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AVONEX & MEDICARE

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    AVONEX & MEDICARE

    Medicare covers 80% of the cost for my shots IN A INFUSION CENTER. Is anyone else in this situation and get financial assistance from BIOGEN for the other 20%?

    #2
    If you get a supplemental insurance and get the F coverage for about $150 a month your infusion will be covered. I am guessing you are talking about Tysabri because you say infusion center but, you also say Avonex and shots so, I am confused
    Linda

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      #3
      Hi Ginny:

      Medicare sets prices and fees by contracting with providers and suppliers. Because prices are set by contract, Medicare forbids any contractor to violate their contract by waiving a copay or paying the copay of a beneficiary. That's why Biogen can't provide financial assistance for the 20% copy -- it would be a violation of their contract with Medicare and, therefore, illegal. If Biogen is paying anyone's 20% Medicare copay, they're doing it illegally.

      The only time Medicare allows for financial assistance is for low-income beneficiaries whose income (or lack thereof, really) meets a poverty threshold. And many of those beneficiaries also have their medical costs paid by Medicaid.

      A Medigap plan might cover the 20% copay for your Avonex injections along with the copays for other Medicare services. But you'll have to crunch the numbers to see whether the Medigap premiums would cost you more or less than your out-of-pocket 20% copays.

      Comment


        #4
        infusion center

        Hello lindaincolorado: The cancer center does infusions (I think they are actually called the Infusion Center)....but my shots are Avonex.


        Originally posted by lindaincolorado View Post
        If you get a supplemental insurance and get the F coverage for about $150 a month your infusion will be covered. I am guessing you are talking about Tysabri because you say infusion center but, you also say Avonex and shots so, I am confused

        Comment


          #5
          medigap

          Hello jreagan...
          Thanks for the explanation on Medicare and the illegal stuff. I do have the medicare supplement and the 2016 price per month will be $199 so its definitely worth it.

          Originally posted by jreagan70 View Post
          Hi Ginny:

          Medicare sets prices and fees by contracting with providers and suppliers. Because prices are set by contract, Medicare forbids any contractor to violate their contract by waiving a copay or paying the copay of a beneficiary. That's why Biogen can't provide financial assistance for the 20% copy -- it would be a violation of their contract with Medicare and, therefore, illegal. If Biogen is paying anyone's 20% Medicare copay, they're doing it illegally.

          The only time Medicare allows for financial assistance is for low-income beneficiaries whose income (or lack thereof, really) meets a poverty threshold. And many of those beneficiaries also have their medical costs paid by Medicaid.

          A Medigap plan might cover the 20% copay for your Avonex injections along with the copays for other Medicare services. But you'll have to crunch the numbers to see whether the Medigap premiums would cost you more or less than your out-of-pocket 20% copays.

          Comment

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