Announcement

Collapse
No announcement yet.

Seeking advice in dealing with Medicare co pays

Collapse
X
 
  • Filter
  • Time
  • Show
Clear All
new posts

    Seeking advice in dealing with Medicare co pays

    Good afternoon, friends. I have been on Avonex for 10 years and will be enrolled in medicare May 1st. Under the advantage plan (HMO) I plan to enroll in, my co pay for Avonex will skyrocket for me to $6,500 per year. And, of course, I expect that will increase as the cost of the drug increases. I am sure I would not qualify for poverty level assistance, but having to pay this much for Avonex will mean no more vacations, dinners out, gift giving, etc.

    I've heard there may be foundations out there that are able to help. Any advice? Is anyone on medicare working with a foundation that can help with co pays if you're not at poverty level? I know, by contract, Biogen is not able to help medicare patients with co pays. Which really stinks.

    Any ideas out there on how to get that changed? Does contacting law makers help? Just looking for a ray of hope, I guess, for those of us on fixed incomes that would like to be able to visit grandchildren in another state every now and then.

    Thanks for listening and best wishes out there to everyone in the same boat! I feel your pain.

    ** Moderator's note - Post broken into paragraphs for easier reading. Many people with MS have visual difficulties that prevent them from reading large blocks of print. **

    #2
    Unfortunately, if you are on Medicare, discounts are not allowed. I am on Medicare (65+) and also on Tysabri. Because it is covered under Part B, my monthly medical expenses are $275.00. Switch to an infusion?

    Comment


      #3
      Contact

      the National MS Society as well as the MS Society of America. They may be able to help you.

      Comment


        #4
        Sticky

        You can also check out the Sticky for Financial Assistance that's right above this thread.

        Comment


          #5
          I get copay help from Medicaid through the state here in Idaho. There's probably something similar in your state.

          Comment


            #6
            Insurance question

            If you are not on straight Medicare, but rather a replacement policy that you pay extra premium for, is that considered Medicare?

            For example, instead of Medicare, you take out a Medicare replacement policy with Blue Cross/Blue Shield. Are you still considered on Medicare? Your policy is with Blue Cross & you are paying the premium. Therefore, shouldn't financial assistance still apply?


            I have asked the financial assistance counselors but not one can answer.

            Comment


              #7
              Doodlebug - I don't know if this answers your question, but when you turn 65, you sign up for Medicare. You don't have to, but you will be penalized. It''s s good idea to take out supplemental health ins, but Medicare will be your primary ins and the supplemental is always secondary.

              If you are still working at 65,here is what I read:

              If your employer doesn't require you to sign up at 65, you don't need to enroll in Medicare, nor will you be penalized for not signing up during your initial enrollment period. ... You can still have other insurance, but once you apply for Medicare, it becomes your primary health insurance.
              1st sx '89 Dx '99 w/RRMS - SP since 2010
              Administrator Message Boards/Moderator

              Comment


                #8
                Doodlebug --

                I wish that I knew more about financial resources. I do know that some of what we are eligible for changes if we are on Medicare.

                Here is a list from our Resource Center. Maybe someone else can chime in on where to start when looking at the list.
                https://msworld.org/resource-center/...ial-assistance

                Originally posted by its2much View Post
                the National MS Society as well as the MS Society of America. They may be able to help you.
                And, yes. Some of these agencies have MS Care Navigators that might be able to direct you to resources. Stu's News and Views has a social worker Navigator who might be able to help to direct you. Email at Info@MSViewsandNews.org

                Please look around the Resource Center blue link, that i posted above,for phone numbers, or feel free to ask for help if you need contact information. I can't guarantee that I know all the answers, but I can try to help you to look.
                ~ Faith
                MSWorld Volunteer -- Moderator since JUN2012
                (now a Mimibug)

                Symptoms began in JAN02
                - Dx with RRMS in OCT03, following 21 months of limbo, ruling out lots of other dx, and some "probable stroke" and "probable CNS" dx for awhile.
                - In 2008, I was back in limbo briefly, then re-dx w/ MS: JUL08
                .

                - Betaseron NOV03-AUG08; Copaxone20 SEPT08-APR15; Copaxone40 APR15-present
                - Began receiving SSDI / LTD NOV08. Not employed. I volunteer in my church and community.

                Comment


                  #9
                  What I found

                  Originally posted by hbkat View Post
                  I've heard there may be foundations out there that are able to help. Any advice? Is anyone on medicare working with a foundation that can help with co pays if you're not at poverty level?
                  I found an article entitled "4 Things I've learned about Paying for MS Medications. Written by Ed Torias on 2-15-19. There might be some good answers for you there.

                  I also found on Medicare.gov website a list called "Pharmaceutical Assistance Program". It lists drugs and programs that may assist.

                  Good luck!

                  Comment


                    #10
                    I Actually read "Medicare & You"!

                    What I was previously referring to was a Medicare Advantage Plan, that incorporates Part A, B, & D.

                    Because these plans are compliant with Medicare rules, I am surmising that they must comply with government anti-kickback rules which disallows offers of assistance programs to patients in exchange for them to stay on higher cost drugs.

                    This leads me to a question--at what point do you decide to stop your DMD because of age & cost?

                    Comment


                      #11
                      Originally posted by Doodlebug View Post
                      This leads me to a question--at what point do you decide to stop your DMD because of age & cost?
                      That's a question I ask myself too. Prior to starting copaxone in 2008, my MS was out of control. Frequent and severe flares. I worry that going off might bring those back.

                      I don't have an answer, but here is a link to a previous thread that addressed your question.

                      https://www.msworld.org/forum/showth...light=Stop+dmd
                      ~ Faith
                      MSWorld Volunteer -- Moderator since JUN2012
                      (now a Mimibug)

                      Symptoms began in JAN02
                      - Dx with RRMS in OCT03, following 21 months of limbo, ruling out lots of other dx, and some "probable stroke" and "probable CNS" dx for awhile.
                      - In 2008, I was back in limbo briefly, then re-dx w/ MS: JUL08
                      .

                      - Betaseron NOV03-AUG08; Copaxone20 SEPT08-APR15; Copaxone40 APR15-present
                      - Began receiving SSDI / LTD NOV08. Not employed. I volunteer in my church and community.

                      Comment


                        #12
                        Check this study out

                        Originally posted by Mamabug View Post
                        That's a question I ask myself too. Prior to starting copaxone in 2008, my MS was out of control. Frequent and severe flares. I worry that going off might bring those back.
                        Check out the study called DISCOMS on clinicaltrials.gov.

                        We're starting to stray off topic. We should start a new thread!

                        Comment


                          #13
                          Originally posted by hbkat View Post
                          Good afternoon, friends. I have been on Avonex for 10 years and will be enrolled in medicare May 1st. Under the advantage plan (HMO) I plan to enroll in, my co pay for Avonex will skyrocket for me to $6,500 per year. And, of course, I expect that will increase as the cost of the drug increases. I am sure I would not qualify for poverty level assistance, but having to pay this much for Avonex will mean no more vacations, dinners out, gift giving, etc.

                          I've heard there may be foundations out there that are able to help. Any advice? Is anyone on medicare working with a foundation that can help with co pays if you're not at poverty level? I know, by contract, Biogen is not able to help medicare patients with co pays. Which really stinks.





                          Any ideas out there on how to get that changed? Does contacting law makers help? Just looking for a ray of hope, I guess, for those of us on fixed incomes that would like to be able to visit grandchildren in another state every now and then.

                          Thanks for listening and best wishes out there to everyone in the same boat! I feel your pain.

                          ** Moderator's note - Post broken into paragraphs for easier reading. Many people with MS have visual difficulties that prevent them from reading large blocks of print. **
                          Biogen helped me find assistance through a fund called The Assistance Fund. I take Tecfidera and have a very small monthly copay. There are many funds available but the money runs out fast. Sometimes the pharmaceutical company can get you on a free drug program for 6 months. I believe Avonex is made by Biogen. Get in touch with them. You can get help but it is a lot of work.

                          Comment

                          Working...
                          X