I recently turned 66. I've been in this battle for nearly two years now. Before that, I lost my job as well as my retirement and had to go on Social Security. Along with Medicare, I was also receiving Medicaid to compensate the difference Medicare wouldn't pay. I now got a letter stating that I do not have a qualifying level of Medicaid and it will come to an end. As every knows our Cancer treatment is very expensive. I'm on a clinical trial now that seems to be working for me but again is hugely expensive. I'll lose my treatment because I just can't afford a Medicare co-pay. Is anyone in the same boat? Is there other programs for low income?
Insurance dilemma and Medicare. - Advanced Prostate...
Insurance dilemma and Medicare.
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RalphieJr64
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have you looked into medicare supplements or HMO(which are often free or close)?
I have a specialized HMO plan...and pay 0 copays...0 EVERYTHING. Some small drug bills...
gJohn
John, I just received this notice and haven't explored any options as yet. It's nerve wrecking enough fighting this battle and not to have peace of mind with worries of my treatment ceasing. Thanks for your post.
It's a war on two fronts. Looks like good adve is already coming in. All the best.
Thank you
Have you looked into Medicare "Help" ? Again, it's based on income levels..or you wait until you spend the maximum out-of-pocket amount then Medicare will pay 100%...Call Medicare and talk to a Rep...
I’m just starting the process of looking.
Actually there is no out of pocket max on Medicare part D so after you pay your $5,050 out of pocket max there is still the 5% copay with no max. For instance, Xtandi is $10,000/mo the copay is $500/mo. So that’s x12 for the year. Lupron and Xgeva are nearly the same so that's another $500/mo. Now, Xtandi does have an assistance program if you qualify.
If you are being treated at a research hospital there are grants. I will not get into the donut hole explanation but I do not qualify for aid from the drug company...I would have paid 3000 bucks and 500 for Xtandi, they got a 7500.00 grant so I end up with a much smaller out lay....alway inquire....
Is Mayo Clinic considered a research hospital?
Tell them your situation and ask if grants are available...
Get a secondary med coverage that will pick up the other 20 percent not covered by Medicare. I pay an additional 158 a month for Aetna and I dont see a bill ever
Bill, does that include preexisting conditions?
It should because I think Obama Care rules are still in effect, at least for the time bring. Someone correct me if I’m mistaken
Yes. I got coverage 4 yrs ago when I went on disability and retired and this was well after my diagnosis
What about the coverage gap on the prescription drug plan (PDP) also referred to as Part D. The donut hole starts at 3820 outlay from PDP provider and then I have been told that I am responsible for the next 5100. After that they will charge 5% of the cost of Zytiga.
I have been told there is no way around that. Am I missing something other than assistance if you earn less than 81K in a 2 person household.
I hope it’s different for low income seniors
I guess the Medicaid picks up your Medicare premium also?
No it doesn't.
So if the OP has never had a Medicare supplemental policy and does sign up for one now wouldn’t that be signing up for the first time and pre-existing conditions would be covered?
Haha I hope. Thanks
Try contacting the Patient Access Network. They can help with costs if you qualify.
Thanks
Are you a veteran? If so, the VA can help.
No. I’m not.
No one should fight cancer battles alone. There is help to be found if you look for it.
Thanks for your information.
You could apply for clinical trials. Oftentimes the medicine is free. They are doing much mixing. For example abiraterone and prostvac, a fowl pox vaccine. NIH flies u to Bethesda MD. I get Xtandi there, They offered me degarilix but I'm on Lupron and it's covered. If you're not working check out clinical trials.
I'm currently on a clinical trial.
So I think I’m correct that under existing (Obamacare) law a new application for a first time medical plan is required, under Obamacare, to accept pre existing conditions, at least until trump changes the law
I did thank you.
If you can swing it, the G Plan is decent. We've all had to play the insurance game. One extra thing to remember, Medicare works on the calendar year. We had to pay double at first because the Plan required that deductible, even though we had met the other ins. plan's deductible. If you can make it to the beginning of the calendar year, you won't have that extra payment. Also, look into Grants. Try PAN they accept PC patients. We got a grant. Also, have a chat with Tall_Allen, if possible. He is a wonderful source of info. Good luck🍀❣
There is an open enrollment period every year, sometime around October I believe. Supplements in that period have no health questions. Medicare advantage is a separate HMO situation they have different rules.
As Johnny Carson would have said "Correctomundo.." for first time applicants no pre-existing issue, or for changing providers in the open-enrollment time period.
My insurance guy emailed me 2 days ago about switching companies to save some money, but he hadn't thought about pre-existing. I pointed that out to him and haven't heard a thing since.
As has been pointed out elsewhere in this blog Medicare advantage plans, while economical for most situations, do rely on networks. The problem with that for many of us is that clinical trials that may be a huge benefit in terms of OS and QOL may very likely be outside your network and therefore not financially accessible.
I've been on my clinical trial for year now. I just hope there is a light at the end of this tunnel.
Try Aetna HMO then once you have a supplement contact Fund Finder and it will direct you to available grants. Best of luck.
Thank you
I could not afford my medication as I had no insurance. Found an assistance program which allowed me to get my Zytiga ($12,600 a month) at no cost.
RalphieJr64• in reply to
Thanks, I'm glad for you.
Many hospitals have financial assistance programs that you can apply for that will help pay uncovered costs. Ask the social worker in your doctors office.
Some drug companies also provide financial aid, Xtandi is one of them, they have an excellent program that covers what Medicare doesn’t if you qualify.
Ed
Thanks, looking at everything right now.
I believe that if you already have medicare with or with out a medicare advantage plan you can sign up for a medicare supplement plan your are subject to conditions.
If you are going from an advantage plan to a supplement plan then you are subject to conditions.
Can be bit confusing so be careful and certain before signing up for anything.
I just went on medicare and I opted for a Plan G supplement. As Nalakrats said, especially for guys like us, the supplement is the way to go.
I opted not to go for Plan F because it is highly likely to be phased out and cost to maintain could sky rocket.
Plan N is basically the same as G except you are responsible for charges over medicare allowable. This is rare and in some states not allowed. My cost difference in my area between the two plans was $2.00 per month so I opted on side of caution. At age 65, for plan G, I pay $102.00 per month. FYI - plans do increase each year as you increase in age.
Supplement plans do not have drugs or dental or vision bundled. You would have to purchased a Plan D for drugs and another for dental and vision if so desired.
Please be very careful and research thoroughly. Medicare site has magnificent tools. There are numerous reliable source articles on web & u tube.
Medicare is magnificent however there is no question that it could be made much simpler.
In my opinion Plan D stuff is predatory to the consumer. Another case where government could fix if put people before greed.
Please, this all is just my QUICK opinion, do your own research because what you do now for medicare could have serious ramifications.
I sincerely wish you and everyone else here best of luck!!!!
BTW - when I got my Plan D info from my provider, I'm certain my first year of premiums went towards the paper & printing for all the rules, "Abridged" Formulary and coverage documentation.
I always felt the drug industry was crooked, after this process I feel it is a criminal conspiracy between government, drug companies, & insurance companies to defraud the consumer.
This makes me very sad
I hope somebody can offer you some good advice
Thank you
Don't know what State you are in but it sounds like you were getting " expansion" medicaid through the Health Care Marketplace ( ie " obamacare") when you become Medicare eligible that ends and you have to qualify for Community Medicaid which has much more stringent rules. However with your current expenses I am betting that you would be eligible for what is called a medicaid " spendown" You need to contact your local Social Service Office about this..... whatever qualifying medical expenses you have can be counted against your income and this can push you into the income category each month that qualifies you to collect under medicaid.... so... say you have income of 1500.00 monthly and medicaid qualifying income is 750.00.... you need uncovered medical expenses of 750.00 to qualify for medicaid...... That is not hard to reach with the price of many of these drugs and treatments. DO look into it.
I missed the part about you being 66 yrs old... so I am presuming that you were already ON medicare when you got the medicaid?? Something must have changed with your income for this to have occurred ... Were you on SSI for while and then switched to SSA??
SSI would have you qualifying for community medicaid SSA would likely have you outside the parameters..... I'm wondering if your primary problem is general treatment or affording the drugs ( which seem to be a BIG stumbling block for many with limited incomes.... I note that a lot of folks are offering advice on Supplements and Advantage plans but I am bargaining that you are in a fiscal position that does not make them realistically affordable or adequate to cover the kind of overage that PCA can accrue.... Hope I am wrong about this but if I am right....check out the Spendown plan that I mentioned earlier.... As long as you don't have any substantive savings this would work well for you ( if you do have savings ....different from state to state...these will have to be spent down prior to qualifying for the " spendown"
Social Security notified me that I was being moved from SSI (because of my stage 4 Cancer) back to SSA because I reached 66. You are definitely up against the wall here in California. I pay a premium every month for Medicare and Medicaid was to pick up the rest that Medicare doesn't pay. But it doesn't completely because I'm still getting billed for balances that weren't covered.
Sorry Ralphie, I can't help you. For other low income seniors. I have a Kaiser Advantage Plan. $20 mo. premium + optional $20 mo. dental and vision. Also have $136 deducted monthly from social security payment for medicare. Less than $42,490 year income qualifies for their medical assistance program. $57,610 for 2 people. (Or you spend 10% of gross household income per year on medical - it's in the fine print.) I am in No. California plan. They do not ask about money in bank etc. Only income. They love cancer patients, cause if you follow the money, medicare is paying the big share. So I pay $0, except for premium. Don't know anything about the ifs, ands, or buts. I get SOC only. But SOC is all I can afford anyway. Unless something comes up, Provenge will be my next treatment. 21 months Xtandi so far.
What is SOC?
Standard of Care. Nothing out of the box. Enjoy.
Sorry but I'm not on a soapbox right now... just teed off....NO politics intended. Just pissed off.
Ralph take a trip to Mexico.... Sneak in as an Illegal and the government will pay all of your medical expenses.
We take it on the chin......Shit!
Good Luck, Good Health and Good Humor.
j-o-h-n Wednesday 06/05/2019 7:14 PM DST
Haha you might be right on that. I feel like I'm being discriminated against because I'm an American senior citizen.
Hi there. Please contact Michelle Barry at Senior65.com. Her phone number is 800-930-7956 ext. 717. She is the most knowledgeable and patient person I have spoken with about Medicare supplements and Part D. She does not pressure anyone. She helped me find an Aetna supplement for my husband for $107 per month. He had pre existing stage 4 prostate cancer and there was no problem.
We also called Johnson and Johnson and were quickly and easily accepted into their financial assistance program for Zytiga. We are actually getting it free. They are very nice and told us immediately during the first phone call that we qualified - not complicated at all. Their number is 800-652-6227.
I agree with some of the other comments that you need to be careful about choosing a Medicare supplement. The first time you sign up for it is easy, because they don't count any pre-existing conditions. If you try to change to a different plan the next year, your pre-existing cancer will be taken into account.
Also ask Michelle to give you a history of annual price increases for each company offering a supplement plan. Sometimes the cheapest supplement will end up costing more in the long run because they will raise the price more substantially each year than a higher priced plan might.
Part D is the big problem. This year I think the donut hole is about $3800??? The bad thing is that even after paying for the donut hole you still have to pay 5 percent of your drugs, which can be high with cancer. I think that Trump is trying to close the donut hole, so it might be less next year, hopefully.
Medicare Advantage plans sound good but you are very limited with doctors and hospitals, so you might not get the care you need. I am in Texas so it might be different in other states.
Please reply to me if you need to. I am happy to talk with you. God bless!
Thank you. I am currently on Molina Medicare here in Southern California. I pay a Medicare premium amount of $134.00 each month. I'm also on a payment plan program with the Cancer Center that is treating me because Medicaid does not cover the rest completely. I have a phone interview with them on June 24th. Thanks again for your help. I will definitely follow through.
Work with 1 or 2 qualified insurance agents who know Medicare supplemental rules, get everything in writing. I took the full supplement when I went on Medicare, saved me a fortune. The right agent may find a path missed by others.
Thanks. Can I ask what your treatment program is? And also what out of pocket you are paying for your premium and copay?
I pay $170 month supplement (Idaho), I pay nothing else, except prescriptions. My treatment plan is more complex than most in addition to PC which has spread extensively from my leg to my job and ribs and spine in between, I have eight where sarcoid tumor on the inside of my spinal cord being treated with heavy duty. I also have serious back issues L-3 @ L-4, and a blood disorder known as MDS, an early form of blood marrow cancer. These all affected my treatment.
Specifically for PC have done multiple rounds of radiation, hormone injections, Zytiga. while the meds require a bit of out-of-pocket, my other medical bills over the past 4 1/2 years have been over $500,000, and with my settlement I paid nothing extra.
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