Medicare Advantage Plans Any Tips, Insights or Suggestions?
My Medicare becomes effective October 1st so I'm in the process picking plan and am wondering if anyone is willing to share what they've learned with picking a plan as well as any tips etc. What companies and/or plans may better suite my condition
I've had Taxotere, Zytiga and am currently on Xtandi. Going forward my Mo suggests Cabzataxel/Carboplatin, Xofigo, palliative radiation treatments etc, etc.
I am currently on SSDI due to progressed nature of my PCa.
I'm based in Broward County Fl.
Thanks in advance my brothers and stay strong.
Best Sam.
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SsamO
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I'm in South Florida and I do not see that we have a Medicare F supplemental. As far as the advantage plans available go I do see a PPO Option with most plans.
When you get Medicare advantage you enter a HMO. All treatments and consultations have to be done in the system of the HMO. If you go outside, (to other State for a consultation or treatment you will have to pay in full).
The regular Medicare pays anywhere you get treatment in the USA, if the doctors or the hospitals accept Medicare, which all of them do. You have to pay 20% of the cost determined by Medicare for the consultation and the treatment.
You can get an insurance to cover this 20%. In general the plans offered by different insurances companies cover 80% of the 20% that Medicare does not pay. With the insurance, the 20% that Medicare does not pay, is paid for the Insurance company (16%) and by you (4%) .You can get treated anywhere in the USA.
You pay premiums for Medicare part B and part D (% of your adjusted gross income during the previous year) and the premium of supplemental insurance. The insurance plan may also cover part D and you have to pay whatever co-payments the insurance offers.
This ^^^. Actually, docs don't HAVE to accept Medicare, and in some specialties quite a few do not (psychiatry, for one). But the key point is that Medicare Advantage is MANAGED CARE, and that means you're stuck with the network if you want coverage. Some of them have no premiums, and they're not doing it out of the goodness of their heart--you're getting less.
I also have a Medicare Supplemental and Part D--most people will get an "F" supplemental plan; I got a "G", which is essentially the same except that I pay the Medicare Part B deductible which I believe is about $185 this year. But the premium is about $30/month less, so it makes sense for me.
Also, these plans differ from state to state, so make sure you are going to the right place for information.
dentaltwin where do you live? As I stated above in South Florida many PPO Advantage plans are available and while I see no mention of "F Plans" there are Medi-Gaps plans to chose from.
Like billy 1950, I have a Medicare Supplemental plan from United Healthcare through AARP--this is in NY State. Their rates are competitive, and my RP was one of the first things they got to pay for. My Part D is through a company called Silver Script. I'm not on any expensive drugs, so they haven't really been tested yet. But I see what they've paid for my generics (zero) and I don't pay much either, which has me wondering how my small independent pharmacy is surviving.
I believe the government is moving toward phasing out Plan-F, suggesting that Plan-G (which is identical except you pay the annual Medicare Part-A deductable - right now it's $185) is sufficient - especially since Plan-F typically costs more - the amount usually about what the deductable is.
I have Medicare and Plan-G. I paid $185 so far for my treatments for PCA (which included 45 radiation treatments, 3 month Lupron shots, consulations, etc. ALL of these have been paid and I can go wherever I want - as long as they accept Medicare.
Your comments are accurate in so far as the enrollee has chosen an HMO model advantage plan. I chose in Florida to go with the United healthcare/AARP Medicare advantage plan PPO model.I have been very satisfied with this plan.
I am on a supplemental plan N from AARP which goes thru UnitedHealth care. These supplemental plans are Medigap plans. In addition, a person needs to purchase Medicare part D for prescriptions with a (supplemental plan). I wasn’t happy with the limits placed on Medicare Advantage plans. The best to you!
I am ok with AARP...it’s a supplemental plan with UnitedHealth....I was talking about the limits that Medicare advantage plans have, not supplemental plans...go to Medicare.gov which may help in understanding the plans...
I became eligible for Medicare on March 1. I did a lot of research and spoke to several professional "advisors." They helped even though they each had an agenda.
1. I was advised against Medicare Advantage plans for reasons that others have articulated. Do your due diligence, but I don't think anyone with Pca should do managed care. I joined AARP and spoke to 3 other brokers. 2 recommended by friends and 1 I found on my own. I went with the cheapest one for the supplement. My payment is 136.31 per month for Plan G. That was the least expensive by a good bit.
2. All supplemental plans benefits are government-mandated. There are a lot of providers and different pricing plans based on community experience. I think that is odd since there is no difference in what they cover and how. Plan F and G are the highest level of benefits and cost more than the others. I did the math and decided G was the right one for me. There is a small out of pocket but I calculated it to be less over the course of a year than the higher premium for F. One of the brokers said they are phasing out F for G over time. (No idea if that is true). One provider threw in a silver sneakers gym membership. I found that the eligible gyms were $25-$30 a month and it was no bargain as the premium was about $30 bucks more than I pay. In my opinion, the "extras" did not provide enough value to make a criteria for a decision.
3. Medicare Part D providers were the most confusing for me. My medication changed dramatically just after I signed up. The coverage gap is tough to deal with. I had to pay the $5,100 donut hole obligation over 2 months as Zytiga is very expensive. Now they copay is 5% of the cost of Zytiga per month. I had some confusion with the timing of Part D and was uncovered for prescriptions for a month. It was my fault, and inconsequential in March, 2019. In May, 2019, it would have been horrible. A heads-up to suggest questions to ask as you decide.
IMHO, a Pca fighter can't "afford" to save money on Medicare Advantage plans. My Uncle used to say that to my Aunt when she said she bought something on sale. "I can't afford to save any more money." Not exactly an appropriate metaphor, but it was cute and you might consider the concept as you evaluate.
Thanks very much for taking the time to share your insights and experiences. All that you have said will be taken into consideration and I appreciate your uncles words as well. I will no doubt stay away from managed care, and consult a broker as well.
I concur 100% as I researched heavily and for me found Plan G a better value than F. Also understand that F maybe phased out leaving a reduced pool forcing increased premiums beyond age based increases for those who remain.
Drug plans I found a nightmare particularly if have to guess at what drugs may need in future. I believe the pharmaceuticals insurance and industry purposely make this convoluted and totally rigged against consumer to maximize profits at the cost of consumer physical and mental health... truly a tragedy and presents what happens when you have capitalism with an absence of social responsibility.
Once you pick a plan you are sort of stuck with it. In theory you can transfer from plan to plan, but they get to discriminate against you for pre-existing conditions (such as prostate cancer).
They all have the same coverage. Medicare reviews and approves of disapproves the coverage, and the plan just pays for it.
Pick a large plan that is likely to be around for a while and active in all 50 states. The AARP plan might be OK.
Oh, and anyone with prostate cancer should avoid an advantage plan.
With respect to Part D coverage (drugs) it is really hard to choose. I did a sensitivity analysis with the most expensive prostate cancer medications and ended up choosing Express scripts. The part D coverage you can change once a year and they do not discriminate against pre-existing conditions.
I happened to check in tonight and came upon this thread. We joined Medicare 12 years ago and United Healthcare Part D. I haven't checked back in with changing anything since we did this that dozen years ago.
We could be looking at a stage where we would need hospice. We just had a hospital stay for pain management where I asked the social worker what help I could get with at home care. She said none. We'd apparently have to have Medicad for that.
My question is I can see where I have to get our ducks in a row now more than ever. We would not even think of Advantage after this thread. Thank You. I was able over the years to handle a lot of information, but now with stress I am in need of support.
I am alone with my husband. We don't have a network. I am ready to take this on and am grateful for the heads up and posts.
Where is the best place to begin. It's late and I don't even know what Medicare he has except I do know we used to hit the donut hole. Should I call Medicare? Is there still the one month ability to change plans in November? I have noticed that Medicare is covering less and less. An example is our primary care doctor prescribed Miralax (the prescription) stool softeners .. both can be bought over the counter so they wouldn't cover those even though they were called in as prescriptions. They covered the pain meds.
We aren't ready for hospice, though we must be practical about that possibility- it would be at home.
While we share a lot of good information here, I would like to advise you do your own due diligence. Each of our circumstances is different. The decision to avoid Medicare Advantage is probably a good one, but it is advisable to call a couple of brokers and/or providers and give them your specific circumstances to help evaluate. Medical circumstances and financial. For instance, I did not ask any questions about hospice when evaluating coverages. I am nowhere near that point but....I will look into it now.
I used United Medicare Advisors. I spoke to a rep for Mutual of Omaha, another advisor recommended by a friend, AARP, and one other I can't remember. I chose United Medicare Advisors after charting the answers and coverages with what I perceived were my priorities at the time. Confirmation bias being what it is, all my friends were happy with their decisions, even though I disagree strongly with at least one of them. My friends were surprised I didn't make the same decision they did.
In sum, the information you get from this community is of immense value, but it is a good idea to make sure it fits for your family. Trust but verify!
Thanks.. I'm first going to call a provider we see since I know the billing person. What we have now has been working, though again repeating- it's imperative that I revisit.
I never thought about hospice care and though we don't seem to be near that- I've seen things happen quickly as in fractures etc. AARP has worked for us all these years- good advice 'trust but verify'...
I've spent the last 12 years doing just that.
We were diagnosed stage iv over 12 years ago ! I've spent 100% of my time navigating treatments, I'm not looking forward to the 0% catching up on Medicare and the plans. The advice I got could be outdated. Here I go, Thanks a great deal.
Hi SsamO. You received a lot of very good information here. I will be turning 65 in October, and after going over everything on the net, I'm going to go with plan N. If money is no object, then plan F is the way to go for you before it gets phased out, but, be careful, ask questions if it may increase in price more dramatically in years to come compared to the other lettered plans. To be cheap now with an Advantage plan, is, in my opinion, "penny wise and pound foolish". I live in PA., so, the way I understand, doctors in my state aren't really allowed to charge a surcharge for services, so, plan N is most appealing here. Plan G covers this "surcharge", but, you pay more. Yet in reality, all you have to do before you see your new found doctor, is just ask if he or she accepts Medicare, if they say yes, you're good to go, if not, simply find another doctor that does, which is where plan N comes into play, it's cheaper and all you have to do is ask what the doctor does or doesn't accept.
If you live in certain states and under 65 supplemental plans may not be available.(insurance companies win again...) I live in Wa. And was forced to take an advantage plan due to this stupid rule.
By the way if you do go for AARP United Healthcare plan F don't take their Part D. It's expensive and doesn't pay much for most drugs. I am on Silver Scripts and I am looking to change again this year.
When I signed up for Medicare due to SSDI I was warned to stay away from advantage plans, they can change what they cover on a dime. Before you sign up for a drug plan be sure to review the formulary or list of drugs each plan covers to be sure all your meds are covered. The SSA website is very helpful for all of this and they are easy to reach by phone to answer questions.
It’s important to get secondary coverage too, to cover costs regular Medicare doesn’t cover. I’ve got Humana for my secondary and drug coverage along with regular Medicare and I’ve been very pleased so far. Don’t forget that Xtandi offers a patient assistance program too if you qualify, it’s definitely worth looking into.
I live in NJ. My plan is Aetna prime Elite. The plan is an HMO but it covers me anywhere I go. It does however need to be in network doctor care, but the plan is excepted by all of my Doctors and many more. I pay no monthly premium and drugs are also covered for next to nothing copays. I also have grants that for the most part cover any additional costs by copays and deductibles. Do some research there are plans and funds made available to us to help in our what seems like a never ending battle. Never give up never surrender. Leo
I have been on Traditional Medicare Part A, part B, And Blue Cross Blue Shield Medical Supplemental Plan F for 10 years now. During that time I have lived in Texas, Florida and South Carolina. I can go to any doctor that accepts assignment of Medicare and have not had any medical bills since I have been on Medicare.
I chose traditional medicare with a supplememtal "plan F" and part D drug coverage thru AARP. I like the traditional because no prior approval needed and everyone seems to accept it. It costs a little more but worth it. I never get bills for anything.
Thanks for your reply 406ca. It does seem the supplemental plans in our area are a bit different than in others. If I may I might have a question or two going forward and would ask through the chat/private message function above. Again thanks for your reply. Best S.
Now, ask your Medical Oncologist if he is in the Advantage Network..... if you like your doctor, you can keep him,.... right........ ask if new drugs must be “stepped” before usage..... Abdm don’t forget to ask your other specialists, like a Cardiologist heck even your family doctor,
Look Government Healthcare sucks, but there is a definite advantage between plans....
Concerns about Medicare Advantage Plans and Cancer Coverage
The HHS Office of the Inspector General (OIG) recently found that Medicare Advantage plans deny care—inappropriately—at relatively high rates. It may be that prior authorization rules are a reason that sicker Medicare Advantage patients are more likely to dis-enroll in their plans than healthier people.
Four in 5 Medicare Advantage enrollees are in plans that require prior authorization for some services, including for Part B drugs, hospital and skilled nursing facility stays, lab tests, home health and medical equipment.
Step therapy requirements can mean that patients are denied access to new and better medications until they have tried a less expensive drug. For cancer patients, this can mean delays in using the best treatments to treat their cancer, side effects and treatments.
If you plan to travel, you will need to contact your Advantage plan to find out if/which benefits are available out-of-state. If your plan does not offer out-of-state coverage, the same firm may offer another plan that does, or you may need to find a similar plan offered by another firm in your area. If you decide to switch to a different plan, however, you will need to wait until the annual Medicare Open Enrollment period (October 15 to December 7). You can also use the annual Medicare Advantage Open Enrollment period (January 1 to March 31) to switch to a different Medicare Advantage plan or switch to traditional Medicare.
Making decisions regarding which Medicare plan is right for you can be complicated and confusing. Cancer patients often find that original Medicare is their best option for covering treatment costs.
I'll have to save this for a few friends - who haven't had any real medical needs yet, and like to brag on their $0/monthly "Advantage" plan that includes "Silver Sneakers".. which they've never used.
One relative is finding out how piss poor the plans are. She very badly needs a hip replacement, but her plan only covers certain surgeons and she's had 3 month delays so far in getting the hip replaced. It's not only cancer patients - it's anyone who might have a health issue.
Plan F is being phased out (but I’m told grandfathered) so I went with the next best, Plan G. The thinking was Plan F participation will inevitably shrink and Plan G’s will then grow; greater participation theoretically results in greater premium stability, and vice versa.
Historical premium data determined my choice of a Plan G carrier, and I got that data from a consultant (free). It is my understanding that all these letter plans have standardized provisions, so the only difference between carriers is the cost and degree of service. In my case, for example, the AARP Plan G premium was >$100/month higher than most others. I didn’t go with the cheapest, but the carrier with longevity and a stable premium history. My experience has been great so far (2nd opinions no problem!), with the exception being my Plan D drug plan - stupid thing wouldn’t even cover any Shingrix vaccines.
Personally, absent a sterling history in Las Vegas I would stay away from any Medicare Advantage plans.
Also, I believe every state has free consultants for this stuff, including comparison of premiums for all plans offered in the state.
You will get a handle on it, don’t worry SsamO. Good luck.
Thanks for the kind words Bobby it all can be a bit overwhelming at times, and talking with a consultant will no doubt help,
A lot of people oppose Medicare Advantage plans, but we have been very happy with ours, Kaiser Perm. Not available everywhere but the biggest reason we went with it is the availability of doctors who will see us. I could not find ANY medical doctors in our area who would accept new patients, medicare or otherwise. They are overwhelmed by the case loads these days. All of my doctors have been the best, while they have to prescribe standard of care of course, they each have supported me in my decisions whether or not it is was what they recommend. And, I don't mess with any paperwork for payments, etc. The cost is fair and the care has been excellent. Don't avoid HMO because others have been told their bad, check it out for yourself, each of us is in a different circumstance and what works for one may not for another.
If you can afford it the supplemental plans are the way to go. You can select the best providers in any area. If you need to run off to Mayo or MD Anderson or MSK, NP. I, like some others who have responded have the AARP United Health Care Plan N, cost is 136.00 /month and you must pay the yearly deductible of 185.00 but after that you are on cruise control. If you need to come up here to Moffitt, you can do so at any time.There are supposed to be some co-pays on certain office visits but I think I've only been charged that once. I have the great fortune of having an ex-girlfriend as a VP at UHC so if I have any problems she's on it. Just another good reason to treat everyone you're with nicely. I read last year the F and C plans are going away starting in 2020 which is probably why you don't see them as available. For part D, I use a cheap AETNA plan which doesn't pay much and then use GoodRx for most drug purchases.
Now plan d Prescription united healthcare Of 5300 that you are Responsible for once a year now They paid the biggest part of it just make of Medicine after thatsure you look at the plan for prescriptions and yours are on it
Also look for grants that can help you with your medication cost
Stay away from everything but Medicare...as primary.....they speak the truth below...I have a story but no need in repeating....Medicare is accepted where Advantage plans are not....Blue Skies I Remain Grounded .....Sky King
Wow you have plan f why would want to go to something different i am stage 4 prostate can you think how much money they have spent on me,for the last 3 years,with all the radiation and all the chemo and now i am on xtandi. 4 caps a day that alone is $10,000 a month,that's a forever pill,all my dr visits x rays mri's. my lupron shots that alone is $5000,now you want to change plans,I started this plan f when i was 64 now i am 75, AND NOT ONE CENT OUT OF POCKET.think about it.it does not matter what state your in,and another thing if you get any papers in the mail that says you might owe money, don't send any money if your on plan F,let the ins company and medicare work it out.i even got a power chair from medicare and plan F another $ 5000 still no money out of pocket if the doctor does write a script.if you are able to get plan f you will be grandfathered in......when they try to change things,am in west Tn buy the way silverscript is a good idea also
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Why, if you have prostate cancer, you don't want a medicare advantage plan 
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