Medicare plans

[kesslm]

I will be turning 65 this month and have been looking into different Medicare plans...original Medicare and adding a Medicare supplemental plan plus part D; also adding GoodRX of something like it; or a Medicare advantage plan. Any input from those of you on Medicare plans would be helpful. I take Brukinsa now and will probably be needing other expensive medications at some point. Thank you.

[cllady01 Former Volunteer]

There are many discussions in the following RELATED POSTS link

have discussions about who chose what and why and experiences.

healthunlocked.com/cllsuppo...

Good luck to you as you choose and make a commitment for the year.

Here is the one posted most recently with link to getting the information by Linkisgterguy

healthunlocked.com/cllsuppo...

[kesslm in reply to cllady01]

Thank you for sending on the links.

[Pacificview]

Hi,I chose origional medicare, plan G supplemental and plan D. For my wife and I, we are very happy with it. Anything medicare covers, plan G will pick up the rest. The plan D was the weak link. But starting 2023, all vaccines will be covered. Then in 2024, a $2000 out of pocket annual copay for plan D comes into effect.

That just leaves dental, hearing and eyeglasses on ones dime. Although, you can certainly pick up a plan to cover that. But typically I just pony up for those. If you need ear or eye surgery its covered under medicare A & B.

We go to anyone and anywhere. Because most all Docs, clinics and hospitals take it. I typically have chosen my own Docs and call them directly without referrals.

Works for us....all the best.

[kesslm in reply to Pacificview]

Thank you. This information is very helpful.

[gardener58]

Consumer Reports has an article that goes over the pros and cons of each type of coverage. I access it thru a link on my town library's web site. I can copy the information and send it to you if you want.

My wife and I have zero premium medicare advantage plans and are quite happy, although we are not heavy consumers of healthcare.

We live in the northeast and have had no problem finding providers who accept our insurance.

[kesslm in reply to gardener58]

Thank you for sharing your experience. It's helpful to hear others' experiences.

[lankisterguy Volunteer]

Hi kesslm

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If you have been part of a HMO or had to fight with a medical insurance company that denied coverage for a medical visit or procedure for a few months afterwards, you know what it will be like under a Part C Medicare ADVANTAGE plan. The insurance company is a Monday morning quarterback that will deny many things hoping to wear you down so you just pay the bill vs. continuing to fight for what you are owed.

For most medical procedures like CT Scans, blood tests and even some doctor visits there will be a "copay" that might be 20% of the full "retail" list price of the procedure.

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A friend has an Advantage plan, and also CLL, here in New Jersey. Her insurance won't cover any doctor or hospital in New York City, and there are few CLL expert doctors out here in suburbia. Any visit to an ER or Urgent care is disputed as are most medical procedures if she doesn't get authorization in advance, and even when she does there is still a copay.

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Having Medicare Part A, B, & D plus a supplement is about $300 more per month than some Advantage plans, but if the doctor or hospital "accepts" Medicare none of those battles occur. I can choose any doctor and facility in the USA that participates in Medicare and if there is a disagreement over payments, I am not involved or responsible for any "bounce bills."

For everything except drugs taken at home, my supplement covers the copay which is 20% of the Medicare rate - which is normally only 10% of the list retail price. So that copay is about 2% of the list price.

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I have taken 4 different modern targeted drugs. Rituxan & Obinutuzumab/Gazyva are covered under Part B, so my supplement pays those copays. For Idelalisib I was in a clinical trial and Medicare & my supplement paid everything. For Ibrutinib, Venetoclax and Acalabrutinib/Calquence, the specialty pharmacy arranged for a non-profit to cover my copay, so I have had no out of pocket costs in the last 10 years since I got Medicare coverage.

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Len

[kesslm in reply to lankisterguy]

Very helpful information! I am most concerned about the oral chemo drugs taken at home. I have heard there are other ways to get them paid for.

[lankisterguy Volunteer]

Hi kessim,

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If you are seeing a CLL expert, ask about the support staff's involvement in arranging copay assistance. They may say that the specialty pharmacy will handle it.

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For my current Calquence prescription NY Presbyterian has their own pharmacy and they obtained a grant from LLS.org for my first year, and from Healthwell Foundation for the 2nd year.

When I started Venetoclax, the doctor's staff arranged for Genentech to provide the drugs at no charge for 6 years.

For Ibrutnib, the specialty pharmacy - ONCO360 arranged a copay from Patient Assistance Network.

Most of these copay assistance programs will still cover CLL patients with annual incomes over $90k and some to $150k.

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If you are concerned about copay for Part D drugs, you can talk to a counselor at lls.org/support-resources/f...

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Len

[1935husband]

both my wife and I have expensive Cancer treatments that are covered with a PPO Advantage program. We have no monthly fees other than the Medicare monthly charges. We choose our own Dr. that is on their accepted list without a referral so the copays are lower. Have not had any issues getting the best Doctors with expertise in CLL and Oncology

In one case drug copays are about $10,000/year. In the other treatment is capped at $4000/year because it is a hospital treatment. I would stay away from an HMO because of denial of treatment issues. The retail costs of theses treatments and drugs are over $400k/year

Everyone has different issues but in 2024 the drug limit will drop to $2000/year.

[BeckyLUSA]

I was diagnosed 6 months before I applied for Medicare. We found an insurance agent who took us under her wing and helped us with all the decision making. She advised a full blown supplement for me and an advantage plan for my husband who is very healthy. I do have rather hefty monthly payments ($200 monthly) for it, but for all the medical bills I ring up, it works out the best for me. The co-pays and unpaid potions that I would be required to pay far outweigh my monthly payment. In the 6 yrs I have been on Medicare, I have paid less than $100 in “uncovered” procedures/expenses. That includes 2 major surgeries, numerous CT’s Ultrasounds and MRIs, IVIG every 6 weeks and visits to my CLL specialist every 3 months. Plus numerous injections for hip and lower back pain management and normal visits to other specialists, dermatologists, gastroenterologists, ophthalmologist, etc. It is easier for me to pay the $200 monthly for the peace of mind of knowing everything will be paid for. My husband’s advantage plan has no premium. But he does have the option to shift to a supplement without any pre-existing conditions exclusions as long as he stays with the same company.

I would advise finding a Medicare specialist to help you through the maze. And start early.

[lexie in reply to BeckyLUSA]

I agree about seeing a Medicare specialist but not one of those parading as a Medicare specialists at shopping centers, libraries or senior centers. They represent their specific company pushing Advantage plans. I know, I went to a few and was so mad I walked out.

[DelrayDave]

I have original medicare, a plan F supplement, and an rx plan D, both from AARP United Health Care. My wife has a Humana medicare advantage plan. With the new laws about limiting out of pocket drug costs starting in 2024, you are far better off to go with original plus a supplement plus a plan D. You avoid doctors refusing to see you or charging large fees because they are no longer in network. You would not believe the problems my wife and I have had with hers. Mute all the TV ads. By all means avoid HMO's, the worst kind of plans. But with CLL I strongly advise original plus supplement plus plan D.

[lexie]

I made sure to get traditional Medicare with a supplement for myself after the nightmare my husband went through with a Medicare Advantage plan. We had to fight to get rid of it and switch to traditional so he could be seen by a hospital that performed many successful organ transplants, not one that thought they would test the waters with an inexperienced team thrown together. As his caregiver, it was up to me to sort the mess out and it was so stressful that I developed shingles at that time. I have a very, very negative attitude toward Medicare Advantage.

Be aware that if you are seen by the Mayo in Florida or Arizona they do not consider Advantage plans to be in network... "The letter sent to Florida beneficiaries said that 'marketing for Medicare Advantage Plans may indicate that you can be seen at any facility that accepts Medicare, however Mayo Clinic in Florida is out of network on these plans'. " Oct 20, 2022. Link below.

I suggest making sure that where you are being seen or may be seen in the future accepts Medicare Advantage if you are considering that route.

medpagetoday.com/special-re...

[bayside64]

I started with a Medicare Advantage Plan and was very fortunate that I was able to change to straight Medicare with Plan F as a supplement. I pay slightly more than $300.00 a month and everything is taken care of. It’s really one less thing for us to worry about.

[Corkyrissa]

it’s best to stay away from advantage plans. I have had Medicare A& B along with Blue cross plan 65 c select , plus a part d for my meds. The Blue cross can no longer be purchased thank goodness I’m grandfathered in. I pay $240.85 per month and this covers me for dental. Advantage plans are good if you are pretty healthy. My girlfriend has advantage plans and she can’t go to the drs because of the co-pays. Go see a social worker at your local senior center. Good luck everyone.

[bertie260]

I do agree that Advantage Plans (USA) are not the place to be when treatment times and hospitalizations are possibly on the horizon. A night in the hospital will cost approx $1750 - almost a year's worth of supplemental premiums. Plan F and G supplemental are very good plans - Plan N will save you some money with likely little downside risks compared to F and G. - check it out. BUT you should first always know whether your state is a "Guaranteed Issue State" . If your state is not a "Guaranteed Issue State" please navigate carefully when it comes to maintaining coverage. Finally, many people change to a supplemental plan only to find out that your annual physical is not covered but its a small price to pay compared to the typical risks of an Advantage Plan.