HELPING YOU PUT TOGETHER YOUR MEDICARE PUZZLE
MBG IS AN INSURANCE BROKER AND IS NOT ASSOCIATED, ENDORSED, OR AUTHORIZED BY THE SOCIAL SECURITY ADMINISTRATION, THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, OR THE CENTER FOR MEDICARE AND MEDICAID SERVICES (CMS)
In the field of ophthalmology, Eylea has emerged as a critical treatment for conditions like age-related macular degeneration (AMD) and diabetic macular edema (DME). The medication promises improved vision and quality of life, but many are concerned about its affordability. In this blog, we’ll dissect the relationship between Eylea and Medicare.
What is Eylea? 👁️
Eylea (aflibercept) is an injectable medication that helps to slow vision loss and improve eye health in people with certain retinal diseases. By blocking the action of specific growth factors, Eylea reduces abnormal blood vessel growth and leakage in the eye, common issues in conditions like AMD and DME.
The Cost Implication 💵
While Eylea offers remarkable benefits, it comes at a considerable price. Each injection can cost upwards of $1,850, making insurance coverage almost a necessity for patients in need of regular treatment.
Eylea and Medicare 📜
The silver lining is that Medicare does generally cover Eylea, primarily through Medicare Part B, which handles outpatient services, including some medications administered by healthcare providers.
Coverage Specifics 📘
Medicare Part B usually covers 80% of the medication’s cost after you meet your annual deductible. This leaves the remaining 20% as your responsibility, which can still amount to a considerable sum given the high cost of Eylea injections.
Supplementary Plans ⚙️
To offset the 20% you’re responsible for, you can opt for a Medigap or Medicare Advantage Plan that covers outpatient medical services. These plans can significantly reduce your out-of-pocket costs.
Prior Authorization and Restrictions ⚠️
Even with Medicare coverage, some restrictions may apply, such as the need for prior authorization. Always consult your healthcare provider and Medicare plan for details.
Eylea has significantly advanced the treatment of retinal diseases, offering hope and improved vision to countless patients. While Medicare typically covers a portion of Eylea’s cost, it’s essential to understand the specifics of your plan to fully grasp your financial responsibility.
The relationship between Eylea and Medicare exemplifies the vital role of healthcare coverage in making groundbreaking treatments accessible to the masses. 🌟
MBG IS AN INSURANCE BROKER AND IS NOT ASSOCIATED, ENDORSED, OR AUTHORIZED BY THE SOCIAL SECURITY ADMINISTRATION, THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, OR THE CENTER FOR MEDICARE AND MEDICAID