I signed up for a Blue Cross plan F PPO which I know will work well but the more I read about plan D and the potential costly meds this disease may require I get a little concerned. I did sign up for a Blue Cross plan D. A little background I was self employed and retired a year ago. I carried a commercial Blue Cross PPO policy which was not cheap but my Zytiga and Xtandi were covered at zero cost. All claims were paid without question. Compared to policies today the deductible was not that bad and ER visits are covered 100% no deductible. The bad news that policy took a huge jump in premium to 25k a year for my wife and I so you really have no choice but for me to go the Medicare route. So going forward my wife will remain on our commercial policy for now at a greatly reduced premium. My agent strongly advised staying in than plan as opposed to going the ACA route. What kind of experiences have people had out there with the drug plans? I checked the formulations for 2020 and most potential drugs seem to be on there. But the potential out of pocket expenses seem pretty high.
So 12/1 I Start Medicare With Some Co... - Advanced Prostate...
So 12/1 I Start Medicare With Some Concerns.
I don't know what state you're in but my wife and I went on AARP United Healthcare plan F and D. Plan F is great we haven't paid any medical bills in 11 years. As to Part D, we switched out of that after one year.
There are programs to help with the really expensive drugs. I have been on xtandi, zytiga and Provenge. I didn't pay anything for any of these.
I live in Illinois. Blue Cross is a major player here.
Just remember you don't have to take Part B and D from the same company.
The formulations for BCBS was very extensive. I checked some others using Xtandi as a sample and some did not cover it.
See my response to Gearhead.
Magnus: Please explain. You "switched out" of Plan D, so what did you switch into so that you get Xtandi and Zytiga and Provenge at no cost?
I switched my part D to Silver Scripts. But as I said there are other sources for the cost of the very expensive drugs. I was on a drug trial for zytiga so Johnson & Johnson paid for the drug. Provenge was covered by the Patient Access Network. I am on a drug trial for xtandi so the drug is paid for by xtandi Solutions.
I have been fortunate in this respect.
How did you get xtandi, zytiga and Provenge covered without any out of pocket cost. I may be going to one of those soon and have Medicare, Plan F, but I thought any plan D would still require some out of pocket cost on the drugs. Thanks and good luck.
You can go online and there are sites that calculate the anticipated costs of medications for each plan.
was on a drug trial for zytiga so Johnson & Johnson paid for the drug. Provenge was covered by the Patient Access Network. I am on a drug trial for xtandi so the drug is paid for by xtandi Solutions.
Thank you for the response
I'm in Tennessee; moved here from NY about 10 years ago. While i NY I was on that AARP United Healthcare, but when we each got a letter saying $1,500 was due on each of us *(wife and I) because they had neglected to take the plan money from Social Security, I told them what THEY could do with their mistake.
Later I discovered that Blue Cross was being sued in a class action suit in California . Some 7,000 folk were included.
So when we moved to Tennessee I checked plans. We initially went with Humana, but the local docs were generally in agreement and recommended we switch to Blue Cross--which we did and are very happy with. No questions about cancer treatment; co-pays bearable; help when we need it.
I am under the impression all Medicare D policies have a 6300$ catastrophic cap? Is this true?
I’ve seen estimates as high as 12k for some drugs.
But I think it’s capped at 6300$? Even though projection is higher.
Catastrophic coverage
Does anyone here on Medicare have a supplement Rx plan that when combined with Medicare, pays all cost, including copay, for Zytiga or Xtandi?
Thank God for charitable organizations like PAN to help pay drug copays. I stay on my PPO and have a part D plan linked with it. I pay almost nothing for my drugs because PAN paid my first copay for an expensive CAT 5 drug. The first payment put me into the catastrophic level where I now only pay 5% for all drugs. All my other drugs I order brand name, not generic, because I only pay only 5% now.
The 5% resets in January, and PAN will pay the full 33% copay again and I will be back to 5% again for all my other drugs for the remainder of the year.
Beware the following difference in setting premiums for AARP/United Healthcare versus all other Medicare Supplement-Medigap polices, at least for Illinois, but probably similar elsewhere:
All others use "Attained Age: Your premium will increase as you grow older. Additional increases
due to higher medical costs or higher than expected claim costs are also possible. For example, if you buy a policy at age 65, when you turn 70, you will pay whatever the company is charging for a person 70 years old. However, any rate increase that occurs must apply to the entire class of policyholders in which you are categorized,
not just to you as an individual."
AARP/United Healthcare uses "Community Rating", in which, when I enrolled, the premium does not increase with increasing age for age 77 and beyond, and with a 3%-pt premium discount for ages 76 down to 65 relative to the premium for age 77; i.e., 3% discount for age 76, 30% discount for age 67, and so on.
For Illinois, the state government provides a comparison of premiums for Medicare Supplement policies from various providers at, for the Chicago area, web site "www2.illinois.gov/aging/shi.... I believe there are similar tables for other parts of Illinois. (That is also the source for the above info in quotes.)
Note that there are counselors and networks who provide advice regarding medical policies for use with Medicare, and that they will, with the applicants approval, fill out and submit applications on behalf of folks in or going into Medicare. I believe they receive payments from the companies to which they submit applications. However, beware: the medicare solutions network rep that I consulted did not point out the major issue for premium amount vs. age described above, and also quoted the Blue Cross-Blue Shield rate for women instead of men, so I initially selected BCBS. However, after BCBS levied a larger premium than he had quoted (due to my being male instead of female), and with more time to investigate after having retired, I looked into the issue in greater detail, and found that AARP-UHC premiums were lower than BCBS initially, with BCBS becoming progressively more and more expensive with increasing age.
I believe there are some other companies that offer lower initial premiums than AARP/UHC, but I would be wary of the long-term viability of those companies and policies.
On the plus side for BCBS, I understand that in Illinois they have been accepting all applicants without medical underwriting even after initial enrollment, but that they are not under any obligation to continue doing so.
Best wishes in making this decision!
I'd just like to caution people on the Plan-D calculation websites. Many are really flawed, including the Medicare one. Medicare sorts all results by default by the lowest premium. Usually the lowest premium plans also have the least drug coverage and highest co-pays.
They did have a popup today telling us that's the case, and suggesting sorting by drug costs & premium to find total costs.
You really do have to include your entire drug list to find out what each plan actually covers and what your out-of-pocket drug costs will be. Many plans now have a deductable, some plans it applies to all drugs and all tiers, other plans only Tier 3 & 4 & 5. And different plans put different drugs in different tiers.
The donut hole numbers are uniform since that's a Medicare requirement... but different plans "pay" different amounts for different drugs while in the hole so it's really a challenge to figure out what plan is actually best.
I have a Humana plan that I've had for years. This year they're changing the name of the plan, introducing a deductible, and lowering the premium. If all my drugs were covered fully ($0 co-pay mail-order) it would be easy to go wtih it, since the deductable only applies to Tier 3 & 4 drugs. Turns out one of my drugs is a Tier-3, so I will end up paying part of the deductable, but with the lowered premium my overall yearly cost should remain the same.
That's the sort of thing you've got to do with every plan. The catch I now have - Humana also offers a Humana-Walmart plan. Looks like the same coverage as my plan but at much lower monthly premium. I've been trying to figure out what's going on with it, but not having a lot of luck figuring out why the one is so much cheaper. There HAS to be a reason.. probably a much more restrictive set of "Preferred/Approved Pharmacies"... or the Tier coverages are different. Looked and found the reason. It's a pay now, or pay later sort of thing. Their coverage on the drugs is different - more "cost-sharing" even on 90 day mailorder. So while the premium is less, the drug cost is more. The total is less, but I'm not sure I'm willing to be pecked to death by ducks.. so I'll probably stick with what I have.
Oh - every plan I looked at that covers NJ - has a clause in it "Chemotherapy Drugs Not Covered"..
I have blue cross of Kansas. They dropped plan f but G is same just pay the deductible of 170 I think. Covered everything so far. Radiation,mri,dr visits.
My part D is 57$ and the generic Zytiga is 205 a month. Brand name cost me 535$. Going to generic if I go back on.
I’ve been on Medicare F and I have not paid anything or received a bill. So far so good.
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