Could he substitute teach? Lots of teachers in my area do that - lots of flexibility. No lesson planning. Work as little or as much as they want.
3 Likes
to be clear, Part D (Rx) has an open enrollment period in early winter.
Those with Medigap Supplement (Part B) plans (PPOās) do NOT have any open enrollment. With the exception of a handful of states, once you choose a Supplement plan you are locked into that plan, and to change, may require medical underwriting.
Part C plans, aka Medicare Advantage (think of all the TV commercials), primarily HMOās, do offer open enrollment and you can change Advantage plans to another Advantage plan.
Today, approx half of enrollees have a Part B Supplement and the other half choose a Part C Advantage plan.
Deleted
Helpful explanations. My husband and I often shake our heads and say, āhow do the stupid people deal with all of thisā? And actually, I should probably talk to my 97 year old father (quite sharp but not good on the computer) - usually he just does Same at enrollment, but there are changes in PlanD this year.
1 Like
I too just started my infusions at the RA doctor because it costs me $0 as itās covered by Part B and my $240 deductible is reached first month every year due to an annual procedure.
1 Like
Good to hear that. My husband has PA and his rheumatologist has said he can change his medication to an infusion.
Since this year for 9 months, his retiree healthcare is being changed to private/on the marketplace, I wonder if this is a good solution for us.
Ugh, itās so complicated and we wonāt have any pricing until November 1. And then we get to do it all over again starting in September
Husband see his rheumatologist in 2 weeks, it will be a question he can ask and we will hope the doctor will have an answer for.
1 Like
Thatās why we did Part G. Part N and the G/N high deductible plans are good plans, but we donāt live in a state that allows us to make changes without underwriting. We want to keep things as simple as possible for when we need that simplicity. It amazes me that Part D is such a moving target ā¦ itās for old folks, and the older we get, the more difficult complicated things become.
1 Like
Itās possible that infusions are more expensive for typical health plans, and that coverage under Medicare differs from coverage under non-Medicare plans. Definitely something to look into.
The rheumatologist has said that the infusion route will be cheaper as itās part of medical care and not medicine. Very confusing.
Itās why osteoporosis medication is an infusion, because itās billed differently for Medicare.
To give an example, I hear the osteoporosis medication is a shot but since Iām not on that Iām not 100% sure
It was that donut hole that was the problem with RA injections (Enbril, Humira, etc) because you would hit it after the 1st or second month - since regular employer provided healthcare doesnāt have the donut hole, your injections are covered all year long as a drug. To bypass the donut hold in Medicare, you go to the doctors office and have them infuse you for an in office treatment that is covered by Part B of Medicare at no cost to you other than your deductible (I have G so it was $240 but thatās covered for me in Jan every year by an annual procedure). Instead of Part D drug coverage, you are doing Part B in doctor office medical coverage.
Iāve only had my 2nd injection but now Iām wondering - since there is a $2000 cap on out of pocket, and if my other prescriptions reach that anyway, then I probably could just do injections at home? Although I have to say, my infusion is only 30 minutes and there is no pain like the injections (or so I hear). Iām meandering again.
2 Likes
Iām recently turned 64 and the Medicare discussions have been helpful. I will be better informed and careful to make sure I make a good decision.
I talked to my sister today who is 73. She said she has Medicare and her employer retiree insurance which is also for her medications. She said the retiree prescription plan is similar to what she would pay for prescription plan through Medicare. She is switching to an infusion for her immune suppressant. She said one benefit is no longer having to deal with the mail order company.
His second part-time job is tutoring at his old school.
1 Like
Can yāall taking about infusions rather than injections explain how that works? What is the infusion called and what injection is it replacing? How often do you go vs how often were the injections.
I take an injection (skyrizi) via my dermatologist that is mega-expensive so I get financial assistance. I see my rheumatologist next week and want to be able to ask her about infusions.
My husband was on Enbrel and is now on Humeria, both shots. He has been on co pay assistance but itās not allowed on Medicare. Federal law
The infusion alternative is Remicade. He has psoriatic arthritis.
Iām not familiar with the medication you are on.
OK, whoa! Copay assistance is not available on Medicare??? Iām in for a world of hurt.
My sister also has psoriasis arthritis. Over the years I know she has been on Enbrel, Remicade and a few others. I wish I could recall what she was just switched from. It was an injection but she has had a hard time fighting a fungal infection in her esophagus which the immune suppressant was likely a contributing factor. She just switched to an infusion. She has Parkinsonās so Iām involved in some of her medical appointments. I know the formulary has changed some years and she has to switch to a different medication that is covered.
This is the best explainer Iāve seen on this board. Thanks!
1 Like
Injections are the self injectible weekly shots like Enbrel and Humira - Infusions are like IVās where they put a needle in your arm and you let the medicine drip in over time. My infusions are of Simponi Aria and it only takes 30 minutes and I only have to have it every 8 weeks as opposed to weekly injections. I believe the time it takes for an infusion is specific to the type of medicine and the amount.
Not on Medicare yet, but my bone drug, Prolia, is a shot given in the cancer centerās infusion room. (Clear as mud?)
My injection is every 12 weeks. If I only had to sit for 30 minutes for an infusion every 12 weeks Iād do that if it means dealing with payment is easier. I swear, it feels like every 12 weeks refilling my specialty drug Iām re-creating the wheel.
1 Like