Jim3, I just went to the Cigna website and entered Privigen in the PDP area. They indicated my drug is not covered. You’re on Plan G, but they kicked me off the Plan G adviser tool because I’m not 65 yet (will be in July). Maybe they’ll cover Privigen on Plan G but not a PDP.
David, so sorry to here…Yes the gap plans are for medicare only. I would talk to a local ins. agent to get facts. Our agent has helped us immensely. good luck and may God Bless you in conquering this disease.
Jim3
David, I’m 70. Been on Medicare for many years. I have a supplement plan, Humana, this year. Prior I had a supplemental plan for part B. With prescription D separate. Both plans I have come from International Sheet Metal Workers Union. They are a little different and probably cost less for an excellent coverage. Everyone knows the high cost of all this treatment and such. So far this year my out of pocket is $147. That’s for hospital stay 5 days, with IVIG, numerous doctor visits and infusion center visits. I do have to pay a copay for prescriptions I get at a drugstore. I have to coordinate with the VA, Veterans Affairs, for my lastest drugs and then those are covered. My first 5 day treatment the neurologist who first started my journey thru this crap wanted to do a home infusion. But my neurologist, who the first one handed me off to and does have the experience in CIDP, would only do a hospital stay for the first one. The home infusion with Medicare and my supplement would pay all but $1600. They said that that was my part D co pay for the IVIG. Home nursing was completely covered.
With all that, and it was long winded, said…Start NOW and RESEARCH. Find a supplement you can afford and the coverage you need. Contact one of the supplement services they have groups that will help you to find a plan for you… now is the time for research. You have 6 months after you turn 65 to enroll. But with your CIDP I wouldn’t wait till the last minute.
First, thanks to all for a lively, informative discussion! It’s just remarkable to me that each individual has to reinvent the wheel with Medicare – so much misinformation from experts who should know and insurance providers who don’t know what their own plans cover…
I spoke with a Medicare expert at my specialty pharmacy (Matrix Health / Biologix) which provides both the Privigen and the home nurse. Here are notes I took. If anyone cares to weigh in, I’m all ears (or eyes)…
You will need secondary insurance to pay the 20% portion.
Medicare Part A is hospitalization and is not relevant.
Medicare Part B covers outpatient medical care. However, home specialty nurse is not covered. It does cover infusion centers, but the infusion center has to specifically be a “Medicare Certified Center.”
Medicare Part D is the optional pharmacy coverage. It does pay for the IVIG medicine, but it only pays for specialty home nurse infusion for immune deficiency diseases other than CIDP. CIDP is specifically not covered by Medicare for home specialty nursing.
Secondary insurance is only for Medicare Parts A and B, Not Part D. Therefore, since Part B covers infusion centers, secondary insurance will handle that.
The beginning of each year we need to fulfill the deductible and get through the doughnut hole. At the start of the year, you have to blow through your deductible before the secondary coverage will kick in for the 20% Medicare does not pay. That’s typically $1,500 per cycle. However, every year Medicare sets a new amount for the doughnut hole, which is post-deductible and pre-catastrophic. This year, that amount was $6,350. At that point, the patient is responsible for 5%. Many specialty home nurse providers have financial assistance and get grants for this, but there must be a financial hardship. Most IVIG patients with home nursing get financial assistance.
I ran this by the specialist: “So, given that I will not likely pass the financial hardship test, with the doughnut hole and the deductible, I’m looking at around $10K per year if I want to have a home specialty nurse for my infusions.” She said yes.