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

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

Profile picture for shula @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

Jump to this post

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

REPLY

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

REPLY

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!

REPLY

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

REPLY

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

REPLY

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.

REPLY

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.

REPLY
Profile picture for shula @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.

Jump to this post

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.

REPLY
Profile picture for laurensb @laurensb

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

Jump to this post

$5,000+

REPLY
Please sign in or register to post a reply.