Medicare B coverage of Evenity

Posted by amli65 @amli65, Sep 12, 2022

Medicare B coverage info for Evenity. How much do they pay per month for it. Medicare could not answer the question about cost or the assignment they pay per month. Does anyone know?
The amount would help to see if it would be affordable.

Thank you in advance for your input

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@hardingv

If you have traditional Medicare (with or without a medigap plan), Tymlos is not covered under Part B. Rather you need a Part D RX plan. (I don't know anything about Medicare Advantage plans.)

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We are still in Open Enrollment- until December 7. Now is the time to call 1-800-Med-ICAR and shop for a Part D plan. They can tell you which ones cover Tymlos or whatever you are interested in.

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@susanfalcon52

I had my sixth dose of Evenity last week. My Medicare Part B covered it at 100% because I have it in an infusion center.

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Susan ,
I can’t remember if you told us if you have the advantage plan ? My insurance rejected the infusion center and I give my own injections. I live in Nevada and all states are different I guess . I was paying $560. Per shot and my recent went down to $340 .

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@kristie2

Susan ,
I can’t remember if you told us if you have the advantage plan ? My insurance rejected the infusion center and I give my own injections. I live in Nevada and all states are different I guess . I was paying $560. Per shot and my recent went down to $340 .

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Kristie2,
I’m not on an Advantage plan. I’m on traditional Medicare. Part B pays for Evenity because I have it in infusion center.

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@susanfalcon52

Kristie2,
I’m not on an Advantage plan. I’m on traditional Medicare. Part B pays for Evenity because I have it in infusion center.

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Thanks

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My numbers were better after one year of Prolia but I had dental work so I quit it and my doc put me on Evista for 2 years. My latest scan had much worse numbers. Now she wants to put me on Evenity starting after I turn 65 in August. She told me to research Medicare supplements so I can afford it.

I can't seem to get anywhere looking on my own in a confusing maze of companies and policies.

Can anyone tell me exactly which supplemental plans cover most of the cost? Or is it true that Part B will do it? I'm otherwise very healthy and am in NC if that makes a difference.

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@bonesmcgee

My numbers were better after one year of Prolia but I had dental work so I quit it and my doc put me on Evista for 2 years. My latest scan had much worse numbers. Now she wants to put me on Evenity starting after I turn 65 in August. She told me to research Medicare supplements so I can afford it.

I can't seem to get anywhere looking on my own in a confusing maze of companies and policies.

Can anyone tell me exactly which supplemental plans cover most of the cost? Or is it true that Part B will do it? I'm otherwise very healthy and am in NC if that makes a difference.

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bones,
Yes, Part B does cover Evenity. It has to be administered in a doctor’s office or an infusion center.
I have traditional Medicare with a supplement (I have AARP which is United healthcare). I’m sure that whatever Part B plan you choose will cover it. I would certainly ask.
The cost of Evenity is shocking. I see it quarterly when I receive my EOB from Medicare. Each dose is well over $5000.

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Interesting. I wonder why my doc didn't know that. My doc only told me that it would be under a medical benefit, not an Rx benefit.

I did call my pharmacy and they said each shot is $1000 and are given 2 at a time so it would not be $5000 here in NC.

I'm new at this but Part A and B come automatically with Medicare, but a supplemental plan gives more coverage and in some cases is 'free'.
I thank you for your info which shows I should go with the same supplement you have and would like to know if you're in NC.

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@bonesmcgee

Interesting. I wonder why my doc didn't know that. My doc only told me that it would be under a medical benefit, not an Rx benefit.

I did call my pharmacy and they said each shot is $1000 and are given 2 at a time so it would not be $5000 here in NC.

I'm new at this but Part A and B come automatically with Medicare, but a supplemental plan gives more coverage and in some cases is 'free'.
I thank you for your info which shows I should go with the same supplement you have and would like to know if you're in NC.

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I have traditional Medicare and AARP UnitedHealth. I am in NC and haven't paid a dime yet. Do t rely on your docs to know what is covered by whom. Unless you have a doc that has experience. Do your home work with Medicare and supplemental.

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@gravity3

I have traditional Medicare and AARP UnitedHealth. I am in NC and haven't paid a dime yet. Do t rely on your docs to know what is covered by whom. Unless you have a doc that has experience. Do your home work with Medicare and supplemental.

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Forgot to add that I've had 9 so far

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@bonesmcgee

Interesting. I wonder why my doc didn't know that. My doc only told me that it would be under a medical benefit, not an Rx benefit.

I did call my pharmacy and they said each shot is $1000 and are given 2 at a time so it would not be $5000 here in NC.

I'm new at this but Part A and B come automatically with Medicare, but a supplemental plan gives more coverage and in some cases is 'free'.
I thank you for your info which shows I should go with the same supplement you have and would like to know if you're in NC.

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Your doc was correct. It is under a medical benefit (Part B) and not under a Rx benefit (Part D).

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