1. < Osteoporosis & Bone Health

Evenity and Medicare - What do plans cover and how much?

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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bonesmcgee | @bonesmcgee | Jun 15 10:46am

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.

REPLY
2 replies
susanfalcon52 | @susanfalcon52 | Jun 16 6:50am
In reply to @bonesmcgee "My numbers were better after one year of Prolia but I had dental work so I..." + (show)
@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.

Jump to this post

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.

REPLY
bonesmcgee | @bonesmcgee | Jun 16 6:58am

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.

REPLY
3 replies
gravity3 | @gravity3 | Jun 16 7:04am
In reply to @bonesmcgee "Interesting. I wonder why my doc didn't know that. My doc only told me that it..." + (show)
@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.

Jump to this post

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.

REPLY
1 reply
gravity3 | @gravity3 | Jun 16 7:05am
In reply to @gravity3 "I have traditional Medicare and AARP UnitedHealth. I am in NC and haven't paid a dime..." + (show)
@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.

Jump to this post

Forgot to add that I've had 9 so far

REPLY
njhornung | @normahorn | Jun 16 7:29am
In reply to @bonesmcgee "Interesting. I wonder why my doc didn't know that. My doc only told me that it..." + (show)
@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.

Jump to this post

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

REPLY
1 reply
babs10 | @babs10 | Jun 16 8:05am
In reply to @solveigsp "I am getting Evenity monthly now. Today I’ll receive my 8th set of injections. I chose..." + (show)
@solveigsp

I am getting Evenity monthly now. Today I’ll receive my 8th set of injections. I chose Evenity because the other option would have cost me out of pocket $20k for the year. I didn’t look up the cost but it is negligible. The injections are not fun and I have to get my lab work done in advance to check my calcium levels to ensure that I can get them. I got Prolia for 5 years before this. I can’t know, of course, how these are working but I seem to be fine. I hike in the hilly woods nearby and lead an active life without fear. So, I think It’s a good choice.

Jump to this post

@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.

REPLY
connibar | @connibar | Jun 16 8:06am
In reply to @bonesmcgee "My numbers were better after one year of Prolia but I had dental work so I..." + (show)
@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.

Jump to this post

@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!

REPLY
1 reply
bonesmcgee | @bonesmcgee | Jun 16 8:18am
In reply to @connibar "@bonesmcgee , I have AARP medicare advantage. I was told Eventity would only cost a $20..." + (show)
@connibar

@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!

Jump to this post

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

REPLY
bonesmcgee | @bonesmcgee | Jun 16 8:22am
In reply to @normahorn "Your doc was correct. It is under a medical benefit (Part B) and not under a..." + (show)
@normahorn

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

Jump to this post

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

REPLY
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