Insurance

[MRT276]

Any recommendations on good insurance plan/company you all use ?

[SPEEDYX]

They all the same !!!!bad!!!!...You have to explore every aspect of coverage and especially drugs.....its a battle just like the one we are in!!!!

[MRT276 in reply to SPEEDYX]

Man it’s hard!!!

Im willing to explore and get on the best coverage possible

Thank you

[SPEEDYX in reply to MRT276]

Definitely research I have oxford UHC...I pay $2100 for me and my wife....a lot of money decent coverage...it covers Zytiga which I take also just signed up for medicare...will see how it works out...All the best to you...fight on!!!

[MRT276 in reply to SPEEDYX]

Thank you

[Concerned-wife in reply to SPEEDYX]

On Medicare if you have traditional, not managed care Medicare Advantage, you can change Part D plans ( prescription drugs) each year. The tool on Medicare.gov is very helpful. We are saving thousands with generic abiraterone vs Zytiga and switching plans. Look at the overall yearly cost not just the deductible and premium costs.

[SPEEDYX in reply to Concerned-wife]

I am happy it is working for you that is most important the the medical cost can be quite a burden....it was a nightmare just to try to sign up fo Medicare.I still cant access SS web site all kinds of issues..no kidding 25 phone calls....they sent me wrong cards now I have to go to there in person...when they open which I think they are now.I was instructed by 2 insurance advisors 1 who only deals with medicare to keep my current UHC insurance at a cost of 2100 month..for 2.....they say the only way to keep it under control somewhat is to have both coverages especially as treatment and hospital cost changes!...Hopefully as Medicare kicks in I will see the advantage...I deal with the goverment all the time....not a great experience....dont trust them...I constantly get different answers to questions...Praying and trusting all goes well in your husbands battle!!!

[Magnus1964]

It's different state to state. For seniors you might look into AARP United Healthcare.

[MRT276 in reply to Magnus1964]

Thank you

[V10fanatic in reply to Magnus1964]

That's who my insurance broker recommended as well.

[Dett]

We have Carefirst (in Virginia) through my husband’s employer and we’ve been extremely pleased. They’ve never questioned or denied a treatment protocol, even when we were told by doctors that they would, and they’ve paid virtually the entire cost of my husband’s treatment. Unfortunately, employees were recently advised that the health insurance policy is being renegotiated since costs have become prohibitive. We’ll see what happens.

[MRT276 in reply to Dett]

I will call them tomorrow

Please update and let me know what have come up from the negotiating

[Dett in reply to MRT276]

Negotiations take place between the individual employer and the insurance company. As an individual, I would imagine that you’d be offered their ‘generic’ policy for individuals, with the option for different levels of coverage (low($) to high ($$$) end - like the ACA). I know almost nothing about insurance, but you can expect high premiums and high deductibles since you don’t have the leverage of a large company. You’d have to research coverage for specific conditions and therapies.

[monte1111]

Just all depends on your situation. Some have dollars and fly to Europe and etc. I'm with Kaiser in Central California. On the Advantage Plan. (Some say to never get on an Advantage Plan.) Standard of care. Qualifying for their medical assistance plan, I pay $40 a month premium. That's vision, dental, medical. (Dental sucks. My opinion.) (About $145 a month for MediCare.) My co-pay $0. That's all. Why aren't we all paying the same for medical premiums? Why aren't we all being billed the same for medical treatments? Why? Only The Shadow knows.

[maley2711 in reply to monte1111]

Regarding advantage, those plans are required to cover everything that traditional Medicare covers. Here is the question though.......what if traditional Medicare covers some treatment or type of medical treatment equipment that is not available at Kaiser??????

anyone have definitive answer......must Kaiser then cover such a procedure done at anothe facility? The other problem with Kaiser, or maybe most Advantage plans, is limitations on specific MD selections outside Kaiser, or outside some Advantage network?

[HopingForTheBest1 in reply to maley2711]

A main difference between Medicare supplement plans vs advantage plans is that advantage plans offer a network of doctors, while supplements don't restrict where you go as long as they accept Medicare. Out of network is almost always more costly with advantage plans. Also, while advantage plans typically include drug coverage, you can't choose your own drug plan which can cost you less.

Definitely check out Medicare.gov for unbiased advantage and stand alone drug plan comparisons.

[Daisyelaine in reply to monte1111]

Depends on what your state and county funds. It varies quite a bit.

[Survivor1965 in reply to monte1111]

When I retired three years ago I stayed on my former companies COBRA plan, 3 years now. My understanding was the part D drugs would kill me as Xtandi alone is like $12,000/mo not to mention the Xgeva and all the others. Figured any part D medicare plan would be worse as there is no out of pocket max.? What are your thoughts on this Monte?

[monte1111 in reply to Survivor1965]

I'm on Kaiser Advantage Plan, No. California. My cap is about $7000 on services and about $6000 on meds. They do have a financial assistance program that is just amazing.

[Xtandiuser]

I have Humana secondary with my Medicare. It is GREAT! $116 and $144 per month! Also check to see if the manufacturer of Zytiga will send your pills to you free! I applied through my Cancer Clinic and I am getting Xtandi free for a year!!! I think Humana somehow pays a like for it, actually! Best Wishes!

[Survivor1965 in reply to Xtandiuser]

Is that secondary deal considered a part F do you know?

[leo2634]

I have Humana as a supplement plan to Medicare $135.00 a month . It covers my Eligard injection, Xgeva, doctors visit, any and all tests. I pay nothing other than my premiums and a $300.00 up front deductible once a year. I couldn't be happier with this plan. The drug plan I'm on is Cigna they are pretty much all the same they stopped covering my generic Zytiga for 2021 so my Medical Rep. Is signing me onto Silver Script who does. You should also look into grants that will cover your amount you're left to pay after all is said and done. I pay $0 co-pays. Its a tedious process but worth the research . Leo

[Don_1213]

I'm traditional Medicare with Mutual of Omaha for a part G supplement. I have no complaints - after the annual deductible I've paid nothing for a lot of medical activity (I also have cardio-vascular stuff that's being attended to besides PCa..) The big advantage that I don't want to give up is - not being restricted to a network of MD's and hospitals. Being able to see any MD and go to any hospital really removed worry about finding the best course of treatment no matter where it is.

I did - just yesterday - take a look at coverage with an "Advantage" plan - and the restrictions on the plan networks astounded me - completely turned me off to the idea. I also looked a few weeks ago at an AARP Plan-G offering. Prices looked really good until I saw the reason why - the price basically doubled if "the applicant is being treated for various conditions.." which weren't spelled out unless you actually make an application to them. My WAG is conditions such as cancer or cardio issues are on that list of exceptions.

The past 2 days I've been reviewing the drug plans (Plan-D) - and as usual - they've managed to push costs off on the members of the plan by moving about half of the drugs I take from Tier-1 (no copay for mailorder) to Tier-2 (typically $10 co-pay). If you take no drugs the plans might save you money - but if you take drugs (can't imagine anyone here doesn't) - it's gonna cost more for 2021.

[Concerned-wife in reply to Don_1213]

I believe it is difficult to change supplement plans after your first choice. They are underwritten and can refuse you with a few exceptions. Luckily it is easy so far to study the drug plans and change each year.

[Don_1213 in reply to Concerned-wife]

It certainly wouldn't surprise me if it is - if the government regulations don't prohibit that sort of action - you know the insurance companies are simply looking at the bottom line.

One other thing I noted - in all the "Advantage" plans I looked at - your primary physician has no co-pay. Specialists are another story, the co-pays ranged from $15/visit to $50/visit. I see my primary care guy twice a year usually. I see specialists - at least one a month. The co-pays really would do away with the cost-savings they claim.

[Daisyelaine in reply to Don_1213]

The advantage plans get a GAP approval for out of network. Like we’re in CO and there’s no proton center here. My husband is having treatment in Atlanta and AARP Advantage through United Healthcare covers it after the deductible, which for the year is $4500. No copays of premiums and it includes drug coverage.

[MRT276]

Everyone has been so helpful!

It’s just insane how insurances and getting treated for cancer is so complex these days

[SPEEDYX in reply to MRT276]

It's the Grand Design for them to make billions...they never suffer thru any crisis....spend billions on stupid commercials...Even at work I had to an extra 800 dollars on liability insurance for the damage by the looting and destroying of property of businesses across the nation.....What kind of joke is that....We are more and more being controlled and have no say

[carbide]

Medicare, if over 65. I am on BC/BS Advantage Plan. Has Part D. Per expensive drugs (Zitiga)

I got a grant from Johnson & Johnson foundation. Best luck.

[Danielgreer]

Hi MRT, there are many variables to choosing a health plan, but at a high level, you want to think about the 1) cost of the monthly premium vs. 2) the cost sharing amounts you will be responsible for, which you’ll have to estimate based on your projection if claims. Also, 3) network coverage is another biggie. You want to make sure your current/future providers are in the network. As far as carriers go, I would try to choose one that has a good reputation and stay away from smaller carriers.

[JPnSD]

So main drawback for Medicare Advantage...you're limited to a certain network of doctors/resources and major roadblocks when you try to go out-of-network...while Regular Medicare is not limited...you can go anywhere they accept Medicare patients....BUT you are exposed to 20% co-payments...unless you are within 24 months of when you first signed up...then you can get a supplemental plan to help cover those costs. If you have PC and are beyond 24 months...you are SCREWED! You need to move to another state to requalify for a supplemental plan....otherwise, if you have a pre-existing condition, underwriters will disqualify you for a supplemental plan! You will also need a Part D plan for Drug coverage with Regular Medicare.....and if you haven't done this initially...you incur penalties on your premiums...that never go away. Welcome to health care for Seniors in America! It can only get worse if a certain party has its' way in getting rid of ALL pre-existing condition protections for health insurance across the board. VOTE!

[maley2711 in reply to JPnSD]

One party has a better and cheaper plan to replace ACA, and will also protect on pre-existing conditions....however, that party has never revealed the details of such promised plan.......I've been eagerly waiting for the last 4 years. What needs to be done is assure that, like ACA, Medicare supplement plans cannot discriminate based on pre-existing conditions!!! Is there any senior lobbying group for that change?

Should an American citizen's medical coverage be dependent on a given citizen's intelligence and ability/inability to successfully determine the best coverage plan for that citizen and all the unknown future medical problems that citizen will confront?

[Shooter1]

Luckily I have VA to cover drugs now that I retired. (finally a benefit from being injured 47 years ago) , Had UHC for years at work and they covered 100%. I had to extend my working career to keep coverage for the first 2 yrs of this war. Now pay up to $11/mo for Xtandi.

[j-o-h-n]

I left the US and went to Mexico and then snuck back in through the border.... Soon I'll be getting free coverage by the our government. Hola Amigos.......

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 10/23/2020 6:57 PM DST

[Bigboss322]

Any insurer that you choose you need to do all the background research that you are able to before you sign anything. I learned that the hard way as I didn't know what to look at when getting my first one on the plumbing company that I own. Thankfully with the help of a lawyer friend, I was able to get out of that god-awful deal and he also helped me look into the contracts for the new insurer that I wanted to get. I finally went with generalliabilityinsure.com/... and I'm super content with the coverage I get.