Rheumatoid Arthritis Support Group
Rheumatoid arthritis is a chronic, inflammatory, multisystem, autoimmune disorder. It is a disabling and painful condition which can lead to substantial loss of mobility due to pain and joint destruction. The disease is also systemic in that it often also affects many extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and...
Hello friends....... I almost never post here, but I read it every single day and think of you folks as friends in a common cause. I have lived with RA for ten years now. Recent discussion here has me worrying about what's going to happen when my health insurance switches over to Medicare in two months. My intention is to enroll in the United Healthcare supplemental plan, but my insurance guy knew nothing about what will happen with Enbrel co-pay assistance. All he could say was, "Whoa, it's a tier 5 drug.......that's gonna cost you." Do ya think so?! Does anyone have experience making the leap to Medicare and taking Enbrel? Is there any continuing assistance? As an extra added bonus (not), it looks as if injectable Mix is also a tier 5 goodie on this plan. I'm feeling a disturbance in the force here. Anyone have advice? Thanks in advance----Kathy
Medicare themselves will not pay for a biologic - that comes from the Part D (prescription plan) that you choose. Medicare however does cover infusions I am pretty sure.
When you search for a Part C provider (or Part D coverage) you have to look at what meds they cover and at what cost to you. The Medicare site is pretty good with the search. Your insurance guy saying "that's going to cost you" is just wrong - just too lazy to look it up.
https://www.medicare.gov/find-a-plan/questions/home.aspx
Then there is the "donut hole" which puts a huge twist on it all.
https://www.healthcare.gov/glossary/donut-hole-medicare-prescription-drug/
With the exorbitant cost of Enbrel and Orencia I have been taking this year, I hit the "donut hole" in a couple of months and blew through it in one more, putting me in the "catastrophic" category pretty quickly at which point the cost percentages for self-administered drugs changes dramatically in your favor.
I would advise that you go to an independent insurance agent and ask them to run the figures for you. I was going to go with United Health Care as well as I was already on that but he said not to...they try very hard not to pay claims and hold up payment forever! He advised to find an Anthem or BC/BS as they pay quickly and resolve problems very quickly.But an agent can run the figures on their computers and find the best coverage for Enbrel if you want to stick to that. But yes, it's a tier 5 and my policy covers only 25%. So while the agent is looking at all the drug plans, you can be talking to the .Enbrel manufacturer and find out what they can do for you when you switch.
Then sign up for the drug coverage through the agent...they can help you if there is a problem. Mine even called me to let me know that Anthem had a computer glitch and my payment would taken out of my savings account about 2 weeks late but not to worry......everything would stay normal and I wouldn't lose my coverage. It doesn't cost you anything...the agent gets paid by the insurance company....and then he'll help you for as long as you have that policy. Saves hours of feeding your drug list into the computer program on Medicare and waiting to see who pays what....you have to do each insurance company! Let an agent do it for you. Save your fingers!
Jen