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Old Thu Oct 25, 2018, 09:27 PM
JoMac53 JoMac53 is offline
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SCT with Medicare: Supplement vs Medigap policies

I would like to get a current discussion going regarding Medicare paying for SCT. Also anyone having experiences with Medicare Supplement insurance plans vs Medicare Advantage plans paying for SCT. And the drugs afterward, which Medicare D plans are better for the after-transplant drugs? Please chime in... Thanks. Jo (decision time - turning 65 in Dec)
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Joanne, 64F; Dx Pancytopenia May '17; Primary MDS RAEB-1 Aug '17. Currenly weekly CBC, Granix shot if ANC below 1.0
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Old Fri Oct 26, 2018, 12:15 AM
rar rar is offline
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My SCT and associated expenses were billed at $3M. Medicare paid at about 40%, I have a plan F plan and paid nothing. An advantage plan would have been much more expensive.. Drugs can be very expensive. I have one drug that retails at $12K a month. I have had walgreens and walmart plans that seem to cover most drugs. The best you can do is to guess what drugs you will need and plug them into the drug plan selector at the Medicare site.

Ray
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Old Fri Oct 26, 2018, 09:16 AM
JoMac53 JoMac53 is offline
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Thank you, Ray. Wow, that's mind boggling.

Do you know if there's a list anywhere of drugs commonly used after transplant? Also, with the Plan F, as far as you know, does it matter which insurance company you go with (other than the cost for your premium)? I mean do you have to check that the hospital will take that coverage (Aetna, Blue Cross, Humana, etc) or does that not matter with Supplement plans? I see signs up in doctors offices all the time saying they're in network or out of network or no longer accepting this or that insurance. I think they're talking about HMOs and PPOs in the Medicare Advantage plans but I'm not a hundred percent positive.
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Joanne, 64F; Dx Pancytopenia May '17; Primary MDS RAEB-1 Aug '17. Currenly weekly CBC, Granix shot if ANC below 1.0
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Old Fri Oct 26, 2018, 02:33 PM
rar rar is offline
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By law all plan F have to have the same benefits. Most doctors like to deal with AARP. In general all the plan D offer all the common drugs. It is the uncommon ones that get you.
If a doctor or hospital accept Medicare assignment they will treat you for what medicare and plan F will pay in full. If they don't accept Medicare assignment they can charge up to a 10% surcharge, but you are still fully covered. If they won't treat you go elsewhere. This is never happened to me.

I with you success with your transplant.

Ray
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Old Sun Oct 28, 2018, 02:27 PM
JoMac53 JoMac53 is offline
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I'm getting shots of Granix (Tbo-filgrastim, bio-similar to Neupogen, Zarxio) but everything I find online for any of these drugs says it's off label to use it for MDS. Anyone know if that means insurance won't pay for it?
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Joanne, 64F; Dx Pancytopenia May '17; Primary MDS RAEB-1 Aug '17. Currenly weekly CBC, Granix shot if ANC below 1.0
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Old Sun Oct 28, 2018, 02:43 PM
rar rar is offline
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Some plans cover it others don't. With part D your copay would be $4k to $40K. If you go to medicare.gov you can enter your drug list and they will tell you what your costs would be for all the plans.

Ray
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Old Sun Oct 28, 2018, 03:33 PM
JoMac53 JoMac53 is offline
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Thanks, Ray.
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Joanne, 64F; Dx Pancytopenia May '17; Primary MDS RAEB-1 Aug '17. Currenly weekly CBC, Granix shot if ANC below 1.0
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