Giant Cost of bridge therapy

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Pat Hicks

Member
Joined
Jan 6, 2009
Messages
10
Location
Hattiesburg, Mississippi
I had aortic value surgery in 2001. I also have to have colonoscopies once every two years due to ulcerative colitis. I have always used bridge therapy of Lovenox, and the cost was reasonable because of the insurance coverage I have. Now it has changed. I have one more year on insurance with cost of Lovenox astronomical. Then I go on Medicare which means it will be even higher. What can I do? Does anyone have another option? I certainly do not want to be on coumadin but also don't want to stop coumadin for about six days because I sure don't want a stroke. Can anyone give me any advice?
 
Pat, first off, can I fix your name or do you want it like that?

Next, Medicare. You'll have a choice of signing up for drug coverage or going to a Medicare Advantage plan and nearly all of those have prescription coverage. I'm on one and my copayment for the Lovenox was $5.60. Not bad for a $739 prescription.

Your next option is going to www.needymeds.com and filling out an application and submitting it to the drug manufacterer. You may qualify for free medicine or greatly reduced cost on it.

http://www.needymeds.org/papforms/loveno0022.pdf

The patient cannot have prescription insurance, be ineligible for any federal or state programs and have an income at or below 200% of the Federal Poverty Level. The patient must also be a US resident. This program has both an insurance verification component and a patient assistance program but only one form. There is an appeals process for those with insurance who cannot afford the co-pays.
 
The price you pay: $5.60. Is that for one syringe?

Nope that was for a box of 10 pre filled 80mg syringes.

I'm on a Medicare Advantage HMO plan. Primetime Standard Plan. Everyone has something differrnt to choose from in their area. If your not on Medicare yet, go to there website and look through advantage plans in your area to see what's available and what things will cost you. I'll get you the links.

http://www.medicare.gov/

http://www.medicare.gov/MPPF/Includ...COUNTY&ExternalSourceID=&MPPF_PDP_Integrate=N

This is my particular plan and by the way, you may qualify for extra help from the Federal Government depending on your income. If so, your costs for the Premiums and prescriptions may be lower then whats in the charts. Like my plan has a $47 a month premium. I'm 100% subsidized, so my cost is $18.60 for a month instead of $47.

http://www.medicare.gov/MPPF/Includ...=default&WinDisplay=NewWin&county=39151|STARK
 
When I looked at the Medicare options, it became clear that the Advantage Plans have co-pays for every office and hospital visit. You will want to check those out. Another downside from my viewpoint was that you had to use Doctors and hospitals that were IN NETWORK.

As a Heart Patient in Mississippi, you may want to see someone at the University of Alabama at Birmingham (a well known and respected Heart Hospital). I would be surprised to see that UAB was included as an in-network hospital for a Mississippi resident.

The alternative to Advantage Plans are Medicare Supplement Plans (also called MediGap Plans) plus an independent Prescription Drug Plan which allow you to see ANY Doctor, ANYwhere, WithOut Referal, for ANY reason!

You can compare Drug Plans on the Medicare Website.
Alternatively, go to a Walgreens Pharmacy and ask them to run a Cost profile for ALL of the participating Medicare Drug Plans in your state using their Excelleng Program. It will list the Top 5 Advantage Plans and the Top 5 Medicare Approved Drug Plans for the drugs you take. It will also give you a complete list (all 49 in Alabama!) ranked by Annual Cost with contact information for each plan. This Walgreens Program provided even more information than the Medicare on-line program. Outstanding!

In Alabama, BlueRx (from Blue Cross of Alabama and Tennessee and for those residents ONLY) came out the least expensive of 49 providers, especially for Heart Patients. Even their common Brand Name Heart Drugs were listed as Tier 2 (out of 3), including Lovenox.

Many of the other companies listed the common brand name Heart drugs as Tier 3 which negated their 'low tier 2 co-pay enticements.

Start reading Medicare and Me (available from Medicare or their website www.medicare.gov) followed by the guideline for buying Supplemental Insurance. Call your State Health Insurance Assistance Program (SHIP) telephone number on the back of the Medicare and Me book for guidance. There should be *several* providers available in your state, some with familiar names and many with names you have never hear of. Hopefully the SHIP advisors can suggest some providers that would be good for you. Call them and ask for their Medicare Supplement Plan Information packet.

After a while, it will become clear who the best providers are for your area and needs. It does take some time and study!

If you don't like your first choice, there is an open enrollment period every Nov 15 through Dec 31. What Genius came up with a 6 week open enrollment period that encompasses Thanksgiving, Christmas, and New Years? I better stop now :)
 
I'm just wondering who can afford to stay on regular Medicare. Beleive me, those office visit copayments aren't anywhere near what your going to pay with traditional Medicare.
 
I'm just wondering who can afford to stay on regular Medicare. Beleive me, those office visit copayments aren't anywhere near what your going to pay with traditional Medicare.

The Medicare Supplement Plans (A through L) pick up what "Original" Medicare does not cover (i.e. the 20% co-pay and the $1000+ hospital deductable).

There are 12 Government Defined plans available, provided by Private Insurance Companies which must be licensed to sell their (identical policies) in the states they choose to do business in. (I'll spare you the details of the 12 different plan options... see the aforementioned references to read about them).

'SOME' companies still provide a "Retiree Health Care Spending Account" to retirees who lose their standard company group insurance when they go on medicare at age 65.

These funds can ONLY be used to buy supplemental Health Insurance OR to reimburse the retiree for medical expenses. Sadly, such plans are becoming like dinosaurs (extinct for more and more people).
 
Yeah but what does one have to dish out for a medigap policy?

That Varies GREATLY from plan to plan (remember the 12 government defined plans?) AND from Insurance Company to Insurance Company (and .... and...) which is why it is necesssary to compare.

That said, Plan F which covers the medicare deductables and co-pays (Bare Bones Policy) plus extended Nursing Care and Foreign Travel (back to USA) and "excess charges" (by Doc's / Hospitals that don't accept the Medicare Allowed Amount) runs from 116/mo to 150/mo with a sliding increase that varies from company to company as you age, even going over $200/mo with some companies. These prices also vary from State to State so you want to go with a company that does a fair amount of business in your state (to share the over a larger population base).

The RX Drug plans can run from $31 / mo with a (different) deductable depending on company to $250/mo (I couldn't believe some of those Drug Plan Prices!) and you have to look at the Formularies to see if all of your drugs are covered and under what tier (there are different co-pays for each tier).

The BIG SECRET that many don't want people to know is that they are often better off using the Walmart (or whatever) $4 Generic Drug offer than filing under the insurance plan for Generics (I won't get into the long details of how and why!) Even the Walmart program didn't put that little trick into their equation.
 
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