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 drug she injected at home once a week. The $12,000 card covered her deductibles and co-pays, while her individual insurance policy covered the balance up to $80,000 a year.
But when Ms. Rosenwinkel turned 65 last February and enrolled in Medicare, she was no longer eligible for the card. Even if Enbrel is covered by Medicare Part D, the annual copay can be as high as $7,000.
Ms Rosenwinkel’s rheumatologist advised her to change her medication. Because the new drug is given monthly at the doctor’s office, it is covered by Medicare Part B, which covers outpatient services. Medicare and its private plan, Medigap, cover the full cost. “I didn’t get any bills,” she said. “I’m so grateful.”
Prices for wheelchairs, patient lifts and other durable medical equipment can also be high. Medicare pays 80 percent if the doctor and provider are enrolled in the program. Disease-specific organizations or local aging organizations can recommend non-profit groups that provide free or discounted equipment.
Mr. Schwartz’s wheelchair cost $30,000 with a $6,000 surcharge. But Medicare does not cover the standing frame, which improves muscle and bone strength by allowing users to stand with support. To pay for a $15,000 device, he raised over $10,000 through a GoFundMe campaign.
Another source of financial assistance: tax write-offs. Taxpayers can deduct medical expenses that exceed 7.5 percent of adjusted gross income. Eligible expenses include: medication expenses, home improvements such as support bars, living assistance expenses, and medical equipment. To take advantage of the deduction, Dr. McClanahan said people who have large medical bills should consider using sources of taxable income, such as an individual retirement account.
While he deals with his physical and financial problems, Mr. Schwartz helps raise money for other MS patients. In 10 years, first for the Myelin Repair Foundation and then for the Multiple Sclerosis Society, he made six tandem skydives. He hopes to jump again in June.
“People say I’m amazing and it’s nice for people to tell you how amazing you are,” he said.