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SF Bay Area provider recommendations

Prostate Cancer | Last Active: Sep 27, 2025 | Replies (10)

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Profile picture for thmssllvn @thmssllvn

Medicare has traditional fee for service [FFS] care. A; Hospitals, (automatic ), B: 'doctors' D; drugs. B & D are optional most get B & D. You do need to register for Medicare before it would be in force.

Supplemental Insurance: coordinates with A, B & C depending on one of the 10 state approved 'Medi-GAP' policies. Jeff mentioned there may be problems getting insured (Health) with diagnosis of Prostate Cancer. I believe he is referring to these supplemental Medi-Gaps.? I do not know how the Affordable Care Act [ACA'] anti-discrimination to prior illness protection applies if at all. Medi-Gaps often pay the annual 'in patient deductible' for 'A' costs., it typically pays for co-pays of 'B' costs. My brother has an AARP (UHC) supplemental Medi-Gap which pays 80% of his 20% B co-pays or 16% leaving a 4% residual responsibility.

NOTE: Medicare is the final payer. If a spouse is younger and still in the workforce with generous group health insurance available to both of you: double
check the added costs of the spouse and review coverages carefully. Group pays first, Medicare A, B, D next. The various plans are stacked in order and after consideration and payment if any the claim is automatically forwarded to the next payer if any.

Medicare Advantage is the managed version. Although cheaper for the time being because of federal subsidies it limits Out of Network care options, e.g., only exclusive providers [EPO] or it cost too much for non-preferred docs.[PPO]. With traditional FFS Medicare plans you could go to Mayo HQ to get a choline PET-CT scan if useful as it is the only place that has it. Forty years ago I knew someone who went there because he had FFS traditional Medicare. At the time they were the only place to use 3D CT fabrication of hips not the modified off the shelf versions. He was young for hip surgery, every advantage was helpful for him to avoid early revision with the unique duplication of his anatomy.

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Replies to "Medicare has traditional fee for service [FFS] care. A; Hospitals, (automatic ), B: 'doctors' D; drugs...."

@thmssllvn

At the recent PCRI conference they mentioned that the choline PET scan is not worth getting. Much preferred to get the PSMA pet scan or the FDG pet scan if there is a question about another cancer type or neuroendocrine cancer.

@thmssllvn
Thank you for your reply specifically about Medicare. We just had a meeting this morning about options going forward. Here’s what we found out which may be helpful to others.
We are not on an Advantage Plan as my husband only signed up for Medicare Part A when he was 65 and he just kept his regular Kaiser plan through employment. He will be able to sign up for Supplement (he’s going with plan G) within 6 months of signing up for Part B. We were able to confirm that it would be very, very difficult to go to a Supplement if he were on an Advantage plan because of the preexisting condition of cancer. They can’t refuse him if he takes the Supplement Plan first. We were being pressured to take the Kaiser Advantage plan through insurance brokers that the company works with to manage the health insurance. We were told we could always switch later. I’m very glad we investigated further.