Affording Wellness: Migraine and Medicare
Once you are on disability for more than two years, you become Medicare eligible. This means you must use Medicare or give them a reason why you are declining coverage. Medicare is a complicated system that offers hospital coverage (Part A), health insurance coverage (Part B), and drug coverage (part D). There are many varying plans from which you can choose to assist with health insurance and drug coverage.
There is a perception that Medicare is inexpensive when, in actuality, it can get very costly both between the monthly premiums and out-of-pocket expenses.
There is no way I can cover all of the information about Medicare in this article, but I’ll touch upon a few key points related to migraine management.
Finding a plan that includes your doctors
It can be tricky ensuring that your particular doctor is covered under your plan, so when you choose a plan, make sure to speak to a Medicare specialist in your area who can tell you whether or not your neurologist/migraine specialist and general practitioner is covered. There are many plans available, so it’s worth finding one that has both your general practitioner and your migraine doctor included (and any other doctor who is key to your care).
Choose a plan that covers your migraine medications
As most migraineurs know, most migraine medications are quite pricey. The current CGRP treatments (Emgality, Ajovy, Aimovig) are around $800/month out of pocket. Botox is over $1500/out of pocket, depending on the dosage. The triptans can be incredibly costly, depending on the type.
It is very important to speak to a Medicare specialist in your area who can walk you through the list of your medications to figure out which ones are covered by what plan. It is, unfortunately, unlikely that you will find one plan that will cover all the doctors you need and all the medications you need. You will likely end up having to face the reality of paying for some of your medications out of pocket. To this end, you will need to work with your specialist to find a plan that will cover your most expensive medications.
GoodRx is a coupon program that assists people with paying for medications out of pocket. It can be a significant help in making ends meet. You can look it up online, and they also have an app that’s easy to navigate. You enter your medication into the search bar, and it will show whether or not the medication is available through their system. If they have a coupon for it, they will show what nearby pharmacies are participating in the program - and which ones will give the best deal.
It does mean you will likely have to go to various pharmacies to get the lowest cost medications (depending on how many medications you take). Still, the cost differential is dramatic and worthwhile.
My thoughts on Medicare so far…
I used GoodRx for two medications and found it provided major savings. However, that same pharmacy couldn’t fill another prescription due to supply issues, so I had to get it elsewhere and pay out of pocket. I don’t love the fact that I feel I’m having to focus more on my migraine management due to juggling these many logistics. I certainly would have preferred to continue using my one pharmacy (which doesn’t participate in Medicare). It can feel a bit odd to be on Medicare when you’re under 65. It’s definitely not set up for younger people. I have yet to use the coverage for health care.
Are you on disability/Medicare? Have you tried GoodRx? Let us hear from you in the comment section below. We’d love to learn from you.
When it comes to planning vacations or other events where travel is required, how much does migraine factor into your decision-making?