Prostate cancer care and Medicare

I have original Medicare and TriCare for Life. They’ve covered everything.

I have Medicare (not Medicare advantage) plus a supplement and they covered everything.

I also have Medicare and United Health thru AARP - covered all salvage radiation but I did have a $2000 copay for 6 months of Orgovyx.
But it lists for $2800/mo. So I didn’t complain!
Phil

I have Original Medicare and a Part D prescription drug plan. My only out-of-pocket costs have been towards a portion of the Part B deductibles in some years:
> 2020: $198.00.
> 2021: $136.30.
> 2022: $144.03.
> 2023: $45.66.
> 2024: $0.00.
> 2025: $0.00.
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I’m on original Medicare with a supplement and a drug plan. Regarding care decisions, with original Medicare I can go to any provider that accepts Medicare without referrals. Regarding costs, my supplement has $0 deductible and picks up any excess Plan B charges. So for my NS RARP at Mayo Phoenix I paid $0 and never saw a bill. Under my drug plan I did have a small copay for my take home prescriptions at the Mayo pharmacy, but no charges for the drugs during my operation as they’re covered under Part B. But I do have my monthly Medicare Part B premium, my supplement monthly premium, and my drug plan monthly premium. As I understand it, the Medicare Advantage plans are “managed care”, so (generally speaking) the monthly premiums are much lower but there are copays for many services and (more important and concerning to me) they’re “managing” my care. And I believe most of them require referrals and limit you to their provider networks. Since you already have a high risk of needing additional care during your lifetime, if you can afford it you might want to consider going with original Medicare and a cadillac supplement (such as Medigap Plan G) and a good drug plan so you’re in control of what doctors you see and which treatments you select (within the limits of Medicare approved services). I’m no expert, but my understanding is that it’s usually pretty easy to later “downgrade” to a Medicare Advantage plan if you so decide. But if you go with either a cheaper Medigap plan or a Medicare Advantage plan, depending on the state you live in you might not be able to “upgrade” later without undergoing medical underwriting (which means the insurance company doesn’t have to accept you or can charge you a lot more). I’m not a medicare expert and I’m just sharing my opinion. You can learn a lot about your Medicare options and supplement plan prices at medicare.gov. Also you can search this website for "medicare" and you'll get a lot of hits. Best wishes.

well said. I also found Mayo Phoenix will not take a Medicare advantage plan. All expenses were covered with the Medicare original, plan F supplement.

Agree 100% with above posts.
Traditional Medicare together with a G supplement and a Part D plan the best coverage package.
If not affordable, Medicare Advantage second choice with possible network limitations.
Traditional Medicare w/o a supplement plus a Part D plan would be another option to maximize choice; however exposes you to copays and coinsurance.
Initial enrollment best opportunity to elect comprehensive Medicare Supplement; cannot be rejected or priced higher for preexisting conditions.
Best wishes.

My husband has gone to Mayo Rochester for prostate cancer treatment and monitoring since 2011. He has original Medicare and a supplement through our university and a Part D prescription drug plan through AARP/United Healthcare. Rochester does take original Medicare, but the other two campuses do not, as far as I know. Between Medicare and the supplement and his part D plan, everything has been covered 100% except for occasional not large drug copays, which are now capped at $2000 per year.

I have an original Medicare plus a part F Medicare supplement. I was treated at Mayo Clinic Phoenix, and it was completely covered by my Medicare and supplement.

I have traditional Medicare plus a supplemental plan from CareFirst (BC/BS of Maryland) that covered everything. I didn't have Orgovyx (wasn't told about it and didn't do research) so I don't know if that would have been covered. The Elegard I actually received was fully covered. I had the PET scan too and that was fully covered.
I would never think of enrolling in a Medicare Advantage plan. You might get frills like gym memberships, but for real medical problems, you would be constantly fighting with the insurance company and losing.