I was just reading in the forums about the widely varying cost of PMSA PET scans, and it reminds me that I’ll soon turn 65, and have to figure out the whole Medicare/health insurance thing.
We currently have the cheapest “Obamacare,” Ambetter, which, while badly run, seems to have paid a large percentage of my diagnostic tests ($69k, so far). I foresee a bunch of expenses in my future (prostatectomy and pelvic lymph dissection, possible radiation…), and wonder what I should do regarding my pending Medicare enrollment.
Do any of you older folks have any suggestions which way I should go? Medicare? Medicare & supplemental? Other?
I appreciate any suggestions/advice you might have
Thanks in advance.
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Jpburns
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I have Medicare and a Blue Cross Blue Shield Medicare supplement plan (F). I was Dx 2018, had many many scans, including 2 PSMA scans. Never paid a dime. I would recommend against any “Advantage” plan.
i have Blue Cross/Shield medicare advantage blue PPO. i had PC with 20 ext beam radiation treatments with Lupron ADT $175K total cost. i paid $5K out of pocket. i thought that was pretty good🤷♂️
Plan f is no longer available. Plan g is exactly the same except you have to pay the part b deductible. Much better value. Wife switched from f to g this year. I couldn’t because of my cancer.
Since its your first year, getting a supplemental Part G to Medicare will have NO pre existing medical questions. Take advantage of it!! BCBS is a good one to start looking at.
Medicare Part A and B are no brainers. Part D needs to be researched.
I’m in the same boat. I have a Medicare decision coming up. It appears the majority of opinions here seem to be pro-medicare supplement and anti-Medicare Advantage. Why is that? If I compare a BCBS Supplement and Rx plans against an all encompassing Advantage plan I would pay about $2400/yr more in premiums for the Supplement & Rx plans and I would pay an additional $485 in deductibles that I wouldn’t pay on the Advantage plan. So from a financial perspective I would have to pay almost $3000 in co-insurance and deductibles on the Advantage plan to make the supplement/Rx plan more attractive. I’m not seeing that I would do that.
So, is there something besides the costs that points people to the supplement path? I know there’s concern about the limited provider networks of some Advantage plans but BCBS has a very large network. I live in Vermont and BCBS is pretty much universally accepted.
When I turned 65, I was in perfect health and signed up for an Advantage plan. The very next month, I got my G9 Dx. In trying to get all the opinions I could, I wanted to go to one of the big centers, MD Anderson, Mayo etc. I quickly found out they did not accept any Advantage plans. As all of this happened within the first 6 months of enrollment, I was able to change over to a Supplement plan with no underwriting. Best thing I've done as i have yet to have anyone say they didn't take my BCBS plan.
You WILL run into trouble with approvals down the road with an advantage plan as well as not having full control over which practitioners and facilities you can use(eg….sloan-Kettering refuses all advantage plans). You are quite right about the expense and if you are the kind of person who can deal long term with those hassles by all means save some money…..just keep in mind that your choices won’t always be yours to make and a time May come that you really want them.
I’ve gone with a BCBS supplement - Plan G and a BCBS part D policy. It cost more up front than an Advantage plan but the supplement’s virtual universal acceptance and only having to pay the $234 annual Plan B deductible was ultimately the deciding factor.
Many people like Medicare Advantage because the cost is low and you have other benefits. The problem with Medicare Advantage is that you give your Medicare part A, B and D to the insurance company running the plan.
Then the company negotiate with hospitals etc as a capitate systems. It may work if you stay in network and the chances of doing second opinions out of network are limited or they won't happened.
The most freedom in selecting doctors and hospitals or cancer centers, is to enroll directly in Medicare part A and part B you will pay directly to SS according to your income (it is deducted from SS payments) and then look for a supplemental plan to cover the 20% Medicare part A and B don't pay and with this company get part D (medicines, the cost will be deducted by SS according to income).
In this way you own you Medicare part A and B and you can go to any Doctor or place in the country they accept Medicare. The plans are specific for each county. The best to me are the PPO supplemental plans
I know there are Advantage PPO plans.....didn't know about supplement PPO plans> so, they are same as non-PPO supplement plans, but pay less if a Doc, etc, is not in a certain PPO???
I have BCBS PPO in Massachusetts. $72 per month. Dx in first year. MGH accepts and I do not think I paid more than $1k for RPP and 39 radiation treatments. just saying it
If Medicare pays the supplemental PPO pays, regardless of networks, plans etc.. Strait Medicare allows you to go to any doctor in the Country who takes Medicare , the supplemental PPO’s respect this Medicare rule.
Make sure your specialist team will take the supplemental insurance you opt for. I know of one MO in California that doesn’t take BCBS supplemental anymore due to approval delays/denials. You get one shot at choosing a supplemental carrier, so choose wisely if you go that route.
To clarify, you effectively have only "one shot" because if you wish to change your mind during open enrollment periods, carriers can deny you because you have cancer. The first time you enroll by right, when you turn 65, everybody has to accept you with no medical questions. So that's why your first choice has to stick.
Medicare Advantage gets your Medicare dollars and doles them back out to you. How do you think they make money? By paying less for your care (that's why major cancer centers don't take Advantage) and denying treatments.
I've looked at Mayo, MD Anderson, and MSKCC, and they only take a small number of Advantage networks. I did not do an exhaustive search so I shouldn't have implied that there are none.
Teleguy, you actually get two shots—one selection upon first enrollment and then again, if you switch within the first 12 months of first enrollment in Medicare B. I had an advantage plan for the first year but switched to a Medigap plan at the end of the first year. No underwriting required—no questions asked. Selecting independent drug plans to fulfill part D, which is necessary when going the Medigap route, are a bit murkier and require research to achieve a good fit. BTW, we live on an island north of Seattle. Finding a convenient PPO is very difficult , so having an advantage plan was way too restrictive. With Medigap plan G, I can go anywhere that accepts Medicare and have no out of pocket expenses. Granted, we pay premiums to Regence for it, but considering the change in my health and the need to be flexible with my providers, it’s been well worth it.
That is news to me> I thought supplement plans pay some or all of the 20% that PART B doesn't pay......in other words, if a claim is approved by and paid by Medicare, then supplement must pay also???? Is there perhaps another reason for the MO's decision> perhaps he doesn't accept Medicare at all...not all Docs do.
We will bill your insurance company, however we may require full payment up front. We only accept Medicare and some PPOs – We do not accept or bill Medi-Cal or HMOs. Payment is due at the time of service (copays, deductibles, and any out of pocket).
WE ARE PROVIDERS (IN-NETWORK) WITH THE FOLLOWING INSURANCE COMPANIES.
In -network has nothing to do with Medicare, and neither do Medicare supplements.
All I can speculate is that this MO has had problems with delay in payment from certain supplement insurers.
In Oregon, there is a 60 day period before and after your birthday when you can switch supplement carriers without underwriting. I think Cal may have that, or even some more liberal legislation. Unfortunately, that still does not address the problem of folks who become unhappy with their Advantage plans and want to switch to a supplement. Congress has been considering that issue, but sadly nothing yet. Obamacare is better in that one respect...never underwriting problems that I know of.
I do think you've confused BCBS Advantage with BCBS supplemental as there is no one to approve or delay payments with plain Medicare plus supplemental. I have AARP United Healthcare supplemental so I have no direct experience with BCBS but I've had treatments, that I have chosen, that cost over $100,000 a pop and not a peep out of anyone, nor a penny out of my pocket.
I have Medicare + Anthem Blue Cross Supplemental (Medigap). Avoid Medicare Advantage Plans! They will bombard you with robocalls, mail, and TV ads. That's because they are a rip off.
Medicare + Anthem Blue Cross Supplemental here, too. No questions or limitations. Started in 2007 and just now encountered my first co-pay: $75 for Orgovyx.
Could I ask what state you’re in? I searched for Orgovyx in the prescription section, and while my urologist was listed, they were listed as “not in network.”
To reply to Jpburns and also update my previous post... I am in KY. And my co-pay has just been corrected to $10, courtesy of an Orgovyx promotion. As explained to me by Onco360, the specialty pharmacy that sends me the Orgovyx, the mfr of Orgovyx (Sumitomo Pharma Switzerland GmbH and Pfizer) pays $65 of my full $75 co-pay.
Medicare Advantage is wonderful until you need coverage - then it's not so great. All my relatives who used to brag at the Thanksgiving table about their MA plans and "Silver Sneakers" (not one of them ever saw the inside of a gym) - are ALL now complaining about denied treatments, delayed approvals, etc from their marvelous Advantage plans.
One advantage plan recently was accused by the government of using AI bots to deny coverage. The criteria they used wasn't medical, it was how likely the patient/MD was going to appeal the decision and if it went to negotiation how likely the insurance company was going to win.
There is a reason you're bombarded with advertising for MA plans - they're VERY profitable. For the insurance companies and the agents selling the plans. And they are SELLING them.
Somewhere here a few months back I posted a link and some info from an organization for retired people that analyzed just HOW profitable these plans are. The plans receive an "incentive" plus your medical payment that would have gone to Medicare when they sign you up. The agent who signs you up receives not only a commission on signing you up - they receive that commission EVERY YEAR you stay in the plan, and it's not insignificant money (I seem to recall around $600/annually.)
With Medicare and a supplemental plan - the supplemental will increase in cost as you age.
The rates for the supplemental plans (at least in NJ) can cost you several thousand dollars a year, especially as you get older. If an agent sells you a plan, he gets a commission (and I'm not certain if it's an annual one or not) from it. Plan D for drug coverage also costs you out of pocket - and prices really are all over the place and it takes careful calculating to get the best deal. It used to be the mail-order pharmacy was always cheaper than a local pharmacy.. the best plan I could find for me (with some semi-expensive drugs) is cheaper this year if I have all the drugs filled at a pharmacy in my local Acme food market.
That all said - once you meet the annual deductable for A&B - everything I've had done over the past 5 years has been paid for no questions asked, and every hospital and doctor seemed quite happy that I had Medicare and a supplimental. Compared to the experiences of my oh-so-smart relatives - it's a much better situation to be in when you do get ill. I now get to gloat just a bit at the Thanksgiving table when the subject comes up.
Advantage plans are required to offer and cover anything covered by Medicare.....but network limits your clinic/hospital/Doc choices. Also, I believe if your annual billings are always high, in those years the supplement option might end up costing more in those years than an Advantage plan.
Kaiser has paid for 2 PSMA PET scans for me......no questions asked. It appears they might be phasing out bone scan and CT as SOC ? When MRIs were still fairly new to the biopsy world, it took an appeal, but Kasier paid for a fusion biopsy at local med school urology clinic. Kaise didn't yet have the equipment,software for fusion biopsy. Kaiser urologist supported the appeal!!!
When wife hospitalized for probably a virus that caused delirium, dignosed as probable encephalitis, during hospitalization for 10 days, a 24 hr person was assigned to her bedside...for several days!!!
I'm pretty sure Medicare Advantage plans have their own rules for prior approval--so while a service may theoretically be covered, it may not be covered for YOU.
You said: "Advantage plans are required to offer and cover anything covered by Medicare.....but network limits your clinic/hospital/Doc choices. Also, I believe if your annual billings are always high, in those years the supplement option might end up costing more in those years than an Advantage plan."
The supplemental plans such as Plan-G, once signed up (and for initial signup when you start Medicare existing conditions can't be counted against you) cannot charge the subscriber any more for high-billings. It's a fixed price once subscribed. It goes up with age - that's legal. It doesn't go up with illness - that's illegal. And while Advantage plans are required to cover (not offer) what Medicare covers, they are free to add restrictions on qualifying to cover something. And coverage for things like physical therapy - can be quite limited in an Advantage plan, and require prior authorization. With Medicare - I can go to PT all on my own - no MD prescription required, but if I get a prescription the PT is basically unlimited as long as improvement is shown in the results of the treatment.
Glad to hear they took care of your wife, but what's the deal with requiring an appeal for what's standard of care treatment like an MRI?
BTW, I think a negative of Advanatge is inability to change the Part D part of Advanatge...only way to do that would be to change Advantage plans as far as I know.
My husband, 73, and I are on Medicare with the AARP United Healthcare Supplement and a AARP Walgreens Plan D.
He is being treated at Mayo in Phoenix and they will not accept Medicare Advantage plans…
I think you will find more hospital systems and providers not contracting with Advantage plans… they don’t pay well and they restrict what services can be provided to patients .
But how they offer it makes the difference. Denials of treatment requiring appeals are common, and guess what - Doctors would rather not spend their time arguing with insurance companies to get you treatment. Plus they can require it be done in their network which might not be the best place to have something done. I can make an appointment with any doctor I want to who accepts Medicare and know it will be covered. I don't need a referral, I don't need to pre-qualify, I don't need any tests/steps beforehand.
Accept the fact that insurance companies are in it for the money, then decide how you want to spend your Medicare allotment. The insurance company has one master - the stockholders - and they have one interest - a maximum return on their money. Companies, despite Citizen United have no souls, greed is their motivating factor.
so, I would like to understand this...Medicare will cover an unlimited number 1st, 2nd,3rd, 4th, etc medical opinions for a given malady? I am not sure denials are common...per the link above, 35 million Prior requests for 2021, but 2 million denials.....and 80% of denials were reversed on appeal. Sadly , looks like there was good legislation that passed the House, but certain Senators vetoed it !!!!!
I'll just address this - I had 2nd, 3rd and 4th opinions on what my treatment should be, and actually had a 5th opinion. No approval needed to get these, Medicare + partD = no cost to me. There is no prohibition written into Medicare on what for or how many or how often you can see doctors. If it's an FDA approved treatment - it's paid for - 100% with Plan-D.
FWIW - the typical prices actually paid are a small fraction of the billing prices most medical practices (including hospitals) submit. Medicare simply denies payment for what it considers duplicate claims (where one procedure is actually part of another procedure they're already paying for..) The medical organizations/doctors who take Medicare agreed to this, and understand it.
As far as "non-profit" plans like Kaiser - I had a close relative who worked for Kaiser for 30 years. It doesn't have stockholders, but if their costs + expenses like administration aren't met things are not happy in Kaiser land. It might be worth asking what the head honcho at Kaiser is paid... dunno about Providence.
I had a good friend who worked for one of the Advantage plans. He was an MD who was licensed in NY, moved to Florida and never succeeded getting a license in Florida (never explained to me why.. but perhaps the island medical school he went to wasn't all it was cracked up to be, and apparently licensing has some sort of qualifying tests.)
Anyway - after working as a used vehicle salesman for a number of years, Advantage plans came along, and they needed people with "MD" after their name to put a name on denials and to negotiate appeals. Despite not being licensed where he lived he qualified for that position. And he made the decisions. Were they good decisions? I hope so - but it's not a crack leading MD making them, it was someone who couldn't get a license. He very unfortunately succumbed to pancreatic cancer a few years ago. And now they're using AI-Bots to make these decisions.
I wish you all the luck with your Advantage plan and am happy it's worked for you so far. What I've observed with relatives - it sort of depends on what illness you have how happy you are with their plans. Anything requiring repeated sustaining treatments over long periods of time are likely to experience issues. (Like my BIL's denial of PT after a stroke, he now lives in a wheelchair.. he's paying for outpatient PT from his own pocket, the MD wanted him to take in-hospital PT and it was denied. They're not too happy with their plan now.)
Sorry - that is worded in a confusing manner. What I meant to say was - With Plan G and a Supplement the treatments I had were done at no cost to me besides the annual deductible of Medicare ($240 this year.) As long as it's an FDA approved treatment - the cost is covered 100% by Medicare and a Plan-G supplement,
Traditional Medicare and a Supplemental G level is best I have UHC the AARP .. plus Part D drug coverage . The supplemental are no brainers , every companies Alphabet plans are the same G is G not matter who sponsors so it is a mattter of cost which is based on your geography and customer service. Time to read reviews from your area. This makes your coverage totally portable . I live in Northern CA and went to get treatment at Sutter and USF . After BCR went for 2nd opinion at USF and MD Anderson .. not a bump along the way . The only pain is Part D you really need to import all your drugs and multi pharmacies to compare plans it’s a pain … good luck
Medicare.gov is very helpful. Has tools to help you choose what plans are available where you live. Yes,this varies based on where you live. You need to start studying before you turn 65. An insurance broker might be able to help, just be careful to know what plans they sell. I will echo, if you can afford it, get supplement and part d drug plan. Not Medicare Advantage. You can change your drug plan every year but supplements in most states are medically underwritten after the initial choice. Choose well.
I totally agree with others supplemental Plan G if you can afford the premiums is the ONLY way to go. Please sign up for it as soon as you’re eligible.
Some supplement plans do not include Mayo or Cancer Centers of America. Hubs did not have one of these so our broker switched him a year ago. Next thing you know he needs to get into Mayo for this disease. We feel lucky she steered us this way. Second the classic Medicare. Many docs won’t take Advantage.
Oh it’s also nice to get a plan that includes Silver and Fit health club membership
My Medicare Advantage PPO program has been wonderful. No copays for anything except in-patient hospitalization and it is $300 regardless of length of stay. It paid in total for all my scans and outpatient treatments. The companion drug plan is very good, too. I pay $72.30 per month for both Orgovyx and Xtandi. I know many have had bad experiences with their version of an Advantage plan but ours is terrific (so far). The inequities in the American medical insurance system are stunning.
United Healthcare Medicare Advantage PPO. There are dozens of versions of this plan depending on funding sources and administrative rules set down by the contracting agency. Some versions good, some versions not so good.
Thanks for the info. Can you tell me how you shopped around for Orgovyx on your drug plan? I currently get it from my urologist, but when I tried searching for it on the Medicare site, my urologist was listed, but they were listed as “not in network.”
I get both Orgovyx and Xtandi from OptumRx home delivery which is affiliated with my Medicare Advantage plan. I stopped dealing with a urologist years ago and instead went with a urologic oncologist based on advice I got from members on this site.
You most definitely want some sort of supplement to Medicare. When I signed up 10 years ago I received packets from 8 or 10 plans, many without even requesting them. They offer a bewildering array of options. At the time I was in excellent health so I chose a middle of the road plan from Ucare. Ucare only operates in Minnesota and I think some nearby states. Little did I know that 2 years later, one week after I retired, that I'd be diagnosed with prostate cancer. So cassic! There are services that will help you choose a plan if you want to give them a try. I'm not sure if they charge fees or if they get paid by the insurance companies.
I've been very happy with the coverage. The first year my medical charges were $196,000. I was astonished even though I'd spent my entire career as a physician. Most doctors are unaware of the shocking costs of the tests they order or the medications they prescribe. Anyway, Medicare disallowed most of the charges. The final cost paid by the insurance was about $26,000 and I ended up paying about $500.
Since you are already diagnosed with cancer I'd say get the best plan you can afford. Likely you'll be happy in the long run. Medicare is a life saver, really. As an aside, I'm sort of half way between conservative and libertarian but I think there are some things our government must provide and decent health coverage is one. If only they could cut the waste and reduce the Byzantine bureaucracy! But every politician promises to do that. Ha!
a supplement will allow you to go to any doctor or hospital in the country without a referral. MD Anderson, Duke, Sloan Kettering, etc. advantage keeps you in a local PPO which may not be the best resource for your condition.
You will have only one opportunity to pick a supplement when you hit 65 without medical underwriting, so go with that. You’ll probably be unable to get it later. Plan N was my choice. It will have fewer sick people over time and rate increases will be kept to a minimum. Plan G is good also but more people choose it because of a lower cost, but rate increases will be more over time.
Advantage also requires pre approval for procedures while supplements don’t.
My plan covered a recent surgery and hospital stay 100%.
There are lots of good YouTube videos on Medicare options.
If you can afford it, do NOT get an Advantage Plan no matter how hard they sell it. Sign up with old 'original' Medicare with the best Plan G you can find. Another benefit besides being able to choose your doctors, is that if you live in two places part of the year, you will be covered in both, NOT just for emergencies. I live most of the time in one state, but my oncologist is in another!
Agree! We have the same situation. Plan G got him in to Mayo out here in Phoenix. I needed a doc here quickly for a pre-op and the desk gal said it’s lucky I was not in Advantage or I could not have gotten in so quickly.
One thing we noticed about United plans, the premiums go up quite a bit if you’re over 75.
It depends whether your plan is age driven or community driven. If it is community driven everyone in the plan pays the same of the same sex. Your premium will be higher when you begin at 65 because you are paying more to keep the older members premiums down but when you are older you reap the benefits of the community driven plan. We have AARP UNC and it is community driven.
Medicare AND a good supplemental plan. I am 77 and have paid nothing for my treatment, other than co-pays on some cardiac meds. Avoid Advantage plans!!
Do not under any circumstances take out an Advantage Plan....they are scams and could realistically cost you your life in denied treatments. I was on one before i got my cancer diagnosis but was a patient at Mayo for something else. We received a letter from them stating they would longer accept Advantage Plans and I called to ask why. The rep told me it's because the Advantage Plans would consistently deny coverage for lifesaving treatment and they would always delay payments. Was lucky enough to be able to change back to regular Medicare and a Blue Cross Supplement Plan G and A Plan D. Yes it seems like it costs more but it really doesn't after you factor in all the Advantage Plan deductibles. After my G8 stage 4 diagnosis Mayo has treated me with all the tests including PSMA with zero expense. All the major cancer centers have followed suit Find a guy on Facebook Marvin Music. He gives a lot of good advice videos.
1. You can go to any doctor who accepts Medicare nationwide, with NO network.
2. Once you get the Supplement, you're in, if you join when you sign up for Medicare. No physical required. If you try to join later, a physical generally required, which may mean pre-existing conditions limitation.
As for Plan D (Pharma plan), Medicare has an excellent tool for researching costs by plan. Let me know if you have questions. Using Medicare's Web site actually restored one's faith in our government! It sure beats insurance company websites and medical providers websites.
I have to agree - the Medicare website is marvelous. I do research in depth the Plan-D options every year since the companies like to optimize their profit by changing what tier drugs are in, I actually change plans (sometimes within the same companies offerings) almost every year. Medicare.gov makes it simple to make the comparisons and figure out the most cost effective plan based on your drug prescriptions. It's a wonderful tool (and you should combine it with GoodRX - which sometimes has coupons for a drug that price it less than you Plan-D copay.
Yes I do the same. I also look at different pharmacies in the same year, because some are way cheaper on one drug, way pricier on another. I do use GoodRx, and also Singlecare. Other similar plans are also around, but haven't used except those two. Yes, you have to fight em with every tool in the tool box!
If you can afford it, don't hesitate to go with traditional medicare and a medigap plan, preferably the G plan which covers everything but the annual medicare deductible ($240 in 2024). No bean-counting underwriters determining your care nor any referrals needed to go for care anywhere in the US that accepts medicare (I've haven't found any that don't yet).
You can pick whatever doctors and treatment facility YOU want. My wife and I decided to go with traditional medicare and a medigap plan to make potential treatment easier when traveling domestically. At the age of 69 I was diagnosed with prostate cancer. I studied the disease and latest treatments, made a phone call to MD Anderson, and traveled there (500 miles) for all my formal diagnosis and treatment (proton therapy, 24 mo ADT). Never paid a dime other than travel expenses, the paltry deductable, and part D copay expenses. Never a question about coverage for any diagnostic test (including PSMA-Pet scan) or treatment. I initially selected my "dream team" of doctors at MDACC and never had any issue with medicare coverage.
Part D in 2024 caps at max of $8000 OOP (about $3200 out of my pocket) and next year will cap at $2000 (and I assume even less of my pocket). My Wellcare part D plan is $6.30/month and both my Orgovxy and Erleada are on the formulary.
For the most part, especially with cancer, you may never have the opportunity to change your plan without "underwriting" so pick wisely.
I'm fortunate that here in Oklahoma a bill was recently passed, OAC 365:10-5-129(f), that adds Oklahoma to the list of 8 states that allow a medigap policy holder to change to a similar or less plan every year around my birthday. My plan G has recently gone up to $241 a month and I can switch to another plan G provider for half that much. Personally, I'm on the fence about changing this year due to my distrust of most things related to insurance and know that I have great coverage at present. I likely will pay the extra $120/mo this year just for peace of mind. Peace of mind that I have had throughout this ordeal with traditional medicare and the medigap plan I have. I have a lot of compassion for the brothers on this forum who have the added stress of dealing with for-profit insurance companies for what should be routine diagnostic tests or treatment options.
medicare and supplement. We use aarp. Almost everything paid. You can’t get our supplement but the other one pays almost everything to. Check Aarp and some others. I would not get advantage plan
I have medicare plus AARP United Healthcare supplement, and never need to pay for anything outside of prescription drugs. Virtually every good doctor accepts medicare, and the supplement plan is obligated to cover doctors who accept medicare.
Whether you sign up for a Medicare Advantage Plan or Medicare plus a supplement, you still have to be careful in and out of network coverage. I have had Kaiser Medicare Advantage here in San Diego. I have access to a no cost supplement plan through my wife's retirement. When I was diagnosed in October, I started fretting about the coverage. However, I stuck with Kaiser and now I have a coordinated cancer care team with referrals to UCSD cancer center for radiation. I have had PSMA PET, MRI and CT scans all looking at the tumor. The only cost that seemed high was for Orgovyx ADT at $27 a day. But I had a reaction, so I stopped that and went to Elligard for $174 for 3 months. I like Kaiser, because I have a medical home there and a Primay Care Doc who is my advocate.
Just to pile on: when I was a caregiver for my parents and I went to a new doctor, the first question was always "What insurance do they have?" When I would say traditional Medicare with supplemental, you could see the relief in their face and, more than one, I heard a muttered, "Thank God!"
Needless-to-say, when the time came I went with traditional Medicare and AARP United Healthcare Plan F (was 10 years ago so there are more plans now), plus a Part D plan (I spent everything to only have a house and a car so I could qualify for Medicare and extra help from Medicare so I don't pay for drugs, either). Also, that year I was diagnosed with Stage 4 PC with extensive bony mets, so that was a big factor as well.
Best decision I ever made. When I lived in Florida I went to Cleveland Clinic and Mayo and Moffitt (along with all my local doctors, even when I changed them up).
Now that I'm in NYS I've been going to University of Rochester Medical Center and another local practice or three and when I decided I needed to confirm a treatment choice I got a telemedicine appointment with Memorial Sloan Kettering in NYC. I've switched between doctors here, too.
I've had ADT, Provenge immunotherapy (over $100,000 for each of 3 sessions), chemo and now Pluvicto (over $100,000 for each of 6 shots), not to mention dozens of CTs, MRIs, bone scans, DEXAs, PET scans (yes more than one) and there has NEVER been a pre-approval or question of payment for any treatment, surgery or medication.
Would I like to not pay for the supplemental? Of course, but not at the expense of getting the treatments and doctors I want. I'm sure I'll never live to see universal free healthcare in the US so I'll continue down this path secure in the knowledge that I made the best choice for me.
My husband and I have AARP United Health Care supplement with A and B. We want the flexibility to go to any Medicare provider in the country. Our plan includes free access to rec centers and gyms in the area and a dental discount plan.
The D part you really have to look at every year and not only consider what you are prescribed currently, but what you think may be prescribed in the coming year. We started with AARP Walgreens part D plan, but the premium doubled for 2024 so we went with Wellcare part D that doesn't have a monthly premium at all. We just needed to switch Zytiga prescription from Walgreens to Safeway. Even though Walgreens is in the Wellcare network of approved pharmacies for our area, Safeway is the cheapest for us. If you can figure out the Medicare search website, it really does work very well, and I have found it to be very accurate. medicare.gov/plan-compare/#...
Make sure that you get your old coverage cancelled at the same time your new coverage goes into effect. We had problems when my husband's employer didn't cancel his plan when they should have so the claim with Medicare was denied because he had other insurance. We got it straightened out, but it was a pain. Also, when I tried to cancel my Cigna policy after I went on Medicare they told me I had to do it through the exchange since the policy was purchased on the exchange.
Talk about timely: medpagetoday.com/special-re... - a discussion with one of the people advising congress on Medicare Advantage plans. It reveals the excess payments that Medicare is making to the MA plans, and how they've failed to stop this practice.
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