Treatment when you are over 65.

I’ve been reviewing this issue since I qualify for Medicare in September due to being on disability 2 years.  I’ve ultimately decided to keep Medicare and keep my very rich employer sponsored retirement plan until I run out of money to pay for that plan ( there’s a fund with my employer), although it will cost me an additional $1600 year. If I don’t take Medicare, they will charge me a penalty of 10% per year on the premium. I have talked to a friend who is an expert in this area and she cautioned against the Medicare Advantage Plans. Plus I think they are going away soon. She suggests if you go straight Medicare going with the G or F Medigap plans. As far as Part D plans, that’s the weakest link. You really have to run your meds against their respective formularies to see how you would fare. And they change formularies often. And we Cancer patients change meds often. It’s all very complicated. 

Hi OldBeauty, Interesting questions! I wasn’t eligible for Medicare when treated but do know a bit about Medicare. I wish I had been on Medicare at the time I was treated. My commercial self-insured insurance through my employer caused me to incur about $20,000 as my financial responsibility over a two year period.  

Difficulty obtaining access  to care or providers based  on payer type varies by geography. Private practice doctors versus group practice doctors can decide not to “participate” or accept Medicare patients. However, most physician group practices accept Medicare recipients because that population is so large.

There is a common practice of NOT discriminating against patients based on their payer type. Typically Medicare Advantage offers a few additional coverages that are NOT related to cancer directly like routine eye exams or “Silver Sneakers” health club memberships. The majority of expenses incurred for treatment of cancer are addressed by CMS (Centers for Medicare Services ) by regulations called National Coverage Determinations or Local Coverage Determinations found on the CMS.gov website. 

Personally, I think Medicare Advantage insurance products offer incremental improvements in coverage for services but you won’ t see direct financial savings on services associated directly with cancer treatments or interventions. You could call the health plan that is administering Medicare on behalf of the Centers for Medicare Services and speak to a sales agent. They should be able to provide a more specific financial comparison. The health plans in your state that administer Medicare products on behalf of the Federal government also have websites with frequently asked questions. Also AARP might be helpful or a Senior Linkage type organization in your state. The complexity of health insurance whether private, commercial or government payer is confusing and hard to understand yet so critical to our well-being! Others no doubt will post their experiences as you requested. 

Lori 

I can't say enough about this medigap plan.  I've been in treatment (chemo/radiation/avastin for maintenance) under Medicare for almost 5 years and have had absolutely no out-of-pocket expense at all.  Medigap plan F pays your deductibles and then your 20%.  Have had PT 2x during this timeframe as well and chiropractic treatment also.  No problems getting seen by any doc and receive treatment at one of the top cancer centers in the country.  As far as choosing between plan F&G, I would advise you go with G as no new members will be allowed in F as of 2020.  The govt doesn't like that the plan pays the deductibles.  My guess is that by cutting off new, younger members the cost is likely to go up.  If I'm eligible myself, I would switch to G.  Not sure though if this "event" does away with the pre-existing condition criteria.  Not enough info out there at this time.  Hope this helps.

Mary Ann

Quite honestly I can't say much about pard D as I take very little medication.  For what I do take, I consider what I pay to be much less than my annual premium.  In fact I'd almost consider getting rid of part D but you never know what the future holds so I hang on for now.  Perhaps other sisters have had more experience than I have.

been wonderful.....I had it a few years and did not use it...had NO gap coverage...but something in the back of my head said get it right befote I was diagnosed this year....Blue Cross of NJ....Part D is Cigna.....But AARP has a really good plan.

From what I know about the Advantage...if you can..stay away.   Limited network and preauthorization can be needed.

Good luck

I should add that when I see a medical doctor, I have no deductible or copay with Plan F.

My dealings with insurance have been challenging. Both me and my husband had cancer treatments that occurred  over two plan years with 3,500 deductibles and 5000 max out of pocket max and we were not yet eligible for Medicare.  How I wish the cancer had waited till I was on Medicare. I know there may be some advantGe plans that might not be great, but his is Humana advantage and has been very good now. Where we live there is both an HMO and a PPO plan with them. I am a different story. I have Medicare as my primary and my teacher retirement plan as secondary. Unfortunately this is in Illinois and really messed up. Because my birthday was in December I had to choose from many different teacher retirement plans as secondary. I thought I had it all figured out and then my oncologist switched to a different hospital association, so during open enrollment which was May I chose a different plan which starts in July. Great figured out as my next appointment is in July. Well now I’ve been told my oncologist is moving back to Texas in October. Ahhh! I will have to find a new one and then in October select a new Trail teacher retirement Medicare plan. The circus continues!!

I started out at 65 with a Medicare Advantage Plan.  The co-pays came much too frequently with my follow-up cancer visits and appointments with a few other physicians I see fairly regularly.  I felt like I couldn't go to the doctor as often as I needed to go without worrying about my co-pays.  This plan was offered through my husband's employer, but we paid a good portion of the bill.  Fortunately for us, my husband's employer decided to stop handling its employees' insurance needs and set us up with a place that helped us find the best coverage for the best rates and gave us a stipend to do that.  We were able to get an AARP Medigap Plan F only because my husband's company had ended its coverage.  Otherwise, I probably wouldn't have been accepted into the plan, having had cancer at 61, and not having gotten into the Medigap plan when I first turned 65 (mainly because I didn't know anything about it).  The Medigap plan has been wonderful for us.  We haven't had any medical bills other than pharmacy since we got into the plan. As far as pharmacy goes, there is a huge difference between part D plans.  I started out in a Humana plan but I've had to switch to an Aetna plan because of the number of prescriptions I take.  My husband, who's only on 5 prescriptions, finds the Humana plan cheaper for him.  When you're enrolling, make a list of your prescriptions first, then take the Medicare booklet that Medicare sends you about 3 months before you enroll, and look for their help number on the back of the book.  They're supposed to help you find the prescription plan that's cheapest for you based upon the drugs you take.  Some regions have services with additional people to help you enroll in the most advantageous plans for you.  My biggest problem with the D plan coverage has been the donut hole.  Fortunately, the donut hole is closing and will be at 25% for all drugs after you have spent something like $3,750 out of pocket each year, starting in 2019. Even with being in the donut hole every year and the higher costs of a Medigap plan as compared to a Medicare Advantage Plan, I think we still spend a lot less than we would have had we stayed in the Advantage Plan.  The services such as dental and vision coverage can be purchased separately.  We have both.  We keep questioning whether or not the dental coverage is worth having.  It probably isn't, with all the limits of the coverage.  The vision coverage is only slightly better. Our Advantage plan had a free YMCA membership.  The Medigap plan hasn't had any gym coverage in the past, but it will be adding some partial coverage of certain gyms starting July 1 (50% of the monthly service charge). 

The place that helps us find our coverage did tell us that although Medigap plan F is going away in 2020 (I don't know about plan G), we are grandfathered in.  They said there has been some speculation that there will be changes in coverage or costs to us then, but nothing is definite yet.  For anyone who is turning 65 now, be sure to get into it when you're first eligible.  Otherwise, underwriters might not accept you with your history of cancer.  I don't know if that's true of all companies that offer it or not, but the service that helps us hinted that that we could be refused because of a poor health history if we hadn't lost our coverage elsewhere (for no fault of our own).