Enbrel and new Medicare insurances

iVillage Member
Registered: 01-08-2006
Enbrel and new Medicare insurances
13
Sun, 01-08-2006 - 9:03pm
I would like to ask the people what they are doing that are on Medicare and have to go with the new medicare insurance and who are taking Enbrel?
What help are you getting to pay for the Enbrel? My husband makes a decent salary and, therefore, we are too high for most of the help which is for low incomes but with a $l,500/month drug I need financial help! I was getting it through the Enliven Foundation but since I now have presp. insurance, if you can call it that, they cannot help me with the Enbrel.
If anyone else is having this same problem and you have found some foundation to help you pay for the Enbrel, please let me know. Also, I am so worried about the $3,600 'hole' that you have to pay out in cash for your drugs. Please let me know what you are doing and thinking? Being on the Enbrel, you get to this 'hole' in a month and half.
I take the 50mg. shot once a week now but am thinking about trying the 25mg. because it is half the cost. I tried to stretch the 50mg. shot out to 2 weeks but could only go for l-l/2 weeks. Any comments on the 25mg. shots?
I know I have a lot of questions. Thanks for any help or any feedback. Judy

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iVillage Member
Registered: 03-25-2003
Mon, 01-09-2006 - 1:35pm
I am sorry that I cannot help with this. I pay $50 for 3 mths. with my insurance. I know copayments with Enbrel are a big problem for many people. Did you ask Enliven if they had any other suggestions? Or your dr?
iVillage Member
Registered: 03-25-2003
Mon, 01-09-2006 - 1:53pm

Judy,

I also take Enbrel, but declined Medicare coverage (which I became eligible for this month)because currently my husbands insurance covers it 100%. I think that "donut hole" clause is absolutely ridiculous! And it's so true that you'd get there in no time using Enbrel, since it's so expensive. Is there anyway you could get better coverage through your husband's policy? Good luck! I hope you'll be able to find a solution.

Barb

iVillage Member
Registered: 11-03-2003
Mon, 01-09-2006 - 2:40pm

Judy, welcome to the RA board.

Molly

iVillage Member
Registered: 01-08-2006
Mon, 01-09-2006 - 4:45pm
thanks but yes I asked Enliven but the help I was on was that you could not have any medical insurance and now I do with the new medicare law for new presp. insurance and they said they cannot help me anymore. My Dr. said he does not know what to do and a lot of his patients have the same problem. He thinks the whole thing is a big mess!. Maybe someone will have found a foundation or something that can help me and others like me. thanks again. Judy
iVillage Member
Registered: 01-08-2006
Mon, 01-09-2006 - 4:51pm
Actually I thought that if you already had medicare you had to go on one of those insurance programs. My husband's insurance would not take me before or would not cover the RA and said it was a pre-existing condition so I never got on his insurance. I will see if they will now take me and if they will cover the RA now, maybe things have changed, but then still think I had to have been on his insurance, don't think I can now get on it. Do you know? thanks for your help. Judy
iVillage Member
Registered: 01-08-2006
Mon, 01-09-2006 - 5:12pm
Molly, thank you for your information. I will definitely check all of it out and let you know what I find. I did file an application with Medicare but our income is too high on their chart, and most others chart, and I was declined. I have called medicare and they said they cannot do anything with an income over $22,000, I think. So, I have to find some company who do not base their help on just what a person makes. Even though my husband is over the amount but under $30,000, it is not enough to pay for a $l,500/month drug and this $3,600 out of pocket hole. I am looking at maybe trying the 25mg. Enbrel once a week instead of the 50mg. I think that would be a little less but still very expensive.
Thanks again for your help and I will let you know what I find out after checking into everything. Judy
iVillage Member
Registered: 03-25-2003
Tue, 01-10-2006 - 11:32am

Judy,

Actually I had my existing insurance before I was eligible for Medicare. They sent me all the paperwork but I declined, although I'll still get hospitalization regardless - I think they call it Plan A. I can always sign up during their open enrollment period if need be. It was always my understanding that if you got on a group plan, they can't deny you coverage for a pre-existing condition, at least that's how it is in California. If I were to try to get a policy on my own I know I'd be immediately denied, but since I went through my husband's company, it was no problem.

Barb

iVillage Member
Registered: 01-08-2006
Wed, 01-11-2006 - 10:26pm
Hi Molly I checked into all the information you gave me and again they all are based on income, but thanks for trying. I will keep looking. Judy
iVillage Member
Registered: 01-08-2006
Wed, 01-11-2006 - 10:34pm
Hi Barb and thanks for your message. Insurance companies did not have to take you several years back and then they changed the law in IN and now they do have to take you, some make you wait l yr. with a pre-existing disease and then will cover after that but they will make the insurance so costly that you can't afford it. I got on medicare and then got my Enbrel through the Enliven Foundation so didn't worry about it til now! I don't think since I am already on medicare I can go on my husband's insurance, I think I have to take one of these new ones but I am going to call medicare and check that out for sure. I am so afraid a lot of our older people (and younger) are going to not take their meds now becaue they won't be able to afford them with the 'hole' in these insurance companies. I probably will have to try the 25mg. once a week instead of the 50mg. and hope it will work but still not sure I can afford that. Thanks for your message. Judy
iVillage Member
Registered: 11-03-2003
Thu, 01-12-2006 - 12:51pm
Judy, I am so sorry that this seems to be a dilemma with no solution, or at least one that is not readily apparent.

Molly

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