Medicare coverage and tarceva

Hi all. I am on SS disability and eligable for medicare part B. My husband has coverage, so I opted not to take the part B. However, things may be changing in his employment status. Can anyone help guide me through this process. I know a little about part D, does it cover tarceva? Also 20% can be alot of $$ to a cancer patient. Are there suplimetry insurances that cover that 20%? Are they expensive? I don't know where to start. Any input would be greatly appreciated. Thank you.
Love and Peace, Laurel

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If you lose private coverage as a result of job loss, you will receive a special enrollment period beginning the date of either termination of the job or termination of the policy ... I can't remember which.

If at all possible, go to a Social Security office, get all the info and paperwork completed and filed there. There is always a long wait, but bring a book and stick it out. In the end, It is infinitely easier and more efficient than trying to do it over the phone.

You can shop for and purchase a Medicare C plan to cover the 20% Medicare does not cover through a private insurance company like BC/BS. Be certain you understand what you are getting, particularly in regard to possible "In Network/Out of Network" restrictions. You will want unrestricted coverage if you get - or someday may seek - treatment or opinions at an out of town cancer center.

My current Part C costs about $230/month, and pays for itself.

Medicare Part D covers prescription drugs and can cost around $35 per month. You can analyze your typical and anticipated drug usage and determine if it is cost effective for you to purchase this.

In NY, I am almost certain Tarceva is considered a chemotherapy drug and is covered as if it were administered in a clinic like a traditional IV chemo, but I think this varies by state, so understand your state laws before making your decision on part D.

Parts C & D must also be purchased in the special enrollment period.

Good luck!

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It will take longer than you might expect to receive your medicare card, but you will not have a gap in coverage as long as you indicate on your paperwork that your start date begins the day immediately following the termination of your current plan.

My doctors were very cool about this and just made a note in my account and kept re-submitting until my enrollment worked its way through the system.

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Hi Laurelann, I hope I can help you a little with my knowledge of Tarceva and Medicare. I will be starting Medicare in December because I will be 65. I live in the state of Texas. New York and Texas have a Parity law which requires private insurance companies to cover Tarceva as major medical. I believe this is what Bizezgrrl is talking about. Medicare charges Tarceva as a prescription at this time. On Medicare, it will cost us about $5,000.00 out of pocket and then around $240.00 a month for a bottle of 150 mg. for the rest of the year. I was told to check out about 5 different companies for Part D to make sure if they covered my health needs and then to choose. I plan to take care of this by phone . As for me, I was told they would automatically enroll me for Medicare and send me my card and I could choose my Part D up to 3 months of my starting Medicare. I hope this has helped you and I will be interested in what other have to tell you. Best of luck to,you.

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Try contacting the manufacturer of Tarceva in the USA - they have a financial assistance program and they are very good! Start with the Tarceva website

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Wow. Did I come to the right place! Thank you all for such great information. I am still looking over your posts. There is a wealth of knowledge here. Ruth, Tarceva w/site, duh! Good starting point.
Betty, it seems you and I are about in the same place, shopping for part C? D? I will certainly share anything I find out. . Bizezzgrl, Does that $230.00 a month include part B? Tarceva ?

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@Laurelann, I am right in the middle of this myself. The cancer hospital I go to has a finance office that will help patients find a good supplemental policy. It has been a tremendous help. I live in Michigan and we do not have the parity law here. :( I am still researching payment. Great advice on these posts! Thanks all!

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I was shocked to learn that because Tarceva is not a chemo drug but a targeted drug, Medicare Part B will not pay for it. Using Part D for prescription drugs is a nightmare because Tarceva costs about $5000 a month so the co-pay is exorbitant. I had to drop my insurance and switch to one which included prescription drugs so I didn't have to deal with Part D Medicare. I think my co-pay would be about $40 a month which is fine with me. Got to love our heartless U.S. medical insurance system. Kick em when they're down!


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Mom is on MedicarePart B, lives in MO, Her co-pay amt is 2o%. Moms doctor put in order early last week for 100mg Tarceva, and as we wanted it asap, mom charged a copay amt. of $1900.00 over phone with pharmacy company (US Bio Services) when they called on Friday. She received it in mail this past Monday. Pharmacy co told us that based on her income, she would likely be eligible for copay/financial assistance through the drug manufacturer; and Mom would be able to get a credit on her card after all the paperwork went through. Got a call back on Wednesday with a fax # to send proof of income. Said we'd be notified when all was finalized.

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