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

Susanfalcon,

I am on Trad Medicare with a supplement. I spoke to a rep from Medicare yesterday - looks like I’ll need to call my advantage plan, again, to check on the coverage limits. I’ll let you know…

😎 Cheers!

Hi @susanfalcon52

I phoned Medicare and was referred back to my Advantage Plan . . . it looks like, in my case anyway, that Evenity injections are covered under "medical services" and therefore come with a nice co-pay program (meaning it's nice of me to co-pay). I'm glad you're lucky enough to have a supplement that covers it 100%!

Cheers!

@beanieone my Advantage plan quoted me a $20 copay and then are charging me $776 a month!! I have been fighting them for months

same thing happened to me.
I called my Aetna Advantage with the names of their agents I had talked to on what dates, and after months of nothing, they reduced my bill $600, said they were sorry for the misinformation, and would train their agents better. Laughable. I dropped them., after reading in numerous sources of the abuses possible under Advantage plans. Now on Medicare Traditional--costs a little less, but has much better coverage.

Hi @connibar

Unfortunately, I didn’t get a quote prior to starting Tymlos or Evenity, but figured whatever the price was, I was investing in my future health. Tymlos was covered under Part D (the first several months were gut wrenching $$-wise) as a prescription med. After reaching the gap/MOOP, the price was very reasonable.

Evenity, however, ended up with a price tag of about $450/monthly because of that sticky, old “it’s administered in the doc’s office” thing.

When I checked on coverage, I too was told there should only be a $35 office visit co-pay; that was quickly rescinded and clarified. Hmmm . . . I’m guessing that Prolia would be handled the same way as Evenity with the same price tag (or possibly more) forever!

Glad to be finished, at least for now and moving on to Reclast.

Cheers! Have a great weekend!

beanieone,
I guess it’s not really about luck. I just chose to go with Traditional Medicare and pay for a supplement. The $170 a month I pay has been well worth it.
I paid zero dollars for Evenity, zero dollars for Reclast, and zero dollars for a lot of other expensive procedures that various doctors have put me through.

susanfalcon,

I, too, have the Traditional Medicare along with a Supplemental Plan. Your information about $0 co-pay for these OP meds is why I revisited the possibility of the same outcome for myself. I’m guessing it’s the coverages in the Advantage Plans that may vary from state to state or company to company that make the difference. Meds suddenly become “services” when they’re administered in the doc’s office. The monthly premium for my PPO is $0 in my county, so there’s that.

Thanks for taking time to help me with this! Have a great weekend. Cheers!

Did Medicare cover it all because mine said it doesn’t?

@jolie2525 I have Traditional Medicare. I received my Evenity injections at an infusion center. This is a Part B designation as outpatient medical and the injections were administered by the infusion center's nurses. My Evenity injections were completely covered (at $5000/month!). When my endocrinologist prescribed Evenity he told me that I would have to go to an infusion center at a medical center/hospital for these injections. He said this is not a Part D prescription designation.

If you have a Medicare Advantage Plan (which is not Traditional Medicare) then your planjolie2525 I have Traditional Medicare. I received my Evenity injections at an infusion center. This is a Part B designation as outpatient medical and the injections were administered by the infusion center's nurses. My Evenity injections were completely covered (at $5000/month!). When my endocrinologist prescribed Evenity he told me that I would have to go to an infusion center at a medical center/hospital for these injections. He said this is not a Part D prescription designation.

If you have a Medicare Advantage Plan (which is not Traditional Medicare) then your plan is administered by the insurance company that you signed up with such as United Health Care or Blue Cross/Blue Shield. to administer your Medicare. If you called your insurance company and they said Evenity is not covered then I suggest you call them again and tell them that Part B does pay for Evenity and that since Traditional Medicare covers this under Part B they are required to do the same.

Thank You so much for your help. I did speak with someone at my insurance company and they said they only covered 80% and my responsibility is &545 a month but can’t afford that. Maybe it’s because Aetna in Florida doesn’t cover it?