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Lupron and Medicare Part D

Prostate Cancer | Last Active: Jul 18 1:20pm | Replies (19)

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@fortunateoldguy

You may not qualify for a Medicare supplement (Medigap) plan as you already have a cancer diagnoses. Supplemental plans are underwritten by an insurer and preexisting cancer of any type can be a knockout factor and may result in denial or coverage. If you are granted coverage, the question is at what price they charge. It will likely be high due to the preexisting cancer diagnosis.

Instead, look at a 5-star (preferred if you can find one) or 4-star Medicare Advantage plan with a Plan D drug plan that includes Lupron in their formulary. It’s generally a Tier 5 drug which are pricey. You can’t be denied and most 5 or 4 star plans are every bit as good, if not better than Medicare supplemental plans. Work with a qualified insurance broker near your primary residence as they will compare all the plans for you in your area and don’t fall for the Medicare Advantage plans you see on TV commercials.

Also check for copay assistance that maybe available from the manufacturer, Abbvie.

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Replies to "You may not qualify for a Medicare supplement (Medigap) plan as you already have a cancer..."

@fortunateoldguy Actually, if @bluegill is signing up for Medicare for the first time and looking at Traditional Medicare the insurance companies that sell supplements are no longer allowed to turn him down due to cancer or any other pre-existing condition. That used to be the case but it was changed some time ago. I looked at this very carefully when I first signed up for Medicare. If he chooses to go with Medicare Advantage and later on wants to switch back to Traditional Medicare and wants a supplemental plan then the insurance companies could very well turn him down at that point in time.

@hbp also writes about Medicare and what he learned. He landed into an exception that worked for him.