Prostate cancer care and Medicare

I have original Medicare along with a Blue Cross Blue Shield of MN supplement plan. I went to four different doctors for opinions and ended up at the Mayo Clinic in Rochester. I did not have to pay for any of the visits, tests, or scans. I purposely chose regular Medicare so that I would have the opportunity to go to Mayo if anything big ever came up, I didn’t expect it to be three months after I enrolled. I am very happy I made the traditional Medicare choice.

Since this is a medicare thread. I have been on medicare for 8 yrs. I qualify for plan F. Price keeps going up every year. I am now at $350 month with Humana. I like the silver sneaker option since I go to gym every day. My insurance rep says plan G is a little cheaper but other companies such as United Health Care and Blue Cross are similar in price. Plan G is about $90 month cheaper. Probably be better to pay the $275 yearly deductible. However Physicians Mutual has a plan G for $220 month. Anyone have Physicians Mutual? I would have to be pre-approved which gets harder the older I get.

I have Medicare advantage with Kaiser in Northern California. I really never had to fight with my insurance company, If I have something they treat it. I pay $91 a month for it, but that includes free membership in a gym And $300 every other year for glasses. My wife pays $70 a month because she doesn’t get the gym or glasses benefit.

I pay five dollars to visit a doctor, sometimes. I do pay around $200 for a PSMA PET test or an MRI. For knee replacement surgery I paid a couple hundred dollars. I do have to pay for drugs, The $2000 Max for Medicare, The $13,000 a month it cost for Darolutamide Paid for it the first month (I got charged a little over $2000), And the rest of my drugs are free for the year. I had surgery on a cyst on my face. It cost me $5.

I have a GU Oncologist To guide my treatment, And she has Acquiesced to almost everything I have requested. I did have a problem with wanting a PSA pet test before my PSA got above .2, But she agreed that once it hit .7, no problem. When Zytiga Started giving me heart issues. She had no problem giving me Darolutamide, even though it was not recognized for the exact cancer status I was at (at the time could not have metastasis to get it).

I’ve had two knees and a hip replaced without issues, My other hip was giving me problems and they agreed to replace it, But going to the gym regularly has made it so that it doesn’t hurt any longer, So I canceled the surgery when they called me to make the surgery appointment.

There is no insurance company per se when I have issues, My doctors work for the insurance company so their decision is what happens.

Be aware that many supplemental insurance companies will not insure you if you have prostate cancer. That may leave you with just Medicare and no supplemental coverage, unless you get Medicare advantage.

That's true if you try to change from an Advantage plan to a supplement or had original Medicare without signing up for a supplement. In fact, I doubt most (any?) supplemental plan would underwrite you at that point if you had PCa. But if you sign up for a supplement at the time of your initial enrollment in Medicare, there is no underwriting allowed. That's why I chose to go the supplement route with original Medicare from the get go. Plus some states have some limited ability to change supplemental plans down the road. For example, where you live in California, there's a "birthday rule" where you can change plans yearly to a like plan with a different insurance company. Not that great, but at least you're unlikely to be stuck with a single insurer.

Just one thing to include

If you have Medicare advantage and want to switch to original Medicare, then supplemental insurance companies can review your history (underwriting) to decide whether or not to cover you, even in California. If you do it within six months of joining Medicare, there is no underwriting. It’s possible there is a state out there that has different rules.

Ditto...