Blue Cross and Zytiga recommendations?

[dougnola]

Hello gentlemen. I’m going “on the market” in the USA for health insurance for 2020 and I need to make a choice by 12/15. Blue Cross/Blue Shield seems to come up the most on healthcare.gov. My biggest monthly predictable expense is (generic) Zytiga and Lupron every six months. Any advice on getting the lowest out of pocket for these drugs with the different options? I was $0 with Cigna but that will end. Thanks for your advice! Doug. ✌️

[Danielgreer]

Hi Dougnola, it appears you are looking for an ACA plan? You’ll want to look at the premiums and the out of pocket costs in making your decision. The lowest out of pocket may have higher premiums so you need to look at your total anticipated cost. Also, if you get premium assistance and assistance with your out of pocket costs (called cost sharing reduction) you’ll need to consider that. My understanding is there are phone resources to help you work through the decision. I’ve never bought an ACA plan so I don’t have direct experience but I work in the health care field and know some general things.

Other considerations besides you premium/out of pocket costs is the type of plan HMO vs. PPO and the network. You’ll want to make sure the doctors and hospitals you use are in the plan’s network.

[dougnola in reply to Danielgreer]

Hi Daniel. It is ACA. Thanks. I was noticing that some limit choices and I know I want the widest range of choices of care facilities in that my oncologist, radiologist, particular, are in two different hospitals and I don’t want to lose them. Doug

[Hex40 in reply to dougnola]

I did my Medicare supplemental signup through a BCBS agent. He described most of the ACA plans as glorified HMOs so be very careful. Again good luck.

[MeliaQuinn in reply to dougnola]

Hi - I am not sure where you live but in Colorado there is a website called Connect for Health Colorado. You can plug in your estimated income for 2020 and it will provide you with your estimated monthly premium. It will show you all of the plans and carriers along with copays, out of pocket maximums, etc. You can also plug in doctors names to see if a particular plan such as Anthem Blue Cross Blue Shield, Bronze HSA has a doctor that you want in network. We are changing from Kaiser to Anthem as we want to be able to see doctors within the UC Anschutz Cancer Center. Good luck!

[cesanon in reply to dougnola]

I would stay away from United Healthcare. Whoever is in charge of reviewing prostate cancer treatments is really quote retrograde. Who needs that.

[Hex40]

I had a commercial Blue Cross policy that covered meds but applied it to the deductible. For high price drugs like Zytiga I paid 0. For some reason they were covered differently. That said the premium quote for 2020 is 25k. Fortunately I just started Medicare. My suggestion is be very careful. Specifically ask about coverage for Zytiga and Xtandi. They may treat high priced drugs differently. That is how Medicare plan Ds work. It’s all about the fine print.

[abmicro]

I would never change to a medicare advantage plan HMO. Limits your dr choices. If you need Zytiga, stay with a medicare PPO and contact PAN about a grant for Zytiga copays.

Once they pay our first copay of Zytiga, all drugs after that hit the catastrophic level and you pay only a 5% copy for the remainder of the year for any other drugs. Now I only order name brands because I can afford them.

[TJGuy]

Hi just signed up myself, several things. I go through the healthcare.gov for states that didn't create their own, NC in my case. So just being a educated professional person thinking I'd be able to figure this was WAY WRONG. So the web site is first inacurate, it told me my providers were out of network. My doctors we're not covered. I was depressed. I expressed my anger and depression to my health team and they put me in touch with a Affordable health care broker for ACA coverage.

This broker knows the in and outs. First showed me how to choose the plan where my hospitals and Doctors were in network throughout the entire US just limited in my immediate metro area. But pointed me to the correct plan for my local providers. Just like a PPO.

Then showed me how to save $15k to $17.5k in premiums each year. Then showed me how lower copay,deductibles, and Out of pocket to almost nothing.

Also you must signup on the actual healthcare.gov website, not say a BCBS website for ACA for BCBS for example.

Don't think you know how to do this yourself.

And don't fall for any healthcare.com. go to healthcare.gov Note the .gov. But find a ACA Broker thru a local hospital or your hospital. And make sure you use the website to signup, don't fill out paperwork and mail that to someone to enter it for you this can cost you big. My broker cost me nothing and saved me maybe $25-30k per year.

[herb1]

Doug and others: I repeat my warning--it seems to be the actual pharmacy that decides the actual costs, at least under the Medicare Drug D plans. Also if looking at advantage plans, be sure you would be accepted with prostate cancer and, may be more important, if you're not happy will you be able to get back into standard Medicare plus a useful medigap plan-after the first year the Medigap plans are not required to accept all, is my understanding.

[cesanon in reply to herb1]

"it seems to be the actual pharmacy that decides the actual costs, at least under the Medicare Drug D plans."

Actually not the so called "retail price" is a negotiation between the pharmacy and the Part D insurer. It can vary from plan to plan even within the same insurer.

For a while with Express Scripts it was cheaper for me to by with a GoodRx coupon, than to buy at their retail less the deductible.

For some reason, halfway through the year that changed.

It's just crazy, how can you buy something if you can't evaluate what you are buying?

You sign on for a year, but they can change their pricing whenever they want.

[Star_Bright]

Hi everyone, Medigap plans are guaranteed issue IF you enroll within 6 months of starting Medicare.

[jmurgia in reply to Star_Bright]

In new York State Medicare Supplement (also called Medigap) Plans are required to take you at any time with whatever pre-existing conditions you have (guaranteed issue). There is no "medical underwriting". It's important to be looking at information specific to your location. I have a Medicare Advantage Plan, but it's good to know that I have the option to switch to a supplement.

When my family COBRA plan doubled in cost Plan for my wife in 2019, we went thru a "Marketplace Facilitated Enroller" for a marketplace plan. He works for the local BCBS affiliate, but enrolls people in Child Health Plus, Medicaid, Essential Plan and the ACA "Metal" Plans. He got her a "Gold" plan for half the price and "low or no cost" plans for my 3 teen and young adult children. He also ran the numbers for the subsidies available. The New York State of Health (marketplace) website is indecipherable (makes the IRS tax code look simple). We needed a guide.

[Star_Bright in reply to jmurgia]

I did know that with regard to NYS and I applaud them for that decision.

However, I was writing a general fact as most plans past 6 months are underwritten. There are a few exceptions to eligibility but they are narrowly defined past six months.

[jmurgia in reply to Star_Bright]

Hi. I was just pointing out that there are benefits to living in New York State. All the media (including local media) seems to run are articles bashing everything around here (Syracuse). Most of the literature online is "general" and hence the need to find someone local (broker) to educate oneself to the local variations in eligibility and coverage.

[Star_Bright in reply to jmurgia]

As a displaced New Yorker (now in rural Pennsylvania) I miss my home state! I too hate the negative press it receives. I was very happy growing up and living there for most of my life.