Before becoming eligible for Medicare, Deborah Rosenwinkel, who lives in Wheaton, Illinois, and has rheumatoid arthritis, used a manufacturer’s discount card for Enbrel, a biologic drug she injected at home once a week. . The $12,000 card covered his deductible and co-payments, while his individual insurance policy covered the balance, up to $80,000 per year.
But when Ms. Rosenwinkel turned 65 last February and signed up for Medicare, she was no longer eligible for the card. Even when a Medicare Part D plan covers Enbrel, annual co-payments can reach $7,000.
Ms Rosenwinkel’s rheumatologist advised her to change her medication. Since the new drug is injected monthly in the doctor’s office, it falls under Medicare Part B, which covers outpatient services. Medicare and its private Medigap plan cover the full cost. “I haven’t received any bills,” she said. “I’m so grateful.”
Prices for wheelchairs, lifts and other durable medical equipment can also be high. Medicare pays 80% if the doctor and provider are enrolled in the program. Disease-specific organizations or local aging organizations may be able to recommend nonprofit groups that provide free or discounted equipment.
Mr. Schwartz’s wheelchair cost $30,000, with a $6,000 co-payment. But Medicare did not cover a standing frame, which improves muscle and bone strength by allowing users to stand with support. To help pay for the $15,000 device, he raised over $10,000 in a GoFundMe campaign.
Another source of financial assistance: tax deductions. Taxpayers can deduct medical expenses that exceed 7.5% of adjusted gross income. Eligible costs include: drug costs, home improvements such as grab bars, assisted living costs, and medical equipment. To take advantage of the deduction, people with large medical bills should consider tapping into sources of taxable income, such as an Individual Retirement Account, Dr. McClanahan said.
As he faces his own physical and financial challenges, Mr. Schwartz helps raise funds for others with multiple sclerosis. In 10 years, first for the Myelin Repair Foundation and then for the MS Society, he performed six tandem parachute jumps. He hopes to jump again in June.
“People say I’m amazing, and it feels good to tell you how amazing you are,” he said.