Medicare Supplement Plan: Recommendations for stage iv?

hi MrsDivine!

I am not sure if this will help answer your question but I can share with you what I do.

I was on Obamacare through the Marketplace when I was diagnosed in 2017. My insurance was $300/month payment with a $7500 deductible. You can imagine what a financial mess that was for me all of 2017 (I am not rich with money I am rich with love!)

Anywho - in the beginning of 2018, I had to decide which Obamacare/marketplace insurance I was going to get. I really couldn’t make sense of any of it - it’s meant to confuse the heck out of us, sadly.

The hospital where I see my MO has a social workers/financial support office and team of individuals. They told me about a Medicaid program for women with breast cancer who make under a certain amount (I think it’s $45K/year?? But don’t quote me!) for which I qualify.

The insurance is called Keystone First and so far it has covered everything and I have not had any copays except for $1 when I got my wisdom tooth extracted at an oral surgeons office.

I wonder if this is sort of close towhat you are looking for?

if you are not of retirement age you may have fewer options if you don’t have a trusted health insurance broker maybe a friend does. Brokers who deal with everyday are knowledgeable and can explain what each option entails.

Medicare is more complicated than it should be, so I join Hudson in recommending that you seek out some expert help in navigating it. Either a State Health Insurance Assistance Program (SHIP) counselor (every state has them, see the Medicare website) or, especially if you are under 65, a broker who knows Medicare inside and out.

As for which plan to choose, Medicare supplement plans are standardized and you pick the one that offers the level of coverage that you want. Plan F, which pays your share of the charges for all Medicare-approved services, is probably the most popular, and Plan G, which pays everything except the annual deductible, is also popular.

In some circumstances, you can avoid having your pre-existing conditions considered in determining whether you can get supplemental coverage and at what price. Obviously, this is highly desirable if you actually have a pre-existing condition, especially a serious one such as breast cancer. For example, under federal law, insurers offering Medicare supplement policies cannot refuse to sell you a policy or charge you higher premiums because of a pre-existing condition, if 1) you are over 65, and 2) you apply within six months of enrolling in Part B. If you are under 65, or if you aren't covered by the federal law because you aren't within the six-month window for initial enrollment in a supplement plan, then you need to check and see if your state provides some protection against the pre-existing conditions problem. Some states are more helpful than others in that regard. You can see why an expert might come in handy in figuring out what your options are.

You are very wise to start thinking about this before you need to make a decision. I hope you will find the coverage that you want without too much trouble!

I have a Medicare Advantage HMO plan. No premium beyond the Part B amount, no deductible, reasonable copays when required, and because I live in a good-sized city, lots of choices for physicians and hospitals. Oh, and pharmacy coverage is included with no additional premium.

Just adding one more point. Oral targeted therapies are covered separately by Part D if you do not choose a Medicare Advantage plan or do not have some other qualifying Drug Plan. I found the copays for the targeted therapies shocking when I switched to Medicare. But I was able to qualify for drug copay assistance through PAN foundation and Patient Advocate Foundation.

You probably already know this - but in a nutshell -- Medicare part A pays the hospital -- however there is a deductible per inpatient visit (don't know how much it is this year) Medicare part B pays the doctors at 80% - you pay 20%. A straight medicare supplement policy to help with medicare coinsurance and deductibles is over a $100.00 a month -- probably closer to $170 monthly. The medicare website has a list of coverage options for these supplements. Blue Cross used to be a popular one. Then the advantage plans began -- they are worrisome to me, but I know a lot of people who have them --- When my parents were living with me at the end of their lives I dropped their medicare supplements because we were spending more a year on the supplement than we were saving on medical care. Example - took mom to doctor -- charge $100.00 -- free medicare payed $80.00 -- the supplement payed $20.00. The supplement Insurance that month was $160.00. I got caught one time when she was hospitalized for a broken hip. Had to pay the hospital $1,500 deductible. When my mom went on hospice she kept them for almost 7 years because Medicare doesn't have the staff to watch medical stuff --- a patient is not supposed to be on hospice longer than 6 months. So it worked for me - although was taking a little chance. The very best people to talk to you about insurance are the people who file insurance claims in the doctor's offices.

Divine and Jessie,

That's exactly what I did when I started Stage IV treatment: I talked with the insurance claims filers in my oncologist's office. They were very helpful and happy to be of help!

Tina