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Stelara: Transforming Dermatology and Gastroenterology, All Thanks to Medicare

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)

jim.neil@medicarebenefitsgroup.com734-657-4797

MEDICARE INSURANCE

MADE SIMPLE

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Introduction 🌈

Stelara has emerged as a powerhouse medication in the treatment of psoriasis, psoriatic arthritis, and Crohn’s disease. But the cost can be a considerable hurdle for many. This blog post will explore how Medicare coverage intersects with Stelara to make this transformative treatment more accessible.

What is Stelara? πŸ’Š

Stelara (ustekinumab) is a biologic medication that targets specific proteins involved in inflammation. Administered through injection, it has proven effective in managing symptoms and slowing the progression of various chronic inflammatory conditions.

The Cost Factor πŸ’΅

Stelara is not cheap; a single dose can range between $20,000 and $30,000 annually, depending on the condition being treated. This makes Medicare’s role in covering these expenses crucial for patients.

Stelara and Medicare πŸ“˜

Stelara is most often covered under Medicare Part B when administered in a healthcare setting like a doctor’s office. It can also be covered under Part D if self-administered.

Coverage Nuances πŸ“Š

Under Medicare Part B, you typically pay 20% of the Medicare-approved amount after meeting the Part B deductible. If covered under Part D, the costs will depend on the specific drug plan’s formulary and tier structure.

Prior Authorization and Quantity Limits ⚠️

Your Medicare plan may require “prior authorization,” meaning your healthcare provider must demonstrate the medication’s medical necessity. Also, there may be quantity limits or other restrictions depending on your Medicare plan.

Supplemental Options πŸ›‘οΈ

A Medigap policy can help cover the additional 20% under Medicare Part B, or you might consider Medicare Advantage as an all-in-one alternative with added benefits.

Conclusion 🌟

Stelara has truly revolutionized treatment in its therapeutic areas, offering patients a new lease on life. Although the cost can be prohibitive, Medicare offers a viable pathway to affordability, particularly through Part B and sometimes Part D.

Understanding your Medicare coverage can be the difference between feeling overwhelmed by medical expenses and experiencing the life-changing benefits that Stelara can offer. 🌟

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)

https://medicarebenefitsgroup.com/contact/

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What Our Customers Have To Say

Shecter Calendar
Shecter Calendar
2023-05-12
Very knowledgeable, friendly, easy to work with.
Cindy
Cindy
2023-05-11
Jim was a great resource who was recommend by my financial advisor. His explanations of the various options were straight forward and very informative. He asked me pertinent questions about my health in order to tailor a plan to best fit my needs.
beth swartz
beth swartz
2023-05-10
very knowledgable
Loventry Robinson
Loventry Robinson
2023-05-10
Jim is patient and very knowledgeable in his work. He helped me to get the Medicare advantage plan I wanted, and I am very satisfied.
Teresa Orr
Teresa Orr
2023-05-10
Jim was very helpful in explaining coverages and explaining the steps I needed to take to get Medicare. I highly recommend him. He is very knowledgeable on all aspects of care and made it easy for me to enroll in coverage.
Laurie Eisenbraun
Laurie Eisenbraun
2023-05-08
Jim was able to provide tailored Medical Gap policy solutions that fit my and my husbands individual needs. Jim is knowledgeable about all the potential policies that could work for us.
Denise Bensch
Denise Bensch
2023-05-04
I want to thank James Neil for making the Medicare Insurance sign up process so easy. He took what I thought would be a frustrating and confusing process, and made it a pleasure. He clearly explained our options and gave us information in an easy to understand manner. I will definitely recommend his services to friends and family.
Chris Bensch
Chris Bensch
2023-05-04
Mr. Neal is extremely knowledgeable & helpful. He did an excellent job of explaining how everything works and presented our options clearly. I'd strongly recommend anyone nearing retirement, considering a benefit change or simply looking for an overview of their options contact him.
Patrick Lennane
Patrick Lennane
2023-05-01
Awesome experience, explained all options clearly and made it easy to make a healthcare decision. Highly recommend!
KATHY TROHA-AUSTIN
KATHY TROHA-AUSTIN
2023-04-24
These two (Jim and Jennifer) were awesome. Extremely knowledgable about the entire process. Would highly recommend them.