Medicare Part D for catastrophc coverage

nonekeep11

New Member
I am trying to find a medicare Part D plan that would cover catastrophic events such as infusion or chemotherapy at oncologists office or very expensive brand name drugs in the event that that those services might be required down the line.I can afford to pay for most generic drugs with cash using goodRX .Are there medicare plan D that has a reasonable premium out there that someone would recommend?

We don't anticipate needing those treatments but just to prepare ourselves.

Thanks
 

MBSC

Well-Known Member
Infusion drugs, including chemotherapy, given in an office/clinic setting are typically covered under Part B. Original Medicare covers 80% of the approved amount. Most Medicare supplements (Medigap) cover the remaining 20%.

Part D generally covers self-administered drugs and some preventive injections. There are only a few oral-only cancer drugs that fall under Part D. There is no cap on Part D cost sharing but the coinsurance drops to 5% once a person enters the catastrophic phase. The closest insurance product that will cover these costs are critical illness/cancer indemnity plans. They pay a flat amount, say $25,000, if you develop cancer. You use the money for anything you want including drug cost sharing and travel expenses for cancer treatment. These products pay high commissions to the insurance agents who sell them so be careful if you decide to pursue this.

You should pick a Part D plan based on your current needs. Some people choose the plan with the lowest premium and just use GoodRx because the overall cost is lower. If a person goes on an expensive new prescription mid-year that is not on the plan's formulary, the prescribing physician can submit a 'formulary exception request' to potentially have the drug added to the formulary for your account until the next Open Enrollment Period to change plans.

More info on Critical Illness plans: https://www.investopedia.com/articl...6/critical-illness-insurance-who-needs-it.asp

More info on Cancer-only plans: https://www.thebalance.com/cancer-insurance-4777634

Your costs in Original Medicare

You pay a Copayment for chemotherapy covered under Part B in a hospital outpatient setting. For chemotherapy given in a doctor's office or freestanding clinic, you pay 20% of the Medicare-approved amount, and the Part B Deductible applies.

Source: https://www.medicare.gov/coverage/chemotherapy
 

nonekeep11

New Member
Thank you MBSC for the information.Would you please explain a little more on the statement"There is no cap on Part D cost sharing but the coinsurance drops to 5% once a person enters the catastrophic phase." I am new to this but I am learning from people like you who don't mind helping others.Deeply appreciated.
 

MBSC

Well-Known Member
Thank you MBSC for the information.Would you please explain a little more on the statement"There is no cap on Part D cost sharing but the coinsurance drops to 5% once a person enters the catastrophic phase."
There are 4 phases to Part D drug coverage. They are explained in the website below. You have to click on each phase to read about them. A person enters the final phase (Catastrophic coverage) once they have spent $6550 on 2021 drugs purchased through the Part D plan. From then until the end of the year, the person has a 5% coinsurance on their drugs. Let me know if you have any questions after reviewing the link.

Part D coverage phases: https://rxmedicareplans.com/Learn/Stages
 

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