Avastin... Part B but D on MA?? How to help a poor widow?

[Ardvark]

New customer takes a periodic injection with Avastin for Macular Degeneration(wet form). I believe it is a Part B drug. She can get it on Medicare Advantage but it is a $300 copay Tier 5 PA drug. How often she needs it varies. Sometimes monthly. Other times, once a quarter to every 6 months.

Normally, I would default to a MedSup except she is a recently widowed lady with SocSec being her only income(approx $1600/mo). She has about 80k in the bank from selling her house shortly before her husband passed away. She is living with the kids and really worried about her money. She balked at the MedSup premium (with PDP @ $170/mo for a G).

Running the numbers makes MA look good IF everything goes okay. And that is what she says she wants but any bump in the road and she will be in trouble.

Let's not make this an MA vs MedSup thing. I'm looking for good guidance to help a poor widow.

 

[vic120]

those injections can be expensive if you can get OE or GI do medsupp

even IF you can barely make sense of it on injection cost one hospitalization, Some surgeries OR PT and you're over

Plus networks and everything else you sacrifice to be on MA

Plus she won't pass underwriting

 

[somarco]

Present the facts and let her decide. If it works out for her, fine. If not, it is on her, not you.

 

[asher]

google prescription assistance
there's probably a foundation that will cover the copayment

 

[Helpico_Insure]

New customer takes a periodic injection with Avastin for Macular Degeneration(wet form). I believe it is a Part B drug. She can get it on Medicare Advantage but it is a $300 copay Tier 5 PA drug. How often she needs it varies. Sometimes monthly. Other times, once a quarter to every 6 months.

Normally, I would default to a MedSup except she is a recently widowed lady with SocSec being her only income(approx $1600/mo). She has about 80k in the bank from selling her house shortly before her husband passed away. She is living with the kids and really worried about her money. She balked at the MedSup premium (with PDP @ $170/mo for a G).

Running the numbers makes MA look good IF everything goes okay. And that is what she says she wants but any bump in the road and she will be in trouble.

Let's not make this an MA vs MedSup thing. I'm looking for good guidance to help a poor widow.

This lady isn't poor until she depletes these 80k. And Somarko is right:lether know what she can do.
Also check here if not already avastin - Google Search

 

[sman]

New customer takes a periodic injection with Avastin for Macular Degeneration(wet form). I believe it is a Part B drug. She can get it on Medicare Advantage but it is a $300 copay Tier 5 PA drug. How often she needs it varies. Sometimes monthly. Other times, once a quarter to every 6 months.

Normally, I would default to a MedSup except she is a recently widowed lady with SocSec being her only income(approx $1600/mo). She has about 80k in the bank from selling her house shortly before her husband passed away. She is living with the kids and really worried about her money. She balked at the MedSup premium (with PDP @ $170/mo for a G).

Running the numbers makes MA look good IF everything goes okay. And that is what she says she wants but any bump in the road and she will be in trouble.

Let's not make this an MA vs MedSup thing. I'm looking for good guidance to help a poor widow.

I don't believe that would go through the prescription benefit on MAPD. Since this medication is administered by a medical professional, she likely would pay 20% on most MAPD plans.

 

[somarco]

I don't believe that would go through the prescription benefit on MAPD. Since this medication is administered by a medical professional, she likely would pay 20% on most MAPD plans.

I (almost) had a client approved for this condition and treatment. Copay's ran $600 or so each time. SURPRISINGLY got him approved for a G plan at standard rates . . . he changed his mind before the policy went into effect . . .

SMH

 

[sman]

I (almost) had a client approved for this condition and treatment. Copay's ran $600 or so each time. SURPRISINGLY got him approved for a G plan at standard rates . . . he changed his mind before the policy went into effect . . .

SMH

Oh wow. My guess is he regrets that decision at this point (assuming he is getting the shots). I have a client who gets shots in her eyes (not sure if it's that medication though) and she gets assistance and pays zero for it (she's on a MAPD).

 

[vic120]

I (almost) had a client approved for this condition and treatment. Copay's ran $600 or so each time. SURPRISINGLY got him approved for a G plan at standard rates . . . he changed his mind before the policy went into effect . . .

SMH

What company approved it? I could use a carrier that would approve Mac Injections.

I have been denied several carriers, The reasoning its incomplete therapy same as PT except there is no end to it Apparently they always need another shot every 6 months or so

Once a person gets injections they say it never stops so therefore its considered incomplete therapy

 

[LostDollar]

New customer takes a periodic injection with Avastin for Macular Degeneration(wet form). I believe it is a Part B drug. She can get it on Medicare Advantage but it is a $300 copay Tier 5 PA drug. How often she needs it varies. Sometimes monthly. Other times, once a quarter to every 6 months.

Normally, I would default to a MedSup except she is a recently widowed lady with SocSec being her only income(approx $1600/mo). She has about 80k in the bank from selling her house shortly before her husband passed away. She is living with the kids and really worried about her money. She balked at the MedSup premium (with PDP @ $170/mo for a G).

Running the numbers makes MA look good IF everything goes okay. And that is what she says she wants but any bump in the road and she will be in trouble.

Let's not make this an MA vs MedSup thing. I'm looking for good guidance to help a poor widow.

(Caveat, I am not an agent. I am a Medicare Beneficiary who uses an HDF Medigap plan.)

Is this a situation where the HDG Medigap would be useful?