Lupron and Medicare Part D

I had my prostate removed and I have had no treatments. My wife has GBM and medicare part B covered her injections. I think ,as someone else mentioned, her Oncologist handled all the approvals. I would discuss this with them. It shouldnt be their first rodeo. I would say Lupron as an injection provided by the Dr becomes covered under part B. My wife has had 5 surgeries, Immunotherapy injections, 4 hospital stays, participated in a trial, 3 ambulance calls, and dozens of lab work, and testing. I have not had one bill.

There are independent licensed medicare insurance agents, that are paid by medicare, not you, that can give you guidance on what kind of medicare insurance would be a good fit for you. I personally would start with a medicare supplement as that allows you to step down and step cheaper to a medicare advantage plan later. Having a medicare advantage often does not allow you to upgrade to a medicare supplement Good Luck!!

Lupron injections are covered under original Medicare Part B when given in a hospital outpatient setting or in a doctor's office as an outpatient service. My husband has original Medicare and his Lupron injections have been fully covered for many years when given at Mayo Rochester or at the Simon Cancer Center in Indianapolis as ordered by his local medical oncologist.

As for your question about a Medicare Advantage plan, the bottom line is Don't Do It!! There is a lot of information out there about why they are a bad idea. A reputable independent health insurance consultant or agent can explain the pitfalls.

Very helpful comments. Thank you all. I'm going to save all this info for December when it's time for me to decide on a plan.

Not a Medicare expert but will speak from personal experience. My husband is covered under Medicare A/B, a supplement, and a prescription drug plan. Lupron injections done at the clinic/by the physician have been covered under Medicare & supplement, not the prescription drug plan.

When we were originally selecting options at age 64 & 6 months, a knowledgeable friend advised picking a supplement because if you ever have health problems, the coverage is better and cost savings are enormous. Apparently advantage plans work for healthy people, but those with health issues benefit from the supplement option.

The injections go through part b because it's a procedure. Our medicare and supplement cover them.

It is classified as a treatment and therefore covered under original Medicare Part B when given in an outpatient facility or office. The Medicare.gov chat reps rarely give detailed answers. You should ask the oncologist's staff, who have undoubtedly dealt with Medicare claims like this repeatedly.

Here is an article you may find helpful.
https://www.patientpower.info/navigating-cancer/financial-and-insurance/cancer-patients-which-medicare-plan-is-best

You are 100% correct on what you said. I would highly recommend a traditional Medicare supplement plan such as Plan G and a good Part D plan. (Plan F is no longer offered to new enrollees) Depending on where you get your treatment now and possibly in the future; remember ... many providers do not accept Advantage Plans and that is true with Mayo Clinic.