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

You do not have to have broken bones to qualify for Evenity. I qualified without having broken bones or severe osteoporosis. I have Medicare Part B and a supplement to cover the costs.

When I was getting the year-long injections, I had to pay a $391 co-pay plus the cost of the enterologist co-pay. I had an Anthem BC/BS Advantage plan.
When it was time to renew my yearly plan, the insurance rep told me that if I had had a Medicare supplement, it would have been covered fully since it was administered in a doctor's office.

I have been seeing on this site that others have been approved for Evenity without having a broken bone. I would check into this again.

Just completed my second shot of Evenity.
Received an invoice showing charges for Feb. I have Medicare Advantage plan through Wellcare. The invoice showed that the injections totalled approx $8,000. After processed through ins. my coat was $345.
After spending an hour and a half on the phone w/ins.,. The conclusion was that every month I would be responsible for $345 each month until my deductable had been met.
They pay 80/20 until deductable is met. Then they pay at 100%.
Your deductable will be different with each insurance co.
My shots are not at the PCC's office.
It is at an infusion office. (Specialist)
I can't afford this each month and am looking for a different avenue. But, hope this clarifies how the system works with Medicare. Yes it covers 80% until your deductable is met and then covers 100%.

I have never gotten a shot in the dr's ofc. Was told they don't do shots anymore. If your Dr approves to get the RX from the pharmacy and administer it, then I believe, yes. I was referred to Innovative Infusion for my shots.

From an invoice of $8,000 my part is $345 after the ins pays their 80 percent until I pay all my deductable.
Every single month.
I cannot do it.

I am getting shots because I have severe osteoporosis. But haven't had a broken bone, yet.

At 100 percent after you meet your deductable

I will be getting my 10th shot of Evenity this month. My doctor sends me to an oncology office with Baptist Healthcare to get this shot. Medicare, Part B and my Medicare Supp has paid for my shot so far. I could not get this shot if I had to pay for it. I have a burst compression lumbar I fracture, injuring L1 thru L5 along with S12. My fracture has not healed in two years. I could not get surgery due to the Osteoporosis. I am planning on getting surgery as soon as my numbers improve and my spine surgeon plans to do my surgery. My injury has ruined my life. I can now only stand for 4 to 5 minutes at a time. I have to either sit or lie down. I hope to be out of my pain soon. I had the same problem before starting the shot of not knowing if Medicare, Part B and Supplement would pay. I just took the chance knowing that I would have to divorce my husband of 30 years, so that I could get the money for the shots. That is if the insurance would not pay.

Medicare Advantage is NOT traditional MEDICARE. Medicare Advantage is private insurance company with a Medicare connection. Depending on who your insurance company is will vary as to costs.

Traditional MEDICARE is national and the same everywhere. No referrals are needed. They pay 80% and any supplemental insurance ( mine is AARP) covers the 20% of health care and hospital costs.

Injectables have a unique place in all of this. So best to check it out with your Evenity provider in line with your Medicare or Medicare Advantage plan as they could be quite different.