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Topic: Medicare and the cost of Chemo

Forum: Stage IV/Metastatic Breast Cancer, Open to All To Contribute —

Topics here are started by members with a Stage IV/Metastatic Breast Cancer diagnosis, but open to all members to contribute to discussions. Please note that there is a separate forum, Stage IV/Metastatic Breast Cancer ONLY, where topics are open only to those members.

Posted on: Aug 4, 2020 02:59PM - edited Aug 4, 2020 03:00PM by Simone80

Simone80 wrote:

Hi ladies. My sister recently had a double mastectomy and is currently on Medicare. She is worried she will not be able to afford the cancer meds and chemotherapy. She told me Medicare only pays for 80%. My cancer meds are paid for by my insurance so I'm not much help.

What are others doing to get help with paying the 20% deductible?

Dx 7/2001, IDC, Right, 1cm, Stage IIIA, Grade 3, 7/13 nodes, ER+/PR+, HER2- Dx 1/2019, IDC, 1cm, Stage IV, metastasized to bone/other, ER+/PR+, HER2- (FISH) Targeted Therapy Ibrance (palbociclib) Hormonal Therapy Femara (letrozole)
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Aug 4, 2020 04:16PM BevJen wrote:

Simone,

She is correct that Medicare pays only about 80% of the cost of medical care. I am on Medicare, and I have a Medicare supplement plan (also known as a Medigap policy). It picks up the other 20% so long as the service is covered by Medicare. I don't know that much about Medicare advantage plans, but I think they pick up more. One thing she can do is to look into switching to Medicare Advantage during open enrollment in the fall, but that won't kick in until Jan 2021.

As for meds, if she doesn't have a Medicare advantage plan, then one option is to get a Part D prescription plan. Those pay for other meds (not infusion drugs that are usually paid under Part B of Medicare.) So, for example, if she was on an AI, which is a pill, the Part D plan would pick that up.

In addition to all of that, she should contact the drug manufacturers to see if she can get some assistance. They usually have income tests, but usually you can get some $$ from them. Her oncologist's office should have someone there who can help her with all of this, and she needs to speak up and get some help from them in securing some financial assistance.

Microwave Ablations,Liver 3x ;Radiation Therapy to Femur (Both) April 2021; total hip replacement (R) and placement of rod (L) to stabilize femur both sides; immunotherapy (single agent - keytruda) Dx 11/2003, ILC, Left, Stage IIIC, 13/18 nodes, ER+/PR+, HER2- Dx 6/2006, ILC, Stage IV, metastasized to other, ER+, HER2- Dx 5/2019, ILC, Stage IV, metastasized to liver, ER+/PR+, HER2- Surgery 7/4/2019 Targeted Therapy 7/31/2019 Ibrance (palbociclib) Surgery Lymph node removal: Left, Sentinel; Mastectomy: Left, Right; Reconstruction (left): Pedicled TRAM flap; Reconstruction (right): Pedicled TRAM flap Chemotherapy TAC Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Surgery Lymph node removal; Mastectomy; Reconstruction (left): Pedicled TRAM flap; Reconstruction (right): Pedicled TRAM flap Hormonal Therapy Faslodex (fulvestrant) Hormonal Therapy Femara (letrozole) Radiation Therapy Immunotherapy
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Aug 4, 2020 07:07PM Cksbrown wrote:

So far, my Medicare, my part D policy and the supplement have picked up the tab for everything. I had BCBS when I had my surgeries and radiation in summer 2017, but started with the Medicare when it came time for chemo tha fall. I have not received a bill for anything. Now I am taking Arimidex daily and it costs me $7.30/month. I can handle that.

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Aug 4, 2020 08:06PM Simone80 wrote:

Thanks BevJen and Cksbrown for your reply. I think she just overwhelmed right now and doesn't know where to start.

Dx 7/2001, IDC, Right, 1cm, Stage IIIA, Grade 3, 7/13 nodes, ER+/PR+, HER2- Dx 1/2019, IDC, 1cm, Stage IV, metastasized to bone/other, ER+/PR+, HER2- (FISH) Targeted Therapy Ibrance (palbociclib) Hormonal Therapy Femara (letrozole)
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Aug 4, 2020 08:22PM nopink2019 wrote:

One correction to BevJen's comment. Medigap plans do not have open enrollment. If you have qualified for Medicare for more than six months, in order to get a new plan or switch plans, you must complete a health questionnaire. Plans are labeled A through N, missing a few letters. A plan with the same letter must cover same things, regardless of who sells it. Difficult to compare pricing, without calling each offeror. Agents can help, they typically get a commission but don't charge you directly.

Medicare Part D drug plans do have open enrollment each fall. Fairly easy to enter your drugs and compare cost between plans. You can change your plan each year. Warning about drug cost. I am on targeted therapy, administered via a pill. In January, I pay $2,400. Then I hit the Medicare donut hole. After that each month I pay $540.

Caveat , I am not an agent. But I have used one for my husband and me to great benefit. Good Luck, insurance can drive you crazy.

Dx 2008, IDC, Stage IA, Grade 3, ER+/PR-, HER2- Dx 2019, Stage IV, metastasized to bone/liver/lungs, ER+/PR-, HER2- Chemotherapy 8/22/2019 Taxotere (docetaxel) Chemotherapy 9/12/2019 Xeloda (capecitabine) Targeted Therapy 11/8/2019 Kisqali Hormonal Therapy 11/8/2019 Faslodex (fulvestrant) Targeted Therapy 5/10/2021 Afinitor (everolimus) Hormonal Therapy 5/10/2021 Aromasin (exemestane) Chemotherapy 11/14/2021 Xeloda (capecitabine)

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