Considering going off my COBRA policy and getting onto Medicare Part B to save some money. Currently on Xtandi, Xgeva, Lupron/Eligard. I have the costs figured for my current meds but tough to know cost for the future meds once the current stop working, which is a virtual certainty the way it is explained to me.
Anyone on Medicare A, B, D be willing to give me an idea on what you pay for something like LU177 or Chemo? I asked Mayo PHx and they told me they havent actually administered LU177 yet so cant give me estimates.
Pretty tough to know if I should switch if I cant figure out future med costs
Many thanks, Johnny
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Survivor1965
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The advantage plans may pay for everything if the treatments are done in the network, but you give your medicare to the insurance companies. In these plans. the hospitals and the doctors bill the insurance company and they can not bill medicare. There are places which may not accept medicare advantage.
I prefer a PPO.. I keep my medicare and I can go to any place where medicare is accepted. Drs and Hospitals bill medicare and they also bill the insurance (PPO) and I pay 20% of the 20% that medicare part B does not cover.
We have Medicare and a supplement, Plan G. We pay nothing. Everything is paid for after the annual $233 deductible. Pluvicto, chemo, no charge. We have an Rx plan through my former employer, which is expensive but his Orgovyx and Xtandi are free. For the two of us, our total monthly premiums, including IRMAA surcharges, are around $1200.
We went through Boomer Benefits. They are so helpful. I did a lot of comparison first. We have an Aetna plan. All supplements are the same, within a category, for what they cover. They all must cover the 20% that Medicare does not cover. So the only difference is rate, rate history, and processing speed. Best of luck to you!
The treatments you mention are covered and you buy a Medicare supplement to cover the 20% copay. You also should buy a Part D plan for pills. Pills are not covered by Medicare. Go to Medicare.gov and you can study the costs of plans where you live
Alternatively you can buy a Medicare Advantage plan but they can restrict your providers.
Medicare.gov has info on MA too
I have read from other men , but not used, Boomer Benefits can help you do this free. Or you can find a local broker but beware of what plans they sell
I also have Medicare A and B, a plan G Medicare supplement plan, and a prescription plan (part D). Eventhough I don't use Abiraterone anymore this is probably the most important benefit. Formularies change almost every year, so it makes sense to use a good agent that can guide you. The only thing I have to pay for my Keytruda infusion is the annual part B deductible. Initially a Medicare Supplement is around $147 a month. It does go up as you age at a rate of approximately $10 per month per year. If your doctors are in the network and the formulary has your drugs, a Medicare Advantage with drugs (MA-PD) maybe a good choice. They have things like dental, vision and hearing as well as all drugs and you should get the PPO version allowing you to have a greater choice of providers. Hope this helps a little, good luck with you treatment, my brother just went through 6 sessions with Lu177 in the Netherlands and feels ok.
I’m not a shill for the company but I found Boomer Benefits to be really helpful when I went through the process. They explained that since Part D changes every year, it doesn’t pay to worry about future medications and they will help you choose the best plan for the medications you take NOW. As for the ones you mention, all of those are 80% covered by Part B, with the remaining 20% covered by a Medigap plan. I am on the MN version of Part G.
I don't recall paying anything for my Taxotere under Medicare in 2017. I gave up my company sponsored PPO plan to switch to Medicare in 2016. After my premiums for Medicare and AARP United Healthcare Medicare Supplement, I've rarely had to pay anything out of pocket for any diagnostic or treatment. Some of my medications require modest out of pocket expenses, the most expensive being Eliquis @ ~$250-300 every 3 months. Have been waiting for a generic Eliquis to come along.
I am only 56 so cant get a medigap plan in AZ, have to be 65 here. Also cant use part C medicare because Mayo Clinic here in AZ doesn’t take advantage plans. Should've put all of this in my original post.
You could look at becoming Social Security Disability Income eligible, if you have a certain type of prostate cancer you automatically qualify, which means you will get the max SS benefit and qualify for medicare.
I’d add a caveat around Medicare + supplement covering all costs for things like Lu-177, chemo, etc — that is (well, “should be”) true, but only if you have the medical condition that qualifies you…e.g. you must be castrate-resistant and have prior exposure to a taxane to qualify for Lu-177 treatment. As I understand it,, whatever FDA has approved as per clinical trial (e.g. VISION in the case of Lu-177 aka Pluvicto) is the basis for what Medicare will cover.
I would love for someone to tell me I’m wrong on this. The acronym I use for that type of thing is 2G2BT….
I think you cannot get Lu-177 until all other treatments have failed. Also, I've read where having chemo in front of Lu-177 makes Lutetium less effective.
if you can find that reference and point me to it, that would be great. I’m not all that clear around whether chemo per se makes it less effective, or whether being further progressed and thus needing chemo is what makes it less effective.
States: " Prior chemotherapy has been shown to be a worse predictor of response and survival outcomes with 177Lu-PSMA-RLT [22–24]. In a retrospective study, Barber et al. observed better PSA response outcomes in taxane-naïve patients as compared to taxane-pretreated patients (57% versus 40%, respectively) [22]".
If you read that NIH paper from groth12345 in link above, I believe there’s one section describing a reasonably good set of responses even for those with taxane exposure. I wouldn’t rule it out.
I’m still not convinced that it’s the chemo per se; I’d bet there would still be a wide range of outcomes for those who’ve done chemo, same as for those who haven’t. Keep the hope, brother.
From a (very) quick read of the paper, it seems we have correlation — but not causation. The study was retrospective, and the author freely admits an underpowered sample size for, IIRC, all but one endpoint. If someone has read the paper more closely than I did, and has a better insight, please correct me.
This correlation, regardless, is something I’ve been aware of and I’m not dismissing it. I’m just still trying to clarify whether chemo-naive patients do better on Lu-177 only b/c they needed the chemo since they were further progressed, and the later disease stage explained a trend of weaker Lu-177 responses … or whether there is some biological impact from the chemo that specifically undermines subsequent Lu-177 treatment, even if the patient does chemo in an earlier stage of disease.
SurvivorMedicare coverage usually follows FDA approval but there can be a lag time before medicare adds the new treatment to the approved listing. The FDA snd Medicare are not linked and both can be slow
I am on Medicare A,B,D. PLus United Healthcare SUpp. 80/20 rule. Med pays 80%. Supp 20%. I have been to Mayo, MD Anderson, U of F, MSKCC, Moffitt all accepting both. On Zytiga, plan D didnt help much but GOOD RX by passes and gives choices for best price. Was at Walmart. Now at Publix. New bill signed yesterday will max out at $166/mo or $2,000/yr. Dont know on Taxanes (Docetaxel but assume you will be covered. I was with a 200,000 employee healthcare plan that was supposed to be gold std. was more expensive (3x more$), and still had major deductibles. If we could only get the 100 US Senators off their special ins, and on Medicare, it would probably be even better. Only my humble opinion, Mike
On the Medicare plan, your drug expenses are capped at $2,000 by the legislation just passed. I have Kaiser and Advantage. Fortunately Kaiser has almost every kind of specialist on staff, so referrals are never an issue. They also pay for my gym membership.
Twice I was referred to outside professionals in the last few years at no cost to me.
Kaiser is a nonprofit, which I believe alleviates a lot of nonsense about denying claims. I would probably never again get profit seeking insurance.
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