Cost of Evenity injections

Posted by shula @shula, Jun 17, 2023

Does anyone know what is the out of pocket cost for Evenity if one has traditional Medicare with a supplement vs Medicare advantage program?
I was told by Aetna Medicare Advantage CONY the the out of pocket cost is $602.89
for each injection visit. They said Evenity is a tier V medication. I heard Medicare part B covers 80% and Medigap or supplement covers 20%. However I think the out of pocket cost for every Evenity visit would be costly.. appreciate a reply and thanks. Shula

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@shula

Thanks for your reply. Do you have AARP UHC advantage program or traditional Medicare with part A and B?
I note that a few people said their part B covers the cost for the injections with traditional Medicare.
Shula

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Following… I wondered this also. I have traditional Medicare with AARP supplement.

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I was told that my Plan F (UHC) would fully cover the cost of Evenity when I called UHC.

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Part B covers 80% for those of us on Medicare Advantage and I assume for those on regular Medicare, since it is given in the office. Those with supplements may get the other 20% covered. Correct me if I am wrong!

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I have a Humana advantage plan and I just got my first bill. It was for $463.

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Can anyone tell me how much their doctor or facility charges Medicare for an evenity treatment?

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My doctor bills around $2,200 each month which I think is about the going rate. I have a medicare advantage plan - my copay is approximately $83.00 a month. But medicare advantage plans vary so copays could be different.

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A while back I was told by Aetna Medicare Advantage CONY the the out of pocket cost is $602.89.
I want to correct this statement.
I called AETNA MEDICARE Advantage CONY again and they informed me that if Evenity is approved (requires prior approval) then there would be no out of pocket costs.

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@shula

I thought the donut hole is for Medicare part D plan. Evenity is billed under Medicare part B plan.
I do not think the donut hole applies when a medication is administered in a doctor’s office. It does not qualify as a prescription medication. That is my understanding. Thanks for your reply.

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Yes the donut whole does apply which I am in on a Medicare Advantage plan. my out of pocket cost is $561. and I will be self injecting.

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@laurensb

Can anyone tell me how much their doctor or facility charges Medicare for an evenity treatment?

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$5,000+

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