Re: another Medicare question - is Avonex covered?
- From: "rose" <rosedawn_scott@xxxxxxxxx>
- Date: 29 Nov 2005 08:29:53 -0800
Ted Hart wrote:
> So, I was talking my friend today who has to go on Medicare. She needs
> to take the avononex injection but says she will have to pay 20% of it.
> Well, I'm sure you know how expensive it is but the 20% is more than
> she can afford. She also said that she would have to pay the same
> percentage for her other MS drugs - I know she usually has at least a
> half dozen bottles of pills with her at any time. She is 40 and is on
> SS disability and receives very little income.
>
> So my question is, is this true or is she confused about the coverage?
> I know she is having a major problem understanding the coverage right
> now. I told her that there are probably advisers out there to help but
> I really don't know that either.
hi Ted, yes it's true. with some extra verbiage thrown in, no extra
cost!
if you go to http://www.medicare.gov and click on "Medicare Reform" or
whatever they're calling it now -- "Medicare Changes" might be the
section -- there's a big, giant list of Plans to join.
some of them are HMO/PPO types of plans, which include doctor visits
and hospitalization, as well as prescription coverage. if your friend
is very low-income, then some of these plans offer very small co-pays,
but it IS a complicated process. first, one must make sure that the
prescriptions, treatments, etc., that s/he uses are covered. Avonex is
going to be covered by all or most of them.
another choice is to leave Medicare Parts A & B the way they are, and
simply sign up for "Part D coverage" -- that's the stand-alone
prescription drug coverage benefit. then, the rest of her care would
remain the same; she'd be able to see her own doctors, go on as before,
but with the added prescription benefit.
all the plans have variety but the deductible is going to be fairly
high for all of them. since your friend does take expensive meds,
meeting the deductible won't be a problem, although the ability to PAY
the deductible may be. after the deductible is paid off, Medicare
covers 20% of one's prescription costs till you hit the so-called
'donut hole,' where you're responsible for a couple thousand bucks
completely on your own; after the hole part, Medicare will then cover
95% of prescription costs, till the end of the year, when it all starts
back over again.
> Also, at one point she mentioned a supplement to Medicare that was
> somewhat affordable and made coverage better. Would something like this
> cover the avonex and MS medications if they are not covered by the
> base coverage?
if your friend was referring to a "Medi-gap policy," those are being
done away with once Part D commences. as far as the M.S. injectible
drugs, the pharma-co's may have "patient assistance programs" that help
with deductibles and/or co-pays. i don't recall the name of the one for
Avonex, but i bet either someone here will know, or you could google
'avonex patient assistance program' and see where that takes you.
also, if she's very low income, then she may well qualify for a
Medicaid "back," where Medicaid will pick up the deductibles and
co-pays that Medicare doesn't cover. she'd have to check with her own
state for Medicaid info.
i'd suggest calling the local chapter of the M.S. Society, and seeing
if they have folks available to help patients make sense out of the
Medicare/Part D plans and help ensure that they join one that will
cover their own meds and fit their own needs. my local chapter DOES hve
such a program, and they've been *extremely* helpful, IME.
best of good fortune to you and your friend,
rose
.
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