Before she became eligible for Medicare, Deborah Rosenwinkel, who lives in Wheaton, Illinois and has rheumatoid arthritis, used a manufacturer’s discount card for Enbrel, a biologic that she injected once a week at home. The $12,000 card covered her deductible and co-payments, while her individual insurance policy took up the balance of up to $80,000 per year.
But when Ms. Rosenwinkel turned 65 last February and enrolled in Medicare, she was no longer eligible for the card. Even if a Medicare Part D plan covers Enbrel, annual copayments could be as high as $7,000.
Mrs. Rosenwinkel’s rheumatologist advised her to change her medication. Because the new drug is injected monthly in the doctor’s office, it falls under Medicare Part B, which covers outpatient benefits. Medicare and their private Medigap plan cover the total cost. “I didn’t get a bill,” she said. “I am so grateful.”
Wheelchairs, patient lifts and other durable medical equipment can also be expensive. Medicare pays 80 percent if the doctor and provider participate in the program. Disease-specific organizations or local elder organizations may be able to recommend nonprofit groups that offer free or discounted devices.
Mr. Schwartz’s wheelchair cost $30,000, with a $6,000 co-payment. However, Medicare did not cover a standing frame that improves muscle and bone strength by allowing users to stand with support. To pay for the $15,000 device, he raised more than $10,000 in a GoFundMe campaign.
Another financial help: tax write-offs. Taxpayers can deduct medical expenses that exceed 7.5 percent of adjusted gross income. Eligible expenses include: drug expenses, home improvement supplies such as support poles, assisted living expenses, and medical equipment. To take advantage of the deduction, people with large medical bills should consider tapping into taxable income sources like an individual retirement account, said Dr. McClanahan.
While dealing with his own physical and financial challenges, Mr. Schwartz helps raise money for others with multiple sclerosis. Over 10 years, first for the Myelin Repair Foundation and then for the MS Society, he has made six tandem skydives. He hopes to be able to jump again in June.
“People say I’m amazing, and it feels good when people tell you how amazing you are,” he said.