Medicare questions
Comments
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DodgersGirl, I am not 65 and just started Medicare in October. I had a person who helped me with the advantage plan I chose. I didn’t do medigap. If you have any friends who went through someone to help you choose which plan would be best, I would do that. I didn’t have to do anything special to get A and B. They sent me the card way ahead of time. It’s the other parts you need to sign up for, but that would be about three months out. The plans will depend on where you live. The advantage plan I have is a PPO. I don’t pay an extra premium but 80/20 for everything.
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KBL,
Thanks for the info!
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Dodgers- I just started Medicare Dec 1--- after 2 years on SSDI. The Medicare Red/White/Blue card (Parts A and
came in the mail with a Welcome packet from Medicare. I did not need to do anything for that. Then, I talked with an insurance broker that deals with Medicare. Got the name from my insurance lady that handles my Life Insurance and Home insurance. I chose a Supplement (Medigap) versus Medicare Advantage. The insurance broker showed me what was available in my area (goes by zip code). Then I chose a Part D drug plan the same way. I have not used the Drug Plan yet, but my Lynparza was going to be $3,000 a month copay so I signed up with Astra Zenica for Financial Assistance. I now get Lynparza for free thru Astra Zenica. I have not filled any other meds yet, but I think my copay for my blood thinner is $47 a month (one of my more costly monthly meds). I have not had any appointments yet to see about my copays for docs or scans. But the way I understand it I have to pay the Part B deductible and then everything is covered (Supplement picks up the 20% Medicare does not cover).
So, you do not need to do anything for Medicare. It will just come to you. But, you do need to talk to an insurance person about choosing Medigap or Advantage Plans and what is offered in your area. I could not have figured it all out myself. It is a bit confusing.
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Candy-678,
Thank you for the info
i was hoping there would be time to get signed up for a medigap policy but wasn’t sure how that all came about if I didn’t apply for Medicare.
Yes, I will need a medigap, Plan G, and a prescription plan part D.
Thanks again
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I got an advantage plan, and I’m curious about the difference. I’m on Xeloda, and the most I’ve paid is $36. Last month it was $17.
Candy, I know you got a supplement plan, but I’m not sure why. Is it better with our diagnosis?
So far my cancer doctor visits have run around $125 a month. That’s with the Faslodex and then Zometa every three months. I don’t pay a premium. My MRI next Saturday is going to be $150. I have a maximum out of pocket of $5,000. If I got an MRI through my husband’s insurance when he was working, we paid the first $3,000 out of pocket before it was 80/20. I’m so appreciative of the Medicare plan. The MRI at the beginning of the year would have cost me about $1,000 when I had my husband’s insurance.
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KBL- I don't really know if a Supplement (Plan G) is better. I will wait and see how 2022 goes and how much I am really out of pocket--- with docs, scans, meds, and all of it. My insurance broker did advise me that Medigap was better for my situation compared to Advantage Plans. I told him of my cancer diagnosis and that I travel across State Lines to my cancer center. He said that Advantage Plans have Networks, and the Supplement does not, so he said that was better for me with going outside my area for care--don't have to worry about Networks. Also, he said that it was better since I have multiple doc appointments and the frequent scanning. I guess I will not have co-pays each time I go to the doctor. Just the yearly Part B Medicare deductible, and then I will be covered.
I am not on Xeloda, but I heard/read that since it is "chemo" it is covered under Part B Medicare and not Part D prescription coverage. I don't know if that is true. My Lynparza is targeted therapy and is billed to the Part D prescription drug plan. When calling for my monthly refill from the pharmacy for December, I was told they ran it thru the Part D drug plan and my co-pay was $3,032.91 to be exact. And my Lupron injection is covered under Part B Medicare (II did have that done in December under this new insurance plan and was told not to worry because it would be covered under Medicare--- over $3,000 injection). I was told my Lupron and Xgeva-- injections given in a medical setting--is covered under Part B Medicare.
I do have premiums--- for Medicare (taken out of my SSD check), the Supplement Plan G, and the Part D drug plan. So maybe 6 of 1, 1/2 dozen of another. Pay premiums but not co-pays,, or no premiums but co-pays each doc or scan. Just have to see how much I spend at years end.
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Thank you for the explanation, Candy. Now I understand the difference. Yes, Xeloda, thankfully, is covered under Part B. I saw that you applied to Astra Zeneca. I’m so glad they’re helping. If I was still on Ibrance, I would have been filling out the paperwork for Pfizer. I agree, it is probably around the same in the long run for costs, but I can see since you go across state lines why you have a supplement instead. It makes a lot of sense.
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Candy, when it’s time to renew, you may want to ask again about the difference in plans. My particular Medicare advantage plan does not tie me to any specific hospital or doctor even. There are networks for insurance but my plan is $0 copay in or out of network with a max $1,000 annual deductible regardless of network status.
And yes, Xeloda is part B. I presume all chemo drugs fall under that category but I’m not totally sure.
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I think the easiest way to remember is any oral medication filled by your pharmacy is Medicare part D. Medicare part B covers any drug administered IV (chemo) or IM (intramuscular) like falsodex. I think coverage is much better under part B. I believe that is correct.
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Mae- Yes, next Oct when we renew I will look into the differences again. I will have a year under my belt with Original Medicare and a Supplement and see how much I am out of pocket--- with premiums plus any co-pays that come up--- and how much my copays are when going to the pharmacy for my meds. And see if Medicare Advantage might save me some money. I read/heard that going from Medicare to an Advantage Plan is easy, but if you have an Advantage Plan it is hard to switch to regular Medicare if you decide to. Hum... I don't know why that would be.
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Candy,
The kicker in going from an advantage plan to a supplement is that you can be subject to a physical. Pre-existing conditions (such as breast cancer) can prevent you from being picked up by the supplement plan. The only time this doesn't matter is when you first sign up. That's why it's important to choose wisely.
I have Medicare and a supplement plan. In the almost 5 years since I've had that combo, I have had to pay out of pocket less than $100 total. Of course, each month I pay a fee for my supplement plan. As for Part D (prescription drugs) I reassess that every year during open season (in the fall) and figure out if I should change plans. I just changed my Part D plan for the first time. With Part D, though, it's a complete crapshoot because you have to try and figure out what drugs you might have to go on during the upcoming year and select accordingly
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Is there anyone on here who is on Medicare but also has private insurance because your spouse isn't retired? If so, how does that work? Is there a good reason to either keep or get rid of the private coverage?
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kris_2000, I had looked into it because my husband was still working. From what I understand, here is how that works. Depending on the company, one will be the primary and one will be secondary. You could waive Part B while you have private insurance, but I decided not to because it was too much of a hassle. My husband decided to retire, so I looked into COBRA for me. If you get Medicare, then COBRA, you can keep COBRA. If you get COBRA before Medicare, I don’t think you get to keep it. I weighed getting COBRA, but my portion was going to be over $600 per month, and it had a $3,000 out-of-pocket before it reached 80/20. Not worth it. In the end, my husband is on COBRA and I’m strictly on Medicare. I believe your husband’s insurance and Medicare will decide who pays first and who pays second.
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When you get on Medicare due to turning 65, does it start the first day of your birth month, regardless of when your actual birthday falls in the month?
it looks that way from what I'm reading , just want to make sure I'm getting it right ✅ because my birthday is the last day of the month
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Olma61, if I’m not mistaken, Medicare starts on the first day of the month. I am not 65, but I believe it works the same way, whether it’s disability or age. Your Medicare card should also have the day it starts on it.
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olma,
I went on Medicare this past September. I turned 65 on 9/25, but my Medicare coverage started on 9/1. Medicare kicks in at the beginning of the month in which you will turn 65.
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Medicare starts on the first day of the month. Your previous insurance ends on the last day of the month you paid if it is Medicare (if you change Medicare coverage) or if you pay other insurance on another day of the month make sure you don't quit paying too soon. If it is not the end of the month, you may be double-covered for the days inbetween which is ok. It is best to call your insurance company to make sure. That is better than having no insurance for a couple of weeks.
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thanks for the replies here ladies! Sorry I didn’t see these soone
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Help. Part D questions
I am being moved to Medicare this summer due to being on disability for 2 years but am not 65 yet.
I know I need to purchase a supplement plan or Advantage plan and am working with someone to get that done.
My questions (fear) deals with Prescription Drug Plan (part D). Right now I am I using my insurance through my job as a retirement deal and don’t pay more than $25 per prescription. With Part D, I have to deal with donut holes and catastrophic insurance. Sure sounds like my meds are going to bankrupt me.
How is everyone handling the cost of cancer drugs?
I realize the IV kind are covered by Medicare but I am taking Verzenio which is a pill and is very expensive. I feel like I would hit the donut hole in the first month
how is everyone handling meds?
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Dodgersgirl,
Does your clinic have someone to help research out and help patients get help paying for their drugs? Mine does and that person has been a godsend.
Also the manufacturer of your drug should have some type of compassionate assistance. Check that out on their website. I also take a spendy oral chemo but the manufacturer is covering the cost due to my (lack of) income.
Keep looking for help with paying for that drug.
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Mojos— thanks for the suggestions. When you are on Medicare, you are not able to use most of the manufacture payment assistance. I do not qualify for lack of income assistance as my pension doesn’t meet those targets
I will ask about help from m my medical group. My old MO group did have such an employee. I recently had to switch medical groups and don’t know if such an employee exists. Great suggestion. Thanks.
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Dodgers- I PM'd you, but my Lynparza pills was going to cost me $3000 a month with my Medicare Part D Plan. I applied with the drug manufacturer and they supply me with the med for free thru their Assistance Program. It was based on my income though. True, that with Medicare it does limit what programs you qualify for. When I was on Ibrance for instance, I got a co-pay card thru the manufacturer, but I was on insurance. They told me I would not qualify after I was put on Medicare. Then I changed to Lynparza anyway.
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Candy—thanks. I sent you a PM, too
Between Social Security and pension, I don’t think I qualify for financial help
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dodgersgirl, did you ever find help? Sorry I do not check this forum often but just saw your note. I get my Verzenio free from the manufacturer. I got it through my oncologist office. The nurse there applied for me and I did not have to qualify, just received it on her recommendation. You might ask. I am on Medicare. The donut hole is bad but tops at $6000.00. Then you get it free.
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is anyone here getting PHESGO on Medicare? I'm going on Medicare very soon and I'm wondering if it's in the formulary for part B drugs.
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intolight— thank you for your reply!
I worked for a full week with local, knowledgeable insurance people to find a solution that works for me. That donut hole is a killer given the retail price of Verzenio.
As fate would have it, now that I am on Medicare because of 2 years of disability (not due to age), Verzenio was deemed to fail and I have been moved to Xeloda which is retail around $4500 and my cost is about $10 every 3 weeks.
I suspect my next chemo will be IV and that is costed as Part B
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I'm most likely moving to my vacation home at the end of the year. It's about three and a half hours from my current home in the same state. I'm not bummed about moving my cancer care to the same institution in a different town, and I know it's covered by Medicare. My question is because I want to keep my current gastroenterologist. He's the one who saved my life. I don't trust anyone else. Since it's that distance, I will have to change my plan to the new zip code. Has anyone moved to a different county more than 150 miles away and been able to see a doctor in their old town? I have a Medicare Advantage plan,and I'm not sure if it's wise to go back on original Medicare. My insurance guy tells me I can't get a medigap plan because of my diagnosis. Maybe I could have if I picked that first. Also, I'll be on Medicare a year next month. Does that make any difference? I'm hoping to hear real-life experiences. I may also call Medicare but am not sure I want to do that yet. Thank you.
I’d also appreciate if you do have original Medicare if you could ballpark how much it is per month for premiums with medigap and Part D with Stage IV cancer. I think I would go with Plan G.0 -
kbl, I am a little confused. I have medi-gap with a Stage IV MBC diagnosis and was put on it in March this year when I moved states. I was diagnosed in 2016. I pay nothing for office visits and have no co-pays. I do have small pharmacy costs--usually under $10. I was able to get my oncologist' office to get my Verzenio free from a foundation. I don't know about your question to use your original gasteroentologist, but depending on the plan you can choose whomever you want to see. Check carefully, but some plans allow you to see anyone even in a different state. I pay a little more, but it is totally worth it. Check the medicare supplement company. It may vary by state too, but I have Aetna supplement with original Medicare and Medi-gap, and use humana for pharmacy pharmacy. But each company also has stages and varying plans. Each state is different so be diligent.
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intilight, thank you. Are you over 65? The problem now is I’m not, and my guy said supplements are a lot more costly, and some states don’t offer supplements to people under 65. I can choose a supplement at 65 if I want to switch then, but that’s four years away. I am going to stick with an Advantage plan. It’s not been bad.
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kbl, ah...that is the difference. Yes, I am over 65.
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