It’s open enrollment time for those of us 65 and over residing in the United States. I start Medicare in January. Trying to figure out what options, i.e. advantage or supplement can be overwhelming. A good friend of mine, Brad, is licensed in California. Brad is very knowledgeable, honest and trustworthy. He will devote as much time to you as needed. So if you are a California resident and would like his information, please message me and I will provide it to you. I hope this message is acceptable.
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MJCA
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I know many have been happy with Medicare Advantage, but BEWARE! We split our time between a couple of States and the coverage varies as well as what the providers will accept. For example PSMA would not have been covered as a first option in MN under their Medicare Advantage. We have 'old-fashioned' Medicare A & B and had no issue and can go anywhere in the US that Medicare is accepted. Also, I may have incorrect information, but at one point The Mayo did not accept the Advantage plan.
I've went through, pc cancer, triple bypass, and much more. Advanage plans, part C has served my needs very well. Treatments, doctors, hospitals. Much lower cost than supplements, unless you were in a pension plan where your company pays for it. I was not.
Medicare Advantage plan in my zip code (they are zip code sensitive):
My plan Aetna Medicare Essentials PPO = has paid way more than Medicare A-B-D (if you choose B, be sure to choose a D plan also) = A-B-D 'may' be better if you travel, but even if I do, I make sure I get the expensive care at home base. A-B-D is a straight 80/20 plan = you pay 20%. Me? Most of the time I pay Zero copays for most generic medicines and general medical care. I have used this for over a decade and there is no comparison, I have paid a lot less than A-B-D.
Don't believe me or Kevinski65. Go to the Medicare website and compare plans as related to your zip code. I have NOT done this in a decade, but I am thinking that it is much better than a decade ago. The more information you list, the closer your comparisons will be.
Oh, and did I mention, the additional payment I make is 'ZERO!' That's right, all I pay is the standard Medicare deduction taken from my SSA payments.
So if you choose A-B-D, ensure that you review the D plans (many of which require extra monthly payments) and B-supplemental plans (most of which require extra monthly payments).
Yes you are right, Mayo clinic does not take advantage plans. However, If you have Part B of original Medicare are you charged 20% for Scans etc. Have you had to pay 20% for part B treatments etc?
Signed up with Anthem for Medigap, as soon as I hit enter in my online application, it said approved, and emails an approval, paperwork arrived in 13 days. Medicare account already reflects it. AARP/UHC for PDP, and similar results.
It's so great to make appointments to specialists with no issues.
I made an appointment at UCLA with a renowned Uro Oncologist, Cardiologist, and Endocrinologist!!! Was first asked if I had a Referal, I responded, I have Medicare, and Im self Referal. The response was: Ok great, when would you like to see the doctor!!!
The hard pard will be asking the Doctors to separate Part D prescriptions from Part B as local pharmacies dont do well with billing part B (Diabetic supplies. Needles, blood testing items
)
I have AARP as a PDP in January, and they told me OptumRX is their proffered mail order for scripts.
Any one in Socal using a DME mail order house?? (Durable Medical Equipment)
Interesting, it will take one week prior to receiving insurance approval. I use DME as well, currently I use Byram Healthcare my prior insurance used Shield Healthcare. I have had no issues with Byram; there were some with Shield. I hope this can be of some help!
I have a question about Part D. Does it covered the prescriptions that ones are taking daily OR does it include the prescriptions that ones are taking while hospitalized? I think the prescriptions that are taken during the hospitalization are covered under Part B but we haven’t talked to the brokers yet so i thought I would ask it here.
Hello. I saw this post about Medicare so I am asking a question My question: I am getting ready to sign up for Medicare. I am planning on signing up for old fashion plan A and B. I was talking to a man yesterday who carries supplemental insurance for co pays and meds on plan D. He was talking about High-Mark which is a PPO,. He said that it is kind of an advantage plan but I can go anywhere I want to go. Is anyone familiar with this? Is it a good plan and company with prostate cancer w/ bone Mets. I am taking xtandi also. I get exgeva and Lupron in a medical facility. I have a lot of questions trying to understand what is the best way to go.
Medicare Advantage is private insurance with a portion paid for through the government. As a portion I mean that the government pays the insurance company a set amount per year for each person enrolled, say it was $20,000. The insurance company earns a maximum profit by keeping as large a percentage of that as possible. This why pre approval and denial of care is seen with Advantage plans. To the consumer it seems like a good idea when you sign up because there is no premium as with a medigap policy(which as PCa sufferers we all need with regular medicare). However, Advantage plans come with a price. You will be confined to a regional network of care givers. this may not be an immediate problem if you live in a large city with good hospitals and lots of doctors, but in rural areas this can be a major drawback. Also, some of the premiere hospitals have recently announced that they will not take patients covered by Advantage Plans, Mayo and Cleveland Clinic are among those.
Another problem with the Advantage plans are that they have made it almost impossible to switch from an Advantage plan to Regular Medicare should you later change your mind. If you are able to the premium you pay may be subject to re-evaluation based on your health status. You can be charged a much higher premium if you have an illness. When signing up with regular Medicare at 65, the premium will be the same no matter what illnesses you have.
I have Regular Medicare with a Plan G medi gap policy. My Income has been really low since I've been sick and all I pay is the $105.00 monthly medigap premium, the state handles the rest. No matter what length of time I may spend in a hospital in a given year, my out of pocket won't exceed $3000.00. Last year i was in the local hospital for two weeks with kidney issues and another stay in a hospital in Virginia for 10 days(I was visiting my brother when a major blood clot occurred). For the local hospital I paid nothing and for Virginia I paid $800.00. My co pay for Orgovyx is $11.00/month.
If the cost of Regular Medicare and part D are issues for you, I would suggest looking into "extra help", most states will pay both the monthly Medicare premium and Part D if you have a low income.
And last, the survival of regular Medicare is on the ballot this year. Medicare Advantage was a Bush era creation envisioned as a gradual way to eliminate government administered universal medical care for seniors. The Republican party has announced a plan to make medicare Advantage the default option.
There is a lot of information on this thread and a lot we have to digest. But just wanted to clarify for you that Part B is the Medicare designation for the part of Medicare that covers doctors, etc. As others have noted, you have to pay the $185/month premium for Part B to Medicare and it is deducted from your SS check. Associated with Part B are the Supplemental Plans sold by private companies and those are Plans A-N. Plan G is the most complete of those Supplemental Plans. You have to pay the premium for the Supplement to the private company. It can be tough to keep it all straight, particularly the first time through!
In defense of Medicare Advantage plans, we have been on one for 6 years and they have been wonderful - they have never refused any kind of procedure or test or drug and everything for my husband who was diagnosed with advanced PCa in the spring was approved immediately and covered. That said, we are changing to traditional Medicare/supplement/Part D drug plan. Our Advantage plan (Harvard Pilgrim Health Care) is leaving the state for 2025 so it is no longer available so we have a window to enroll back into traditional and supplement without underwriting or risk of refusal for pre-existing conditions. Since we don’t know future treatments for him, we are taking this opportunity.
Thank you, that does help. My wife and I applied for traditional Medicare A &B. We will go from there. Like you said the first time thru is confusing. But I think we are getting there. Thanks Keith.
I ended up getting a (AARP/United Healthcare) supplemental plan as well as a cheap drug plan (WellCare). Avoid Advantage plans if you are actually sick, like we all are.
did the WellCare prescription plan work out for you? For my husband, WellCare has No preferred networks that offer abiraterone at a reduced rate, so would need to get it by mail order. We were hesitant to switch to WellCare last year because of this ( we have a local specialty pharmacy that is in network for his current prescription plan) But the WellCare plan is still listed as our cheapest option given his current meds.
The two meds I take (Orgovyx and Abiraterone) are available mail order, but I've been lucky enough to get my meds through grants (abiraterone) or manufacturer's patient assistance plans (Orgovyx). I recently was told Orgovyx would stop giving me free meds. But I believe they have my income level wrong. We'll see.
The point is, these meds are so expensive (Orgovyx was $83/day) that whatever drug plan I had, it would cost a fortune. No plan would make them reasonable. But... next year there's that $2000 cap on cost for meds (thanks Joe!) , so if worse comes to worse, it wouldn't be catastrophic to pay that.
Thank you. The abiraterone is not too bad with the Part D insurance. ( 130 a month going down to about $70 a month) but the prescription plan itself is going up to $90 a month. Maybe that $2000 max will help.
The Medicare world is fraught. At this point in our lives we shouldn’t be faced with a decision that requires high levels of information and expertise that few of us have and could have such an intense effect on our future health. But we are, so here are some things to keep in mind.
1. Medicare advantage (MA) is mostly a one way street. Once you start down the path, it mostly impossible to go back to traditional Medicare (TM)
2. Private insurers and brokers profit from selling you MA.
3. Private MA carriers make money by limiting and denying care.
4. A vast majority of MA denials are eventually overturned by Medicare but only a small number are appealed. Appeal is difficult and time consuming.
5. If you are on this board you now or some day will need treatment from providers that MA often won’t cover.
6. The extra coverage that many MAs provide are often severely limited or of low value.
7. MA will save you money up front, but consider the long term cost.
MJCA said: "Trying to figure out what options, i.e. advantage or supplement can be overwhelming. A good friend of mine, Brad, is licensed in California. Brad is very knowledgeable, honest and trustworthy. He will devote as much time to you as needed."
What is he licensed in? Medicare Advantage plans are sold by licensed salespeople on commission. Medicare Advantage is privatized Medicare, private insurance from companies who take your Medicare allocation, pay the sales commissions and expensive TV ads, and make a profit from giving you less than you paid for. In exchange for attractive frill benefits of little cost to the company, you are limited or denied truly expensive treatments and medications for serious diseases like prostate cancer.
I once waited several hours in the lounge of a car shop with a person who was a MA salesman. He was in continuous back and forth cell phone calls with an undecided and doubting person he was pressuring to buy his MA plan. One selling point was "Medicare is going away".
Medicare Advantage is a step on the path to replacing Medicare with Direct Contracting Entities: juancole.com/2021/12/grabbi...
And your question? I was JUST trying to be helpful and all I am receiving are comments and pushback that really have nothing to do with MY post. He is licensed in the State of California to sell advantage plans, supplemental/medigap/part G as well as part D, prescription drug plans. Brad does not represent every insurance company. He IS honest enough to tell a prospective client that he/she can obtain less expensive insurance from a company he does not represent.
We don't mind your referral, but you opened up the discussion to Medicare plan selection. Timely too since this is the enrollment period that closes soon. We are providing feedback on what we've found to be the best options. Sorry if that takes business away from your friend. Most of us aren't in California anyway. Using a broker does make sense except that the one I used put me in an advantage plan that sucked.
we went with UnitedHealthcare for our supplement to Medicare A and B. Other than our yearly deductible all husband's treatments have been covered: surgery, radiation, chemo three times, pluvicto. We re-visit our drug plan every year, especially for drugs like zytega and Xtandi.
Medicare, for us, has been better paying than the health insurance we had while employed.
Any of us that are turning 65 (in the USA) and are diagnosed already have a huge "advantage" with this decision (supplement vs Advantage). You are NOT medically underwritten when applying at this stage. At least in our plan (in Wisconsin), all premium increases each year are "community rated", not individually rated. I'm now 71 years old and i'm so glad that I picked a supplement at age 65. Yes, I have to pay for a separate Part D Rx coverage, but soon, in 2025, each person has a $2,000 out of pocket maximum for prescription drugs under Part D. Each year, this maximum will be indexed to inflation. Hopefully no more life saving decisions due to being unable to afford these very costly anti-cancer meds. The long and short of this, I am so thrilled my spouse and I chose a supplement over Advantage at age 65.
There are a lot of questions about Medicare and also a lot misinformation.
So here are my thoughts.
Part A has no cost to you (you have been paying your entire working life) It is hospitalization and things that happen in a hospital or care facility.
Part B is your Dr's visits and precedures, tests etc. It will cost $185.00 for 2025. Per person if married. (you and your spouse have separate accounts. It pays around 80%. The $185.00 is deducted from your Social security. Part be has a deductible, of $240 (2024) not sure about 2025 yet, I sure it is available if I look.
Part D is a drug plan. Lots of them out there, some pay more than others, some less. Generally there is a monthly fee. But some do not have one. Look long and wisely.
So to get help with the 20% You have to get either an advantage plan or a supplement.
Advantage plans are most times less expensive. But buyer beware as they are Insurance plans with their own rules, preapprovals, rules and regulations, and deductibles. Lots of plans to choose from. I think they all suck. Some times an Advantage plan will have a Plan D baked into it. Be careful.
Supplements are more expensive but they cover everything. No bills other than the Part B deductible. A number of Plan types, but if you take say a plan G, all companies that sell a plan G, have the same coverage as defined by Medicare. Loo up "Medicare Supplemental Plans" and look over the chart.
I will assume if you are on this site you have Prostate Cancer of some variation. You will have Dr Bills, procedures, radiation, etc. You need a supplement Plan.
I was diagnosed in 2023, I was already on Plan G supplement from AARP United healthcare. Multiple PET scans, MRIs, Biopsy, 2 types of radiation and all the stuff that goes along with it. No bills
I use Well Care Value Script for Plan D, No Monthy fee. Picks up all of the small stuff. Abiraterone co-pay is covered by a Non-profit that the Cancer center helped me get enrolled with.
There’s a plan F under ordinary Medicare it gives you 50,000 overseas. It also pays all deductibles including the part b 250 deductible. You have to then get an rx plan which cost a little a month. Most of the ordinary supplements are guaranteed renewable Whereas advantage can drop you if your costing them too much. They’re conditionally renewable.
Yes the Plan F is available. I guess the key is to look at what you are doing or planning to do and make a decision from there.
For us (PC warriors), an advantage plan may have some alure on lower cost, but I think in the end it will cost those who chose it, more money and certainly more headaches, and possibly helpful procedures and tests.
I went into Medicare in 2021 planning on a Plan G. Then my diagnosis was not until late 2023. I was glad I had the plan G.
If you want the ability to go to any center of excellence in the nation, choose a supplement, not advantage. Advantage is (usually) ppo based, meaning local docs and the need for pre-approval for all procedures. Supplements are accepted wherever Medicare is, 99% of the nation. Don’t be swayed by cost, your life may depend on this.
My wife and I both chose to go with traditional Medicare and a supplement. We chose the "G" plan, Mutual of Omaha for the supplement, and Wellcare for part D coverage. Our reasoning at the time was the peace of mind knowing we could obtain medical care anywhere if a something came up while traveling. We figured we could always convert to an "advantage" plan any time in the future if the rates rose beyond what we would want to pay.
About 4 years after starting Medicare, I was diagnosed with prostate cancer. Since I had traditional medicare, I had the option to obtain my treatment from anywhere in the US that I selected without some underwriter for a profit-based health care management company making or influencing my decision. After much research, I simply called MDACC and made an appointment. I did not tell them about my local diagnosis and started from scratch with testing and diagnosis from a center of excellence. I selected the doctors I wanted. Other than travel expenses, I never paid penny. There was never a question of coverage or any dealing with insurance at all. The only way I knew what the charges were was by looking the explanation of benefits from Mutual of Omaha and the claims paid by Medicare. I asked about a PSMA test and had one as part of my initial diagnosis. Many advantage plans make this very difficult. I opted for proton radiation - many advantage plans make this very difficult. With an advantage plan your choice of doctors, health care facilities, and likely treatment options will be limited.
After my diagnosis I was resolved to never change from Mutual of Omaha and accept the rate increases every year since I knew the underwriters would never accept me (even from Mutual of Omaha).
Prior to the Affordable Health Care Act, my wife and I went for a few years after my corporate job ended paying about $400/month for health insurance with a $12000+ annual deductible. My wife was only able to get insurance through the state "high risk" pool due to diabetes and I could only purchase a policy that excluded any coverage related to the statin drug I took to control my cholesterol (whatever than means, probably any heart issues). We paid cash for all doctor visits, testing, and lab work. The Affordable Health Care Act was a godsend for us (and millions of others). Currently paying a bit over $400/month for superb insurance is well worth it for us. Better yet... Recently, here in Oklahoma, the legislature adopted a "birthday rule" that give us the opportunity to change our traditional medicare supplement within 60 days of our birthday. My Mutual of Omaha plan has risen to about $240/month but now I have the opportunity to select a different company that offers the exact coverage (they have to by law) and I can drop back to about $115/month for the supplement. My Wellcare drug plan has gone from about $10/mo to $6.30/mo last year to 0.00/mo for 2025. In 2025, we will be back to paying a bit over $230/mo and have complete peace of mind regarding health care. I have had to fight with insurance companies in the past and generally lost the battle. As long as traditional Medicare is an option, I will never have to worry about that.
If you would like an unbiased opinion feel free to contact the broker that I originally used to sign up. David Windsor at 972 548 7767 medicaresupplements4less.co.... He brokers both medigap plans and advantage plans and also has been treated for prostate cancer. He has the medigap G plan and the same supplement I will be changing to in a couple of months.
You have a really big decision to make and if you can afford and decide on traditional medicare, you will always have the opportunity to move to a lessor medigap plan or a (profit-based underwritten) advantage plan at any time. If you choose the advantage plan you are likely stuck with it or a similar one for ever. Good luck with your decision.
I have no idea how the term "advantage" was ever part of the rebranding of the Medicare Modernization Act, but I'm sure it would be a great story with some high-price ad agency backstory. I get mail, email, texts, and phone calls every week trying to sell these policies.
I think what really defines the medicare advantage plans is - there is an entire company that has taken over selecting the care that the plans are going to deny - and that company is used by the majority of plans. The denials often aren't done by an MD (as is required) and are sometimes done just because the chances of someone filing an appeal is low.
It's a profit driven industry, and if they can make more profit by denying care, or restricting access to only their selected doctors/facilities - that's what's going to happen. There are a number of MD's in my area who won't take advantage patients, they find they waste too much time writing appeals that are then simply rubber stamped as approved. The plan just wants to make it a bit more difficult to use the agreed on services all in the interest of improving their bottom line.
I started with 'advantage' as a first time Medicare enrollee. After I was diagnosed with prostate cancer the drug provider dragged their feet for weeks and weeks and weeks to give my Urologist approval to give me an eligard injection. I had to spend hours on the phone to exert pressure to break things loose. Yeah, it's all coming back to me now (that was 8 years ago). Why was approval held up for a very standard prostate cancer treatment? Made no sense and I had to deal with this right after being diagnosed with prostate cancer. Is this typical of 'advantage' plans? You tell me. As soon as the enrollment period opened up I switched to Medicare supplemental plan F. No more fooling around with any budget plans.
My agent here in Florida insisted on a supplement. Said his conscience would bother him recommending an Advantage plan even though he would make a good commission. That's what I did and have had no regrets.
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