I have had 2 insurance policies, Cigna through my employer and Medicare Advantage. I'm now unemployed so will not have Cigna. I'm considering changing my Medicare Advantage to Medicare (part A & B) plus a Medicare Supplement plan (through Cigna, Blue Cross, United, etc) plus a standalone drug plan.
I have mCRPC and have had 27 treatments of chemo (cabazitaxel+carboplatin). My PSA is now spiking and has jumped from 18 to 33 from mid Sep to early Oct. So I'm working on changing treatment from chemo to Xofigo (Radium-223)
Please share your experience/knowledge regarding chemo or Xofigo coverage with Medicare+Medicare Supplement+stand alone drug plan. Also, I'd appreciate recommendations on what companies are best for the Medicare Supplement and stand alone drug plans.
Thank you!
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MechD
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I have been very happy with Bankers Life for Medicare supplemental insurance. But one word of caution. You can easily switch from Medicare Advantage to Original Medicare during the open enrollment period. But if you want to purchase a Medicare supplemental plan you will be subject to underwriting and since you have prostate cancer there is a very good chance that you will be denied or if not denied then charged a very high premium.
Alturia, I've been told that since I lost my Cigna primary insurance, it's a qualifying event and I can switch to Original Medicare plus Medicare Supplement w/o pre-screening questions. Any thoughts? Thanks.
MechD, sorry I am not familiar with that situation. All I can say is try very hard to confirm whether your situation enables you to purchase a supplemental plan without any underwriting or consideration of your pre-existing conditions. Before you switch from Medicare Advantage to Original Medicare.
It sounds like you have to sort of jump off a cliff first - go to Original and then hope to get Medigap? You can't get a Supplemental commitment before you jump? (I appreciate it isn't interesting to keep posting about this, at least for some, but it is meaningful to me.)
If a person cannot afford all the deductibles and extras with Original it is still wise to avoid Advantage? In my senior community, there are plenty of people (maybe me) who can't afford all the insurance premiums, copays, deductibles, drug plan. So I would have thought in that situation, Advantage is at least something, since there are 0 premiums here in OC Cal. But maybe there is poverty help that kicks in? (excluding going to other countries and treatments like that.) Tall says never choose it. I don't recall seeing WSJ mention absolute inability to pay.
No, you can go through the application process. You’ll get a cost. You don’t need to accept it. The part g providers are listed on Medicare. The application is done in the website.
I ran through 5 applications until I was asked about the Cancer. I responded yes. And was denied. I know you can call and apply on the phone and see if you can get the underwriter to quote a fee, but it will be high.
The $0 is for premiums only. You need to look at the maximum out of pocket costs. And the Medicare Advantage plans that I have looked at all have much higher out of pocket costs than Originally Medicare and a supplemental plan. Medicare Advantage plans might be good if you are healthy. Original Medicare and a supplemental plan are better if you are sick. But I buy healthy insurance based on what I need when I am sick, not what I need when I am healthy.
The most important thing is that with an advantage plan you're not free to choose the doctor of your choice and the insurance company has the option to not pay for your services. This is not the case with original Medicare
Yeah, that's why I'm freaking out - healthy now at 75 but yes, the insurance is for someday so I can do what I want if I can afford to. In 10 years of MA/HMO have only had to pay about $170 TOTAL (2 operations, lots of tests, scans, PT etc), plus drugs (all but 1 free). This is great info, but daunting. I can't believe I've been in the dark on this one. Thank you for the input!
Yes, I will get a commitment from Supplemental before jumping back to Medicare Original. I checking on "guaranteed issue right" for my legal right to no pre-screening in my situation.
Perhaps you could find aMedicare insurance broker to help you..or call the supplement companies.
On this same site you can compare the drug and supplement plans in your area. You can input all your drugs when choosing a drug plan. We do this annually. There is a new law that makes the Medicare drugs plans much better in terms of out of pocket next year.
You can. I did it at age 67 when my employer dropped our insurance and gave us a monthly allowance to upgrade. We bought a good part D. Mistake. Gonna get a cheap part D and use GoodRx. In 2025 max oop is $2000 for drugs.
States are different in that regard. I live in Vermont and Vermont does not allow medical underwriting for supplemental plans regardless of when you enroll in them. What it does allow is for the insurance company to charge higher premium if you don’t enroll when you become eligible for Medicare. For Blue Cross the premium is about $100/month higher if you enroll after you become Medicare-eligible.
He just got Part G supplemental, fortunately (he is one of my best friends). But I agree, that it is almost impossible to switch to a Supplemental Plan after one is trapped in an Advantage Plan. One needs a Part D (Drug Plan) too with Medigap because there is a penalty if one tries to get one later. I buy a minimal cost Part D plan. By 2025, the maximum annual out-of-pocket for drugs will be $2,500.
Another friend has an Advantage Plan with Kaiser, and he lucked out, because his oncologist is wonderful. But I worry what will happen if his oncologist ever leaves.
There is no situation where a patient is better off with an Advantage Plan, unless he doesn't know how to find a specialist:
My DX was 1 year after I was with my Kaiser switch from private to MA. Im making the best of it. And it's working, I no longer have detectable PCa thanks to their actions!
Can you PM me your friends oncologist name? Mines great, but always need a backup!!
Most medicines for PCa are injections or infusions, so they are covered under Part B. Abiraterone is available as a low cost generic. Only the second gen anti-androgens, which are expensive, are not covered. In 2024, the maximum out-of-pocket for drugs will be $3,250. In 2025, the maximum out-of-pocket for drugs will be $2,000.
I thought the cap on drug expenses would only take effect in 2025, not 2024. Can you provide documentation on the $3,025 cap in 2024? That’s great news and I can’t believe I missed that part of the announcement (but am sure I did!). Thanks TA for keeping up on all of this.
Hope you are not in a Medicare Advantage program , sis. If so switch to a Supplemental Plan G while you don’t have a disqualifying diagnosis. Advantage is a scam that only advantages the companies. That is why they are so heavily advertised. 💕🙏🏻
The primary reason Advantage could be better is if one stays reasonably healthy. And that's the problem, you don't know what the future holds for your health. I started with an Advantage plan at 65 and was very healthy. Along came 69 and PC diagnosis. So this year I hit my total out of pocket costs that all Advantage plans have. While I enjoyed not having a premium to pay, hitting the TOP puts a damper on that. If you go Advantage, look for one with a low TOP. In GA Humana has a plan with total out of pocket of about $3,800. Not too bad. I'm on Aetna with TOP of $5,500, not as bad as it could be.
Yes, I'm hearing that a lot. Doctors in my are aren't taking Medicare Advantage plans. Looks like it all depends on if I can avoid the pre-screening questions due to a qualifying event (losing Cigna). Thanks.
When I first got on Medicare, I picked an Advantage plan as I thought I was healthy. I got my Dx shortly after. You are allowed to switch to a Supplement plan within the first 6 months of you're initial election without underwriting. Had I tried to switch after 6 months, I would have been denied due to having cancer.
I'm not sure if it's changed, but after I got my Dx, I wanted to see the best and was told by MD Anderson, Mayo and Johns Hopkins that all didn't take Medicare Advantage plans.
medicare.gov actually has a questionnaire to help you determine the answer to your question re guaranteed issue ! It appears to me that you will be out of luck, UNLESS just losing your employer insurance now, at 69, even though already on an Advantage plan, gives you some special rights. Yes, seems like calling the supplemental carrier directly should provide the correct answer..advise to "get it in writing " !!!!!!!!!!!!!!!!!!!!!!!!!!!!
If you are stuck, that is not a disaster in most cases, IMHO.....is Kaiser in your area? Plus , there may be Advantage plans that have top Docs in their networks, and some Advantage plans, labeled HMO-POS, or Advantage PPO, give access to all or almost all Docs, but annual out-of pocket will be higher of course.
Sad but true, Medicare does not exist within the world of Obamacare guaranteed issue!!
we are dealing with this challenge ourselves now..Advantage or supplement? With 27 years as Kaiser employee, wife has earned $60k+ to be applied to all future Medicare B,C, D premiums, plus other out-of-pocket expenses..but she must enroll in Kaiser Advantage, or loses most of that reimbursement account!!!
I can tell you one thing about Kaiser Advantage.....no profits go to stockholders, though perhaps the Docs' total compensation somehow influenced by company's financial performance ? More importantly I think the communication system is EXCELLENT.....zero bother/worry about any provider you see have total immediate access to all your labs, scan, co-morbiities, diagnoses from other kaiser Docs, etc. 24 hr nurse advice lines, and in certain instances, access to 24 hr telappointments on an urgent care basis.....I've used that when experiencing concerning symptoms but unsure about a trip to ER!!!
I'm sure you are well aware of the negatives of most Advantage plans, and some of those do indeed apply to Kaiser. While not impossible to have Kaiser cover a visit to an outside Doc, will definitely take extra patient effort, and with an understanding and agreeable kaiser Doc's support!!
My Sis has traditional Medicare with supplements, and thus I see things are available thru Kaiser that we would miss without Kaiser!!
If you do find you qualify for guaranteed issue supplement, I listened to one Q&A session presented by one of the brokers....and I made note of one of his priorities when advising on a supplement company......number of folks an insurer covers in your area, and secondly, overall size of the insurer...... both are associated with stability of insurer's rates. Additinally, plan G annual premium increases have been much higher that plan N increases.
Hope maybe at least one thing I've mentioned has been helpful?
So much great info, thank you! I'm looking into special rights (guaranteed issue rights, GIR) since I lost coverage from my ex-employer and am on Medicare Advantage. I've found info on a Blue Cross document that one will have GIR if they lost employer insurance while on Medicare Original. I'm contacting State Health Insurance Assistance Program (SHIP) to see if it also applies with Medicare Advantage and will work to get it in writing the no underwriting (pre-screening) from the Supplement carrier.
I'm a little confused and concerned about the N/A regarding out-of-pocket (OOP) max on Supplement policies so will be looking for clarification. I'm guessing the OOP on Medicare Part B covers me there?
I was with Kaiser until moving to Shasta County, CA. Kaiser doesn't cover this area.
You should have Guaranteed Issue rights for 60 or 70 days after the qualifying event of losing your job, but you should verify this, since you are already in an Advantage Plan.
I do agree that you should try hard to switch to a Supplement. The coverage with Plan G is excellent, my husband and brother have had no copays except the annual deductible. The drug plan can be tricky.
Your state SHIPS department should be very helpful. I also use a nationwide broker called Boomer Benefits because they have a customer service department that can help you if you have a problem with a claim. They were very helpful in deciding which type of plan we needed
Brokers make more on Advantage Plans than Supplements, so that’s why the heavy marketing at this time of year
All Supplements are exactly the same coverage; costs depend on your age and zip code.
If you were born before January 1, 1954, your GI will be for the highest plan available, or a Plan F. If you’re born after that, it will be Plan G.
Best of luck to you. I have helped so many friends and family navigate this, and am happy to answer any questions.
Yes I agree that I need to check to see if the GI rights apply with losing employer insurance while on Advantage. I have a SHIP appointment this afternoon.
Do you know how yearly out-of-pocket maximums work with Original Medicare plus Supplement since the Supplement I checked says oop max is N/A?
There is only your annual deductible of $226, next year I think it’s like $230. That’s it! No max out of pocket because there are no copays or coinsurance.
It’s been great. In 2022, my husband had multiple PSMA scans, Guardant testing several times, 4 Pluvicto treatments, and I had breast cancer surgery, chemo, and radiation. Just the small deductible. Relief is right!
I’ve been pleased with Humana for my supplement, as far as drug plans go, that changes year to year. Medicare makes it pretty easy to compare plans on their website. Just create the list of drugs you’re currently taking and it will populate plans in your area, complete with annual cost, etc.
Regular Medicare gives you more flexibility regarding where you can go. The Medicare.gov site provides helpful and easily obtained info regarding ins company quality and ins. company options. Perhaps your having lost Cigna will give you more possibilities for Medigap. I wish you the best of luck!
The USA Medicare system is a "Shell Game".As we are now in open enrollment, the TV is filled with commercials advertising the "Right" Medicare Advantage Plan for you. This is capitalistic advertising endemic in our Healthcare. Sadly, our system in the USA.
I'm on Eligard and Eliquis. The Eliquis (blood thinner) cost more. Why?
A fixed system, a cartel, allowed and advocated by our government.
In California, you are eligible to switch under the “Birthday Rule” without underwriting questions, 30 days before and after your birthday. You need to find a Medicare insurance specialist to figure out the process of switching.
Terminal: In states that accept the Birthday Rule, you can switch to a supplemental plan at any age over 65, without answering medical question within +/- 30 days of your birthday,
The OP is in California, one of the states that accepts the Birthday Rule.
You have been trolling this whole thread. No one not one agrees with you. Your opinions obviously mean nothing to no one. I trust TA way more than you as well my plan administrator.
Say all you want I’m done with your opinions. I’m happy and obviously you are happy. Now move on!!!
I have had traditional Medicare with United Healthcare supplemental plan F since the beginning. I went that route because, as my parents' caregiver, whenever I took them to a new doctor and stated their insurance the office personnel often sighed and said, "Oh, good!"
When I went to Moffitt Cancer Center in Tampa, FL, and signed in they looked at my insurance and said, "Oh, you've got the gold standard insurance."
I have never, let me repeat that: _never_, been turned down or had to get pre-approval for anything -- and I've done Provenge @ $100,000+ each and now Pluvicto @ $103,000+ each, plus many, many CTs, MRIs, bone scans, DEXAs and a couple PSMA PET scans.
I go to whichever doctors I want and get second opinions when I want. Not a peep out of anyone and not a single co-pay. I'll happily pay my monthly supplemental premium for the peace of mind and freedom of choice in my doctors and treatments.
Part D and its co-pays are becoming more affordable. I had to go the poor route and get rid of everything except a house and a car and I can't have more than a few thousand dollars in reserve, but I don't pay anything for meds. Nothing. At. All. If I hadn't the co-pays would have bankrupted me long ago. OTOH, I now get to live in poverty for the rest of my life. SNAP, HEAP and New York's STAR programs makes it a little better.
I don't find any discussion here about the protocol used for annual increases in premiums. Beware that, at least in Illinois but probably throughout the Medicare system, that might make a significant difference in future premium costs. Quotes from the guide for Illinois are in quotation marks below:
"Most companies in this guide use the Attained Age Rating Method." "Attained Age: Your premium will increase as you grow older. Additional increases due to higher medical costs or higher than expected claim costs are also possible. For example, if you buy a policy at age 65, when you turn 70, you will pay whatever the company is charging for a person 70 years old. However, any rate increase that occurs must apply to the entire class of policyholders in which you are categorized, not just to you as an individual."
A notable exception: United Healthcare and AARP/United Healthcare use "No Age (Community) Rating: The premium for a specific policy is the same for everyone over the age of 65, regardless of their age." In 2019 and probably continuing that wasn't the complete story for AARP/UHC: The premium did not increase with increasing age for age 77 and beyond, and there was with a 3%-pt/year premium discount for ages 76 down to 65 relative to the premium for age 77; i.e., 3% discount for age 76, 30% discount for age 67, and so on.
For 2019, starting at age 66, Standard, Non-Tobacco Plan G, the AARP/UHC (Community Rating) initial premium rate was 17% lower than BCBS (Attained Age Rating), and estimated cumulative cost through age 85 was 27% lower.
Mutual of Omaha might have proven lower-cost, but was a relative newcomer to Illinois, so I chose AARP/UHC. For Plan N, Mutual of Omaha (Attained Age Rating) had 13% lower initial premium rate than AARP/UHC, with lower rates persisting through age 85 and then exceeding AARP/UHC from 86 on, such that the estimated cumulative premium payments wouldn't equalize until age 100, not including any time value of money.
The figures probably changed somewhat since 2018, and there are likely differences for California, but in my own experience I'm glad that I evaluated those two protocols that insurance companies use to increase premiums as time goes on.
Are you not able to continue your coverage by the COBRA option? Basically it allows you to continue your coverage for an extra 18 months. You have to pay for the coverage but I think it might be favorable over say a new policy. Not sure if that helps you.
I may get COBRA which I can have for 3 weeks at a lower rate. I haven’t looked at the rates yet but I had it in the past for a couple months at exorbitant rates.
New Q: Now I'm wondering if I completely run out of money on Orig+Supp, can people switch the other direction back to Advantage and 0 premiums? That would kind of be good to know.
Like Terminal, I've loved my plan and doctors till now, but I definitely haven't stress-tested the Hoag/United/AARP system, since rel healthy. The outcry against Advantage is too strong to ignore.
Then I can sign up for these extra premiums +costs (depending on Supp plan), and at least know I could go back to the MA situation I'm already in now, if too broke. Still would have insurance. And who knows, maybe I can indeed manage to pay for OG Medicare and Gap if careful. I also want to avoid the dreaded "stuck in a medicare nursing home getting $30/month for life" deal. Learned about that mess a few months ago.
Did I hear correctly that if I choose G, I don't need underwriting if go to a cheaper plan; and the opposite? I think I heard you can move freely among the Gap plans offered in your area.
[Unrelated: In Finland, you're ultimately well taken care of, but you wait forever for many dx/treatments. Some of my AFib friends waited a year for first diagnosis in some countries.]
Thanks everyone for all this help. I will be so glad to get home and see what my retirement package actually says. 8 days to go. Kate
It appears both my questions are answered on Medicare.gov. Apparently one could always change to Medicare Advantage (again) later - just odd that anyone would want to. I will verify later by phone because it seems possible to me for financial reasons (less care, less cost after spending all my money on $$$$ care w no lifetime max), maybe only me!
I see the birthday rule for my second question - yes change among gap plans in CA.
It’s been quite a struggle making sense of it all. I’ve been studying it for days and am now, with the help of all in this thread and HICAP, am in the process of applying for Medigap with Guaranteed Issue rights. Thank God marrying my ex to avoid this mess never occurred to me!
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