changing from Medicare to Medicare Advantage
My medical group stopped accepting Advantage a couple of years ago. I wanted to keep my doctors so now I'm paying over $300 for a supplemental plan. I had a mastectomy several weeks ago. I'm not getting chemo or radiation so the only treatment I have left (hopefully) is possible reconstruction. I'm following up on my healing and my options with the plastic surgeon.
I recently learned there is another medical group (UCSD) which has an excellent breast care program and accepts an Advantage plan. I hate to have to start over with new primary care doctor and new specialists but it's a significant cost difference. ($330 a month vs $75 and no need for prescription drug plan which i pay $130 a month for)
My plastic surgeon would not be covered so if I want to continue with him I need to wait to change plans.
I've been told everything I want or need as far as reconstruction will be covered by Medicare. Is that the same for Medicare Advantage?
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Breast reconstruction should be covered the same by a Medicare Advantage plan as original Medicare. Federal law mandates coverage if have breast cancer. I assume you would still have deductibles and co-pays. Just depends upon the plan you choose. A broker should be able to help you with that.
The enrollment period is Oct 15- Dec 7. If you choose to stay with your PS then you would need to have reconstruction finished before enrollment ends. Then make the switch or just find a new PS with your new Med Adv plan.
It’s a lot to consider! Dealing with the diagnosis of breast cancer and all it entails is overwhelming. Wish you the best going forward.1 -
I just wanted to clarify something. If you choose to switch your plan, you have to do enrollment during that specific time frame but your coverage from supplement and original Medicare will still be in effect until end of this year. So you have more time to complete reconstruction if you choose to stay with your PS.
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yes, I would have to complete all the care with the PS by the end of the year, which is only a couple of months now. But my insurance broker said during your birthday month you can change plans and there is no underwriting. so I could keep my current medicare supplemental plan and RX plan until my birthday month and then make the change.
I had skin cancer and breast cancer several years ago and always said I got great care and wouldn't switch medical groups. but I have recently learned that UCSD is the only one in the area that does DIEP flap surgery. I'm not planning on that but that makes me think they are as good as and maybe better than my current group when it comes to breast care.
But (sigh) I don't not look forward to starting over finding a new primary care doctor, new dermatologist, etc.
I have an appointment scheduled with an oncologist at the potential new group. so maybe seeing how that goes will help me decide. In addition to the first consideration, quality of care, there are things like location, ease of parking, etc. Those things may not seem significant to everyone but I have it figured out where I'm going now.
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