Medicare

Welcome to Healing Well and to your "Golden Years". I'd recommend that you provide some more details by adding your history to a signature which will then show up in your posts. You can do so by clicking on your "profile" at the top of the screen.

As you are stage 4, would I be correct in assuming that your are on hormone therapy at a minimum? It will make a difference in your choice of medicare plans. A type C plan (so called advantage plan) will often include prescription drugs, which tend to be expensive. However there are disadvantages to getting locked into a plan C, especially for someone who already has an existing condition. I won't waste my breath here as some people love their advantage plan because they are cheap, but they limit you to a HMO type network.

Standard medicare plan B plus a commercial supplemental plan (F or G) will cost around $250/month depending on your state, but generally allows you to see any doctor at any facility and pays for everything except maybe a small deductible ($180/yr) and you are free to move to any other coverage during annual enrollment. Plan B will cover your ADT injections BUT prescriptions are not included and must be bought separately (plan D).

Personally I have traditional medicare A&B plan a plan G with Aetna, and use GoodRx for generic drugs and the VA for prescription coverage.

YW one Rob to another. There are a number of guys here who have lived 10+ years at stage 4 thanks to modern hormone therapy. There is a group here for G9-10'ers, just use the search at the top. Personally I am officially ended HT but it still lingers. I still get frequent hot flashes but I think are becoming shorter and less severe.

For most guys who don't know what to expect as they age, I would normally recommend the A, B & G plus D plans as I had outlined above. But since your future is pretty much written in stone (HT for life until it becomes castrate resistant, then who knows) there may be some advantage to an advantage plan. You'll need to examine their schedules and find out what each company will cover. OTOH what standard medicare covers and pays is published and well known.

Good luck to you going forward!

Many thanks!

I suggest you stay in traditional Medicare with a supplement plan G and drug plan. This is the best financial combination for you.

Stay away from Medicare Advantage part C. You will have high deductibles and copays and very limited networks.

Plus If you start with Medicare Advantage and then want to go back to traditional with a supplement you will not be accepted due to your cancer.

Supplement plans are underwritten and can exclude you. However if you buy at the time you are eligible for Medicare there in no underwriting or exclusions for pre existing conditions.

Being advanced it is good to keep your treatment options open. With traditional Medicare and a supplement you can go anywhere you want and will not need referrals.

I use Mutual of Omaha supplement and Silver-script drug plan. Both very affordable and have provided excellent service.

JNF said...
I suggest you stay in traditional Medicare with a supplement plan G and drug plan. This is the best financial combination for you.

Stay away from Medicare Advantage part C. You will have high deductibles and copays and very limited networks.
.

This is basically sound advice for someone like you who will need lifetime treatment because, as someone noted above, if you start on a Medicare Advantage plan you will be unlikely to be accepted into a supplement plan later on if you decide to revert to standard Medicare.

But depending on your financial situation - monthly retirement income, amount in 401k or other savings -- choosing the best option may take some research and personal financial risk/benefit decision making. And the best way to do that is to compare plans available in your state on the Medicare website.

My wife and I are in a Blue Cross Medicare Advantage plan and happy with it. These plans differ greatly from state to state, from insurer to insurer, and even among different plans offered by an insurer. Not all Advantage plans are HMOs. Ours is a PPO, which means we can go to any doctor anywhere, though with possible extra cost for out of network doctors and hospitals (though in our plan in and out of network costs are mostly the same). Our plan costs $86 per month each for me and my wife, which is much cheaper than what a Medicare supplement plan and Medicare pharmacy plan would have cost us (around $500 per month combined for the two of us). The co-pays are reasonable - I average about $80 per month for oncologist visit, blood tests, and Firmagon shot. The financial risk is that a major hospitalization for either of us could run us into the plan's annual out of pocket maximum - $4,900 each and that would hurt. When we chose to go with this Advantage plan when I retired 7 years ago we chose to self-insure against the risk of paying the out of pocket maximum in some future years. We weighed the risk of either of us hitting this maximum in any one year against then known cost of higher premiums every year if we went with standard Medicare plus a supplement insurance plan. Our annual medical insurance premium is about $2,000 per year with the Advantage plan vs. an annual premium of about $6,000 per year if we went with Medicare plus a supplement plan. So far the decision has paid off in that neither of us has paid more than a few hundred dollars per year in co-pays or other expenses other than premiums - (though right now I have the monthly Firmagon shots through next April) which means over the past 7 years we've saved at least $25,000 in premiums, but we think of that as self-insurance against running into the out-of-pocket maximum in some future years.

All of that said, I have an ace in the hole that isn't available to many, in that if necessary I can take all of my care to the VA with no co-pays or out-of-pocket maximums if my insurance costs go too high with the Advantage plan, reducing our financial risk exposure to only costs incurred for my wife.
Jim

DaveRob - Perfect time to start studying Medicare options. You can sign up for Medicare when you turn 65 regardless of employment situation but only take Part A at that time which is free if you are still working. When you retire, you have a time window to apply for Part B benefits and will need a letter from employer regarding termination of employment and insurance benefits. Then you get to start paying for basic Medicare ($136/mo/person minimum).

Please be more specific about your retirement/working situation and if you are currently paying for your great insurance in some manner. To go on Medicare, you will pay nothing for for Part A (Hospital Insurance) and $136/mo minimum to get Part B (Medical Insurance). You will have to add Part D (prescription drug coverage) at some additional monthly cost to this or pay out of your pocket. At this point you will have exposure to Medicare deductibles and coinsurance so Supplement plans are nice to get rid of that risk but they can get expensive.

The pre-existing condition issue is the big problem for most of us if you don't take a Medicare Supplement plan when first available to you and you lose that opportunity. Basic Medicare and Supplement plans are nice as you can go to any doctor/facility that accepts Medicare, not just the local doctor networks.

JNF is our house "expert".

I have Medicare Part A (free due to length of contributions, There are cases where you could have to pay).
My Medicare Part B is the standard, the price is going up a tiny bit for 2019.
I use a Cigna Medigap plan that has some quirks in their reporting times, but has paid everything that was expected. I think it costs me about $121 / mo.

For Part D I use an Aetna plan that I researched with every possible med that I could take. It also was a good choice because of the pharmacies that are in the "preferred" (aka 0 copay for some of my meds) category. I think it is $16 / mo and has pretty standard deductible and copay numbers.

The biggest decision point for me was geographic coverage. Most of the Advantage plans in my area are hard-core HMOs that DO NOT cover the states that I travel to for family & friends. So they are out at first glance.

In the Part D geography is also critical, as not all chains are covered. Mine, for example, loves a chain I hate, and won't cover a chain I can live with. But it covers grocery chain pharmacies that exist in the areas I visit. So I've been able to stay with my grocery store pharmacist of 18 years.

It took about 5 months of research in spare time to come up with a final decision.

The biggest negative of Medicare in general for me has been that my GP accepts Medicare, but NOT Medicare Assignment. That means that he will take medicare payments, but then bill me for the difference. Fortunately my uro, onco, eye surgeon (retina issues), and hospital where I get scans accept Assignment, meaning that they adjust the bill to meet what Medicare allows, and the rest goes away.

No worries...America has our back...My daddy told me so...aint that right.Daddy… yes Jonnie that's right...a reference to rMiracle on 34th Street...don't even think you know whats in my mind...even the devil isself...can not...its whats on your mind that counts on this one

Folks, I can’t begin to thank you all for the plethora of Medicare PC info you’ve shared with me today. My main concern going into next year is the cost of the meds should my wife get downsized. I retired at 62 and went our her benefits. That said, I will certainly utilize the info shared as I start to navigate the many ins and outs of Medicare. I’m truly blessed that I feel pretty much the same as I did before my diagnosis however that will most likely change over next couple years. Getting educated today will make tomorrow a better day. Thank you all for your input as it is very much appreciated. Happy New Year to all!

Let me add an important point for clarity. Whether you choose traditional Medicare or opt out of Medicare by using a Part C Advantage plan, you still pay the Part B premium. For most people this is $134.00 per month, but can be higher due to income.

As I have mentioned I use traditional Medicare plus a Plan G supplement and a Part D drug plan. My supplement premium for 2019 is about $130.00 per month and the drug plan is about $22.00 per month, or about $152.00 per month. For the medical portion my total deductible out of pocket expenses will be the Part B deductible of $189.00 for the year. My drug deductible and copays have been running about $20.00 per month. If I used an Advantage plan with zero premium, the most I can save in premiums is the $152.00 per month or about $1,800 per year. But then I take on copays and deductibles for most everything and have an out of pocket maximum of anywhere from $4,500 to $7500 per year and have to deal with networks. In my situation, the traditional with supplement makes more financial sense and eliminates the network issues when I travel or want to choose my own provider.

JNF - Just for reference, Blue Cross in Twin Cities is $219/mo for their Basic Medicare supplement + riders that provides no deductibles or co-pays. I have not figured out when I would actually owe any money since almost everything is covered including excess charges once the riders are added. Part D is another $35/mo for decent drug coverage, but nothing special. You can not buy a G plan directly from them, just F (for one more year?) and N. Seems that there are a lot of variations and cost differences depending on where you live.

Great info indeed.
Out of curiosity, with best case scenario on utilizing best supplemental plans, what should I expect for out of pocket for Zytiga & prednisone on a monthly basis?