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Anyone on Medicare with coverage for Ocrevus?

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    Anyone on Medicare with coverage for Ocrevus?

    Is Ocrevus covered under part B? What expenses do you incur?

    #2
    Hi Temagami

    I am taking Ocrevus and I have Medicare. The med is covered under medical because it is sent to my ms clinic. I was told I would be billed for the infustion room only. So far I haven't paid anything. I am going on the 19th for my first full dose.
    God Bless Us All

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      #3
      I am on Medicare and receive Ocrevus.

      I received infusions 2 in June and one in December in an infusion center operated by a hospital. I just received the first bill, as it took an extraordinarily long time to approve.

      The first 2 infusions were submitted for $30,771 each. Medicare approved amount was $30,771, the amount paid was $13,818, the patient amount was $3,445.

      The December infusion was submitted as $60,330. Medicare approved $60,330, paid $32,877, the patient amount was $1,353.

      In the column where type of coverage usually says B, these all said Outpatient.

      The detail line items were different on all the submissions. I have no explanation for the amounts, as Medicare is a complete mystery to me on their payments.

      I also have a Medigap insurance policy which will pay all or part of the patient amount.

      Your charges and payments may be different, this is just my experience.

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        #4
        Thanks so much for your numbers. When you get to the next full dose, if it is in the same calendar year as the first full dose, will you have reached an out of pocket maximum and no longer have to pay in the thousand+ amount?

        When you signed up for Medicare, did someone guide you through all of the options and plans?

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          #5
          I have Medicare part B and a High Deductible Plan F Medigap policy that covers this. (Part A and Part D Prescription coverage don’t cover this)

          Medicare part B has an annual deductible of $183. After that Medicare pays 80% of the approved amount, leaving the patient to pay 20%. There is no maximum out of pocket on Medicare part B. The amount Medicare approves is generally less than the amount billed. If a doctor or hospital accepts Medicare they agreed to accept Medicare’s fee structure.

          The Medigap policy covers the 20%. My Medigap policy has a low monthly premium but has a $2,300 annual Deductible. My husband’s policy has much higher premiums but a zero deductible. It’s just what you choose to go with.

          None Of this applies if you have a Medicare Advantage Plan also known as Part C. It is more like an HMO and has completely different rules. You are limited to using the doctors who participate in the particular plan you have.

          I was fortunate enough to have the services of a private company contracted by my husband’s employer to help me choose Medigap and Part D policies. The choice of whether to go with Medicare Part B or a Medicare Advantage plan I had to figure out on my own by researching myself.

          AARP has a comparison chart and calculator online I think.

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            #6
            Wow-thanks for laying that out. It makes my head spin but gives a good outline for how to start to figure it out. I cannot understand how anyone could take part B without a gap policy because with our meds 20% of an enormous amount is an enormous amount. Sigh.

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              #7
              Originally posted by Temagami View Post
              ... I cannot understand how anyone could take part B without a gap policy because with our meds 20% of an enormous amount is an enormous amount. Sigh.
              Unfortunately there are several states that do not allow anyone under 65 (even on SSDI) to get a medigap policy. I live in SC and that is one of those states. It sux.

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                #8
                Thanks for that info. I looked it up and luckily my state does allow for a medigap policy. I cannot believe that some states have not taken this need into account. What are people supposed to do?

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                  #9
                  You may find that Medigap policy premiums are considerably higher when you are under 65. The same coverage I have now was 4 times my current premium before I turned 65.

                  If you’re on SSDI and Medicare you obviously have a medical problem, and they charge you accordingly.

                  Once you turn 65 you have 6 months to change your coverage or get the premium reduced without answering medical questions.

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                    #10
                    SC has "extra help" for prescription cost

                    Unfortunately there are several states that do not allow anyone under 65 (even on SSDI) to get a medigap policy. I live in SC and that is one of those states. It sux.
                    msgijo, I too live in South Carolina and have what is called "extra help" (program name?). I was recently approved for Ocrevus and will only have to pay $8.35 per dose.
                    This is an income based program and with the amount I get on SSDI I qualified - it has been a life saver for the savings.

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                      #11
                      Generally, Medicare Part B cover such drugs which you get from the doctor's office or for hospital outpatient setting. Other than this all the prescription drugs are covered under Medicare Part D. If you have been prescribed for Medicare and you are on Medicare then it is beneficial to get the Medicare service. For more information you can either consult an expert who will guide you in explaining all the Medicare details.

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                        #12
                        Medicare and Ocrevus

                        I have been on disability for 15 years and have Medicare with an Advantage plan. My doctor gave me a pamphlet for Ocrevus as I have gone through so many other dmd’s ; gilenya, rebif Copaxone and I my health was declining. She had me fill out a form to obtain financial assistance from Genetech.
                        I am getting the actual infusion from the company and Medicare will cover the cost of the facility where I will have it infused. It seems that you always have to be your own advocate in order to coordinate the medicine that you need.
                        Teresa

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