Q & A: August 2016

Q & A: August 2016

Do I Have To Give Up My Current Healthcare Coverage To Go On Medicare?

Q:  I turn 65 next year, and have very good healthcare coverage through my husband’s employer.  I need Humira for rheumatoid arthritis.  The drug retails for more than $2,250 a dose, which I require monthly.  My husband’s plan normally has a co-pay of $300 for Humira, but through a special arrangement I’m required to pay only $5.  Do I have to give up this coverage when I sign up for Medicare?

A:  It sounds like you are very fortunate.  Under Medicare, your Part D prescription drug initial coverage limit is just $3,310 (based on 2016 costs).  At the price of Humira you would hit the Part D doughnut hole or coverage gap the second time you filled your prescription.  According to the Medicare’s drug plan software, your estimated lowest cost for a full year, including your drug plan premium, would be in the vicinity of $5,036.

That doesn’t even include any other Medicare costs, which are illustrated in the following chart, or costs that aren’t covered by Medicare including dental and vision services.


Description 2016 Estimated Monthly Cost 2016 Estimated Annual Cost
Part D plan premiums $25.00 up $300
Humira $1,277 (initial)

$1,741 (gap)

$1,940 (catastrophic)

Part B premiums $121.80 $1,461.60
Medicare Supplement (Plan F) $130.00 $1,560.00
Totals Up to $2,017.80 $8,357.60


Your decision on when to enroll in Medicare depends on two factors: 1.) your age or disability and, 2.) the size of your husband’s employer.  You are first eligible to enroll at 65, but if your husband’s employer has over 20 full time employees then you would be able to delay enrollment in Medicare while your husband is still working and he continues to have health coverage through his employer.  Once the employment or coverage ends (whichever happens first) you have 8 months to sign up for Part B without penalty during a Special Enrollment Period.

Clearly your costs are exceptionally high and The Senior Citizens League recommends that, when you do sign up for Medicare Part B, you thoroughly investigate the Medicare “Extra Help” program that can help with most of your prescription costs if your income is low, or pharmacy assistance programs that may be able to help keep your co-pays affordable. You can learn more about those programs at www.Medicare.gov. Humira is one of the drugs that has such a program. You can find free one-on-one assistance in choosing the right drug and Medicare plan from a State Health Insurance Program (SHIP) counselor. Many of these programs operate through your local area agency on aging, or find one in your area at www.shiptacenter.org.