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

You (and others) have mentioned their Evenity was covered 100% by Medicare because the shots were given at an "infusion center". How does an infusion center differ from having the shots given at the doctor's office? My dr is telling me that Evenity is very expensive, so I assume shots given at her office are not covered. Also, I have a Medicare Advantage plan (Blue Cross). Are the shots only covered by original Medicare, although you mentioned you have supplemental insurance? Thank you.

"Medically necessary" shots given at the doctor's office are covered under Part B. You should contact your specific plan to confirm Evenity, though.

Medicare Advantage covers whatever Medicare covers.

@ripley I am on Medicare Advantage and we are still covered by Medicare Part B. However I did have a fairly expensive co-pay. I thought there was no difference in coverage between Medicare and Medicare Advantage for use of Part B so I am surprised anyone got it covered 100%.

Shots given at the office are covered the same way shots given at an infusion center are covered, I believe. If uncertain call your insurance company!

It is covered 100% for those on traditional Medicare who have a medigap plan. It is the Medigap plan that pays what is not covered by Medicare.

@ripley I honestly do not know why Evenity must be administered at an infusion center. Evenity is given with two subcutaneous injections. That's all. It's not an infusion. My endocrinologist told me that I had to get Evenity at an infusion center and I also learned from my primary care provider that they do not administer Evenity at their office.

If I had a Medicare Advantage Plan I would call the insurance company (in your case Blue Cross/Blue Shield) and ask that question. Blue Cross/Blue Shield administers Medicare with Medicare as your primary and Blue Cross/Blue Shield managing your health care. I do know that many members here have shared that Evenity is covered by their plans but the amount that is covered seems to vary. That's a puzzle to me. If Traditional Medicare approves Evenity to be fully covered by Part B when administered at an infusion center then why wouldn't Medicare Advantage plans do the same? Maybe it has something to do with the deductibles which vary for each Medicare Advantage Plan?

Correct! I have traditional Medicare A and B, plus a Gap plan, and a pharmacy plan. My part B paid 80% and the Gap plan paid the other 20% for my Evenity at an infusion center.

@ripley I never cease to wonder at the misinformation that just goes around and around in these sites where we are trying to get information on osteoporosis.
The supposed infusion site requirement to get Medicare Part B coverage for Evenity is a prime example of often repeated bad info.
Some of the people stating this indicate their doctors told them it had to be an infusion center.

I know several others have commented correctly on this in this discussion but it's a pet peeve and I couldn't resist throwing in my two cents.
Traditional Medicare will pay 80% for Evenity via Part B. There may be some kind of administrative hassle for doctors to give the shots but my doc certainly does it and Medicare pays the 80%. My Medicare Supplemental (Medigap) covers the 20%.
Some people go thru their Part D drug plan and end up paying a fortune I think. Got to be thru Part B.
I do not know about other insurance plans or Med Advantage plans.
Maybe we should start a misinformation discussion where we go thru our favorite bits of repeated bad info in these groups.

@ripley, @awfultruth, @monkhhi, @naturegirl5, @windyshores and @normahorn, I moved the posts about Medicare and Evenity coverage into this existing discussion:

"Evenity & Medicare: What plans do you have and what is covered?" - https://connect.mayoclinic.org/discussion/medicare-b-coverage-of-evenity/

I did this so that members can easily find, in one place, answers to their questions about Medicare coverage when considering Evenity. They will be able to find it quickly using the group Search.

Insurance coverage can be confusing and frustrating and not always clear. In this discussion, Connect members help each another by sharing their experiences.

I have Medicare Advantage through BC/BS. Medicare Part B, I was told, pays 80% of the cost of Evenity. Of course we also have to deal with the donut hole in some cases.