Medicare Complete coverage or problems

Hello,

I am helping my dad navigate the waters through his recent diagnosis.

We went for a second opinion at Moffit last week (whom I asked before we scheduled, if they took Medicare). The doctor wants my dad to get two additional scans done. I called Moffit and then his health insurance to see if they would be covered.

I found out that Moffit is an out of network provider since Medicare no longer has Part A & B. My Dad has Medicare Complete (the lady on the phone also said "Advantage") and she said it is a PPO. If he goes out of network he absorbs 40% of the cost. That is a lot especially for a disease he will likely be treated for for thie rest of his life.

Questions: What has been your experience with Medicare (and he has no supplement)?

How much are the average costs for brachytheraphy and Da Vinci surgery?

Thanks!

Your father is not using Medicare A and B. Rather he has elected to use part C which is Medicare Advantage. Thus he has private insurance that uses a network preference. You need to talk to his insurance company and find out the providers that are in his network. Only his insurance company can provide factual and reliable information about his coverage and networks.

JNF is exactly right...You just have to be careful to stay "in network" which with most Advantage plans is not too hard to do..

I have a United Health Care HMO type plan that pays everything other than co-pays which are $10, $50, $75 for my PCP, Specialists and ER visits. But I must stay in my network. If your Dads income and assets are fairly low you can apply for "Extra Help" through Medicare which will cover the copays for both doctors and drugs . If he was ever in the military he can get his meds through the VA at little or no cost...

I live in Fl and have the same plan as your Dad......my !GRT 45 fractions ...81Grs. was negociated down to 28K from 150K ?? ...21ST Century told me...my plans out of pocket was $6700........this fall when I can add the supplement for my age of 69 it will be in the $300 extra a mo. plus what they take out of SS...I think about $105-135?.....need to check that . ...Good luck ....Call UHC and get the in -net. stuff....and all the extra doc. that end up helping along the way ...check on them too.....lots of surprises along the way , if you don`t check each

A couple of items.

First, the different Medicare Advantage Plans can have significant differences as to co-pays, deductibles, and networks. So you must deal only with your insurance company as to the specifics of your own coverage.

Second, regarding returning to traditional Medicare A,B,D and a Medicare Supplement Plan. This can only be done during the open enrollment in the last few months of each year. You really can't change it right now. Also with the traditional Medicare you will need a Part D prescriptions plan. When it comes to getting a supplement plan, they can have underwriting constraints that may limit coverage or even deny coverage due to medical conditions and history. So it is important to find these things out well in advance of making any changes.

Relatively, the use of a Medicare Advantage plan presents a lower premium cost each month, but usually has a restricted provider network and higher deductible and co-pays. The use of traditional Medicare A, B, D and a medicare supplement will have a higher monthly premium. However, it will usually have much less cost of deductibles and co-pays. Plus the network is only limited by whether the provider takes Medicare. So you can go anywhere you want with few limitations or additional costs because of network concerns.