Well, at least my insurance is coming through-- but MediCare query too

Howdy. As you may recall, I recently went to Mayo Clinic for an MRI, numerous blood tests, and the C-11 Choline Scan.

I have an excellent insurance plan from work and they have come through pretty well so far, albeit with too many hoops/delays for my comfort.

Anyway, one neat little feature they have is that if I have to go to a (designated) Center of Excellence for a test/procedure that cannot be done locally, they will cover my expenses (travel/lodging) for me and my wife.
Well, the C-11 Choline scan can ONLY be done at Mayo. I did have to provide them with a letter from Dr. Lam's office explaining that he did refer me. The letter plus the receipts did it, although I did have to ask about 3 times. They kept saying the check was mailed in early November. As it turned out, the check was mailed in mid-December (the day after my third inquiry), but I did receive it. Very nice feature.

Then we have my Mayo Clinic bills. There were two bills. The C11 scan was about $7200 and the lab/MRI was about $6900. I am not sure if the doctor consultation was included. Anyway, once again, Mayo heard nothing from my insurance company and in fact they had to send the bills out for a second time.

But I just got the EOB for the C11 Scan and I am very pleased that this was covered (it required one of those pre-authorizations and I never got a written acceptance, but they did indicate verbally it was approved). For this bill, there was a small negotiated discount and my insurance then paid 90% of the balance. So, my part will be under $700. I expect that the other bill will end up being about the same, but who knows. Hopefully, no problem.

At some point I am going to retire. My current contract goes through mid-August and then we shall see.
When I retire, I know I go on Medicare and some kind of MediCare Advantage Plan through the State of Michigan as I am in their retirement system. From what I have read here, that seems to work well. Is that true? I figure down the road I will be past the radiation/Lupron/Casodex stage. Perhaps zytiga or abiritone (ignore the typos). Maybe Provenge. Does MediCare + Advantage cover that?

(When I retire, I have the option of doing COBRA for awhile and keeping my current great plan, but I think at a huge cost -- I doubt if I would do that)

Mel

Post Edited (compiler) : 1/12/2015 10:23:39 PM (GMT-7)

MEL, great that your insurance company is coming through.

I am in the NYC school system, through my wife, who is a retired teacher. My coverage is very good, and my understanding is, that when I go on Medicare, my current insurance becomes the supplemental coverage. I'm sure it's not the same, but probably similar.

Jerry - at your young age, the options seem to be what you outline, or trying to get covered under disability due to Pca.

Mel, by far for G9 like me, the best Medicare supplement is a Plan F or a Plan N that pays all copays and deductibles of the very expensive treatments in our present and future, in exchange for a higher monthly premium that is predictable and constant.

You still have to separately purchase a Plan D for prescription drugs. Lupron is doctor/nurse administered and covered under medicare/Plan F but Zytiga is a pill and covered or not covered as case may be by Plan D.

Since we are on fixed income, there is a foundation that pays for my Zytiga since our combined income monthly checks from Social Security and pensions is less than their $60,000 threashold. The foundation does not factor in our total assets just our cash flow.

I was lucky (as opposed to planned well) to qualify as I had made a fairly sizeable withdrawal before 12-31-2012, for additional living expenses, but had no unusual withdrawals in 2013, and made additional withdrawals in 2014 and 2015 as we cannot live on $60,000 without severly adjusting our lifestyle. So on my 2013 tax return all that showed as income was my social security and pension monthly income, not any withdrawals.

If not for the foundation Zytiga is about $8,000 per month which would quickly put you into the so called donut hole where for a period of time you are covered and then you pay 100% until a second treashold is reached pretty quickly and quite expensively at 8K per month.

The donut hole exposure lessens each year until about year 2020 when it entirely goes away as part of recent health legislation the past few years.

Medicare has a helpful site

www.medicare.gov/part-d/

where you select Drug Coverage (part D) from the top navigation panel and input your zip code, your two favorite pharmacies and your drugs. The site tells you which Plan D plan is best in your situation.

LupronJim

It depends on whether you are talking about Medicare Advantage which includes part A, Part B and Part D but has a copay and deductible for a relatively low premium or zero cost, depending on your zip code, or whether you are talking Medicare Supplement like Plan F or Plan N that does not include part D and so has to be purchased separately.

From a premium standpoint Medicare Advantage is wonderful but you have to factor in the expected on-going costs of claims especially if you are Gleason 8, 9 or 10 like me. Break even poinnt is much lower for a Gleason 6 like Margie's husband, as you can always upgrade next annual enrollment and as usual G7 is somewhere in the middle.

Hormone therapy, Provenge, surgery/radiaiton, Zytiga etc can get very expensive to the poit where you do not want to be paying a percentage of the claims.

You will have plenty of assistance as you will be bombarded by insurance agents when word gets out you are retiring or or turning age 65.

I also checked with the admin staff at my medicla providers' offices to see which insurance carriers they had the best experience with on claims handling.

LupronJim

Mel. I donlt know the answer to your question, probably varies by insurance carrier and plan.

Yeh, I figured you would have half a year's income this year and to avoid withdrwawals next year would have added to your tax burden this year. I retired in 2010.

The mandatory withdrawals at age 70.5 complicate it even further but a good problem to have as you can't take it with you.

Of course, you have a daughter's wedding to pay for too.

LupronJim

Michael:

I know it is NOT an HMO. I think it is a PPO, with plenty of Mi. medicos in network.

I really need to check with the State regarding my options. This is all part of the State Teacher's Retirement System.

It is so confusing, but I waited until 2015 before even asking the questions, since plans seem to change each year.

Mel

Thanks, Michael. That is an interesting point, and the low post-employment income will definitely be my situation for a while. My pension doesn't threaten that limit by any stretch!

Jerry

Mel,

In order to keep our excellent State of Florida insurance, when we turned 65 we were required to enroll in Medicare Part A & B. The State of FL insurance became both our Medicare supplement and prescription drug plan for a significantly lower price than we had paid for full coverage prior to age 65. Additionally, we receive a "Health Insurance Supplement" each month to help offset the cost of the insurance. The amount is calculated based upon the length of employment with the State of FL - $50/month for each 10 years of service. Hubby has 30 years and I have 10 years = $200/month.

We have had practically no out-of-pocket costs for his surgery, radiation therapy and hormone therapy, as well as my medical & surgical care. Additionally, there is no donut hole for our drug plan. The State of FL contracts with Florida Blue and CVS/Caremark for these benefits. So far, so good!

Margie

Mel,

I subscribe to Kiplinger Retirement monthly newsletter, which has an abundance of articles with tips on supplemental Medicare plans. One resource I plan to use when I retire is Allsup advisors; they are independent of the insurance industry and charge $250 to find and evaluate the best plan in your area to fit your needs. You may not need this if your State of Michigan supplemental insurance may be a superior option for you without searching further. All the best to you.