Cost of Evenity injections

I got the procedure code and called Medicare. The assistant there said the code was not on their list. I double checked the code. The code was right. My next step is to get the provider to run the procedure through billing before we do the procedure. We'll see how it plays out.

@kdell Pretty much the same with Baycare Medicare Advantage Plan. $410 a month. I'm supposed to start Nov/2025 but I cannot come up with the $$. I have a $2000 deductible then it will be paid 100% so, I'm going to wait 2 months to start the year.

I have an Advantage plan & my first bill for Evenity was $474.49. My first injection was July of this year, but the billing lags behind. I have not had any fractures nor have I been on any other bone drug. My diagnosis was severe OP, so perhaps that had something to do w/the approval.

Now that we're in the Medicare review/change window I've asked my agent to shop other Advantage plans that might have better coverage for Evenity (I'm not taking any other prescriptions). He found one that has a lower out-of-pocket range that would kick in sooner for 2026 than my current plan. I can always change back to my former plan once I'm finished w/Evenity.

In hindsight, it would have been nice to have planned for all 12 injections to be in the same calendar yr, but when a dr scares you into taking a drug you jump on it quickly (which is so unlike me).

@singingbones. If you switch your Medicare to a supplement (not advantage) but Supplement type plan G,F (there are many with alphabet names A, C etc.), your supplement would cover everything Medicare does not. For example I have Medicare A, and B with Supplement F and I pay about $120/month for F. When I get Evenity my out of pocket is zero because the supplement covers what Medicare B doesn't. It might be worth looking into. I realize the Advantage plans can be cheaper or zero premium but you are having to pay more because they don't cover as much as a supplement.

@normahorn
F Plans are no onger avai;ble but I have been told that a Medigap supplimental plan G is the next best thing.

@deborahla - I made this comparison yrs ago, but perhaps it's time to research it again - thank you!

Yikes. So Medicare does not pay for Evenity?

@deborahla

Just a note to help pay for the deductible for your shots or meds. If your doctor orders the meds on your Part B (doctor part) instead of the Part D (Drug Pan) it will cost a lot less. He did this for me for my Prolia shots. It cost me $300 deductible instead of $600. I still have an Advantage Plan and get my medical Part B back because I am in a Special Needs Plan

jk1938

@jcking1938

@patwerthman I have Traditional Medicare. I received my injections at an infusion center and Part A and B paid for all the costs. I never have a co-pay with Traditional Medicare. They either pay for some procedure or they do not. By the way, I also have a Part G Supplemental Plan that I pay for. This Part G fills in the gaps not covered by Part B of Traditional Medicare.

If a person has an Advantage Plan (sometimes called Medicare Advantage) then the insurance company is a private company that contracts with Medicare. Medicare Advantage may or may not pay for Evenity.