drug company if you need financial assistance.
It has been a big savings for me I was paying 1200 per month for Piqray and suddenly in March I had no charge and did research to find out about Federal change to our co-pay.
I suggest going to a reputable insurance broker to get personalized advice ( my generic supplement G is through State Farm.)
Whatever you do do NOT get a Medicare Advantage Plan. It basically LOCKS YOU IN to what is basically a FOR-PROFIT healthcare plan and subjects you to all their requirements, pre-approvals to see a specialist, copays, red tape, etc, etc!! It is also all but impossible to get out of the plan once you take instead of original Medicare. Original Medicare with a Plan G supplemental is what I have and it's wonderful.
Here's the link to an AMAZING PODCAST that explains everything about healthcare in the USA today. My eyes have been truly opened by listening to it!!!!!
Medicare plus supplement plan G. There is no way I would switch to an Advantage plan! They delay, deny and defer payment! Your drug cost for plan D will be about $3333 this year and then ALL prescribed and approved drugs will be $0. Next year your drug costs will be $2000 total. Make certain to go on Medicare.gov to look at the best supplemental plan premiums and the best drug plan for you.
For six years I have paid $12,000+ for Ibrance plus 5% on all drugs because that was the charge after going through the donut hole in January per year until Biden changed the drug coverage gap starting this year. Any financial aid on coverage is determined by income and I have never qualified. Of course, new administration could change this back to the old ways!
I got on Medicare at age 52. I am on original medicare with plan F with USAA. It is wonderful. See whatever doc you want where-ever you want. No co-pays. For the drug plan, I'm only on anastrozole and fulvestrant, so I haven't had to face the Ibrance expenses.
In South Carolina I had private insurance and I had copays but I wasn't on Ibrance and letrozole yet. I am now on Medicaid because I of being low income and because I moved to the state where my two adult kids live.I have medicaid here and they told me they will pay for my Medicare payments and I still won't have to pay copays under my current insurance. If I would have stayed in south Carolina I would be paying out a lot for medical care. And the Ibrance alone is $16,000 a month. I would probably faint at the copays so glad I am back in Seattle. It's just 2 years before I qualify for Medicare (I am 63 years old today). So my medicaid will pick up what Medicare won't pay for. I live solely on widow's benefits so copays would be brutal.
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