Anyone else have Medicare Advantage

Posted by paulcalif @paulcalif, Feb 11 3:43pm

I've been studying many of the various treatments for prostate cancer. Today it dawned on me that since my insurance plan will only cover a limited number of different treatment options (no idea what they will cover), it might make more sense to only look into the covered treatments. So I'm asking if anyone else here has a Medicare Advantage plan that has already been treated. If so, what type of proceedure did you have. Also, were you able to discover what alternative treatments were available to you. AND, if your insurance didn't cover your proceedure and you paid out of pocket, how much did it set you back? I know some of you will feel this is personal financial information that you won't want to share online and I respect that, but if you do care to share I would really appreciate it, and I'm sure future patients will find it helpful. Thanks in advance 🙂

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New update and new questions.
Turns out I can switch to original medicare until March 31st. I've never had original medicare but I do know that I should have a medigap plan too. The problem is, I have cancer and I'm not sure the insurance companies will write a medigap policy for me now. I checked with United Healthcare, they won't.
So, are there any insurance companies that will? Is it worth it to go with original medicare if I have to pay the full 20%?
At least it would mean that I could go where ever I want for treatment right?
Any thoughts or comments appreciated.

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Turns out I CAN switch to Original Medicare AND I can get a Medigap G plan for $196 a month.
Should I go for it?
I'll have to start studying the different proceedures again.
With original medicare I can go to UCLA, San Diego, or Hoag right?
Is MRIdian MRI guided SBRT?
I think that's what I would choose based on what I know so far. Unless there's a non radiation proceedure that's as effective.
Back to the drawing board.

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I apologize to the original poster who was asking about those who have MA plans. I also do not. Timing is everything. I was diagnosed 2 months before the deadline for me to enroll in medicare and ended up having surgery 6 weeks or so after I enrolled in Medicare parts A/B/D and G (supplemental plan). Once diagnosed with high risk disease I could not take on the risk of an advantage plan where I might not be able to seek out the doctors I preferred and where copays could add up to significant amounts. With the possible exception of the Part D drug plans, my combination of A/B and G has worked beautifully for me. I believe Part C plans are legally required to cover everything Part B covers, but most complaints I hear are that the insurors can drag their feet in approving tests/procedures that result in delays. No issues with those companies making money with the enterprise - they take on risk so are justified IMO in making reasonable profit.

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Who knew, but I discovered yesterday that we have the option to switch to original medicare until March 31st. AND I'll be able to get a Medigap policy. All of the sudden, the posts about original medicare have become relevant to me and I want to thank all of you for posting!!

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@dandl48

If you are thinking about going to Mayo for treatment, Mayo AZ doesn't accept ANY Medicare Advantage plans but MN and FL do accept some but not all.

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I tried making an appointment at both Mayo Florida and Arizona.
I was hoping to stay with relatives there during my treatment.

Mayo Florida told me they don't have proton therapy; but that they can refer their patients to university of Florida for proton treatment. However, they don't accept any advantage insurance plans.

While Mayo Arizona does have have proton therapy, they said advantage plans are usually a problem and more difficult to approve.

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@russ777

I apologize to the original poster who was asking about those who have MA plans. I also do not. Timing is everything. I was diagnosed 2 months before the deadline for me to enroll in medicare and ended up having surgery 6 weeks or so after I enrolled in Medicare parts A/B/D and G (supplemental plan). Once diagnosed with high risk disease I could not take on the risk of an advantage plan where I might not be able to seek out the doctors I preferred and where copays could add up to significant amounts. With the possible exception of the Part D drug plans, my combination of A/B and G has worked beautifully for me. I believe Part C plans are legally required to cover everything Part B covers, but most complaints I hear are that the insurors can drag their feet in approving tests/procedures that result in delays. No issues with those companies making money with the enterprise - they take on risk so are justified IMO in making reasonable profit.

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Macro view: Medicare, is a nonprofit type of system and not suitable for the "for profit" world.
Centers of Excellence and research have higher costs and the MA plans are trying to reduce the compensation paid to these primarily nonprofit facilities, which is causing some of them to refuse to contract due to inadequate reimbursement.
And the MA plans are competing with each other on premiums, and trying to minimize their plan premiums (remember that you still pay your Medicare Part B premium), and then squeeze the provider world to maximize profits.
I support making a profit in a profit driven world, but this isn't it.
And the MA plans have been VERY profitable, so the raptors are hunting hard.

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@paulcalif

Turns out I CAN switch to Original Medicare AND I can get a Medigap G plan for $196 a month.
Should I go for it?
I'll have to start studying the different proceedures again.
With original medicare I can go to UCLA, San Diego, or Hoag right?
Is MRIdian MRI guided SBRT?
I think that's what I would choose based on what I know so far. Unless there's a non radiation proceedure that's as effective.
Back to the drawing board.

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My take is that does not sound unreasonable for the Supplement under the circumstances.

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@aiseman

I tried making an appointment at both Mayo Florida and Arizona.
I was hoping to stay with relatives there during my treatment.

Mayo Florida told me they don't have proton therapy; but that they can refer their patients to university of Florida for proton treatment. However, they don't accept any advantage insurance plans.

While Mayo Arizona does have have proton therapy, they said advantage plans are usually a problem and more difficult to approve.

Jump to this post

You might consider switching to Original Medicare. I'm almost certainly going to switch. The option is available until March 31st. Most people also get a Medigap policy to go with Original Medicare. With Original Medicare, my understanding is you are responsible for 20% of approved charges. This is where Medigap comes in. It helps to cover the 20%. There are several different levels of Medigap coverage. They are made available by private insurance companies, many of the same companies that sell the Advantage plans. Examples are United Health and Blue Cross. United said I didn't qualify because I have cancer but Blue Cross said they will sell me a Medigap plan. That may be because I have my Advantage plan with them, I'm not sure. I had contacted Medicare who told me I would be able to find a Medigap policy but I would need to shop around. If you make the move to Original Medicare, it takes effect the 1st. day of the following month. I'm still learning, but I believe that most institutions will accept Original Medicare. Here is the down side. Medigap costs money. My quote is for $212 a month which includes dental and vision. That's $212 more than I'm paying now. Not sure where that money is going to come from, but I'm determined to work it out.

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I'm of the opinion that Medicare should send out a fair warning about Advantage plans - that your treatment options might be limited as to providers and locations. I have traditional Medicare and a supplemental plan from United American Insurance Company (not to be confused with United Health, which is different). It's a high deductible plan of something like $2700/year now, but it costs me less than $60/month (when I last checked - it's on autopay).

I'm 70 and live in Cape Coral, Florida. When my PSA began to climb last July, going from the 3s into the 4s and 5s, my nurse practitioner sent me for a 3-T MRI at a local hospital. No problems with Medicare. In reading the results, the radiologist predicted I had a high chance of prostate cancer. So I thought about that and called Moffitt Cancer Center in Tampa, about two hours away. There I had a biopsy, PSMA PET scan and Decipher Test. I have a 3+4 and 4+3 Gleason 7 score and was given the option of Radiation or Surgery. My decipher test shows low risk. So I probably have some time despite the 4+3 Gleason score. I spoke to the Moffitt surgeon, and two radiologists there - one for brachytherapy and one for the SBRT route. Their Mridian Viewray, according to what I've read in forum posts, went offline in October. I wanted to check elsewhere and have done three Zoom consults - with The Mayo Clinic in Florida, a couple private clinics in Florida offering focal therapies and a prostate laser treatment center in Houston, Texas. I also visited two local practitioners for photon therapies nearby. I did a lot of research and treatment considerations.

So you can see I'm of the opinion that everybody diagnosed with this disease should check every available and affordable therapy. And that includes Proton Therapy. With traditional Medicare, you could likely go anywhere in the United States if you live here. Plenty of proton therapy centers have been built over the last 20 years. The one I'm scheduled for is at UFHPTI (University of Florida Health Proton Therapy Institute) in Jacksonville, Florida. The one in Loma Linda, California was, I believe, the first one built over 20 years ago. Pick where you think you want to spend your "radiation vacation" and apply there. UFHPTI will Fedex you a very informative package that includes a couple of books written by recipients of this therapy. This will cost you nothing. Just go online and fill out the form. Gather information and research like this for all known therapies from all centers of excellence. With traditional Medicare, you can control your therapy destiny. Good Luck!

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Fantastic comment, thanks for the good advice and best of luck to you in your proceedure. I'm interested in knowing if any of the MRIdian machines are still online. I'm waiting for a call back from Hoag hospital her in So. Cal. I'm thinking that since Viewray is no longer in business that maybe I'll of their equipment is off line now. I know UCLA's is down

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