Would like some thoughts on my next year change option for Medicare or Medicare Advantage looking forward to keeping Prostate Cancer at bay. I finished my HDR Brachy and 25 Sessions of EBRT/IGRT for a Stage 3 (no mets) back in the Spring and early summer. I have been on an Aetna Advantage program. My question for the troops and other warriors is thoughts; if base Medicare with a supplement plan G or N as the back end supplement will give me more options down the road for any needed Hormone Therapy (currently Lupron which my MO says another year or two) or a new medication; and if I do need to have a PSMA type scan. as I think I understand standard medicare covers this vs the advantage plans . Summary –
does a base Medicare Plan open up more options and approvals and less hassle then an Advantage plan?
Medicare Brokers are a very interesting group, not sure I have the right one now and the suggestions are appropriate for Cancer fighters.
that I am fighting the good fight with you and and juststarting to notice the side effects (lupron modes, fatigue and muscle loss. But the last one is on me. I need to get on a regular exercise program to combat the crazy muscle loss. Back on my Mt. Bike, but it will be on flat gravel and local roads here in Arizona (where the tempetures are finally not Oven Grade!)
Everybody have a great (soon to come) Holiday season and fight on!
Cheers,
Tom C = DuctTape
PSA went from a 6 in 2020 to a mid 9 in 2021, then a mid 10 in Jan 2022. Had MRI guided Bioposy that showed some Gleason 7 and 8 and Gleason 9 in Seminal Vescisle (right). Bone Scan showed a few spots that lit up in Thoracic area and hip....but we can tie that back to sports injuries. so no mets
Recommended HDR Brachy, EBRT/IGRT and Lupron. Right now PSA is under .3 so all looks good. and I forget the T levels. just know that Sex drive is matching all reports of ...... that ship has sailed!
Going to try higher doses of Cialis. but it is the Drive; like going from a 70's muscle car to a geometro in attitude. and not caring if the Hallmark Channel is on vs the Workld Series.....
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Ducttape
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When you enroll in a Medicare Advantage plan you give your Medicare to the insurance company. The hospitals, clinics , doctors can not bill Medicare directly they have to bill the insurance company and accept whatever the insurance companies pay them. The insurance companies recover the money by billing Medicare.
I assume the insurance payment has to be lower than the payment directly from Medicare. There are doctors and clinics which take Medicare but they do not take Medicare Advantage. This could be a problem if you have to consult in other places in the USA. For example the Sloan Kettering Cancer Center in NY takes Medicare but not Medicare advantage plans.
Some Medicare advantage plans work as HMOs and you have to consult inside their network. Medicare allows you to have medical care anywhere in the USA.
One of the best options for me is to have Medicare and a medigap plan such a Medicare suplementary PPO. These plans allow to have treatment anywhere in the USA and they pay 80% of what Medicare part B does not pay and they manage Medicare part D (medicines). However these plans may not be available in you County or State and they may be expensive.
Plan N could be a good alternative.
If you are planning to continue to have therapy in the same place , continue with Medicare advantage could be a sastifactory option for you.
if you have traditional Medicare, you buy a supplement for B and also a part d drug plan. I am not aware of a supplement that includes Part D ( prescription drug) coverage. The supplements tend to pay 100% of the 20% Medicare does pay. The Part D plans can still cost a lot for cancer drugs but hopefully in a couple years this will be fixed per recent legislation
It is a medigap plan offered by the pension plan of the University I used to work for. it is very expensive, but the pension plan covers most of the premium.
My timing was very fortunate with DX. I turned 65 and I thought I was very healthy, saw a Dr once a year and on no meds. I went with an Advantage Plan as it has no fee but you do pay a few $$ when you see a Dr. Within 3 months, the Stage 4 DX came down. I then did the calculations and realized that being on a Supplement plan would save me thousands. When you first enroll, you are able to change from an Advantage Plan to a Supplement within the first 6 months without going through underwriting. This has enabled me to choose any provider going forward at no cost.
During the annual enrollment period you can switch from Medicare Advantage to Original Medicare. But if you then apply for a supplemental plan you are subject to underwriting and may be turned down.
Just to clarify for folks, the birthday rule in Calif only applies if you are already covered by a Supplemental plan-- it allows changing companies and to a plan that is equivalent or lower in coverage. It does not allow for new enrollment without underwriting. This is often misunderstood even by agents.
Also, occasionally BCBS has a "guaranteed issue holiday" where they will take anyone without underwriting for Plan G+, cost $200/mo, till Dec 31, 2023. You could sign up for this and switch to a HDG during the birthday rule costing much less, but with higher deductable.
Medicare advantage has many advantages—mostly for brokers and insurance companies. No one with a serious disease looking for advanced treatment potentially on a nationwide basis should ever consider one.
You an always switch back to Original Medicare. But your application for a supplemental plan, such as N, will now be subject to underwriting and given your prostate cancer you are likely or be turned down.
I have had a advantage since 65, a year before the diagnoses. You have an out of pocket maximum then insurance pays 100 percent of everything medical. So with this being said, with the chemo at my cost I will hit out of pocket by March then all treatments, scans, xgeva and eligard will be 100 percent covered without a deductible. Thd trouble is that cancer is expensive and without insurance and a good retirement account like 401k or iras you are sunk, you would have to turn to medicaid or die.
Go to boomerbenifits.com. They are the best at explaining and finding you the best supplement plan to Medicare or Advantage plan . They operate in all states except NY, Mass. Their service is excellent and hopefully all of us on this site will come to appreciate them .
I was told by a Medicare insurance company I cannot change my Medicare plans because I have prostate cancer. I need to be cancer free for two years to change plans. ???
At least in NY state you can change plans during the open enrollment period regardless of health status or cancer. Because you had a healthcare insurance plan to switch from. This is true in at least one "red" state that I know of. The key is maintaining insurance and medicare counts.Supplements & advantage plans differ in how they work for sure but even AARP can help find the plan that fits you. If you like the plan you have stay with it. Only reason they all make a big deal about changing is sales, sales, sales
Regarding Medicare Advantage (MA) it depends on which plan one gets and, if it is a group MA plan, coverage varies widely depending on the contract negotiated by the group. For example, our MA plan is a PPO plan provided by our state's public employee retirement association. No copays, no co-insurance, no deductibles and includes Rx drugs with very low copays. The plan is administered by United Healthcare but according to the negotiated rules set down by the retirement association not United so comparing it other United plans isn't valid. It's a wild game out there, for sure.
OK some basic Medicare info - Since you are not yet on Medicare I'll keep it short and sweet. Medicare Advantage is private insurance - plain and simple. Most serious procedures will require pre-authorization, many are initially denied and then later paid on appeal, but not all. They also are "narrow networks" which means your coverage is in a narrow geographic band. That''s fine if you're in a large city with quality facilities but not so much for anyone else. For example I live in southern suburbs of MPLS. If I had Medicare Advantage, I could go to the U of M but the Mayo is out of network Medicare Advantage plan.
So ask yourself if you want to live like that. You're already sick and now have to fight over finances.
To opt for Medicare Gap coverage aka Supplement during you initial application (Upon turning 65), you do not go through the underwriting process. This is the only time you can escape underwriting from most companies.
If you already have Medicare Advantage and want to switch to Medicare, you will have to go through an underwriting process. You have cancer - get Medicare.
FYI, you can switch within the first 6 months of getting on Medicare without going through underwriting. I was able to do that this year when I found out about my cancer, good timing!
Nicely stated. Advantage plans can be quite a bargain if you are healthy……but when you are under the stress of advanced PCA and in need of cutting edge tx they are SURE to disappoint.
This article explains some of the problems with Medicare Advantage. I think the adds that are currently running selling Medicare Advantage Plans are just as bad and deceptive as the political adds. Medpage has published multiple articles on this topic - medpagetoday.com/special-re...
Not sure what to tell you on the whole Insurance nightmare as I am only 50 and have yet to cross that bridge. I had a RP 18 months ago - and on the Cialis topic - you may want to try spiking the Cialis dose with 50-100 mg of Viagra when needed.. Just try it - and see if it helps.
Some government agency (Justice Dept I believe) was in the news today about going after the "Advantage" insurers for incorrect info promoting their plans. They don't appear to be entirely honest, who'da thunk that of an insurance company?
If you follow this forum - carefully - you'll find numerous cases of Advantage plans denying needed care our fellow victims need - care that would have been covered unquestionably by standard Medicare and Part G. Denials are fairly common, and to fight them you have to get the MD's involved.
Some personal "inside" info: these plans rely on MD's they pay to evaluate claims with the intent to reduce costs.
How do I know this - a good friend who was an MD, licensed in NY, but living in Florida where he couldn't get a license, was one of those doctors. Officially he had an MD degree (from an Island medical school), but he had NEVER actually practiced. He passed away not too long ago of pancreatic cancer, and he was being denied treatments by the insurance company he worked for.
I have regular Medicare and Part G - aside from the expense of Part-G plan, and the deductable for Medicare, I haven't been denied or even questioned for any treatments I've had. The costs of the charged treatments is something over $300,000 (Medicare paid about $100,000). I can go to any MD I want to, any medical facility I want to and NO ONE has to refer or approve me. I've had extensive physical-therapy for over 2 years, at NO cost to me at all.
My brother-in-law and sister-in-law were always telling us how much money they were saving with their advantage plan, and about "Silver-Sneakers" (which they NEVER used) - until the BIL had a stroke. The song changed - they were questioned on treatments, treatments were delayed due to needing approvals, and physical therapy was limited to some number of days as an outpatient, when his doctors wanted extensive in-patient PT. The result - he can't really walk. They're not so happy now (and they could EASILY have afforded the plan-G cost.)
Think about what motivation the insurance companies have to spend the millions upon millions they spend trying to sign up suckers (ie - seniors.) The motivation is profit.
Good luck... if you go with an advantage plan you're very likely to need it.
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and not caring if the Hallmark Channel is on vs the Workld Series.....
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