Medicare - Baffled

I’ll be 65 in April time to get onto Medicare - really confusing!

As some of you may have noticed in my posts I’ve been getting my health care from the VA. 2 things on the VA - 1. I really think I need a more aggressive care - like Georgeton or John Hopkins. 2. I’ve going to means test out this year - being make to much money. it’s the annuity payout I set up for retirement.

Geogetown - Lombardi accepts Aetna - offered in my area. John Hopkins accepts NO medicare advantage plans but does accept Medicare Part B.

With Zytiga as my drug in all of these, I just picked Zytiga so it max out the drug coverage.

If anyone has info on the cost of eligard or lupron is - both as they are given as outpatient need to be calculated separately

Also I’m over looking a lot I expect - any info you can share ?

Medicare Advantage Plans

Both Aetna Plans Accepted by Georgetown – Lombardi

Aetna Medicare Standard Plan (PPO) = Premium $128
Cost to me = Traditional Medicare + premium = 104 + 128
Estimated Annual Drug Cost = $6,735
Health Benefits: Out of Pocket Spending Limit: $5,700 In-Network
Health Benefits: Out of Pocket Spending Limit: $8,800 In and Out-of-Network
Estimated Annual Annual Health and Drug Cost = $9,500
· But drug cost is 6735 – and Out of Pocket Spending Limit: $5,700 In-Network = seems the estimated annual cost should be $12,435

Aetna Medicare Value Plan (HMO) = Premium 38.00
Cost to me = Traditional Medicare + premium = 104 + 38
Estimated Annual Drug Cost = $6,326
Out of Pocket Spending Limit: $3,400 In-Network
Estimated Annual Annual Health and Drug Cost = $8,950
· But drug cost is 6326 – and Out of Pocket Spending Limit: $3,400 In-Network = seems the estimated annual cost should be $9,726

The advantage to me of the PPO? I can go to a doctor outside Aetna's list?

This is intrguing. Medigap Plan F supposedly covers every thing Traditional Medicare does not . I'm looking at the AARP Medigap F - any one have any experience? Is there really no provider cost?

I figure a drug plan is also needed - I picked the enhanced drug plan figuring the latest drugs may not be on the lesser priced plans.
United Healthcare AARP Plan F - $128.45
UnitedHealthcare AARP MedicareRx Enhanced Part D = 82.50
Cost to me = $104 + $128.45 +$82.50
Estimated Annual Drug Cost Mail Order Annual: $6,794
No provider cost???

So if I get eligard or lupron or anything done at all the Medigap F covers 100 %?
Thanks

Bud


No provider cost??

Post Edited (Raddad) : 2/2/2013 8:36:56 AM (GMT-7)

142

I understand I'll means test out of VA coverage. No more VA at all.

Bud

Bud,  My wife and I have been on Medicare Parts A, B, and D for about 10 years.  We have a Medigap plan J (no longer offered) but almost identical to Plan F.  We have not had any medical costs other than our premium.  We have a low cost drug plan (high deductible) because we don't take many meds.

If I had it to do over again I would go with Plan F with the high deductible.  Over the last 10 yrs my wife has had several expensive eye surgeries,  and I have had the basic PCa treatments of surgery and SRT.  Even with the expensive SRT,  AARP is still way ahead. 

To answer your question,  Medicare Part B pays the cost of Lurpon (or in my case, Eligard) as long as it is administered in the doctors office.

Carlos

Bud,last feb 2012, I became eligable for Medicare...my past employer provider a "great" PPO Medicare ADVANTAGE Plan specially designed for their long term retirees.....the brochure touted how great it was..all 160 pages of it, except I missed 2 small gotchas.....anyway I have a difficult prostate cancer that required top notch care prior to Medicare my lifeline was UCSF......well guess what...they were out of the PPO Network of my new whiz bang ADVANTAGE Plan...not to worry  it is a PPO.....well not so fast...it was optional for UCSF to accept...they were accepting but could terminate me any time !!!!!! Holy cow...adrift with an advanced cancer now what!! Anyway by the time I figured this out I had 30 days to get a guranteed acceptance in a Medigap Plan F.....so I dropped my past employer's plan like a hot rock...went to straight Medicare with a Medigap Plan F and Plan D from Anthem BC....so far all doctors have accepted with no problems...I just had major surgery for a new cancer (rectal) with huge bills...we'll see what happens.....thank God I dropped the ADVANTAGE Plan...because I needed a true specialist to perform my surgery due to many co-morbidaties.Be very careful in what you chose...many landmines, time deadlines,et.

Terry

I only know about some of this due to helping my parents figure this confusion out. Reading through the options is enough to drive a person nuts.

I would think you need to really focus in on the prescription cost/cap of each plan, as we both know all of these medications are outrageously expensive. My parents never seem to have a problem with Part B covering their doctor appointments, but they do end up in the donut hole for prescriptions really quick.

I know that my husband's insurance (not medicare) pays for his lupron shot as part of the doctor visit and not through his prescription plan. Hope that helps some.

David,
Is that actually the cost savings to you? Does the portion that they pay go towards your annual max benefit?

I'm pointing out the drug side due to the high cost of Zytiga, Xtandi, etc., as it could wipe our drug coverage quickly from what I gather.

Bud -

Here's another approach you might try in attempting to solve such a complex issue, if you haven't already thought of it and tried it.

There are many state agencies that offer assistance to citizens in health insurance issues, it's usually free, of good quality, and since it's coming from a state agency, it's usually pretty objective.

A fellow I met during my IMRT treatment (we used to talk in the waiting room) swore by the service he got here in Florida from staff at the Florida Department of Elder Affairs. He claimed that advice he got there "set him straight" in making his own health care decisions.

I know you live in Virginia, so the Florida office couldn't help you, but I did a little searching and located the Department for Aging and Rehabilitative Services in Virginia:

www.vda.virginia.gov/

I went to their site, clicked on Site Index and then clicked on Insurance and found what looked like good information about counseling services available to citizens, involving various aspects of insurance. I didn't read any further, but this site and its services offered seemed like something you might at least want to look at. I imagine they get questions like the one you are raising on a regular basis, so they might know something that could help you.

Anyway, maybe worth a try.

Bud,
Just thought I would chime in, for what it is worth!
We are in California, so it is probably totally different, but our mailbox was full of mail when my husband was about to turn 65. One of the mailings we got was from the hospital where my husband had his surgery and they recommended an agent to meet with, which we did, and were very pleased with the policies he recommended for us. He was very low pressure and was more than happy to give us time to decide. That said, my husband has an Anthem Blue Cross policy for the things that Medicare (part B?) doesn't cover which runs us about $180 a month and a Humana Drug plan that runs us about $19 a month. I was on the Humana sight earlier today and you can actually enter the drugs you use and they will give you an estimate of what you will spend a year. We do have a $4700 deductible and so the Xtandi will run us somewhere between $8000 and $9000 this year. ( $4700 deductible and then 5% of the drug cost after the deductible is met.) Also the other drugs he takes will run about $3.00 for a 90 day supply since we use the mail order and our deductible will be met next month! We really should have looked into maybe a different drug plan during open enrollment since my husband wasn't on the Xtandi when we signed him up! Will look into it next year if he is still taking the drug or has moved on to something else that costs a fortune! I am sure there are other companies out there which offer about the same coverage.
We are very happy with Medicare and our secondary. Lupron shots have been covered, because they are given in the office, as well as they covered everything for the Taxotere. We have had almost no out of pocket expense, which has been wonderful!
I also believe that some of the plans I was checking included dental and vision, so watch for that when shopping! It is mind boggling, so good luck.
The Anthem Blue Cross also gives some money off if you have automatic payment and both plans have increased each year, but so has my insurance which we pay out of pocket.
Good luck on this new adventure!

Gary

Not Nam, but South Korea. The South Korea Agent Orange VA disability is specific to those who were in or near the DMZ.

I was about 50 miles south of the DMZ - hence no disability

Bud