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Medicare and chemo

mlbrooks852's picture
mlbrooks852
Posts: 76
Joined: Apr 2010

I am getting ready to retire and we will be looking to Medicare A and B for Dale. Can anyone tell me how well these plans pay for chemo treatments. Do We need to purchase supplemental insurance and if so, anyone know which ones are better?

MOE58's picture
MOE58
Posts: 649
Joined: May 2009

Well I work in the medical insurance field, so sit down and have a cup of coffee while reading this you just might need it.

First off stay with Medicare A&B, DO NOT GO TO AN HMO!!!! and yes usually they will pay for chemo, as its considered Part B, Part B is like for doctors visits, and etc. Usually all places will take this, you don't have to be authorized you can go anywhere and anyplace with straight medicare.

Many people who go on medicare get talked into taking a HMO, for instance like Pacificare, Humana and Humana GOLD etc, anything HMO you will not get to make choices, you will have to go strictly what they say. DON'T get me wrong they are good but you don't have choices on ANY HMO'S say coming to CANCER CENTER TREATMENT here in Oklahoma you just turn in the info and you get great care, you tell them you have a HMO and you get put on a back burner.

Yes you will need a supplement not only for his chemo but for all circumstances, If Dale is ever a inpatient in the hospital you do have a deductible to meet for hospital stay and I think (might be different now) its around 600-800 a per calendar year, for PART B you have a 200 deductible, now 2nd insurance won't pay for the deductilbe but they will pay for anything you owe after its met say for example you have a doctor visit with lab and lab is expensive say your bill is 400.00 medicare pays 300.00 then your supplement will come in and USUALLY pay the balance there is circumstances but usually always.

Medicare is a little more expensive than an HMO and some people fiancially have to take that option, but if you can please stick with medicare.

Now recommendations for the best is BLUE CROSS AND BLUE SHIELD, AARP,

Please when you take out the 2nd insurance policy please let them know he was covered on your previous policy and make sure you do this within 30 days after you retire, as you will need to provide a letter which is called "CREDITABLE COVERAGE LETTER" with this letter they cannot hold any pre-existing conditions againist you or him, and with his cancer you would need this. ITS VERY IMPORTANT!!!! you have this all in place before you retire or close to it.

Medicare will pay the allowable charges, and the doctor has a portion they have to write off and cannot bill you the difference UNLESS !!! you have signed an ABN which is if you choose to have the test the doctor orders and you sign it understanding that medicare may or may not pay for it.

Medicare will not pay for routine visits coded with a V700.0 so always make sure your doctor does not use this code on his requistions.

I hope I have helped you on your quesitons regarding insurance and please if you have anything further please ask i have all the details since i do this for a living.

take care
Lori

mlbrooks852's picture
mlbrooks852
Posts: 76
Joined: Apr 2010

Wow Lori....that is exactly the information I was looking for. They are sending me the papers for part b today. Then do we contact AARP ourselves?.. And do I wait till after the part b papers are signed?

JimsBrother's picture
JimsBrother
Posts: 107
Joined: Aug 2010

In addition to the Medicare parts A and B, there is also part D. Part D is for perscriptions. If there is anything about Medicare that needs changing, it's this. I won't go into detail because I am not on the Part D. I had an alternatice available.

Speak with your pharmacist if you want the most accurate information about what it is and how it works. When considering your supplemental coverage, check into the perscription coverage too. Pay special attention to what they call the doughnut hole. It is the portion between about 2500 and 4200 that you must pay 100% of the cost of the perscriptions. That is not the exact ammounts but it's not too far off. It is easy to reach this doughnut hole where you have to pay everything when you are talking about some of these medications.

You can begin by calling medicare, or visiting the medicare website. On the website you can register and it will bring up your account information associated with your social security number. Do as much research as you can because there are eligibility rules and once you decide it is hell to change. There is a certain time during the year that you can make changes otherwise you are pretty much locked in till the next time year.

AARP is an excellent place for information, and you can be confident you are getting accurate info. Good luck, and God Bless you and your family.

As for your last question, I would contack AARP and Medicare to see how you need to proceed, or sit tight for the moment, Lori will guide you to the right place.

Rob

MOE58's picture
MOE58
Posts: 649
Joined: May 2009

Contact them now!!! get the process going, before you retire, get all the ducks in a row

Do not wait till the part b papers are signed start getting information now you need to have everything in order before the big day of retirement.

The part D well be careful i personally wouldn't take it out but that is your choice, if you can afford the the prescriptions without it would be great.

I am so glad I could help you thats my living I do and please if any further questions don't hesitate to ask.

Glad I could help
Lori

unclaw2002's picture
unclaw2002
Posts: 664
Joined: Jan 2010

I echo what MOE said stay away from the Medicare HMO's --- they try to upsell with free gym memberships, etc. etc. and then when you need care, a second opinion or want to get treatment outside of their network . . . good luck they will turn you down even if your doctor says you need a second opinion or treatment at another facility. My dad had Humana Gold and we were fortunate to get him on regular medicare after he was turned down for a second opinion --- as for supplemental I am not much help there he is retired military and has TRICARE for Life and from what I can tell that is awesome supplemental insurance. If you have concerns about the record, payment record etc of a particular insurance company or provider in your area you might try calling your the department of insurance for your state and asking for the information they have about the company.

Good luck,
Cindy

mlbrooks852's picture
mlbrooks852
Posts: 76
Joined: Apr 2010

Lori.....thanks again. We enrolled in our supplement policy today. Going to wait on the drugs till we see exactly what he will be released on. AARP is what we chose. Happy to have those decisions behind us.

Mary Lou

MOE58's picture
MOE58
Posts: 649
Joined: May 2009

That is a good one. Let me know if i can help futher.

Lori

JimsBrother's picture
JimsBrother
Posts: 107
Joined: Aug 2010

AARP great choice. Good luck.

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