Medicare
Did you know that 4 out of 5 patients who requested assistance from Celgene Patient Support® received their medication?
Your dedicated Celgene Patient Support® Specialist will help you with coverage and reimbursement of Celgene products. For many of your
patients, this includes Medicare. Contact your Celgene Patient Support® Specialist at 1-800-931-8691. We can help you navigate your patients' Medicare
health and/or prescription drug plan.
Medicare is different from Medicaid; however, you may be eligible for both programs. This is called dual eligibility.
Medicare plans
There are different programs within Medicare: Parts A, B, C, and D. The chart below gives general information about these programs. Please call Celgene Patient
Support® at 1-800-931-8691 to better understand Medicare benefits.
| Medicare Coverage |
Part A
Hospital Insurance |
Part B
Medical Insurance |
Part C
Medicare Advantage Plans |
Part D
Prescription Drug Coverage
For an example of how Medicare Part D works, click here. |
| What is Covered |
- Hospital stays
- Home health services
- Hospice care
- Nursing facility care
|
- Doctors services
- Outpatient care
- Home health care
|
- Includes Part A, Part B, and usually prescription medications
|
|
| Enrollment |
- Patients are automatically enrolled at age 65 if they get benefits from Social Security
- If patients are age 65 or older and are not getting Social Security, they will need to sign up for Part A
- If patients are under the age of 65 and are disabled, they are automatically enrolled after they get disability benefits from Social Security
|
- Patients are automatically enrolled at age 65 if they get benefits from Social Security
- If patients are age 65 or older and are not getting Social Security, they will need to sign up for Part B
- If patients are under the age of 65 and are disabled, they are automatically enrolled after they get disability benefits from Social Security
|
- Patients can join if they:
| - | Live in the service area of the plan |
| - | Do not have end-stage renal disease |
- Enrollment is only available during certain times
- Enroll through private insurance companies
|
- Patients can join if they:
| - | Have Part A and/or Part B |
| - | Live in the service area of the plan |
- Enrollment is only available at certain times
- Enroll through private insurance companies
|
| Patient Financial Responsibility |
- No premium in most cases
- Deductible applies for hospital care, mental health care, and nursing home care
- Patients pay 20% of Medicare-approved durable medical equipment
- Patients pay 5% of Medicare-approved costs for respite care. (This care is provided by another caregiver to give the usual caregiver rest.)
- Prescription medications for managing pain and symptoms in hospice care requires a co-payment of up to $5 per drug
|
- Monthly premium
- Deductible for all services
- Co-payments apply for tests, screenings, prescription medications, and services given at the hospital in an outpatient setting
- Patients pay 20% of most doctor visits
- Patients pay 20% of Medicare-approved durable medical equipment in home care
- Patients pay 45% coinsurance of Medicare-approved amount for mental health care
|
|
- Different plans have different premiums, deductibles, and cost-sharing (co-payments and/or coinsurance)
- Not all medications are covered by the plan. Patients may have to pay 100% out-of-pocket for medications not covered
|
This chart is based on information from Medicare & You 2010.
Medicare links
› General information about Medicare
› Find and compare Medicare Health Plans
› Medicare Prescription Drug Plan Finder
Some of your patients may be able to get extra help paying for their prescription drug
costs. Click here for information about this low-income subsidy (“Extra Help”) from Medicare.
Your Celgene Patient Support® Specialist is a dedicated, central point of contact who will work with you to resolve access issues to
Celgene medications. Contact us at 1-800-931-8691 for assistance.
Need further assistance?
Contact us at 1-800-931-8691 or send us an e-mail.