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    • May 3, 2018 at 4:40 pm
    smiller
    Participant

        I would like to know if medicare pays for any type of immunotherapy drugs (opdivo/yervoy).  My  husband has plans to retire later this year but he will be without his health insurance. Now he is thinking this plan may not work.  He has to pay  $1,000.00  as a co-pay even with his insurance so I cannot imagine how much he would need to pay if he had no coverage. 

      Thanks for any advice!

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    • Replies
        • May 3, 2018 at 6:41 pm
        mary1233
        Participant

          I am not an expert so please verify everthing I say before you make a decision.

           

          My concern with Medicare is with the Advantage plans. In my area there are no Medicare Advantage plans that have any of the major cancer centers in their network. So, under an Advantage plan, I could get immunotherapy, but I would be paying out of network fees for the doctors I would want to see.

          You can get Medicare options that will pay for these types of doctors, but it is not cheap and it is complicated. Also it keep changing so you have to keep up with it.

          When I get to the point where I have to set this up I plan to go the the Office of the Ageing to have someone help me understand the options. I am in NY State but maybe there is something similar in your state. You can call Medicare and talk with someone also.  Just don't take advice from an someone who gets paid by selling you insurance. Get your advice from someone who puts your needs first.

          My best to you and your husband.

          Mary

            • May 3, 2018 at 7:04 pm
            smiller
            Participant

                Thank you Mary.  I will have to speak to someone and found out his options.  Sadly enough I know he can qualify for SS Disability right now,  but once again since he is not old enough for medicare at this time,  he would be left without insurance of any kind.  From what I read, Medicaid would take two years to begin in the state of Texas from the time you start disability.  So sad dealing with this horrible disease to have to worry about how to pay for everything. 

              • May 3, 2018 at 7:48 pm
              mary1233
              Participant

                The Texas Health and Human Services website says that this department assists in navigating Medicare and Medicaid.

                Mary

                • May 4, 2018 at 1:22 am
                kst
                Participant

                  Unfortunately, Medicare and Affordable Care Act plans are limited for the good hospitals in Texas. If you plan to go to MD Anderson or Southwest Medical Center I would call them and ask what they recommend.  I would also cover the costs of immunotherapy and targeted therapy under medicare plans.  MDA has a website that covers the plans they accept.  The only Medicare Advantage plan I am aware they accept is Kelsey Care Advantage and it is limited based on where you live.

                  https://www.mdanderson.org/patients-family/becoming-our-patient/planning-for-care/insurance-billing-financial-support/medicare-medicaid.html

                   

                  • May 13, 2018 at 8:15 pm
                  Sharon93065
                  Participant

                    II have Kaiser with medicare, i don't pay anything for opdivo/yervoy or opdibo maintenance. 

                  • May 13, 2018 at 9:56 pm
                  bjeans
                  Participant

                    Did you enroll in Medicare Part D? That's the prescription part. 

                    Beth

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