Since I am nearing retirement age, I am curious what the out of pocket cost in the US is on Enbrel and Humeria? I guess this question would also apply to Medicad if I end up in disability.
Seems like without insurance is what $150? On my insurance I paid $5 an injection I think. Blue Cross
Do you mean medicare? On medicaid it would be 1 - 3 dollarsā¦ On medicare no MATTER the Part d (c if available in your state) You first few months will be 708.00 then 112 for a few more then you are past the ādonut holeā The good news is the donut hole goes away in 2020.
However there several programs that Social Security doesāt mention broadly. Every State has wahts calle a Medicare Savings Program that offers some level of help for most. There is also the Extra Help program which covers the donut hole: https://www.ssa.gov/pubs/EN-05-10508.pdf Cost is between 6 and 7 dollars a monthMake sure you apply in the 2 mos before your birthday month or the 2 months after. You part B will cover several different biologicals fully as back up (anything that is IV) Humira has a foundation that picks up quite a bit. Enbrel not so much. BUT both have a medicare advisor who will get you set up with the right supplement of part D.
For Humira call 1.800.4HUMIRA (1.800.448.6472) and ask for an insurance specialist. They can help you get started.
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Yay, I love this info! Iāll be copying and pasting this to a word document so I can save it for 2020 when I retire! (Iāll hold off until January 1 even though I turn 66 Sept. 4, 2019.)
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@Grandma_J NO NO NO NO NO. It doesnāt matter WHEN you retire or start collecting benefits. IF you do not apply for medicare within 2 the 3 months before or after your Birtday month you willhave to pay the late-enrollment penalty for as long as you have Medicare Part B. The penalty amount could go up 10% for every 12-month period when you were eligible for Part B but didnāt enroll. For example, if you waited for three years to sign up, your penalty could be 30% of the premium. FOR EVER and you are such a tough old bag, that could be many many yearsā¦ LOL
Thanks for the compliment! (I think)
Actually, we visited our Social Security office Wednesday and they reminded me to come in within 3 months before and 3 months after my 65th birthdayā¦and Iāll for sure do that. But Iām not planning on taking my Social Security benefits until January 1, 2019āthey told me Iād get almost half of what my husband gets starting January 1 of my 66th birthday year. I do intend to take the benefits starting 1/1/19, but not retiring until at least my 66th birthday or laterā¦I donāt think I have to go on Medicare until I actually quit working, but I do need to sign up in that 6-month window around my 65th birthday. Donāt worry, my husband wonāt let me forget to do that! 
Iām just hoping and praying I can stay on Enbrel after I retire (and afford it!) because as Iāve mentioned about 30 times Iām afraid of having to switch to Remicade. With that information you posted, tntlamb, Iām hoping things change in 2020 and Enbrel will be an option.
Thanks for the great info. I will keep that in mind and put it on my calendar. Fortunatly the wife works for Atnea in their senrio supplement division and knows all this I found out when I brought it up.
Been reading these post for awhile. Been wondering why medicare part b, c, or d do not want to cover the self admisinter type of drugs. Wouldnt they be ācheaperā to cover than the infusion.
And with part d, one can pay the cost to a certain amount then the coverage kicks in correct?
And are there better states to live in for formulative reasons than others for medicine purposes?
They cover them BUT the copay is huge. This is political part Part D is one of the largest scams ever (think when it passed.) designed to cover the Insurance companies and no one else.
The equal access bill for biologics (and more) has been languishing in committee for years as an amendment to Obama Caree. The part I have been involved with (politically) as an ambassador for the Arthritis association has to do with pediatric rheumatologists. There are multiple options for student loan forgiveness for new docs entering practice, we have been trying for years to get that extended to pediatric rheumatology. Believe it or not if the enter research (as the majority do) they can get forgivness, but NOT if they enter actual practice helping kidsā¦
@tntlamb
Iām always confused about this whole Medicare thingā¦so, my husband has this GREAT (for real) supplement to his Medicare. He pays $0 for doctor visits, very small amounts for med copays, and I think $50 total for any hospital stayā¦I didnāt check, but have been wondering if that same supplement for me would pay a good share of my Enbrel?
Well, we got a letter from the supplement a few days ago (BCBS of MN) basically telling him they will no longer cover him in 2019. Iām pretty sure everyone on it got the letter. Iām attaching it.
Iām worried that his next supplement wonāt be as generousā¦he did pay nearly $200/month for it, but it was well worth the peace of mindā¦
Medicare is combining plans. What happened is states ended up with 4-6-8-10 different Medicare plans that had incredibly minor (and confusing) differences. You will still have at least one, more likely two or three Medicare plans and it sounds like BC/BS will be sending you info any day now.
By law a Medicare advisor canāt advise on what plan to sign up for ā what they do is COMPARE the plans for you. They can tell you the premiums, copays, other coverages, things like that, but they canāt tell you āThis plan XX is the closest one to the plan that went away.ā Only a sales person can tell you that, which youāll find at retail center.
I would say give it a few days until you get the new info, give it a read, then get on the phone or stop in a retail center if you need additional help. There should be a graph in the first few pages that lays out pricing and basic coverages. For enbrel or humira info youāll have to call but there are excellent options out there.
azurelle
(who accidentally has a 25+ year career in health insurance!)
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