Metastatic Cancer and Medicare

[ndastrogal]

Asking those who are in the US and on Medicare - how has your experience with MBC cost coverage? I'm about 3 months away from Medicare and am very confused about coverage for cancer treatments. Medigap vs Advantage? I've read the out of pocket can be enormous. My clinic hasn't been very helpful. This site is the only source that I trust and isn't trying to sell me an insurance plan. Thanks in advance.

[Hidden]

Hi ndastrogal -

A few years ago, when I needed to make a decision re: going on Medicare with a supplemental plan (medigap/advantage) I went to AARP's website and phoned the representative from their insurance partner (United Healthcare). I used to be in the business, actually marketed/managed some Med Supp products, so I know that AARP is a great place to do research and buy....the really look out for their members. So maybe try there?

I know I've seen some great posts here with terrific and detailed info...Maybe try using the search bar, upper right of your screen, to find some of that? I also hope that some folks with real and current knowledge respond...

Good luck with it...Please let us know what you learn...

Lynn

[ndastrogal in reply to Hidden]

Thank you. I will try AARP. Appreciate the response.

[worldtravel75 in reply to ndastrogal]

I also used AARP - super helpful - medicare advantage plans may look good but they have hidden requirements - I was told by an insurance broker to stay away from them.

[ndastrogal in reply to worldtravel75]

Thank you!

[BluHydrangea in reply to Hidden]

I have been on Medicare for two years and have thought my coverage is good. I really like not having copays for dr visits. I have a supplemental though State Farm ( they call it generic supplemental). I have also added the prescription coverage which covers a % of medication costs, including the expensive cancer drugs. I’m on Piqray and have a very large copay. I am not eligible for financial assistance through the pharmaceutical companies— but you may be.

My understanding from lots of research is that the Advantage plans are not good for those of us with chronic illness. Be wary of them.

[hdhonda]

Ndastrogal,

I am on Medicare and kept my insurance from my employer (state of Florida) as my supplement to Medicare. It is expensive because I have to pay the whole thing but well worth it. We have excellent coverage and don't have to review various policies each year to see which is best for our current situation. The supplement covers drugs too. This may not be an option with all former employees, but if it is an option, I would check it out. Blessings, Hannah

[ndastrogal in reply to hdhonda]

Thanks so much.

[Red71 in reply to hdhonda]

This is what my husband and I did...he had Federal Blue Cross/Blue Shield. It is also expensive but I don’t pay any copays. The only thing I pay for is my part of drug costs. They have been very low but have creeped up this year a bit.

Elaine

[hdhonda in reply to Red71]

Mine is BC/BS state employees. The drug prices do keep creeping up. Blessings Hannah

[jersey-jazz]

Dear ndastrogal

I might be the oldest living thing on this website. I was a lucky woman, hardly ever getting sick until my seventy-eight birthday, five years ago. Since then, Medicare and Horizon Blue Cross, Blue Shield of NJ have supported me totally, paying all my bills incurred for treatment for cancers +++++. The big caveat is this: Whatever Medicare does not pay, the gap insurance does not pay.

Luckily, I was made aware of this reality with a simple eye exam issue, not for any PET scan, surgery or the like.

Also, I had an unfortunate personal experience with the Advantage for one year and got away from it as fast as was possible. Others may have had a different and, perhaps, better experience.

Good luck in your search. Personally, I think that much of the rest of the world has it better and right with universal health care.

XXX OOO

[ndastrogal in reply to jersey-jazz]

Thank you. You mentioned gap "does not pay". And a bad experience with Advantage. But you are currently on BC gap?

[jersey-jazz]

I am sorry if I was unclear. I am on Medigap and it has served me perfectly well. I was cautioning you about the few times that the Medigap does not pay. For example, I think that a gap insurance does not pay for more than three PET scans if the situation stays exactly the same and the treatment stays the same. I saw that on the web but will be calling Medicare to clarify. If it is different than my understanding, I will let you know.

XXX OOO

[ndastrogal in reply to jersey-jazz]

Perfect. Thank you.

[diamags]

They make it so darned confusing. I have Part A (Hospital), Part B (Medical), Part F (Supplemental) and a drug plan. With what I have, I can go to any doctor anywhere in the US that accepts medicare (I haven't found one who doesn't) -- which is good as the medical care here in Vegas leaves a lot to be desired. It is more expensive, but well worth the cost. I don't pay any deductables or co-pays and everything is covered.

[ndastrogal in reply to diamags]

It is confusing. Thanks for responding.

[Selmac in reply to diamags]

Hi, I have exactly what you have. My supplemental is blue cross, blue shield for 200.00 per month. I go directly to Medicare for prescription coverage to get the best price. I'm paying 18.00 per month. Every Oncologist I've been to has found someone to pay my share on whatever cancer med I'm on. I went to see a ssd o c a lled insurance specialist who signed me up for supplemental and prescription. They lied about the price and a few other things. I called government Medicare and they helped me find what I needed at a good price and let me change even though it was not enrollment time.

[TNVol]

Be aware that Part D drug coverage processes Ibrance, Verzenio, etc. , and your copays can be horrendous. There are numerous charities and foundations that offer financial aid to patients with various medical issues. Your oncologist should be able to put you in touch with some. I have been very fortunate in getting assistance with my Ibrance and exemestane. I have Medicare, a Part F supplement and Part D drug plan and have been very pleased with coverage.

[ndastrogal]

Thanks. All the info is very helpful.

[George5545]

Hi. My mom is on Medicare Parts A/B and a separate supplemental/drug plan. The costs for her Ibrance would have been astronomical as her Medicare coverage wouldn’t cover the cost. Her oncologist got her signed up for a grant which works with CVS specialty to cover the payment when we refill. CVS specialty is required by her drug plan so I’m not sure how it would all work outside of that. Between the supplemental and the grant there haven’t been any out of pocket costs. Should be interesting to see what the premium is for the supplemental is when it’s time to re-up next year. 🤔

The grant was surprising easy to get. A quick set of questions with the oncologists office and a confirmation letter later that same day! If you do decide to try for a grant, I highly recommend you go through your oncologists office, instead of applying yourself directly.

I believe Medicare Advantage would have covered the cost of the Ibrance but the monthly cost was outside of moms budget. But you might want to look there as well.

Good luck!! ❤️

[ndastrogal]

Thank you so much!

[Dragonfly2]

Hello nds...yiu have gotten some great information and examples on this post. I cannot overstate the importance of meeting with an insurance agent who will run the numbers for you based on your health and wealth...truly this will be a balance between your income level and your medical needs. Your most important decision will be the drug coverage and that dreaded donut hole that will force you to pay thousands before you get relief. Because cancer chemotherapy oral drugs are so expensive, that will be the nut you must crack.

Yes, there are programs out there that will help patients cover the $2+K copay for IBrance but they won’t give you a penny if you have any personal wealth whatsoever...you’ll need to find an insurance that has expensive upfront premiums but will cover your copays reasonably and prepay the donut hole ahead of time. I was diagnosed just as I had to make a decision about taking it the $300 drug portion of my Medicare supplement...and I dodged a bullet...I think..who knows, what the future holds?

America is where big Pharma rules the land...