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@katiegrace

gardenlady,
Do you have an out of pocket max for your drugs, for medicare?
I will be on medicare in another year. I'm just wondering how much per year I will then have to pay for Zenpep. I take Zenpep instead of Creon.
Zenpep is also very expensive.

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Replies to "gardenlady, Do you have an out of pocket max for your drugs, for medicare? I will..."

Medicare prescription drug plans vary, depending on if they are Medicare Disadvantage Plans or traditional Medicare. it is important to learn some of the ins and outs. Traditional Medicare prescription drug plans (Medicare part D) have a basic allowance, "donut hole" and then catastrophic range. This changes and you will need to update information each year. You might be required to use a mail order plan for full benefits so you need to take a look at the requirements. Medical benefits are Medicare Part A and B, A is hospital and B is outpatient services. Medicare B pays 80%. Typically people purchase supplemental insurances, vary in what is covered with the varying levels. Medicare Disadvantage plans (Known officially as Medicare part C, MedicareAdvantage) I am glad I went to traditional Medicare because MSKCC doesn't participate in Medicare Disadvantage plans. Networks vary. Treatment at a major cancer center might be covered. For example, a plan in this area might cover Columbia Presbyterian, Weill-Cornell, or NYU. My sister has a Medicare Disadvantage Plan. She, like myself, has the BRCA gene. She has an unusual form of esophageal cancer. Her Medicare Disadvantage plan covered University of Michigan. I would not recommend it for pancreatic cancer. In any case, her plan covered Cleveland Clinic but not Mayo Clinic. Cleveland and Michigan agreed on the plan so it didn't seem like it was necessary for her to pay for an out of network consultation for 3rd opinion. Since her first line chemo did not stop the cancer from spreading to the liver, she is getting a second line therapy. She will be reevaluated in a few weeks to evaluate her response. She has been advised at Michigan that there isn't an alternative if the current doesn't work. She will also follow up with Cleveland Clinic to review the findings. When I see how my sister has been treated, I am most grateful for my traditional Medicare plan. I am most grateful that MSKCC is relatively accessible to me and covered by my plan. It is more expensive than Medicare Disadvantage however, I think my life is worth it.