Medicare and social security

[Maleko808]

I know there are a lot of you who have researched this. How are folks able to pay for treatments if they only have social security income and Medicare?

[gusgold]

Buy a Medicare Advantage Plan..most have little or no monthly premium and maximum out of pocket costs of around $6700

[Mel58 in reply to gusgold]

my dad has that (a supplemental advantage plan) with out of pocket of 4500. HOWEVER zytiga is considered a specialty drug and falls under different rules. his cost for zytiga is 2800 a month.

[Hidden in reply to Mel58]

I have blue cross plan 65 supplement and the cost of Zytiga is 500 but the donut hole is another 2000. Total with premium is about 8500 a year. See if he can change before dec 7

[Hidden in reply to Mel58]

What Fairwind says has got me thinking. Military service might get the VA involved. Going to look into that one myself. When I was diagnosed at M D Anderson the first thing they told me was they had a group working to find money to help people pay for this drug. I have to assume all the big cancer centers do the same. Your dad would qualify for sure. There were no guarantees and I was still working full time so I did not qualify but call all of them.

[Stegosaurus37 in reply to Hidden]

If you can demonstrate "boots on the ground" in Vietnam, your prostate cancer is "Agent Orange presumptive" and the VA will pick you up without further question. Your DD214 may show that. There are other means - I used an OER. Lists of units that were stationed"in country" and dates are commonly available and any medal citations you got. Your state may have Veterans Service Officers in each county and they are invaluable in assisting you. My experience with the Portland, OR VA has been very positive. Keep fighting.

[Hidden in reply to Stegosaurus37]

Well can’t say I was in the fighting. Spent my time in turkey italy and Germany. Probably won’t qualify for help but the one thing I might is the va home. Nice place near me.

[Fairwind in reply to Hidden]

The VA has changed..Just walk into any VA Medical Center, stop at the front desk, get a number, wait until they call your number, do the interview..Bring your DD-214..If you have served in the armed forces, were honorably or medically discharged and your annual income is less than $38K / year more or less, you probably qualify for most benefits, no service connected disability necessary..Your first appointment will be with your PCP, primary care physician, who will spend an hour with you going over your health history. he / she will then refer you to any needed specialists including an Oncologist who will write any scripts you may need including things like Zytiga and Xtandi, scans, labs, Lupron...Chemo..Your prescriptions all cost the same $8 each. There is no charge for doctor visits, injections or infusions..Usually they send your scripts in the mail (UPS) and you or somebody must be home to sign for them..

[Fairwind]

Yes, look into a Medicare Advantage plan. There are many different ones, the HMO types are usually no cost..Also apply for "Extra Help". If your only income is SS then you should qualify . Extra Help greatly reduces drug costs..If you were ever in the Military, don't forget the VA....

[Jollyjill in reply to Fairwind]

Where do you apply for “Extra Help”? Thanks

[EdBar]

Be careful of Medicare advantage plans, it is a private insurance plan and they can decide that a drug your taking is no longer covered if they choose to do so. Not so with Medicare. I picked up a high deductible supplemental plan and a Medicare drug plan where all my meds were included in the formulary. The donut hole is currently being phased out and Medicare cost is being shifted to higher income beneficiaries to make up for it.

[Hidden]

Thanks I wonder if there is coverage just for the drugs? Cant see leaving my care team at this stage. if I have to spend my wife’s money she says it’s ok. Early in the treatment of stage 3/4 with tumor outside the prostate. Letting the drs worry about it until they tell me something for sure. Not sure why I’m not worried. Think I’m just so happy I quit work it hasn’t sunk in yet.

[Hidden]

I’ll give it a shot

[Hidden]

I’ll start it Monday thanks

[JimVanHorn]

I needed 42 radiations in 2007 and I had no insurance, but in a few years I could get medicare. The hospitals all wanted $130,000. but I found a urologist who had the same machine and charged me $30,000. for the same thing! Then I got medicare for 30 more radiations and they charged me $48.00. Medications are a problem with medicare because of the donut hole. My oncologist for 11 years charged me $50 a visit for 4 times a year, but he had charity that picked up the co-pay. They take $100. out of my medicare payment for having medicare advantage. My insulin was $110. a bottle and the company that makes it sent me 20 bottles for free 4 times last year, but this year it is only $34. for 4 bottles. So I check around and ask questions to lower prices.

[Raymonda100]

Do NOT enroll in a Medicare Advantage plan. If you want to re-enroll in traditional Medicare, when applying for a Medicare Supplement plan, you will be medically underwritten.

[monte1111]

True enough. But Kaiser Advantage plan (Northern Ca.) Costs me $20 mo. With only social security income I easily qualify for their Medical Assistance Plan (and they love cancer patients). They have pd. for Xtandi for almost 16 months now plus the lupron, xgeva and other assorted drugs, ct, bone-scans, everything. (Assets don't count in no. ca. plan, just income, easy to google). Sure, it's only standard of care, but that's all I can afford anyway so don't see me switching plans. I'm just careful not to hit a million dollar lottery ticket 'cause my bills are already closing in on that fast. What a racket.

[Hidden in reply to monte1111]

Agreed

[Hidden]

What part is not right. The income amount? Can’t get that low

[Hidden]

Thanks Bill

[Hidden]

Bill I went to the va with my papers and will not get in because of income. Since I’ve quit work in the middle of the year I can’t meet the 43000 ceiling. I make my wife work and refuse to let her quit. Next year i might make it. Especially if Zytiga heretic doesn’t show up.

[Hidden]

Just called my pharmacy and the generic by Mylan pharmaceutical will be 380.00 to me instead of 503.00 for Zytiga. Not a lot of difference. My dr. Did say it was ok