Waiting and worried about insurance in NYC

Lucy711 - I am not on an Advantage plan and I'm not in NYC, but I have been doing most of this for myself with traditional Medicare, an AARP supplement, and now Part D. I had work insurance too until the end of this past November and that kicked in for the drugs and a few other things that Medicare did not cover.

When I began all of this at age 65, I only had my work insurance, so had a lot of out of pocket (close to $10,000?) and it was killing me. When radiation time came around I decided I wanted to do proton instead of the "regular" photon and almost all private insurance does not cover it (cost is about $65,000.00). I was told by a financial counselor that you are automatically assigned to when you look into proton radiation that Medicare would cover it, so I signed up for traditional Medicare and the AARP supplement after talking to her. I told her I didn't know whether to go with an Advantage plan or traditional. She told me that in her experience working with people at the proton center, the Advantage plans were far more likely to try and find a reason to not cover something, since they are private plans, rather than traditional Medicare. Traditional is still government sponsored and paid. Traditional Medicare covered the proton therapy and the supplement picked up the co-pay thank goodness, as that would have been around $7,000, I think.

When I had the work insurance, traditional Medicare, and the AARP supplement, I was literally paying nothing out of pocket, but now that I've lost the work insurance, I will have to pay for the one drug I take (Letrozole), and the AARP Part D premium and deductible will cost more than the drug, but that's the way it goes, I guess. I also expect that I will have some costs to pick up now because Medicare does not cover some stuff that the private insurance did, e.g. my lymphedema compression sleeves.

It's a hard thing to figure out. One insurance will cover something another one doesn't, but to get the big picture is really difficult. Have you checked online with "My SocialSecurity" and AARP? I found that one or both of them (can't remember now) have calculators where you can enter where you live, your insurance options, the drugs you take, etc. and get comparisons with the different options.

The financial counselor I spoke with said that most people preferred traditional Medicare and a supplement over the Advantage plans, at least in her realm. She also said that most of them would rather pay premiums every month than have to pay unexpected, ever changing, fluctuating, "surprise" out of pocket balances.

I know all of this isn't exactly what you were looking for, but maybe there is something in my experience that could help. Good luck for sure!

I may be incorrect, but I understood that once you drop "original" medicare with a supplement for a medicare advantage plan - going back to a standard plan may require a physical & can be denied. Good luck.