Re: Medicare question, again

[Guest guest]

I don't know about anyone else's, but my xolair is paid under the same clause as

cancer therapy or any other " drug therapy. "   Here is the most recent statement

from medicare:

 

xolair--$750, office service--(I assume that is to prepare and give the shot)

$105; breathing capacity test- $51 and $40 for the office visit.  Total is

946.  Medicare allows 682 and pays 545.  My insurance pays 136 and the

statement always says I am not responsible for what medicare does not allow.  I

get 150 mg once a month.  I can imagine what a bill would be for two shots

twice a month would be!  (I did not include the " cents " which would account for

the discrepancy in the total amounts.)

 

Hope this helps.  My supplemental insurance is GEHA which we were able to keep

(at a price) when my husband retired from the Post Office.  If you go with

someting like Secure Horizons or Humana, I am reasonably sure there will still

be a copay.  My mom was with Secure Horizons and had a copay for everything

except for some of her lab work that she had done every month.  But her copay

was very reasonable, and she was given very good care.

From: Carol <floridabouvs@...>

Subject: [ ] Medicare question, again

Date: Friday, July 16, 2010, 11:47 AM

 

Some time back this question came up and I have read the replies but still

didn't get the answer I need.

Can anyone who is retired and who gets Xolair tell me how that works with

Medicare, Supplements, Part D, etc.

We will be retiring possibly next year and I have no idea how to get any real

information to help me decide what plan to go with. I did one of those on-line

questionnaires and it said I could expect to be out of pocket for drugs about

$7,000-$8,000 a year or more with the medicines I take -- basically Xolair,

Singular, Clarinex. And that's on top of the monthly fees. I would hate to have

to stop Xolair because it's working so well for me.

If you don't want to take up list space with this discussion, please email me

privately.

Thanks lots.

Carol

[Guest guest]

Thanks for the suggestions so far. It explains how the doctor is covered. I

wonder how the Xolair is covered. As I understand, it retails for about $20,000

a year, so if you have to pay full price, or even half price under Obama-med,

you would end up in the " donut hole " with the first bill.

Scary.

Carol

[Guest guest]

The xolair itself is covered like the chemo would be covered for cancer, under

medicare.  Because I have a supplemental policy with prescription benefits, I

have never had to deal with the donut hole.  My mother did, but because of her

very low income, she got help with her meds.  I would have to look up all the

paper work on it and I think it was a Texas organization that helped....

 

If you have insurance where you work and they will continue your coverage after

you retire, you might want to investigate that and see if you can afford it. 

It is usually higher than what you pay while you are working.  All I can tell

you is from our experience and what we did when we retired.  We have had to pay

very little out of pocket for any tests, hospital stays (my husband had double

by-pass and we paid something, but it was very little compared to the entire

cost), only the co-pays for medicines.  We never pay the co-pay for the

doctor's office visit...our supplemental pays that.

From: Carol Corley <floridabouvs@...>

Subject: [ ] Re: Medicare question, again

Date: Monday, July 19, 2010, 12:50 PM

 

Thanks for the suggestions so far. It explains how the doctor is covered. I

wonder how the Xolair is covered. As I understand, it retails for about $20,000

a year, so if you have to pay full price, or even half price under Obama-med,

you would end up in the " donut hole " with the first bill.

Scary.

Carol