Accept Medicare or not ?

labpsb

Hello I posted this in another area it was suggested this may be a more appropriate location.

 I need some input from people on Medicare... although my wife is only 50 on 08/01 she gets Medicare A & B, an insurance friend came over and signed her up for AARPs California F and a prescription plan.

He claimed it was the Cadillac of plans minimal out of pocket and she can go anywhere.

We currently have Kaiser and for the past two years they have done a very good job, Lynne is stage 4 IBC Triple Negative.  She is currently on Avastin and Xeloda (This is the 1^st chemo combo out of many that is working!). 

She is nervous about leaving Kaiser; my plan was to take her to MD Anderson for a complete evaluation and treatment course (spending what ever time we need to in Houston) and then transfer her care to City of Hope or UCLA.  I would be happy to hear from people who have gone to Anderson also people that are using an insurance plan I outlined (Medicare A B plus AARPs gap and prescription).  Any problems paying for treatment??, chemo??? As you know Avastin and Xeloda are very expensive and Lynne may be on them indefinitely.

I have to cement this new direction or can it and keep her with Kaiser, I have about 60 days.

Thank you very much for any input

Best Wishes  

Paul and  Lynne

deb6563

I don't know about the hospitals you are asking about, but I am a medical billing specialist and I deal with medicare and supplement insurance daily.  You would probably be better off staying with the insurance that you have.  Most insurances have a "waiting period" which means they will not pay for any kind of ongoing treatment that you have when you sign up.  Lots of insurances make you wait an entire year before paying any money on a pre-existing condition.  As you probably already know, medicare pays 80% and you have to pay 20%.  20% can be very expensive when we are talking about cancer treatment.

labpsb

Hello and thanks Deb, from what I am reading and have been told from both Medicare and AARP the only preexisting condition both have is renal failure if you can say no to that you are immediately covered on the 1st day for everything else.   AARP also says they will pay the full 20% plus extra if a particular qualified doctor demands it. But this is why I am continuing to ask everyone I can.

Thanks Paul 

Brenda_R

Go to medicare.gov and look up the medigap plan that you listed. They tell what it covers and more importantly, it has a consumer rating.

You should also have received the Medicare and You book. It lists all the insurance options for your state and gives cost, coverage, and ratings.

ninjr

Hi Paul,

Your insurance friend is right. Plan F is the Cadillac of plans, no matter which company it is purchased from. The only difference will be the monthly premium which varies quite a bit. Lynne can go to any doctor, specialist and hospital of her choosing. Please just make sure ahead of time that the providers accept medicare. I haven't yet come across any, but you never know.

If you have a copy of Medicare & You 2009 or go online to www.medicare.gov to find the handbook, take a look at pages 19-20 it lists what part A covers and pages 27-37 list what part B covers and don't worry when you read "you pay 20% of medicare approved amount", that is what you have plan F for. You should have very little if any out of pocket expenses.

Your part D prescription drug plan may have a yearly deductible besides the monthly premiums and drug co-pays. Lynne will most likely fall into the "coverage gap or doughnut hole" which means after you and the plan have spent $2700.00 in 2009, you will pay out of pocket for all drugs until you have spent $4350.00, then catastrophic coverage kicks in. At this point you will only have small co-pays in the range of $2.40 - $6.00 for generic - brand names and/or 5% co-pay for specialty drugs. Some part D plans offer coverage through the gap, mostly for generic and brand names.

By the way, some oral cancer drugs are covered under part B.

Best wishes to you both,

Ninnette

Lizzy90

Hi Paul,



I'm from New York City and my Mom was recently diagnosed with breast cancer 6 months after turning age 65 and joining medicare.

As per my husband's advice who is a trained lawyer with 30 years experience we signed up and bought supplemental insurance Plan F with blue cross blue shield.

She had diagnostic tests-many and lumpectomy and most likely other surgery 2nd for her same breast as one of her margin contained IDC so they need to go back.

So far it seems the bills are beeing paid and I receive statements of bills and charges paid.

She is beeing treated at Memorial Sloan and they accept medicare with plan F combo...

I have 1 advice as I am not from california..when u try to make a decision just call Anderson and try to speak to the financial dept.and pretend u are an incoming patient explain the insurance and then listen...then call back and offer the other plan few hours later then listen.(This is what we new yorkers would do and did)..then u have a much better reassurace but I was so doubtful and now more relaxed and can focus more on treatment and her care rather then the bills.

My personal opinion that plan F is a superb choice and I hope will feel the same way 6 months from now So help me GOD! I hope this helps.

Best wishes from the east coast!

Hanna





.

labpsb

Thank you for the replies...

We are all set on Medicare with AARPs F supplement and best drug plan starting 08/01.  I have talked till I was blue in the face to everyone and it looks like a good decision. 

However my attorney told me to run with the new plan but quietly keep the Kaiser for 2 months to make sure there are no surprises.

Lynne's type of cancer is unusual along with being triple negative.  Our original thought was MD Anderson however one of, if not the top doctor for Lynne's exact type of cancer is a Professor at UCI and a doctor at UCI Medical Center.  Her name is Rita Mehta, she has agreed to take Lynne as a patient so that will be our direction for now.  The Xeloda and Avastin are currently doing a great job controlling the spread in other sites for now.

Thanks again Paul and Lynne

PS... Lynne is even feeling up to a trip to Yellowstone, Yosemite, and Vegas (need to win some spending money) in our motor home in late August.

ccnani

 hi labpsb, My name is ccnani i live in long beach ca.. I was reading your post and wanted to let you know that I am on Medicare and medical. I have IDC Im her2+++ER&PR negative high grade invasive cancer. Had dbl. mast. now scheduled for chemo. All being paid for by medi-medi. Also have drug coverage thru aarp. Your wife is triple negative a rare form and my diagnosis is also pretty rare. I am being attended to at USC in los angeles and the american cancer society and national cancer institute state that the two best comprehensive breast cancer centers in southern california are UCLA and USC. Please contact NCI and research which comprehensive cancer center has treated the most triple negative patients and what their success rate is. Do comparisons. Get second opinions. Not all hospitals have what she might need. I hope everything turns out great for you and your lady and happy vacationing !!!

noora

Hi,

my mother has been diagnosed with stage II breast cancer.  She's Her2 +, ER/PR - . she has Medical as her health insurance and we live in Long Beach CA. I read ccnani's post and am thinking about taking my mother to UCLA. but still don't know much about USC breast cancer center.

could someone help me to reach a better decision. Any help will be greatly appreciated.

panamajayne

does anyone know what the total cost of each Herceptin treatment is?  I have Medicare A&B

sandyv

Panama

I just looked up on google the drug cost of some of the ones I am on and you should find the cost somewhere online. For instance I  looked up Xgeva a shot I need to take once monthly and found the cost to be  $1099.00 per dose yikes! Somewhere on this board ...maybe under stege IV people they have a huge list of places to get help with cost related to cancer drugs and copays because even with insurance the cost is overwhelming sometimes.