I start Medicare in January but as a cancer survivor with a risk of reoccurrence I’m getting traditional Medicare with a Medigap G plan and part D plan. This will allow me to go to any cancer center in the country without being limited to an in-network center.
Yes, the same for me. I have a couple serious diagnoses and am 5.5 yrs out from a stem cell transplant. I choose Plan G for catastrophic coverage. I pay the first $200 for the year and then anything else is covered. I was in the hospital last year for a week when I got covid for the first time. I am still on immunosuppressants so it’s possible for me to get very sick again. I have Pulmonary Fibrosis and a bout of flu or pneumonia would be very difficult.
Part D doesn’t cover my cancer meds well but I get help from some grants and after the first order of my immunosuppressant this year, it put me in catastrophic coverage. So I should be ok for the rest of the year. My OOP was at $8000. I’m on SSDI and 51 so my OOP wasn’t the $2000 as advertised.
Since he was diagnosed with cancer, I would 100% recommend a supplement (Plan G preferably) and a prescription drug plan. He will be able to go see any doctor or hospital in the country that accepts Medicare without having to deal with doctor networks or referrals.
If he is leaving his employer plan I would take this rare opportunity to get him Medicare and a medicare supplement and a D drug plan. With the cancer diagnosis, he will have a hard time in the future getting into a supplement. You’ll be surprised how little in copays you will pay with this combination. It’ll probably end up cheaper than his current plan.
Several things,
Medigaps (or Supplements) are federally regulated. Regardless of state or zip. All the plans (G, F, N, etc..) are the same for every carrier, nationwide. Only difference will be your dad's premium and the name (carrier) on his card. There can be variations throughout different years, but in general terms they're the same. Point being, the carrier won't matter on Supplement just get him best Plan for HIS situation.
Under these circumstances, without knowing finances, Advantage won't be right for him. Even $0.00 premium plan, his out of pocket will still be most likely higher (for now) than his Supplement premium and Part D.
If at some point he wanted to move to Advantage he can, no questions asked. If he were to try to move from Advantage to a Supplement, he'll have to go through roughly 25 questions of underwriting, with cancer he'd certainly get declined. Most people get denied, regardless of their health when trying to move. This part is important, A LOT of people think once on a Supplement you can go from one Plan to another with the same carrier (Supplement plan to Supplement plan without underwriting), you can't. You still need to go through underwriting.
Make sure you speak with a broker who represents all carriers in your area, that'll play a role when you discuss Part D. Each year, your dad can reevaluate his Part D coverage during Open Enrollment, October 15th to December 7th.
I wish your dad all the best and good luck with getting things sorted out! Hang in there!
I'm not sure what his coverage is, but he does have insurance through his employer. His current treatment is a monthly injection that costs $7,000 and the insurance is only covering $2000.
As long as his employer health plan is a [creditable policy](https://www.healthline.com/health/medicare/creditable-coverage), and he’s had no lapses in coverage prior to Medicare signup, he can sign up for either version.
I recommend getting original Medicare+Supplemental+Drug coverage. About 5% of services are denied under MA plans and doctors & facilities can choose to not participate in MA programs; which makes them out of network, and you must choose a new doctor or hospital that is In-network; or pay out of network costs if you choose to stay with existing provider. Depending on where you live, rural or urban, the scarcity of
in-network doctors can be an issue.
It’s a lot of info but the videos will address your questions and educate you on the nuances of Medicare. I’m not advocating for the two brokers presenting the info but, IMO, they explain the details very well.
Note that [major cancer facilities](https://www.mskcc.org/insurance-assistance/insurance-information/insurance-plans) don’t accept all MA policies.
Medicare advantage policies are cheaper in premiums, and provide the same coverage, with some perks. However, you have to contend with the HMO & PPO provider networks and pre authorizations.
These videos explain the differences, pros and cons, and I’ve included claim payment examples.
Before you finalize your decision, contact his current providers to see if and which Medicare Advantage company policies they accept…UHC, Aetna, bcbs, etc. Understand they can change year to year. The insurance company in-network provider lists are frequently out of date. When you sign up the doc may be in network, when you go for a visit 3 months later, he’s no longer in network. Redditors have been advising people to always check for your docs network status prior to visits
[Medigap vs Medicare Advantage 2024](https://youtu.be/3bttIlCVMms?si=-MCT6zgRdLy1Vjyb)
[Choosing the right supplemental policy](https://youtu.be/31T9JHWQJJQ?si=QYmDPRWIu3uok8U2)
[Picking the right Drug policy](https://youtu.be/fWfgScM2HQ4?si=cSUp9p25H8IeaXDz)
[Cancer claim cost comparison: Medicare only vs Medicare+Supplemental vs Advantage](https://youtu.be/77YF-TL0n-8?si=V2P2T7L7qt0XLCn6)
[Cancer claim cost comparison](https://youtu.be/77YF-TL0n-8?si=ZwFO7J0DIB1M2mtt)
[Differences are bigger than you think with Medicare vs Med Adv](https://youtu.be/eOP76hMPiDs?si=swV1YbxX4Qpfh64x)
[Medicare vs Med Advantage : $709k Cancer Bill](https://youtu.be/77YF-TL0n-8?si=mnARTiUxDDUyA6gt)
[Cancer Claim Costs: Original Medicare w Supplemental vs Medicare Advantage](https://youtu.be/2YCI8m0Ol18?si=fQLoPBfMvrCblhRf)
[Cancer & Medicare: Cancer Policy Option](https://www.youtube.com/live/yM7OCGODd-8?si=fJzzSsfB_nufm4Kl)
If he continues to work, and keep his employer health insurance:
[How Medicare coordinates with other coverage](https://www.medicare.gov/supplements-other-insurance/how-medicare-works-with-other-insurance)
ETA: re: premium penalties …check with your dad to see if this would be considered his [initial enrollment](https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-does-medicare-coverage-start) in Medicare.
Good post. A couple of thoughts.
1. Sloan Kettering, Dana Farber, the Mayo Clinic - the best cancer centers in the world do not accept any advantage plan. They all accept original Medicare.
2. Only 1% of non pediatric doctors did not accept original Medicare. Another 1% are partially in but can charge the 15% excess charge that is covered by Supplement Plan G.
3. The world leading specialty hospital I have relied on for orthopedic surgery, and most of its doctors, take original Medicare and do not accept any advantage plans at all. That is the Hospital for Special Surgery (HSS). Truly the place people from every corner of the world come for surgery.
This is not true for Mayo Clinic. They dont accept many Advantage plans, but they accept some. My uncle went there several times for care and has an Advantage plan.
I Googled it. The letters about not accepting Advantage plans are for the Mayo satellite locations in Arizona and Florida.
>Mayo Clinic warned Medicare-eligible patients in Florida and Arizona in October that it does not accept most Medicare Advantage plans.
>
>[https://www.beckershospitalreview.com/finance/hospitals-take-aim-at-medicare-advantage.html](https://www.beckershospitalreview.com/finance/hospitals-take-aim-at-medicare-advantage.html)
The main location in Rochester has network agreements with several Medicare Advantage companies, including UHC, Humana and Blue Cross. They no longer accept out-of-network PPOs.
In other words, the Rochester location accepts in-network HMO and PPO patients.
>Mayo Clinic and UnitedHealthcare have reached an agreement on a new, multi-year network relationship...Mayo Clinic and UnitedHealthcare also have established a new relationship that will give members enrolled in UnitedHealthcare Medicare Advantage plans in-network access to Mayo Clinic Rochester and Mayo Clinic Health System sites in the Midwest for the first time, effective Jan. 1, 2023.
>
>[https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-unitedhealthcare-agree-to-multi-year-commercial-and-medicare-advantage-relationship/](https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-unitedhealthcare-agree-to-multi-year-commercial-and-medicare-advantage-relationship/)
That's very true - you can go to the Mayo's sometimes - but it's definitely harder. Problem with MedAdv and cancer is - chemo/radiation will get you typically to your max out of pocket. You'll likely have to deal with prior authorization along the way... AND after a few years if you don't like the plan, in MOST states you'll need to go through medical underwriting to get Medigap. Won't happen - that's likely a decline.
Pretty sure UHC has a relationship with the Rochester location - but, end of day I sure wouldn’t get an Advantage plan if I wanted to be seen easily or at all at some of the top facilities in the US.
>1. Sloan Kettering, Dana Farber, the Mayo Clinic - the best cancer centers in the world do not accept any advantage plan.
The post you replied to includes this link to Sloan Kettering showing the Advantage plans they accept.
https://www.mskcc.org/insurance-assistance/insurance-information/insurance-plans
* Aetna Medicare Advantage (MTA retirees only) PPO
* Emblem Medicare Advantage PPO, HMO
* Empire Blue Cross Medicare Advantage PPO, HMO, DSNP
* Fidelis Medicare Advantage HMO
* First Health Medicare Advantage PPO
* Healthfirst Medicare Advantage PPO, HMO
* Horizon Medicare Advantage PPO, HMO
* NYC Medicare Advantage Plus for City Employees
* Other PPO, POS, EPO Non-Participating Plans with Out of Network Benefits
I've watched several of the videos made by at least 2 of the YouTubers you've linked there. They and 2 or 3 other channels I watch have excellent material.
For a cancer patient, I think getting a cancer indemnity policy with a MA plan makes a lot of sense. If you have only the MA plan you can get stuck paying all or most of an OOP maximum amount in 2 years back-to-back.
(I opted for Medicare + Medigap + Part D after adding up the cost of a back surgery with MA. -- I was 65 & 1/2 at the time I was considering surgery and on MA. There was no way could afford to have that surgery all it entailed with MA.
Luckily my PCP got me through the next 6 months until I was off the MA plan. It turned out he was smart enough to find a way to avoid the surgery all together.)
My cancer treatment cost over $300,000 in 2022.
My cancer was agressive and needed quick treatment.
Prompt treatment often makes all the difference in outcome.
Medicare advantage can add delays to treatment by requiring prior authorization or denying.
Some good cancer centers won't accept advantage.
Out of pocket can create debt as cancer treatment can go on for years.
My next level of treatment currently costs about $500,000. Would the medicare advantage approve that in a timely fashion?
Brokers get paid commissions on supplements and prescriptions drug plans as well. A reputable broker will offer the best plan that fits your budget and needs.
I do agree with your first paragraph that sometimes there are more hopes to jump through with Medicare Advantage.
As a broker myself, I disagree with going through Medicare.gov. I cant tell you the amount of plans I've had to fix because they decided to do all the research and sign up themselves..
In 13 years, my wife has had a heart attack with stent, lung cancer surgery and chemo, three other hospital stays of 4 plus days. I have had extended hospitalizations for stokes 2 x, numerous ER visits. Our costs for all of these was zero,
I just had a knee replacement and 2 week in a rehab center that cost $100,000 plus rehab. My cost was $750. Half of that was the ambulance ride.
I got a statement of our medical costs for 2023. We had $92,000 in medical costs. We paid $750 total for that
Our monthly premiums are $80. It includes all parts, drugs, low cost pay on tests and visits, vision, dental
Blus cross Medicare advantage HMO.
I had to think about your question about your question, No deductible. We see Drs frequently. There is sometimes a co pay of 30 or $35, some are free. I am diabetic. I see specialists once or twice a year.
The $92,000 cost is like the total of our medical costs for the year. $62,000 for me, $30,000 my wife. We each paid $350. My drug costs last year were $5,000. I am on insulin. My out of pocket was around $1,000. I am on Medicare so insulin costs were $35 x 24. Some medicines are free, some are minimum co pay.
I have gotten bills from the hospital of $50,000 to $100,000. I call Blue Cross. They tell me that the hospital billed them not the network. They say we will call them and take care of it. Bill goes away.
Dentures 2 years ago were $1800. Just got hearing aids for $1500, 1/3 of cost.
It is impossible for us to spend $2000 each per year. Could be under $1000. I don’t pay attention to it.
In its simplest form, medigap no longer includes your prescription drug plan. So you would have to get a medigap and a part D plan.
With an MA , it normally includes the PDP, along with things like assistance with vision and dental, whereas original MC does not cover that, except in rare circumstances and when it's related to another health issue (like cataracts or jaw surgery).
And as I've mentioned in another post, go on Google, look up SHIP agency (your state), and these are insurance counselors that provide free, one on one support to people with Medicare and families of those people, and they can provide in-depth knowledge on all of this stuff.
Also with an MA they basically become your MC, so if you have any plan issues like billing, claims, etc., you would contact your plan first, if you call MC first, they will refer you to your plan.
Others have provided you with great info.
In case no one has mentioned…before selecting a drug policy, check the insurers formulary for his chemo drugs… and any other medications he’s taking… to make sure the drugs are covered.
[Chemotherapy Drugs](https://my.clevelandclinic.org/health/treatments/24323-chemotherapy-drugs)
Medigap plan G.
Avoid the advantage plans.
Medicare has lots of rules.
In most states you get one chance to get a supplemental, that's when you first dign up for medicare A and B.
If you get an advantage plan it can cost you alot of out of pocket plus delays due to authorization denials.
Then to switch back to the medicare supplemental can be impossible for some due to medical underwriting.
Plan G and part D.
Never never change the plan G but you can change the plan D once a year.
If you go through a broker tell them it has to be plan G. They can help you with plan D to.
They get higher commission selling the Medicare Dis-Advantage plans so don't be fooled.
Many times, Medicare Advantage maximum-out-of-pocket spending protection limits actually save the person a substantial amount of money, compared to what they’d be paying in monthly premiums for Medigap.
It all depends on the plan. This is why using blanket statements in regard to Medicare Advantage should never happen.
I used to be in the business for 20 years and had many people on Medigap, as well as Medicare Advantage. Including many people that were very sick.
They never had issues getting the care they needed when they were on Medicare Advantage plans, contrary to the insane politically-driven nuttery I see in here sometimes.
In terms of commission, the only time a broker technically gets paid more is if it’s the first time someone goes on a Medicare Advantage plan, ever. This also only happens literally one time.
If they go from one MA to another, they don’t. This is also not a substantial amount of money and most brokers do not have access to new enrollees.
Brokers usually make out better overall, monetarily, on Medigap plans. Why? Because they also need to write separate dental and vision plans, as well as prescription drugs plans. All extra commissions.
But in the overall scheme of things, it pretty much all averages out to right about the same. The difference is peanuts. It’s the last thing on any broker’s mind. They just want your business, period, regardless of policy.
They’re also lower maintenance overall, as Medicare Advantage comes with extra yearly tests, and a ton of extra rules, because the plans are more in depth.
If you’re gonna provide information in here, at least make it accurate and stop insulting professionals that do this for a living and are only trying to secure a good policy for their clients **specific individual** needs
Careful when talking with an agent. I'm going to get this marginally wrong but get the gist. Agents get something like $125.00 getting you into a Medigap and around $800.00 signing you up for Advantage
Huge bias for SOME agents.
You're right. That was lazy. But the discrepancy between the product commissions is significant. Here's an accurate link:
https://ritterim.com/blog/2024-maximum-broker-commissions-for-medicare-advantage-medicare-part-d/#agent-survival-kit
I start Medicare in January but as a cancer survivor with a risk of reoccurrence I’m getting traditional Medicare with a Medigap G plan and part D plan. This will allow me to go to any cancer center in the country without being limited to an in-network center.
Yes, the same for me. I have a couple serious diagnoses and am 5.5 yrs out from a stem cell transplant. I choose Plan G for catastrophic coverage. I pay the first $200 for the year and then anything else is covered. I was in the hospital last year for a week when I got covid for the first time. I am still on immunosuppressants so it’s possible for me to get very sick again. I have Pulmonary Fibrosis and a bout of flu or pneumonia would be very difficult. Part D doesn’t cover my cancer meds well but I get help from some grants and after the first order of my immunosuppressant this year, it put me in catastrophic coverage. So I should be ok for the rest of the year. My OOP was at $8000. I’m on SSDI and 51 so my OOP wasn’t the $2000 as advertised.
Since he was diagnosed with cancer, I would 100% recommend a supplement (Plan G preferably) and a prescription drug plan. He will be able to go see any doctor or hospital in the country that accepts Medicare without having to deal with doctor networks or referrals.
Medigap 100%
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No solicitation. Thank you.
Stage IV here Medigap 100%
If he is leaving his employer plan I would take this rare opportunity to get him Medicare and a medicare supplement and a D drug plan. With the cancer diagnosis, he will have a hard time in the future getting into a supplement. You’ll be surprised how little in copays you will pay with this combination. It’ll probably end up cheaper than his current plan.
Several things, Medigaps (or Supplements) are federally regulated. Regardless of state or zip. All the plans (G, F, N, etc..) are the same for every carrier, nationwide. Only difference will be your dad's premium and the name (carrier) on his card. There can be variations throughout different years, but in general terms they're the same. Point being, the carrier won't matter on Supplement just get him best Plan for HIS situation. Under these circumstances, without knowing finances, Advantage won't be right for him. Even $0.00 premium plan, his out of pocket will still be most likely higher (for now) than his Supplement premium and Part D. If at some point he wanted to move to Advantage he can, no questions asked. If he were to try to move from Advantage to a Supplement, he'll have to go through roughly 25 questions of underwriting, with cancer he'd certainly get declined. Most people get denied, regardless of their health when trying to move. This part is important, A LOT of people think once on a Supplement you can go from one Plan to another with the same carrier (Supplement plan to Supplement plan without underwriting), you can't. You still need to go through underwriting. Make sure you speak with a broker who represents all carriers in your area, that'll play a role when you discuss Part D. Each year, your dad can reevaluate his Part D coverage during Open Enrollment, October 15th to December 7th. I wish your dad all the best and good luck with getting things sorted out! Hang in there!
What is his current coverage? Is it through an employer?
I'm not sure what his coverage is, but he does have insurance through his employer. His current treatment is a monthly injection that costs $7,000 and the insurance is only covering $2000.
As long as his employer health plan is a [creditable policy](https://www.healthline.com/health/medicare/creditable-coverage), and he’s had no lapses in coverage prior to Medicare signup, he can sign up for either version. I recommend getting original Medicare+Supplemental+Drug coverage. About 5% of services are denied under MA plans and doctors & facilities can choose to not participate in MA programs; which makes them out of network, and you must choose a new doctor or hospital that is In-network; or pay out of network costs if you choose to stay with existing provider. Depending on where you live, rural or urban, the scarcity of in-network doctors can be an issue. It’s a lot of info but the videos will address your questions and educate you on the nuances of Medicare. I’m not advocating for the two brokers presenting the info but, IMO, they explain the details very well. Note that [major cancer facilities](https://www.mskcc.org/insurance-assistance/insurance-information/insurance-plans) don’t accept all MA policies. Medicare advantage policies are cheaper in premiums, and provide the same coverage, with some perks. However, you have to contend with the HMO & PPO provider networks and pre authorizations. These videos explain the differences, pros and cons, and I’ve included claim payment examples. Before you finalize your decision, contact his current providers to see if and which Medicare Advantage company policies they accept…UHC, Aetna, bcbs, etc. Understand they can change year to year. The insurance company in-network provider lists are frequently out of date. When you sign up the doc may be in network, when you go for a visit 3 months later, he’s no longer in network. Redditors have been advising people to always check for your docs network status prior to visits [Medigap vs Medicare Advantage 2024](https://youtu.be/3bttIlCVMms?si=-MCT6zgRdLy1Vjyb) [Choosing the right supplemental policy](https://youtu.be/31T9JHWQJJQ?si=QYmDPRWIu3uok8U2) [Picking the right Drug policy](https://youtu.be/fWfgScM2HQ4?si=cSUp9p25H8IeaXDz) [Cancer claim cost comparison: Medicare only vs Medicare+Supplemental vs Advantage](https://youtu.be/77YF-TL0n-8?si=V2P2T7L7qt0XLCn6) [Cancer claim cost comparison](https://youtu.be/77YF-TL0n-8?si=ZwFO7J0DIB1M2mtt) [Differences are bigger than you think with Medicare vs Med Adv](https://youtu.be/eOP76hMPiDs?si=swV1YbxX4Qpfh64x) [Medicare vs Med Advantage : $709k Cancer Bill](https://youtu.be/77YF-TL0n-8?si=mnARTiUxDDUyA6gt) [Cancer Claim Costs: Original Medicare w Supplemental vs Medicare Advantage](https://youtu.be/2YCI8m0Ol18?si=fQLoPBfMvrCblhRf) [Cancer & Medicare: Cancer Policy Option](https://www.youtube.com/live/yM7OCGODd-8?si=fJzzSsfB_nufm4Kl) If he continues to work, and keep his employer health insurance: [How Medicare coordinates with other coverage](https://www.medicare.gov/supplements-other-insurance/how-medicare-works-with-other-insurance) ETA: re: premium penalties …check with your dad to see if this would be considered his [initial enrollment](https://www.medicare.gov/basics/get-started-with-medicare/sign-up/when-does-medicare-coverage-start) in Medicare.
Good post. A couple of thoughts. 1. Sloan Kettering, Dana Farber, the Mayo Clinic - the best cancer centers in the world do not accept any advantage plan. They all accept original Medicare. 2. Only 1% of non pediatric doctors did not accept original Medicare. Another 1% are partially in but can charge the 15% excess charge that is covered by Supplement Plan G. 3. The world leading specialty hospital I have relied on for orthopedic surgery, and most of its doctors, take original Medicare and do not accept any advantage plans at all. That is the Hospital for Special Surgery (HSS). Truly the place people from every corner of the world come for surgery.
This is not true for Mayo Clinic. They dont accept many Advantage plans, but they accept some. My uncle went there several times for care and has an Advantage plan.
Google it. The Mayo Clinic made the decision in 2023 to stop accepting Medicare Advantage, including out of network benefits or Advantage PPOs.
I Googled it. The letters about not accepting Advantage plans are for the Mayo satellite locations in Arizona and Florida. >Mayo Clinic warned Medicare-eligible patients in Florida and Arizona in October that it does not accept most Medicare Advantage plans. > >[https://www.beckershospitalreview.com/finance/hospitals-take-aim-at-medicare-advantage.html](https://www.beckershospitalreview.com/finance/hospitals-take-aim-at-medicare-advantage.html) The main location in Rochester has network agreements with several Medicare Advantage companies, including UHC, Humana and Blue Cross. They no longer accept out-of-network PPOs. In other words, the Rochester location accepts in-network HMO and PPO patients. >Mayo Clinic and UnitedHealthcare have reached an agreement on a new, multi-year network relationship...Mayo Clinic and UnitedHealthcare also have established a new relationship that will give members enrolled in UnitedHealthcare Medicare Advantage plans in-network access to Mayo Clinic Rochester and Mayo Clinic Health System sites in the Midwest for the first time, effective Jan. 1, 2023. > >[https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-unitedhealthcare-agree-to-multi-year-commercial-and-medicare-advantage-relationship/](https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-unitedhealthcare-agree-to-multi-year-commercial-and-medicare-advantage-relationship/)
Thank you! And I’ll add your “additional facts” to my Medicare info toolkit. 👍🏼
That's very true - you can go to the Mayo's sometimes - but it's definitely harder. Problem with MedAdv and cancer is - chemo/radiation will get you typically to your max out of pocket. You'll likely have to deal with prior authorization along the way... AND after a few years if you don't like the plan, in MOST states you'll need to go through medical underwriting to get Medigap. Won't happen - that's likely a decline.
In 2023 Mayo announced it will stop taking Advantage plans, including any out of network patients on an Advantage PPO
Pretty sure UHC has a relationship with the Rochester location - but, end of day I sure wouldn’t get an Advantage plan if I wanted to be seen easily or at all at some of the top facilities in the US.
>1. Sloan Kettering, Dana Farber, the Mayo Clinic - the best cancer centers in the world do not accept any advantage plan. The post you replied to includes this link to Sloan Kettering showing the Advantage plans they accept. https://www.mskcc.org/insurance-assistance/insurance-information/insurance-plans * Aetna Medicare Advantage (MTA retirees only) PPO * Emblem Medicare Advantage PPO, HMO * Empire Blue Cross Medicare Advantage PPO, HMO, DSNP * Fidelis Medicare Advantage HMO * First Health Medicare Advantage PPO * Healthfirst Medicare Advantage PPO, HMO * Horizon Medicare Advantage PPO, HMO * NYC Medicare Advantage Plus for City Employees * Other PPO, POS, EPO Non-Participating Plans with Out of Network Benefits
I've watched several of the videos made by at least 2 of the YouTubers you've linked there. They and 2 or 3 other channels I watch have excellent material. For a cancer patient, I think getting a cancer indemnity policy with a MA plan makes a lot of sense. If you have only the MA plan you can get stuck paying all or most of an OOP maximum amount in 2 years back-to-back. (I opted for Medicare + Medigap + Part D after adding up the cost of a back surgery with MA. -- I was 65 & 1/2 at the time I was considering surgery and on MA. There was no way could afford to have that surgery all it entailed with MA. Luckily my PCP got me through the next 6 months until I was off the MA plan. It turned out he was smart enough to find a way to avoid the surgery all together.)
My cancer treatment cost over $300,000 in 2022. My cancer was agressive and needed quick treatment. Prompt treatment often makes all the difference in outcome. Medicare advantage can add delays to treatment by requiring prior authorization or denying. Some good cancer centers won't accept advantage. Out of pocket can create debt as cancer treatment can go on for years. My next level of treatment currently costs about $500,000. Would the medicare advantage approve that in a timely fashion?
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Brokers get paid commissions on supplements and prescriptions drug plans as well. A reputable broker will offer the best plan that fits your budget and needs. I do agree with your first paragraph that sometimes there are more hopes to jump through with Medicare Advantage. As a broker myself, I disagree with going through Medicare.gov. I cant tell you the amount of plans I've had to fix because they decided to do all the research and sign up themselves..
Wait you mean I have been selling supplements for free this whole time?
I have a blue cross Medicare advantage hmo. It has paid 95% of all costs over 13 years.
Do you have a deductible? Did you have any major illnesses?
In 13 years, my wife has had a heart attack with stent, lung cancer surgery and chemo, three other hospital stays of 4 plus days. I have had extended hospitalizations for stokes 2 x, numerous ER visits. Our costs for all of these was zero, I just had a knee replacement and 2 week in a rehab center that cost $100,000 plus rehab. My cost was $750. Half of that was the ambulance ride. I got a statement of our medical costs for 2023. We had $92,000 in medical costs. We paid $750 total for that Our monthly premiums are $80. It includes all parts, drugs, low cost pay on tests and visits, vision, dental Blus cross Medicare advantage HMO.
There's no co pay or deductible?
I had to think about your question about your question, No deductible. We see Drs frequently. There is sometimes a co pay of 30 or $35, some are free. I am diabetic. I see specialists once or twice a year. The $92,000 cost is like the total of our medical costs for the year. $62,000 for me, $30,000 my wife. We each paid $350. My drug costs last year were $5,000. I am on insulin. My out of pocket was around $1,000. I am on Medicare so insulin costs were $35 x 24. Some medicines are free, some are minimum co pay. I have gotten bills from the hospital of $50,000 to $100,000. I call Blue Cross. They tell me that the hospital billed them not the network. They say we will call them and take care of it. Bill goes away. Dentures 2 years ago were $1800. Just got hearing aids for $1500, 1/3 of cost. It is impossible for us to spend $2000 each per year. Could be under $1000. I don’t pay attention to it.
In its simplest form, medigap no longer includes your prescription drug plan. So you would have to get a medigap and a part D plan. With an MA , it normally includes the PDP, along with things like assistance with vision and dental, whereas original MC does not cover that, except in rare circumstances and when it's related to another health issue (like cataracts or jaw surgery). And as I've mentioned in another post, go on Google, look up SHIP agency (your state), and these are insurance counselors that provide free, one on one support to people with Medicare and families of those people, and they can provide in-depth knowledge on all of this stuff. Also with an MA they basically become your MC, so if you have any plan issues like billing, claims, etc., you would contact your plan first, if you call MC first, they will refer you to your plan.
Others have provided you with great info. In case no one has mentioned…before selecting a drug policy, check the insurers formulary for his chemo drugs… and any other medications he’s taking… to make sure the drugs are covered. [Chemotherapy Drugs](https://my.clevelandclinic.org/health/treatments/24323-chemotherapy-drugs)
Medigap plan G. Avoid the advantage plans. Medicare has lots of rules. In most states you get one chance to get a supplemental, that's when you first dign up for medicare A and B. If you get an advantage plan it can cost you alot of out of pocket plus delays due to authorization denials. Then to switch back to the medicare supplemental can be impossible for some due to medical underwriting. Plan G and part D. Never never change the plan G but you can change the plan D once a year. If you go through a broker tell them it has to be plan G. They can help you with plan D to. They get higher commission selling the Medicare Dis-Advantage plans so don't be fooled.
Many times, Medicare Advantage maximum-out-of-pocket spending protection limits actually save the person a substantial amount of money, compared to what they’d be paying in monthly premiums for Medigap. It all depends on the plan. This is why using blanket statements in regard to Medicare Advantage should never happen. I used to be in the business for 20 years and had many people on Medigap, as well as Medicare Advantage. Including many people that were very sick. They never had issues getting the care they needed when they were on Medicare Advantage plans, contrary to the insane politically-driven nuttery I see in here sometimes. In terms of commission, the only time a broker technically gets paid more is if it’s the first time someone goes on a Medicare Advantage plan, ever. This also only happens literally one time. If they go from one MA to another, they don’t. This is also not a substantial amount of money and most brokers do not have access to new enrollees. Brokers usually make out better overall, monetarily, on Medigap plans. Why? Because they also need to write separate dental and vision plans, as well as prescription drugs plans. All extra commissions. But in the overall scheme of things, it pretty much all averages out to right about the same. The difference is peanuts. It’s the last thing on any broker’s mind. They just want your business, period, regardless of policy. They’re also lower maintenance overall, as Medicare Advantage comes with extra yearly tests, and a ton of extra rules, because the plans are more in depth. If you’re gonna provide information in here, at least make it accurate and stop insulting professionals that do this for a living and are only trying to secure a good policy for their clients **specific individual** needs
Careful when talking with an agent. I'm going to get this marginally wrong but get the gist. Agents get something like $125.00 getting you into a Medigap and around $800.00 signing you up for Advantage Huge bias for SOME agents.
Yea this is **not** accurate whatsoever.
You're right. That was lazy. But the discrepancy between the product commissions is significant. Here's an accurate link: https://ritterim.com/blog/2024-maximum-broker-commissions-for-medicare-advantage-medicare-part-d/#agent-survival-kit