MEDICARE: Hi everyone...I have a HMO... - Advanced Prostate...

Advanced Prostate Cancer

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wolverine11 profile image

Hi everyone...I have a HMO medicare advantage plan. Downside, I cannot choose my own doctor. I have stage 4 metastatic PC, Diagnosed a year ago. I would like the freedom to be able to be treated by doctors who mainly specialize in PC. Does anybody on this site have original Medicare without medigap coverage? IF SO, HOW WOULD YOU RATE? I AM 78 YRS OLD. At age 65 when signed up for HMO plan I was perfectly healthy and thought HMO plan would suffice. All these years later my health status has changed.

124 Replies

Look at nationwide plans like (BCBS) Blue Cross Blue Shield this may allow you to cross state lines. It's open season now so a great time to change. Maybe ask an insurance broker or compare plans on the net. Good luck!

wolverine11 profile image
wolverine11 in reply to noirhole

Thank you.. will take your advice

BCBS works great for me as supplemental insurance to Medicare. I have Plan F but I don’t think that is offered to new insureds. I wouldn’t touch one of those Medicare advantage plans. I’d speak with a BCBS sales agent to help you decide which of their plans is best for you.

wolverine11 profile image
wolverine11 in reply to 6357axbz

Thank you....I'm in California will call Blue shield Blue cross or maybe go online to look at.

jackcop profile image
jackcop in reply to wolverine11

In LA, BCBS are pushing Medicare Advantage. Tell them you're quits with advantage plan. Yeah, I stay away from advantage plans by anybody, BCBS, Humana, etc.. I am on Medicare original with BCBS as a supplemental ins (Medigap). My big problem is Part D drugs but that's a whole other story.😀

So sorry to hear of your diagnosis at age 78. It just don't get any better, does it.

wolverine11 profile image
wolverine11 in reply to jackcop

Yes, no question advantage plans are heavily advertised in this area. I was trying to find some compromise like ppos that were reasonably priced but they don't look so great I'm really kind of burned out on all of this research I don't know thanks for your input

tsim profile image
tsim in reply to 6357axbz

Yes, F & C, I also have supplemental, the $158 a month is well worth it! I heard that Wellcare is offering some kind of advantage plan where you have limited outside options but I have not checked it out.

wolverine11 profile image
wolverine11 in reply to tsim

Thanks...

tsim profile image
tsim in reply to wolverine11

Also, another thing is that when you are initially selecting insurance types with medicare nobody can deny you coverage but if you are trying to switch from an advantage to a supplemental after the fact you can be denied coverage or at the very least be charged much higher premiums. It's one of the inherent problems with initially selecting an advantage plan. There are also a fair amount of goofy state imposed rules so you have to do your homework.

The regulations for medicare plans are different state to state. Since your already diagnosed your premiums will be higher. If your an AARP member, you can get a discount on United Healthcare supplement plans.

Thanks Magnus..I'll look into it. Not an AARP member but I'll join.If UHC is plausible. Yeah, the Barns on fire & I want to insure it. But I am going to look into medigap plan F. According to medigap I have been with medicare since 2009 so I qualify. However the cost factor unknown at this point. In fairness to my advantage plan, the oncologist I am seeing at least treating me with Lupron and Abiraterone. To this point in 10 months original PSA 960. Nov. 8th 2021 PSA 0.59. Keeping in mind, "Be careful what you ask for. Thanks to all for input,

Plan F is the best way to go. Remember, you will have to then choose a Part D separate prescription plan for drugs. I don't recommend UHC part D. Find another part D plan on the Medicare website.

SuppWife profile image
SuppWife in reply to Magnus1964

Uh oh! I just switched my husband to the UHC Walmart (or Walgreens??) Part D because it looked like it offered the best coverage on things like Orgovyx. He has had Wellcare and it is AWFUL Part D. What did you not like about UHC for Part D?

wolverine11 profile image
wolverine11 in reply to SuppWife

I'm sorry if I misled you. I never looked at UHC part D. I just googled Part D and came up with general plans that cost from 7.50 month to 42 dollars per month. I would suggest get price on Orgovyx from UHC part D.. I hope that works out for you.

We have bc/bs part D and for Xtandi it costs and additional $8000 per year. The monthly policy cost is $150 but they sock it to you for cancer drugs. So don’t be fooled by the monthly premium policy cost. We had a Medicare consultant and this is the best she could find.

Wow, that's unfortunate. You might want to look into goodRX I saw they were selling zytiga for $260 a month. Or you might qualify for patient assistance program from Johnson & Johnson for abby. Good luck

Magnus1964 profile image
Magnus1964 in reply to SuppWife

I am not familiar with UHC for Walmart (Walgreens). However, I just searched it on the Medicare.gov website. It look like it might be a good choice.

Thank you for your input

tsim profile image
tsim in reply to Magnus1964

F and C are no longer available to new entrants after Jan 2020

Magnus1964 profile image
Magnus1964 in reply to tsim

Are you saying no medicare supplement carriers offer plans A or C? That is outrageous. What state are you in?

It sounds like the regulators are trying to force all new medicare recipients into those advantage plans these fly by night companies offer on TV here in Pennsylvania.

tsim profile image
tsim in reply to Magnus1964

It's actually F&C, from Medicare.gov

As of January 1, 2020, Medigap plans sold to people new to Medicare can no longer cover the Part B deductible. Because of this, Plans C and F are no longer available to people new to Medicare on or after January 1, 2020.

They're not booting anyone off but the pool will slowly go down so if you have either your costs will most likely go up a fair amount over time. I was trying to think of why Medicare would want to force more people into Advantage plans?? They are giving these plans a lot of money, that's why they are so inexpensive to participants and offer things like dental, glasses. I'll work on the numbers. I know the F&C plans were quite lucrative for many participants even though the premiums were slightly higher.

wolverine11 profile image
wolverine11 in reply to tsim

I give up, because of my age and having metastatic PC, I've either been rejected, or the cost is to high. And yes that's what makes advantage plans attractive, free eye exams & glasses, free gym membership, maybe dental, up to 30 free rides for medical reasons up to 75 miles away. Plus part D is included, of which has been pretty good for me. When I was in good health at age 65(hardly ever going to Dr.)& chose advantage plan. Some can say I was short sighted.

Magnus1964 profile image
Magnus1964 in reply to tsim

I have not heard of this? What state are you in? If this is true, then forcing everyone onto an advantage plan makes sense. Advantage plans are private companies and are not reimbursed by Medicare the same way as other plans. In fact, the ones I see advertised on TV here in Pennsylvania are being sold by "rip off" insurance companies. They get "has been" celebrities like Joe Namath to be in their ads. These plans were put into place by the G W Bush administration through the 2003 Medicare Modernization Act. It's a quick way to make a lot of money and a sure fire way to get rid of Medicare by bankrupting it. Since they are not really part of Medicare, they pay what they want to pay.

This is not say that there aren't any honest advantage plans. Some hospitals, plus Blue Cross / Blue Shield offer advantage plans. These can be good plans to join.

tsim profile image
tsim in reply to Magnus1964

You're right about the payment structure, whenever the federal government is involved you know it's going to be extremely complicated and cost way too much. They are generally based on some type of geographic consideration as well, reimbursements can also be tailored to induce more participation in a certain area. I travel extensively but my home base is in Florida. There, the MA plans run the gamut. Some of the bigger ones are not bad and provide very high quality, cost effective care. With some of the HMO style run plans I can tell you some real horror stories. It's really important to do a lot of research when choosing the plan if you decide to go that route.

OTPrincess profile image
OTPrincess in reply to tsim

Lots of restrictions with an advantage. They promise the world. If it’s too good to be true…. If you want to switch to a regular medigap plan from advantage plan you most likely have to go through underwriting. Not good for someone who has cancer.

As a pharmacist with over 30 years of dealing with health insurance companies, I would advise you to stay away from United Healthcare or Humana for Medicare Supplement Plans (or any other of their health insurance products); unless you have no choice, wolverine11

Thanks, will keep in mind. I'm a little overwhelmed with so many responses. THANK YOU ALL

dentaltwin profile image
dentaltwin in reply to diamondrn

Your warning specifically is about Part D? (I have Silverscripts, which is now Aetna, in NY.)

tsim profile image
tsim in reply to dentaltwin

I don't understand AETNA, they dumped their original Part D over to Wellcare and now they're back with this. I took it because it's so cheap. In four years they didn't pay for anything, I take that back, I made Publix bill them for a drug that they were going to give me for free! Wellcare was OK but they just dumped my plan and switched me to something new costing 70.00 more a month without telling me. So 7.70 a month is about right

dentaltwin profile image
dentaltwin in reply to tsim

I think I'm paying about $40/month for Silverscript. No, they don't pay much. If you're on an expensive drug I guess you can compare different plans for that drug, but it's pretty opaque. My terrific pharmacist doesn't get much for anything under Medicare.

Tried aarp UHC yesterday, was rejected.

You mean UHC would not take you as a client? Which Carrier do you have now?

I have a Scan advantage plan now. Yes, when I applied on line to secure horizons UHC for either a PPO or plan G can't remember, The question,HAVE YOU BEEN HOSPITALIZED IN THE LAST 3 MONTHS, I answered yes. something popped up SORRY WE CANNOT HELP YOU AT THIS TIME. I received a pacemaker Oct. 2nd 2021. They never asked for reason.

That "three month" question is the kicker. Like you said, it's like trying to get insurance for a barn that is on fire.

It appears that way.🙂

My opinion. Mutual of Omaha or BX/BS Plan G is the the way to go. Premiums are a little less expensive. Freedom to choose any provider that accepts Medicare.

I also have the Medicare Advantage plan which is very inexpensive, but as you say is also very limiting.

If you are going to be following the standard of care and your current doctor is in agreement with your treatment decisions, it might not be worth paying the extra money for choices you don't need and are not using. I had some discussions with my doctor about future treatments so I know my doctor will agree with what I want to do moving ahead. I also get treated at the VA though so I have another option.

I think it's fairly safe to say that going on a clinical trial is at a minimum more difficult if not impossible with an HMO.

Looks like your current treatment plan is good right now and you might go quite a while longer before needeing to change treatments. I see your PSA being low and your ALP still at around 2X ULN although I suspect the ALP may continue to go down along with your PSA.

Wishing you the best in your decision.

wolverine11 profile image
wolverine11 in reply to gregg57

Thank you Gregg...Spent all morning and part of yesterday researching, and I also followed up to the good people that advised me such as medigap plan F of which I can get for 351 per month of which will be added on to next year medicare 170.00 per month. I can afford that. However, the real killer is purchasing part D for meds. The cheapest cost I saw for a monthly Lupron injection was over 800.00 dollars, OUCH. I'm rich but not donut rich!! I pay 41 dollars with existing plan. So Gregg, for me at this time I think it might be wise to stick with my plan. I've been to hospital 3 times had a pacemaker inplanted, etc my cost have been nil...I thank you for your perspective...I will stay with current provider. Oh, also I get abiraterone for freeJ&J assistance program.

gregg57 profile image
gregg57 in reply to wolverine11

Sounds like you are making a good choice for your situation. I have an really knowlegable doctor at the VA, but every time I go in for the past 3 years he smiles and says "Well, I don't think we have much to talk about." My PSA has basically been undetectable and no other problems for 3 years. I get my shot every three months and that's pretty much it. Of course I do use my time with him to try to learn what I can, but it's not a discussion about my treatment.

I would suggest you have a conversation with your doctor about what you are planning to do going forward. Just to make sure you are the same page.

Just as an example: I asked my HMO doctor about what she would do after Zytiga becomes ineffective. She said "I put everyone on Xtandi after Zytiga" I don't agree with that, so I said "I will probably want to go on Cabazitaxel. She was fine with that so there's no problem.

In my opinion, it's worth having that kind of a discussion just to give you some peace of mind.

wolverine11 profile image
wolverine11 in reply to gregg57

My oncologist has the same plan as yours. Results are not so great in general going to Xtandi after Zytiga. Correct me if I am wrong, perhaps 30% or less do well making direct transition to Xtandi from Zytiga when resistance sets in with the latter.

gregg57 profile image
gregg57 in reply to wolverine11

It's not a big percentage that get more than a few months after switching from Zytiga to Xtandi. It's been proven that overall survival is greater if you do chemo first. I've already done chemo once so not afraid of it, most tolerate it well.

I think it's good not to think a lot about the future, but have a general plan in place. I like to think ahead one treatment so I know where things are going and have agreement with my oncologist.

wolverine11 profile image
wolverine11 in reply to gregg57

Yes, I agree it's always good to have a plan B. So wow, you had chemo. For me that comes under the heading,"Be careful what you ask for" I know the latest ASCO reports for 2021, have shown a big benefit of Taxotere with zytiga & ADT given in combination while still castration naive increase OS substantially. I've requested low dose chemo. from oncologist, no go. And I know he does not want to add to first line treatment. I have not pushed him because. I can do everything, meaning taking care of my needs plus able to weight lift & treadmill. Fear of being unable to carry on while going thru chemo, cause I only have 3 people that could care for , me, myself and I. So it is encouraging to here you handled chemo well. Were you working & did the chemo hamper you in any way?

gregg57 profile image
gregg57 in reply to wolverine11

When I did chemo, I wasn't working and I wouldn't recommend that unless you have a job that isn't very physical. It is mainly the first 5 days that are tough. You just feel sick like a bad cold. No fun, but we've all been through much worse.

And things get better fairly quickly after the first 5 days. Then you have 2 weeks of feeling normal before the next round. My activity level went back to normal after the first week out for the infusion. I didn't need anyone to take care of me. I had my wife to help out, but if I was alone, I could have made arrangement for help during the first week. It's not that difficult really.

The main thing to remember, it is killing the cancer. I feel confident that it's giving me a longer life and that's what it's all about.

You can always quit at any time if you can't handle it or just don't want to do it. You only have to commit to one cycle at a time. I will definitely do it again if it can give me more life.

wolverine11 profile image
wolverine11 in reply to gregg57

Thank you for your feedback. Makes sense to me while one is still hormone sensitive to add chemo & knock the crap out of PC.

leebeth profile image
leebeth in reply to wolverine11

Lupron is covered under Medicare B. As such, there would be no copay with a Plan F or G, if your state allows you to switch to a supplement without underwriting. All Med B charges would be covered in full.

tsim profile image
tsim in reply to leebeth

Or N, but I believe you must get the injections at the hospital, that's where I got all mine and they were covered. I'll check into this further.

leebeth profile image
leebeth in reply to tsim

No, the doctor’s office works, too.

tsim profile image
tsim in reply to leebeth

That's good to hear

Part d doesn’t cover Lupron shots..Part D covers oral prescriptions. a supplement would cover these at No or minimal costs to you. IF you can purchase a supplement at this point

I'm curious Wolverine, we have plan F and my husband's Lupron injections have been covered by Medicare and not the Medicare Drug Plan.

I'm glad you brought this subject up. We have a Wellcare part D plan. At this time my husband is not on any drugs other than Lupron for his prostate cancer, but that could change in the future. We pay $32 each for our part D plan, but I definitely want to look into the various coverage under the different part D plans for prostate cancer drugs.

We have the Plan F Supplement provided by USAA and have been very happy with it. Yes, you pay more, but it has turned out to be a god send for us. By the way, if you were in the military in the past you would be eligible for USAA. Some of their products don't require past military service.

Javelin18 profile image
Javelin18 in reply to Dwight777

I want to chime in with my recommendation for USAAL. I’ve been a customer for 30 years. They’re the only company that I’ve worked with that doesn’t screw up. With my auto insurance they send a rebate if they make more profit off investments than they need.

I wasn’t in the military but my father was , and was a member of USAA. I got in a a family member.

Thanks for your input

OTPrincess profile image
OTPrincess in reply to Dwight777

Part D costs $8000 for Xtandi. My plan only cost $250. The cost for cancer drugs is unbelievable.

You don’t have to pay anything for injectable or infused medicines such as Lupron as they are completely covered under Part A of regular Medicare. Only oral prescriptions taken at home need Part D plan. I have Humana/Walmart plan. Very inexpensive for my current meds and great mail order service for three month supplies. But you need to check the oral meds you may be taking such as abiraterone, enzalutamide etc. As coverage and costs can vary widely. There is an online Medicare Part D plan comparison site (not sponsored by any company). Supplemental Plan G replaced the top tier Plan F for more recent enrollees. BC/BC is probably better than UHC in CA. Though all provide exactly the same coverage on Supplemental plans so it becomes a cost comparison and service issue. Dump the Advantage if you can -not appropriate for APC.

Thank you... so do you Have plan G ? which I believe is 315 per month

I'll have to remember this post when the annual Thanksgiving argument about "Managed Care" comes up. That's one of the primary arguments for original Medicare and a Supplemental Plan for the 20% - freedom to go to any doctor, hospital, etc. that accepts Medicare.

They welcome you with open arms (according to my GP/MD the original Medicare patients are subsidizing the "Advantage" patients - the advantage plans have beaten down the payments they make to where there is no profit in them.)

Do original Medicare patients receive better service? It seems that all the medical professionals I've dealt (a lot, unfortunately) with seem to go out of their way to make sure I'm satisfied. They don't always succeed, but they do make an effort.

Medicare "Advantage" plans are great as long as you don't need them. It seems when you need them that the restrictions begin becoming apparent.

wolverine11 profile image
wolverine11 in reply to Don_1213

Thank you for your input

wolverine11 profile image
wolverine11 in reply to Don_1213

Thank you....Will keep in mind

I have a Medicare Advantage plan, it’s a PPO and I can see any doctor that excepts Medicare. My plan doesn’t close me anything.

I live in California, for some reason not to many PPO's. Actually talked to a rep for United healthcare this morning about PPO. He only talked about Medigap plan G. perhaps should have pushed him more about PPO's.Who are you with?

I’m with HumanaChoice PPO. I was with United Healthcare PPO for. Three years. I had no problems until the last year. I have been on lupron for 5 1/2 years. The last year they started rejecting my claims, they wanted more info on each claim. The straw that broke the camels back, they rejected a claim they already paid, right hand didn’t know what the right was doing. I have been with HumanaChoice PPO for two years, no problems. My agent told me If I went on regular Medicare with plan G, drug card and dental plan, it would cost me somewhere north of $170.00 a month. HumanaChoice PPO I have a dental plan, drug card and gym plan.

Thanks...Later today I'll have a look at that humana plan

What is your copay for Lupron and is that monthly or 3 or 6 month injections

3 month injections, I have a foundation paying my copay, they picked it up last March, I think my copay was $98 I would have to look back at my records. I also have a ALFAC cancer policy for the last 30 years. I get a 3 month injection, file a claim, AFLAC sends me $600. So my lupron injections doesn’t really cost me anything. He’ll of a way to make money.

I live near the Los Angeles area Went to site Humanachoice PPO it shows up but when entering my zip code. only HMO's show up. I assume this is a Medicare plan. What state are you located in. I ask because, seems very hard to find PPO"s in my area. That's a really low copay for your Lupron...Thanks

I live in South Carolina. Did a self- referral to a Dr. at MUSC in Charleston. He’s an oncologist that specializes only in PC. I had no problems with my Humana plan. I had a $35 co-pay. They did labs and the Doc talk with us for about 45 minutes.

Sounds like you have a great plan.your plan may not be available here in the Los Angeles area I will check later thanks again

My undrstanding about advantage of Medicare in Cal is that insurers are not allowed to exclude for PCa and other conditions.....at initial OR annual enrollment periods.....more like Obamacare ? Many states have not passed such rules, unfortunately for consumers! Of course, would expect premiums to be higher in Cal also.

Someone here has said.....I thought...that injections are fully covered under Part B.......Lupron not considered a prescription covered under Part D? Part B is just a deductible plus 20% copay, correct? and Medigap would pick up much of the copay/deductible?

Also my understanding that Advantage plans required to cover anything that original Medicare covers? No?? However, perhaps "original" Medicare does not cover Part D?

Philly13 profile image
Philly13 in reply to wolverine11

I would like to suggest that you go on the website medicare.gov/ to plan and compare the Medigap plans and prescription drug plans where you live.

My theory about insurance is that it is for catastrophic events.

In my opinion, you can learn what you need to know on the website if you are comfortable navigating online. If not you should call a broker to help.

I discovered the website Medicare.gov by accident and saved $9,000 on prescriptions in 2020. I was taking Abiraterone Acetate which is very expensive, and stumbled upon a plan that had a special deal for that medication. I thought it was too good to be true. However, it turned out that they delivered.

Just a reminder that open enrollment ends on December 7.

Good luck!

Philly

very unusual...can you tell us which Advantage plan you have Most Advantage plans have networks of doctors ...not any Doc you want...do you have a network and you have lesser coverage if you visit a Doc outside that network?

HumanaChoice PPO, yes it has networks, however, my copay is the same as in network. All other coverages are the same, in network or out of network. I have a deductible but my treatments don’t full under my deductible.

Thank You

so, if your coverage is same in or out of network, why do they even have a network?

I don’t know, I will get my plan out again, I think out of network, I will have a higher out of pocket cost. In network it’s around $3200. I will check later,

I'm with Scan classic, other than not having the freedom to choose my own Dr. out of network, they have been pretty good. There part D is pretty good. I pay 0 for Proscar, Flomax etc. Lupron monthly injection is 41 dollars. I have viewed other oncologist in Scans network and they all handle cancer in GENERAL, not to discount them. Just prefer oncologist urologist who focus mainly on PC. One could make a case I might be to picky. for me, I am finding it to be much expensive to change, starting to appreciate what I have. Thanks

Wolverine:

A question: Does your HMO offer a plain Medicare plan that is not "Advantage"? If so does it allow you to see other docs?

Also, there is a difference between cancer and sore throat or toenail fungus. Oftentimes a responsible insurance company will pay for a second opinion. That's not the same thing is switching treatment to another provider, but may be under some circumstances.

I was diagnosed by a Kaiser HMO urologist in 2003. I didn't think highly of him and asked for a second opinion. The HMO sent me to a very good radiation oncologist - not one with a national reputation, but I was happy with him.

As things turned out I joined a clinical trial and was treated for free at the National Cancer Institute.

Hi Alan...Yes, actually my advantage plan let me go to City of Hope in Torrance ca for a second opinion BUT I WAS NOT ALLOWED TO BE TREATED, just advised, i WAS SHOWN NCCN guidlines(National Comprehensive Cancer Network) for Prostate cancer. Of which, so far I'm on that path. Thanks

I don't know if you are signed up but if you go to MyMedicare.gov you can enter the drugs you take, enter your zip code, etc and it will bring up a list Part D plans available to you.

I have had AARP Medicare advantage for 4 years now, coverage is good, they have covered minus co pays the treatment of the cancer, even paid in full for genetic testing.the xgeva monthly was over 400 but alot more in ghd thousands for them. Arbitrone that is a specialty drug varies, last cost was 227 for a months supply, they cover scans after a 80 dollar copay, 40.00 for a specialist and no copy for my GP. They have been great and my mom had them also , united Healthcare AARP if available in your area.

In order to see your doctors and be treated at the cancer center of your choice you will need a PPO supplement plan in place.

I was diagnosed with PC ten years ago, which has since recurred. I have always been treated at City of Hope in Duarte, Southern California and have several different doctors I see at their facility. I just retired and although the same plan may not be offered in your city and state, I just purchased at a very low monthly premium AARP United Healthcare’s Plan G. This plan enables me to continue to be treated and see all my doctors at City of Hope. I also do not need any referrals to see any specialists. Other that my normal Medicare Plan B deductible of $208 the plan pays everything Medicare normally does not.

We are in the midst of open enrollment season now and I would recommend consulting with a broker who preferably specializes in Medicare and medicare supplements. They usually broker direct and they should be able to get you into a plan at very low cost. You can check The AARP United Healthcare website to review the different plans they offer in your area and compare costs.

Good luck.

wolverine11 profile image
wolverine11 in reply to BMRboy

I just tried AARP and was rejected, questioned asked , have you been hospitalized in the last 90 days. I was for a pacemaker. As Alan Alden once said on MASH. "That's okay I thrive on rejection"That was for plan G

Try goodrx before you fill may be a lot cheaper

Goodrx is good...before getting on assistance program. checked price for abiraterone, I believe was 260 bucks for 1 month. (1000 mg daily)

You can switch to a Plan G supplement that covers every doc in Medicare, but you may have to take a physical and be subject to pre-existing conditions exclusion.

I worry you might not be able to change at this point. In any case, you need to research this FAST, during Open Enrollment, which ends Dec 7. I usually share info directly from Medicare.gov. , but, the following Forbes article provides a good description of your situation and how a supplement, called a Medigap, can reject you for underwriting.

Supplements are regulated by the states as well as federal government so what is availed to you is specific in your state.

I would call a local broker or company which sells supplements to ask. Or you could try your local SHIP in your state.

forbes.com/sites/forbesfina...

If you remain in your plan, you might be able to appeal to the plan to get a prostate cancer specialist. But that is a separate issue to your question at this point.

Here is the official info about your question. medicare.gov/Pubs/pdf/02110...

Thank you...There's a lot to read, will scan later

Thank you all! I turn 65 next October so I’m starting my research now. This has been so helpful! My general feeling thus far is supplemental good, advantage bad. I don’t mind paying a little more to make sure my Lupron and Zytiga are covered…or whatever else comes next should that combo stop working. I’m in Wa State and seem to have a few options including Humana.

wolverine11 profile image
wolverine11 in reply to bean1008

Yes, the responses have been very helpful

ixolib profile image
ixolib in reply to wolverine11

Do you know if Medicare Part B covers Lupron? All my research says " All Medicare plans now cover Lupron" But that is referencing Medicare Part D prescription coverage. Since Lupron is a tier 4 under my plan and it costs 1800.00 a month cash my part D shows my cost will still be 800.00 per month.

If, however, the Lupron is injected at the Dr's office it appears as though they could file it under part B and it would be covered? Can anyone sort this out for me? Thanks

wolverine11 profile image
wolverine11 in reply to ixolib

That is one example of how confusing Medicare is to me, people buying out of state & so on.

Echotango51 profile image
Echotango51 in reply to ixolib

Lupron is coved under part B, you get your injection at the doctor’s office.

Under my advantage plan right now I pay $41 per injection also try to sign up for UnitedHealthcare plan g was rejected

Where you trying to get on regular Medicare with plan G. My agent told me he most likely couldn’t write me for a supplement, since I had PC, if he could it would be a much higher price. I told him I liked my Humana plan. He had an update Humana plan that was much better then the one I had, so went with the new plan.

I hope that works out really well for you

Ok , MD Anderson told me years ago they do not accept Advantage Plans yet the company assured me they would cover wherever Medicare was accepted. Medicare let me back into the program after enrollment had ended. A couple of months after my Proton therapy I got a letter of denial from the Advantage plan...I have been treated at Duke, MD Anderson , and currently at UT Southwestern in Dallas and have 0 issues with standard Medicare. I do carry a plan G but really only for extended stay if ever needed...Once locally I required hyperbaric therapy and the local hospital was happy for Medicare. They remarked Advantage Plans would not pay....essentially you are just an HMO which is not very good...This is all from my experience so just want you to know...Oh and UCLA called me two days before my last PSMA scan and notified me I was covered under Medicare which is only a very recent decision. I gave them my card and all is good....Happy Turkey Day

wolverine11 profile image
wolverine11 in reply to pilot52

Thank you for your input...Sounds like your getting 1st class treatment. Yes the PSMA is a real breakthrough. glad to see was approved by FDA.

bean1008 profile image
bean1008 in reply to pilot52

Thanks Pilot!! Retired FA here ;-) Great to hear about plain old Medicare covering those things that are important to us!!

pilot52 profile image
pilot52 in reply to bean1008

Just pulled into Dallas from Georgia...Getting a work up in the morning from my PSMA scan with CT to hit 3 places which have not shown up yet on normal scans. PSMA looks like what we need to stay in front of the monster....no problem with Medicare....Blue Skies

I recently wrote about this to another post. Short answer is Don't ever EVER select a Advantage plan. You have ONE time only to get full Medicare coverage that when you first sign up at age 65. including preexisting illnesses. If you choose a ADVANTAGE plan which should be called a disadvantage plan. You can be denied coverage for regular Medicare without passing a health exam an then even if you are allowed in. They can charge you Any cost they want.Don't EVER go with a ADVANTAGE plan its a trap.

wolverine11 profile image
wolverine11 in reply to TJGuy

Thanks that window closed along time ago. I'm 78 now, Started on Medicare advantage plan at 65.

bean1008 profile image
bean1008 in reply to TJGuy

Wow great info, TJ! Thanks!!

I have a traditional plan and will always stay with that. No issues, allows me to travel out of state to see a PCa specialist without any problem. When I was initially signing up for Medicare I was given some sage advice from a couple of guys I met at a local PCa support group warning against advantage plans.

Ed

wolverine11 profile image
wolverine11 in reply to EdBar

Thank you

Look at Boomer Benefits.com out of Texas as a broker nothing but great reviews.

I'll check it out

Boomer benefits has a whole series of videos and the founder, Danielle is great, they are licensed in 48 states.

The Medicare site allows you to enter your drugs and determine which prescription drug plan is best for you from a cost standpoint. It is easy to use and very helpful. Like others here, I have avoided Advantage plans because I felt they were overly restrictive with physician choices.

Thank you

We have an Anthem Blue Cross /Blue Shield PPO Medicare Advantage plan. Our only copay is $50 for emergency room visits. The key terminology here is PPO. We go through several hundred thousand dollars (list price) worth of medical care each year and pay nothing. No restrictions on doctor choices. The Part D affiliated with this plan is CVS/Caremark. We both reach the catastrophic level quickly each year due to specialty meds. Med copays are extremely low. Totally happy with this plan.

You have great coverage. Yesterday I called BC/BS talked to a broker, and once again steered toward medigap plan F & G. will call again for PPO. Thanks

bean1008 profile image
bean1008 in reply to Explorer08

Great to hear, Explorer! I currently have BC/BS through my employer's retiree health care but it will end in October when I turn 65. I've had a good experience with them so it's good to hear you have had one as well with a Medicare Advantage plan.

In April of this year I changed from an Advantage to a Supplement Plan (AARP United Health Care). Since the change I’ve eliminated the need to coordinate my care with physicians. I make my own appointments for second opinions, follow up care, and treatments. The physician model that requires you to be referred then return for the results weeks later is archaic and it is frustrating for cancer patients. Not convinced that my prostatectomy should be performed here locally I flew from the south to DC for a second opinion then eventually flew to Baltimore to have my surgery at Johns Hopkins after making all the appointments myself. Better yet where the Advantage plan was costing me a fortune in co-pays, under the supplement I’ve achieved all of this progress in my treatment on my own and I’ve never received a bill for anything. What Medicare doesn’t pay the plan has picked up 100%. Finally, going From a no monthly premium Advantage to a supplement for 148.00. a month literally saved me from going broke.Best of luck and hope this helps.

wolverine11 profile image
wolverine11 in reply to ixolib

Wow that's great. When you say Supplemental plan & you only paying 148 Per month(same as me) is that a PPO plan? cause broker steered me towards plan G medigap cost 315 added to the 148 per month. I will call UHC again. How much are your copays, for example, when you go to John Hopkins (one of the best).

ixolib profile image
ixolib in reply to wolverine11

No PPO and that's the beauty of all Plan G Supplemental plans. Take Johns Hopkins they didn't accept PPO Advantage plans. When I discovered this, I had a week to switch to a Supplemental before I was locked in and I'm so glad I did. No referrals necessary with all Supplemental plans. As to the cost the 143.65 a month is on top of the Part B 148.00 and my Part D drug premium is less than 40.00 so all in It costs less than 330.00 a month. The pricing on these plans seems to be dependent on where you live, and what the average income of the various communities are. My choice was easy. I look at it this way I pay about 1700.00 a year now for healthcare comparable or better than any in the world IMO and all of my bills get paid. I show up to see my providers and after my appointment I never have gotten a bill. The list of labs, scans, tests, surgery, biopsies, MRI's, CT's, etc. that I've had since the first of the year makes me sad every time I review it and especially when I look at what Medicare has paid for these services just this year. I feel fortunate I'm able to pay the extra 200 dollars for a Part G and Part D plan.

wolverine11 profile image
wolverine11 in reply to ixolib

About the area one lives in, may explain plan G you pay 143 bucks. I live in the Los Angeles area quoted yesterday 315.00

bean1008 profile image
bean1008 in reply to ixolib

Great info, ixolib! I will look into the AARP-United supplemental plan!!

ixolib profile image
ixolib in reply to bean1008

One other thing I've read online before is that there is some sort of waiting period or pre-existing waiting period before ongoing cancer care is available on the supplemental policies but that's not the case. When my plan started I had a bone scan 2 days later and never have gotten a bill for it or for countless other visits since that time.

Now ya got me wondering..... is my Chocolate Chip ice cream (two scoops) covered?

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 11/25/2021 6:49 PM EST

wolverine11 profile image
wolverine11 in reply to j-o-h-n

I like chocolate chip ice cream

j-o-h-n profile image
j-o-h-n in reply to wolverine11

Well..... you can't have mine.............

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 11/25/2021 7:30 PM EST

Same boat as you...and once you pass 24 months after sign-up...you can't buy Medigap insurance...unless you move out of your present service territory. It truly SUCKS! Be prepared to pay the 20% not paid by Medicare...and pay for Part D Drug coverage if you switch to regular Medicare.

wolverine11 profile image
wolverine11 in reply to JPnSD

Thanks, no I won't switch to Medicare and take care of those 20% of bills cuz they would be very very expensive I already know that but thanks for your input

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