Part B Injections

Thought I'd just come back here for an update bc this was confusing to me maybe it would help someone else newer in this biz.

Talked to 6 people on expensive part B drugs, all in the $3000 range, all on MAPDs since this OP. No one paid more than $240.

The lady who paid $240 was on HAP MAPD and that was the total for two injections per year. Her injections were for a post cancer drug, the rest were MD. The rest were around $100 plus co-pay (Aetna, Humana, BCBC clients). Not bad.

Still not a real solid answer. Still wonder how the negotiation part works. I didn't see the EOBs or bills. No one really complained. Took their word for it.

So my fear of using MAPD for people with MD was mostly unwarranted. Roll with it, learning more every week still.
 
I went for a cataract screening, after many different tests and machines they told me my AMD was more critical then cataracts and set me up w a retinologist. I asked at the desk what's my copay and there was none. Saw the retinologist, got the injection, still no copays. Looked up my UHC enrollment kit and found out treatment for diseases of the eye are covered at 100%. Surprised me and my regional guy, now wondering if that will include cataract surgery.
 
Thought I'd just come back here for an update bc this was confusing to me maybe it would help someone else newer in this biz.

Talked to 6 people on expensive part B drugs, all in the $3000 range, all on MAPDs since this OP. No one paid more than $240.

The lady who paid $240 was on HAP MAPD and that was the total for two injections per year. Her injections were for a post cancer drug, the rest were MD. The rest were around $100 plus co-pay (Aetna, Humana, BCBC clients). Not bad.

Still not a real solid answer. Still wonder how the negotiation part works. I didn't see the EOBs or bills. No one really complained. Took their word for it.

So my fear of using MAPD for people with MD was mostly unwarranted. Roll with it, learning more every week still.
I definitely still lay out the worst case scenario in 80/20 splits for chemo and injections, but the reality of those "negotiated" 20% copays are generally under the monthly premium of a Plan G. It is just hard, because you don't have it listed line by line in an SOB and no one wants to lead their clients to harm.

I generally still recommend a Sup for those that are taking injections like that for their lifetime, because they know the value of their insurance and appreciate the consistency of a monthly premium versus sporadic copays. Like most things in this business, most people are not going to be harmed by selecting an MAPD or a Med Sup, it boils down to what they value the most.
 
I tell them its going to be up to 20% up to max out of pocket

If they are asking this question then they are likely on Medsup or group plan

If they are new to Medicare I suggest Supplement
If they are on high cost supplement I add up the cost in premium for the year verse the MOO

But always give the negatives let them decide knowing
Never give them a reason to blame you for surprises
 
I tell them its going to be up to 20% up to max out of pocket

If they are asking this question then they are likely on Medsup or group plan

If they are new to Medicare I suggest Supplement
If they are on high cost supplement I add up the cost in premium for the year verse the MOO

But always give the negatives let them decide knowing
Never give them a reason to blame you for surprises
100%

1. Remember who you answer to.
2. Never give a reason to hear “but you didn’t tell me that”. No one gets pissy if it costs less than expected
3. See #2 on rules for switching from MAPD to G/D
4. Anyone on a Part B injection should be on G/D. Or N/D.
 
I got this sorted hopefully. No ones complaining and I check in regularly.

Mostly back then I was caught up on Part B injections for macrodegen. All worked out, most bills are around $60 per injections.

I was caught up bc I didn't understand the "negotiation" part, still don't 100 but better now at gauging costs. Not that I would give an affirmative on costs...sometimes I get too much in my head
 

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