Sprycel, COBRA and the Part B LEP

[kgmom219]

New client, age 72. Currently working and battling Leukemia. Part B was going to be 1/1, but I changed my mind when I saw the drug list.

Sprycel is $15K on Part D.

He's going COBRA, cost is $600/month
2023 COBRA Premium: $7200
2023 COBRA OOP: $5K
2023 COBRA Total Cost: $12,200

Part B 1/1/23
2023 Premium for B, G and D: $373
2023 Part B OOP: $226
2023 Part D: $15K
2023 Medicare Total Cost: $19,700

Part B 1/1/24
2023 Premium for B, G and D: $400(ish)
2023 Part B OOP: $230
2023 Part D: $4K
2023 Medicare Total Cost: $9K

He will pay the LEP for 4 months, at $16/month lifetime. So if he lives to 134 I screwed him on the LEP.

Any thoughts?

 

[somarco]

Call NeedyMeds 800 503 6897 and ask.

Link offers little help, but the folks at NM are very good at pointing you/client in the right direction

Decision Timeframe 2 business days, once application process is complete

[EXTERNAL LINK] - NeedyMeds

 

[somarco]

So if he lives to 134

age 134?

 

[DonP]

New client, age 72. Currently working and battling Leukemia. Part B was going to be 1/1, but I changed my mind when I saw the drug list.

Sprycel is $15K on Part D.

He's going COBRA, cost is $600/month
2023 COBRA Premium: $7200
2023 COBRA OOP: $5K
2023 COBRA Total Cost: $12,200

Part B 1/1/23
2023 Premium for B, G and D: $373
2023 Part B OOP: $226
2023 Part D: $15K
2023 Medicare Total Cost: $19,700

Part B 1/1/24
2023 Premium for B, G and D: $400(ish)
2023 Part B OOP: $230
2023 Part D: $4K
2023 Medicare Total Cost: $9K

He will pay the LEP for 4 months, at $16/month lifetime. So if he lives to 134 I screwed him on the LEP.

Any thoughts?

You run his drug threw a mapd and then move him back to to plan G 1/1/24 under trial rights ? But I’m sure you’ll say he goes to md Anderson and they won’t take mapd

 

[alphawave2k]

Based on your narrative and math, I'd say you should definitely try to "screw him".

On the other hand, DonP offers a potential new angle if you haven't already thought of it.
Sometimes, you have to sacrifice short term pain for long term gain. I always try to remember that in the long run, we're all dead!

 

[somarco]

You run his drug THROUGH a mapd and then move him back to to plan G 1/1/24 under trial rights ?

Fixed it for (not four) you

If D-SNP eligible, Sprycel might be $4500 with some plans, others running $12k.

In order to go BACK to a plan G, the beneficiary must first be in a G plan. Can't get a Medigap or MA without both A & B . . . and B will be effective 1/1/2023.

 

[Brad G]

Is the LEP assessed at month 1 or not assessed unless he does not join B for a full 12 months? He has 8 months to remain on Cobra and 6 months from his Part B effective date to buy a Medicare Supplement with guaranteed issue. Does the manufacturer of Sprycel offer a patient assistance program? Alternatively, could his doctors put him on some type of Part B therapy instead?

 

[LostDollar]

Fixed it for (not four) you

If D-SNP eligible, Sprycel might be $4500 with some plans, others running $12k.

In order to go BACK to a plan G, the beneficiary must first be in a G plan. Can't get a Medigap or MA without both A & B . . . and B will be effective 1/1/2023.

I read OP's post to say Part B not effective until 1/1/2024, although I am not knowledgeable enough to see how client gets a 1/1/2024 effective date rather than a 2/1/2024 effective date.

 

[somarco]

I read OP's post to say Part B not effective until 1/1/2024, although I am not knowledgeable enough to see how client gets a 1/1/2024 effective date rather than a 2/1/2024 effective date.

Mom did not list a date, but I don't think she is working this case over a year in advance. . . could be wrong, though.

 

[LostDollar]

Mom did not list a date, but I don't think she is working this case over a year in advance. . . could be wrong, though.

I read her post to say client doing cobra instead of part b in 2023, for a savings of $7,500 for the year, then starting Part B in 2024.

Assuming client employment stops 12/31/2022, I think Brad G has a good question, Whether or not Part B Employment SEP eliminates months from counting towards 12 months periods for computing Part B penalty. IEP months do, don't know whether or not the Employment SEP months do.

Kgmom's post about "4 Months" is confusing, because Part B penalties are computed on blocks of 12 months when there was supposed to be coverage, rather than 1 month blocks like the Part D LEP.

Kgmom's 1/1/2024 effective date for Part B is confusing to me too, because if client has cobra for 2023, it seems like they could not enroll in Part B until Jan 2024 during GEP, which would give 2/01/2024 Part B eff date?

So
If employment SEP is excludable from Part B coverage requirement, that would leave 5 months without Part B = no Part B penalty.

If employment SEP is not excludable from Part B coverage requirement, that would leave 13 months without Part B = 1 twelve month period = 10% per month penalty--the 10% being of each years premium-the montly amount will change each year rather than being stationary at 10% of 2023 Part B premium.