Medicare

DaveRob said...
...what should I expect for out of pocket for Zytiga & prednisone on a monthly basis?

That's difficult to say. Every plan can negotiate base prices, and set their own formulary.

Zytiga, in my plan, is allowed as a tier 5.

You have to meet a deductible, with mine that is $380 / year, so the first month will hit that.
During the initial coverage phase, my copay would be 25%, until I hit $3820 (the "donut hole").
During the Coverage Gap (aka donut hole), I would pay 25% up to an out of pocket of $5,100.

Then we are off to Catastrophic. There the copay comes down to 5% plus a part of the "dispensing costs".

You have to do all this based on a specific plan if you want real numbers.

I ran it through my 2019 plan:
FULL COST OF DRUG $10,805.65
Initial and Coverage Gap Months $2,701.41
Catastrophic Coverage Months $540.28

So you would burn through the $5100 to get to catastrophic pretty quickly.
My Part D has a blanket exemption for my generic prednisone, so it is no charge to me.

I'd never heard of a "high deductible plan F", but I had heard that plan N was to be phased out, except to those grandfathered in. When I chose plan G I did the deductible-versus-premium calculation and found that plan G with a $183 deductible cost less annually than plan F with no deductible but a slightly higher premium.

I don't know where you got your figures. My plan G just went up from $131 per month to $143 on my birthday. I guess I am one of the lucky ones. Last year I paid the $183 deductible plus around $50 for a blood test that was not covered, including two surgeries and a week in the hospital which must have cost something I don't even want to know about.

The year before (2017) it was two more surgeries plus eight weeks of radiation. And so on and so forth. In 2016 both my wife and I racked up over $300,000 in medical costs. The out of pocket seems minuscule in comparison. Since we've both had cancer we feel it's best to keep our options open by remaining with the "durable" medicare A&B plus G.

RobLee, JNF, yes, it is state and county dependent. I'm in a high cost area--the New York Metropolitan are in the suburb of Westchester just 5 miles north of the city. When we were 60, we were paying $2000/month for insurance for the two of us, back in 2009. I refused to join an HMO.

As long as you have qualifying employer sponsored insurance you do not have to enrol in Medicare at 65. When you then come off the employer sponsored plan you are exempt from preexisting conditions for Medicare Supplement insurance so long as you enroll within 60 days. There is no penalty for part B or D either.

I do suggest that you enrol in Part A at age 65. You have a seven month enrollment window, three months before your birthday month, the month of your birthday and three months following. The is no premium formPart A and it will be secondary to your employer sponsored coverage as long as you are on it.