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Medicare and Med. Advantage and Provenge/Ztyiga/Xtandi/etc.

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Posted 5/20/2015 4:43 PM (GMT 0)
Howdy:

I have turned in my retirement letter, effective 8/15/15.

Starting actually on 8/1, I will be on Medicare Parts A and B and have BCBS Medicare Advantage.

I have no clue how well things are covered with this Plan (I will also have Vision/Drugs/Dental).

I do know I had a great plan at work.

I guess I am seeking some input/opinions in how well the new insurance will be in my fight against PC.

I am currently on HT. I have anther 4-month shot due in early August (my work insurance will be primary at that time). After that shot, if lucky, I can take a HT vacation.

Eventually, however, I am sure the drugs/txs mentioned in the subject title will be mine to enjoy (!), along with various scans/tests, including those regular PSA tests, and perhaps even radiation.

Anyway, any comments in what to expect with the new insurance?

IF I am reading the materials correctly, it might have annual maximums (and above that, 100% is covered) which is good.

But will all this stuff be covered??

Mel (back to square one on all this insurance crap)

Post Edited (compiler) : 5/20/2015 1:08:44 PM (GMT-6)

Posted 5/20/2015 5:10 PM (GMT 0)
Mel, the house always wins but for me a Medicare Supplement Plan F that pays all co-pays and deductibles in exchane for a higher predictable monthly premium works best.

You will still need a Plan D Prescription Drug Plan and dental/vision coverage outside the Plan F.

This tool allows you to put in your zip code and your two favorite pharmacies and drug regiment to find the best plan

/www.medicare.gov/find-a-plan/questions/home.aspx?
Posted 5/20/2015 5:55 PM (GMT 0)
Mel, of course I don't know what your new plan will specifically cover. However, there should be a fairly complete listing of things in the big fat book that you get from them. Obviously, you can also call them with specific question but the quality of the answer depends on the quality of the customer service rep.

Medicare Advantage vs. Supplemental plans is a big decision. Some of the supplemental plans cover virtually everything with no deductible but you pay up front big time for that kind of coverage. Medicare Advantage (for which I pay ZERO in Florida) has some co-pays and an annual maximum out of pocket. I know you are a gambler and have probably realized the odds are generally good with a Med Advantage plan.

I have been on Med Advantage for a number of years and am now well ahead of the house vs. supplemental plans. Of course, if we have some huge problems that threaten our out of pocket max, then I'll have to give some of it back!

Jim
Posted 5/20/2015 6:29 PM (GMT 0)
Mel,

One thing to ask/find out as you decide on the various Supplemental Plan D options. In our case, my dad went with a supplemental Plan F coverage through AARP (United Health), and we discovered that we have to pay 33% of the "market price" of all the new PC drugs, from Xtandi through Zytiga and Xofigo. That means, given the average cost of Xtandi of $100,000+/year, to use that drug, we would have to pay about $3000 per month. The same applies to the others.

Different Medicare supplemental plans apparently take different approaches on this, so you might want to be careful to choose something that is more sane than United Health Care via AARP.

Arthur
Posted 5/20/2015 7:12 PM (GMT 0)
These answers are just what I feared!!!

The choices vary and are confusing.

For me, BCBS is kind of the only choice as I will be back in the State Teacher's Retirement System. They offer a bunch of plans, but the rest are HMO plans and those are restricted to certain regions.

The BCBS is a PPO and I can go anywhere.

Mel
Posted 5/20/2015 10:41 PM (GMT 0)
Mel, my wife is a retired teacher, and I am going on Medicare in November. I was told today, when I called Emblem Health, that the coverage I have now (non Medicare) will continue as secondary to Medicare part A and B. And the coverage will be the same as it is now, except it won't cover the Medicare deductible, of $147. And so no need for Medigap, Medicare Advantage, or anything else. (Aside from drugs which I get covered thru the union)

Not sure of all Teachers Retirement Systems do the same, I imagine there would be some variations, but maybe this gives you some clarity or at least leads you to the right questions to ask.
Posted 5/20/2015 10:49 PM (GMT 0)
My current insurance is not that of a retired teacher, as I was still working at a University, with a great group plan.

Had I not been working and had been in the teacher's retirement system before age 65, then yes my situation would be similar

Mel
Posted 5/21/2015 1:33 AM (GMT 0)
While the posts appear contradictory they are not. For a Gleason 6 or a Gleason 7.Meidcare Advantage that is very inexpensive, sometiems zero depending on your zip code, makes a lot of sense since your expected future claims are not high relatively speaking.

For a G9 where it's only a matter of time before you end up on very expensive treatments, Plan F gets the nod.

If you have the discipline to invest the difference in premiums in a side fund, then the low cost or no cost Medicare Advantage with a savings account may make as much sense for a G8 or G9, but you are betting how long it takes to get to the expensive treatments before the side fund builds up.

Paying a percentage of a huge number cna get very expensive relative to the difference in premiums.

In your case, if you are on spousal PPO coverage it is what it is, but at least it is not an HMO where locations are restricted.
Posted 5/21/2015 2:10 AM (GMT 0)
Congratulations on the upcoming retirement, Mel!

To answer your question, my husband is on BCBS Supplemental and BCBS RX Drug Plan. You can see the drugs he's been through in his signature and we have paid next to nothing. BCBS has never denied a request from his oncologist. At the beginning of every year, due to the high cost of these drugs he's moved quickly to Catastrophic stage or we would be...well...I don't know where we'd be at this point.

It is a difficult decision and all the information, although meant to help, can make it very difficult. When I went on Medicare a year ago I was hating the process but very glad I was finally going to have insurance.

Good luck with your search, Mel, and a sincere Thank You for checking up on those of us who post to Sue's thread.

Susan

2005 Husband dx at 63 yo Gleason 4+3
2006 LRP First post surgery PSA 11.8 Stage IV Start Lupron
2010-2014 Casodex, Provenge, Nilandron, Zytiga, Orchiectomy, Xtandi.
PSA cont rise. Spot on spine & enlarged lymph nodes.
2014 Xgeva & Taxotare
10/31/2014 Last Taxotare due to SE’s PSA was 14.82 now 1.3
2/27/15 PSA 10.48
3/20/15 PSA 13.68 Multiple lesions found in liver
3/27/15 Start Jevtana w prednisone Neulasta 24 hrs after chemo
4/17/15 2nd Jevtana Finally The Great Constipation resolved
5/08/15 3rd Jevtana
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