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Treatment when you are over 65.

oldbeauty
Posts: 176
Joined: May 2012

I hope this message posts; my first attempt was blocked because it appeared to censors to be Spam. 

I'd be interested in hearing from senior citizen sisters who've gone through treatment covered by either Medicare or Medicare Advantage plans.  I turn 65 early in 2019 and can make my application for benefits in November 2018.  I know that Medicare Advantage Plans include pharmaceuticals while with regular Medicare you have to also purchase a separate Part D plan.  Also, with regular Medicare, to get coverage that approximates private Medicare Advantage plans, you need to purchase a separate "medi-gap" policy.  I am not interested in cost comparisons of monthly premiums.  I am more interested in a comparison of out of pocket expenses women have incurred using either Medicare or Medicare Advantage.  Folks who retired with a continuation of benefits under their employer's plans also are different and so would fall outside the comparisons I'm interested in.  Also, do women on regular Medicare find that they have any difficulty seeing doctors and specialists of their choice?  Any input will be appreciated.  Thank you.  Best wishes, Oldbeauty

CheeseQueen57's picture
CheeseQueen57
Posts: 757
Joined: Feb 2016

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. 

CheeseQueen57's picture
CheeseQueen57
Posts: 757
Joined: Feb 2016

i had my own dietetics practice. There were some Medicare Advantage plans in my area (Philadelphia) that advertised a zero copay but had a very limited panel of physicians. One such was Humana and Cigna Health Spring. Also with those plans you require referrals for everything And can only get devices at capitated facilities. (MRI, CT scans, labs, etc)

Northwoodsgirl
Posts: 486
Joined: Oct 2009

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 

MoeKay
Posts: 173
Joined: Feb 2004

All states have a state health insurance assistance program (SHIP) to help with Medicare health coverage decisions.  See:  https://www.seniorsresourceguide.com/directories/National/SHIP/.  This link provides information and links to the SHIP programs in all states. 

What is SHIP?

SHIP is a free health benefits counseling service for Medicare beneficiaries and their families or caregivers. SHIP's mission is to educate, advocate, counsel and empower people to make informed healthcare benefit decisions. SHIP is an independent program funded by Federal agencies and is not affiliated with the insurance industry.

I called my SHIP office to ask about individuals who have not yet reached age 65 utilizing their services.  The rep I spoke to said that they get a new list of companies in October of each year with the new plans that will be offered on January 1 of the following year.  The rep suggested that if you are not turning 65 until early 2019 your best bet would be to contact them for information afer all the new plan information is available in October, so that you have up-to-date information. 

FYI, I have traditional Medicare, but didn't have it during treatment and I also have an employer-sponsored secondary plan.

MMMT SURVIVOR
Posts: 6
Joined: May 2018

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

CheeseQueen57's picture
CheeseQueen57
Posts: 757
Joined: Feb 2016

Great that you had such a great experience with Medicare. Might I inquire what your experience was with Part D?

MMMT SURVIVOR
Posts: 6
Joined: May 2018

Want to add that Plan F and Plan G are almost the same.  Plan F covers the deductible but Plan G doesn't.  Also F is a "guaranteed" plan but G isn't as of now.  Perhaps they will make it so when F is closed to new members.

Also, my oncologist, who I began seeing prior to going on Medicare, does not accept Medicare Advantage plans.  Since I wasn't going to change oncologists in mid-stream, that played into my choosing a medigap plan. 

MMMT SURVIVOR
Posts: 6
Joined: May 2018

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.

CheeseQueen57's picture
CheeseQueen57
Posts: 757
Joined: Feb 2016

Yes, I think the Part D could be a challenge for those of us on multiple an changing medications. 

gbazyl's picture
gbazyl
Posts: 23
Joined: Feb 2018

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

Abbycat2's picture
Abbycat2
Posts: 639
Joined: Feb 2014

I dreaded dealing with all this when I turned 65 seven months ago. I was still working and didn’t think I had time for all this. I have both Medicare Part A and Part B and opted for Medigap Plan F rather than Plan G. Plan F will be eliminated, that is, no new members will be able to sign up. But once you sign up for it, like I did, you can continue to have this coverage until you choose not to to have it . Plan F is more costly than Plan G. However, Plan G sometime in the near future will change, according to my insurance agent. There will be a $500.00 deductible and also a copay of another $2000.00 for the next $4500.00 in charges. Another words, if your Plan G is charged $5000.00, you will pay $2500.00 in out-of pocket expenses. This means that if your medical bills are $25,000, you would have to pay $2500.00. I think this system is so confusing it is almost impossible to know if you are choosing the right plans for you ( Medigap and Part D). As I take only one medication, I chose an inexpensive drug plan - Part D. I can always change it if need be.

Abbycat2's picture
Abbycat2
Posts: 639
Joined: Feb 2014

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

oldbeauty
Posts: 176
Joined: May 2012

I remember when my Dad had cancer and when it was all over, including hospice at a lovely facility, my mother said the cost of treatment was just about zero out of pocket for them.  She had insisted they get a Medigap policy and she, fortunately, chose Plan F.  I am leaning toward regular Medicare with Plan F (while it is still availalbe) and hope that Plan D for drugs is good without any "donut hole" issues, which I don't really understand.  One thing that concerns me is the President's plan to reduce drug prices (it seems to me, for the government, not patients) is to put drugs, like chemo, that are administered by hospital clinics or stand alone facilities, from Part B (which would be largely covered by Medicare and Medigap Part F) to Part D, which would place the copay on the shoulders of patients.  I think you could avoid that if you had Medicare Advantage.  But that is not law now and so I think it's wiser to be guided by the advice of you ladies who've had good experience with regular Medicare.  I've lived long enough to go on Social Security (YaY!) and I've long vowed to live long enough to get "my" Medicare.  It's been a roller coaster these last several years sweating through the challenges to the ACA and whether those of us with pre-existing conditions were going to be excluded.  With Medicare, you can get care anywhere in the country, which appeals to me.  I will research Medicare Advantage bc my provider, a nationally ranked university medical center, has a captive insurance company and offers Medicare Advantage.  But I still like the idea of not being limited to participating providers in a given geographic area.  Thanks for giving me a lot of good info and food for thought.  I continue to study this subject and eagerly look forward to me 65th birthday.  Who would've thought!!  Best wishes, Oldbeauty

MugsBugs
Posts: 100
Joined: Jan 2018

I went on Medicare in September.  Before Medicare I was paying $1,800 a month in health insurance and had never had any health issues.  Before the cancer diagnosis Medicare was a big financial boost.  I was diagnosed January 2nd and had surgery then end of January.  I haven't received a bill so far for any of it.  I had Kaiser Permanente before Medicare and still have Kaiser for the Medigap insurance.  I have received quite a few statements that say "This is not a bill" but haven't received a bill so far.  

I have been really happy with my treatment and reading this board have found that my team of doctors were on point as far as treatment.

Soup52's picture
Soup52
Posts: 871
Joined: Jan 2016

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!!

NoTimeForCancer's picture
NoTimeForCancer
Posts: 2484
Joined: Mar 2013

While I am not yet at retirement age, this post, and all your comments, is very helpful for its information going forward.  Thank you ladies!

pinky104
Posts: 574
Joined: Feb 2013

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).

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