Medicare B coverage of Evenity

@solveigsp, it wouldn't have if you live in the USA. There is an $8000 cap. Next year it will be $2000. That is still ridiculous and people with commercial insurance can get it for nothing.

@bonesmcgee , I have AARP medicare advantage. I was told Eventity would only cost a $20 copay. I am being billed $844 a month!! I am appealing and still fighting with my insurance!

Oh, my. It's disturbing to be told one thing and then be charged so much more. I hope you are successful soon!

Thank you! And just to clarify, you are getting that benefit only through your supplemental plan, not through basic medicare.

Evenity is covered under Medical, Part B. First you need to meet your insurance company’s deductible, than no cost for the treatment for the rest of the calendar year. Come 2025, you start again to reach your 2025 deductible in that calendar year.

What if you have original Medicare but no supplemental plan?

bonesmagee,
I’m not in NC, but the supplements are the same across the country. We have been happy with United Healthcare.
Regarding Evenity infusions, that is covered under Part B, so the bulk of it is covered by Medicare.

I have Medicare advantage which follows the Medicare part B payouts. I just finished Evenity and had to pay 20% of the drug cost which was $416 a month and was $467 by the 12th shot. It was expensive but I gained 20% bone density in his and spine.

As others have said, if you have original Medicare with Parta A and B, Evenity injections given on an outpatient basis should be covered by Medicare Part B - at least for now. (It will NOT be covered if self-administered at home.)

That means that Medicare pays 80% after the annual one time Part B deductible ($240 in 2024). You can get a supplement to cover your 20% co-pay.

The Medigap supplement plans are standardized, with the different options identified by letters. A chart summarizing what is covered by the different options can be found at Medicare:
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Compare Medigap Plan Benefits | Medicare
https://www.medicare.gov/health-drug-plans/medigap/basics/compare-plan-benefits
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And a broader discussion of Medigap supp plans starts at:
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What's Medicare Supplement Insurance (Medigap)? | Medicare
https://www.medicare.gov/health-drug-plans/medigap
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The section on "Get Medigap Costs" gives an overview + a link to a page where you can look for available plans:
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Get Medigap Costs | Medicare
https://www.medicare.gov/health-drug-plans/medigap/basics/costs
Find a Medigap policy that works for you
https://www.medicare.gov/medigap-supplemental-insurance-plans/#/m?year=2024&lang=en
If you talk to an insurance agent or broker, look for someone who is not pushing Medicare Advantage/Part C plans.

If you have original Medicare but no supplemental plan then Medicare pays 80% and you pay 20% (as opposed to being covered by a supplemental plan).