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Medicare Coverage for Tysabri?

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    Medicare Coverage for Tysabri?

    I may have to go on Medicare this summer, earlier than I expected. Waiting on answers on my husband's retirement health care coverage and whether that qualifies as SEP to defer Medicare for another 5 years.

    In the event I do need to enroll, how is Tysabri covered? Do they bill the infusion center vs meds separately? What % is covered? Does your supplemental cover the rest? If so, what type of supplemental did you opt for?

    Appreciate the insight. So much to learn.
    Kathy
    DX 01/06, currently on Tysabri

    #2
    Because it's an infusion Ty is covered under part B. So, 80% is covered, my supplemental picks up the rest. I do not have a copay, that might be because I have F coverage and that might not be offered anymore but, I believe G is offered and that might be close ?? My supplemental is Cigna and I'm thinking maybe I had needed to go with United ?? Cigna keeps going up-maybe they all do. Once you pick a supplemental you need to stay with them or go through underwriting and because we have ms they will not choose to insure you When you first go on Medicare (open enrollment) you are insurable.

    I have an insurance broker, he advised me. He might only be in CO so, I do not know if he can help you? If you want his name and # I will give it to you.

    Linda
    Linda

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      #3
      Originally posted by lindaincolorado View Post
      I have an insurance broker, he advised me. He might only be in CO so, I do not know if he can help you? If you want his name and # I will give it to you.

      Linda
      Thanks Linda. I thought that was how it worked, but wanted to double check. I know I have one shot to get the supplemental right. Hoping next week to get an answer on whether I need to start Medicare in July or SEP extended.

      I was thinking about using a broker to help if need to select. Everyone I know says their supplemental keeps going up, I guess like all healthcare costs.
      Kathy
      DX 01/06, currently on Tysabri

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        #4
        I am on Ocrevus which is also an infusion. Medicare part B and my supplemental Cigna plan F cover it.

        You can go through the plan finder on Medicare.gov to see what your options would be. The plans vary by state. Unbelievably some states do not allow Medicare recipients who are under 65 to buy supplemental coverage. For those of us who can get it, premiums are higher. It stands to reason, if you qualify for SSDI you’re going to have medical issues and more claims.

        If you are under 65 and covered by a supplement, as soon as you turn 65 you need to notify the insurance company. Since you’ll then be “retired” not “disabled” your premium will go down. You only have 6 months to do this without having to answer medical questions and possibly be turned down.

        That makes no sense but it’s the way it works.

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          #5
          Thanks kmallory1 for the background. Never realized the would charge more under 65. Like you said, hard to hide why you ned it.

          It is so screwy. Even though we will have coverage for 5 years under a retiree health plan, it is looking like I have to opt in to Medicare for coverage I don't need all to avoid penalties and medical u/w later when I do need it. Ugh...
          Kathy
          DX 01/06, currently on Tysabri

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            #6
            I joined Medicare 3 years ago, and after spending $13,000 a year on health care, I'm down to under $4000, all inclusive. I'm also a bargain for the government, since I've gone from 13 infusions a year to just 7. Tysabri is still over $6000, but a lot less.
            I tried Medicare.gov but found it the Rube Goldberg of websites. For the iPhone experience, try ehealthmedicare.com. They are just a broker for lots of companies trying to get you on the bandwagon, but that is what Medicare.gov is. You enter your zip code, and they'll show you all the plans in your area. You enter your drugs, and they'll give you the cost of each plan. You can easily compare three plans at a time, and the best advice I got was from a man who said, "Find the cheapest plan to fit your needs and buy it!" There is no benefit in paying more with a better known company. I've had great luck with my Supplemental and Part D, although I did change to another company on the Part D. Plans do go up a bit each year, but it is so much better than my previous cost.
            One hint is to scroll down on the plan page till you see "show all plans" since companies pay to be listed first. You can order plans online, call the provided phone number, or call the company directly.
            If you're under 65, I believe they do list the cost you'll pay which is more than the over 65 cost.
            One other hint I got was with the drugs you take. Depending on which ones you use, it might be cheaper to check with a local pharmacy and see what your cost would be if you pay cash and buy in larger quantities. That's what my husband and I did, and we found it was better to pay cash. We are no longer locked into the "90 day supply" rule. We purchased the cheapest Part D but never use it.
            Good luck!

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              #7
              Originally posted by pennstater View Post
              Thanks kmallory1 for the background. Never realized the would charge more under 65. Like you said, hard to hide why you ned it.

              It is so screwy. Even though we will have coverage for 5 years under a retiree health plan, it is looking like I have to opt in to Medicare for coverage I don't need all to avoid penalties and medical u/w later when I do need it. Ugh...

              Hi Pennstater,

              A suggestion. As a moderator, would you be able to position this thread for access to all in future? The Medicare years, when they are upon us, can really confuse anyone.

              I ask because I needed the responses you received (lindaincolorado, etc.) to confirm what I wanted to tell you the day your thread began but simply was not sure.

              I am sure that others will add to this thread and increase its value!

              Comment


                #8
                Originally posted by 502E79 View Post
                Hi Pennstater,

                A suggestion. As a moderator, would you be able to position this thread for access to all in future? The Medicare years, when they are upon us, can really confuse anyone.

                I ask because I needed the responses you received (lindaincolorado, etc.) to confirm what I wanted to tell you the day your thread began but simply was not sure.

                I am sure that others will add to this thread and increase its value!
                Yes. Are you asking specific to Tysabri or Medicare in general? If specific to Tysabri, I should be able to.

                Once I get some answers and guidance on what retiree health plans are and are not eligible for an SEP, I will update the general Medicare thread and run by other mods.
                Kathy
                DX 01/06, currently on Tysabri

                Comment


                  #9
                  Originally posted by pennstater View Post
                  I will update the general Medicare thread and run by other mods.

                  Was asking from the all to common "Medicare confusion" standpoint.

                  Thanks for considering this. I probably should have reviewed the archived thread first but info has a way of changing.

                  A new year can become a new ballgame.

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