Remicade and Medicare

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Veteran Member

Date Joined Jul 2005
Total Posts : 733
   Posted 12/19/2007 6:21 PM (GMT -7)   
Yes, MediCARE. I'm having a heck of a time getting any answers... hoping maybe someone here has some experience...

I'm trying to figure out what percentage of my Remicade (if any) my Medicare covers... how billing will work... etc. According to my math, and the Medicare website, I'm going to have to pay somewhere around $800 per treatment out of pocket. This scares me to death, because if this IS the case, I'm going to have to come up with a plan B., as Medicare is my only form of insurance right now. Before I had to stop working full time I had good insurance through my employer. Since my last flare and my having to switch to part-time employment without insurance... I've had to bust out the ol' Medicare card for the first time, and I'm clueless!

Every phone number I try to call to talk to a person ends unsuccessfully. First I have to convince them that yes, I'm 26 and I have Medicare and not medicaid. Once this battle is past, I have to explain to them what Remicade IS. One lady at the Social Security Admn. told me that it was a prescription so I had to call my RX drug plan. The RX drug plan told me it wasn't considered a prescription when it was administered in a hospital setting and that I needed to find out what my coverage was for "outpatient surgery"... Anyway... that's just an example of the circles I've been going in for the last two months.

I'm not due for a treatment again until February, but I'd like to get a handle on this in the mean time.

I have the numbers and websites to the Patient assistant programs for Remicade, so i can go that route if I need to - I'm just afraid that the whole assistance program will take a long time to establish, and I'm more than likely going to need my treatment before all of the paperwork is sorted out...

So... in short... Is there anyone out there on Remicade that has Medicare as their only insurance? And if so, what is the coverage like?
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