Connect
← Return to Financial discussions/tips concerning expensive treatment
Discussion
Financial discussions/tips concerning expensive treatment
Osteoporosis & Bone Health | Last Active: Feb 14 6:46pm | Replies (64)Comment receiving replies
This forum really needs someone very knowledgeable about Medicare to step in and try to make sense about all this in a more generally helpful way. There seems to be too many variables from one person to another that makes each individual situation unique and also there seems to be quite a bit of simple misinformation.
For example, Medicare Part B pays 80% of the eligible amount (after annual deductible) and you or someone on your behalf pays the other 20%. Please consult your friend Mr. Google which will lead you to the authoritative HHS info.
IF you do not pay that other 20% then you have either a supplemental plan (private insurance or employee retirement plan) or another governmental program that does pay or a pharma program. The other governmental programs are state-specific and usually income-dependent....hence creating much of the variation about what and how much is covered. The pharma programs appear to be here today and gone tomorrow.
IF you go to an infusion center to receive your osteo treatment, there is a rather complicated formula for whether Medicare considers this a Part B benefit or whether the treatment is covered under your drug plan.....I do not recall all the specifics but one of the factors I do remember about Part B eligibility is whether you have had a previous fracture.
Medicare Advantage is required to cover the same medical benefits as original Medicare. How you pay for those medical benefits is different.
Medical providers are the absolute worst source of info about the financial picture of medical care. Inasmuch as they all seem to have a similarly vacuous response, I suspect there may be a course at med school that teaches a practitioner what to say when a patient brings this up as a consideration.
If I had the time at present, I would contact the Medicare Rights Center. In my opinion, they have the most reliable info about Medicare coverage and cost. Perhaps someone here could convince a staff member at that Center to be assigned to this forum to help sort out all the coverage and cost questions that come up. I have no available time to do this until after the new year.
On the bright side of those receiving Prolia treatment, the patent is set to expire in early 2025 so there may then be available a generic like what is available for Fosomax and Bonita.
Replies to "This forum really needs someone very knowledgeable about Medicare to step in and try to make..."
@rjs. You wrote "This forum really needs someone very knowledgeable about Medicare to step in and try to make sense about all this in a more generally helpful way. There seems to be too many variables from one person to another that makes each individual situation unique and also there seems to be quite a bit of simple misinformation."
I will ask if there is someone from Mayo Clinic to come in to our discussions for topics like this. At the present time I think your suggestions are very helpful including contacting the Medicare Rights Center. Do you have a phone number or website to share for this?
rjd,
I agree that we need a Medicare/insurance expert to advise us. That would be great. The Medicare rights website is very helpful.
AARP has a website that addresses all of it.
As far as receiving Evenity at an infusion center, that’s what I am currently doing. My Part B covers it at 100% and I have not had a fracture.
Also, the Advantage plans are required to cover what Traditional Medicare would cover, but not necessarily at the same amount. Where Traditional Medicare would cover at 100%, an Advantage plan might cover at 50% or 75%.
I live in a poor state. Maybe the poorest in the country. As a social worker for 45 years, I am an advocate for the financially disadvantaged. In my state, low income seniors on Medicare also qualify for Medicaid. Medicaid differs from state to state. The Medicare/Medicaid combination is the best coverage anyone could have. These beneficiaries are completely covered and need no other insurance. In my city, in the poorest areas, I see billboards advertising Advantage plans with this message:
“Hey! If you have both Medicaid and Medicare,_________ Advantage plan can make your benefits even better!”
False. These beneficiaries are giving ip 100% coverage to venture into the Great Unknown of Insurance.
Connect
@rjd- Thank you Thank you for that!!! It is all very confusing and we all have different plans and different financial status’s . I do wish this area would be handled in some way that we could understand and feel better about the choices we are to make…. BEFORE ONE is put on a med so we know what all the financial ramifications will be!!!
Thank you again !! I hope this idea is put into place!!!