MBC and Going on Medicare soon, any advice.

I have an HMO Medicare supplement in California. I'm 81. It is wonderful! I've had great care during my cancer treatments and other minor problems. I couldn't ask for better care. I'd have had to sell my house without it.

I have a Medicare Advantage Group PPO plan (retirement benefit from state university in AL) and am getting all of my treatments (breast surgery/lumpectomy, oncoplastic surgery for symmetry and radiation) and ongoing care at MD Anderson…$18 copay to see docs and ~$200 deductible…I’ve been very grateful for the Medicare Advantage coverage!

I would go broke with an $18 copay. Between us, we have had 18 Office visits in 2023.

@eaglewings22 s22 how much do you pay for premiums total? $18 for specialists seems pretty good to me, in the context of low premiums. Curious to compare.

I really am not sure, because it is deducted from my partner’s retirement check and the annual insurance cost includes her non-Medicare Advantage health insurance as well as my Medicare Advantage PPO plan. I’d guess $200/mo? That is a pure guess…

In my MA plan there are no in-network/out of network hospitals or doctors, so we can self refer to any place or person. Pre-authorization for imaging and some treatments are required, but so far, so good.

Call SHIP. Trust SHIP. The multitude of plans out there, which vary by state, will just confuse you. I believe you'll find you've wasted a lot of time and caused yourself undue stress by doing this research yourself. SHIP volunteers are not affiliated with any insurance company and thus are totally objective. While I appreciate all contributors to Mayo Connect, I doubt this is where you want to be for this issue as you will be looking at plans specific to your region. Good luck.

My medicare starts in April and because of my cancer and knowing what bills to expect coming up what I have chosen. The traditional Part A and B both pay for almost everything the big thing you have to look at is "coinsurance" and that is where the big costs are. I have Medicap G plan which is the plan that covers the most out of pocket expenses. Medigap G will cover coinsurance costs as well as Medicare Part A deductible, it does not cover the Part B deductible which is 233.00 annually (it is subject to change each year) Also bonus and I am excited about this my Medigap G plan also cover gym membership for free! My premium will be 114.00 per month for G. The gym membership is 80 or 90.00 per month so it's a no brainer for me.
Also many of the hospitals that accept medicare "assignment" accept original medicare payment as payment is full. Not sure if that is true with the Medicare Advantage plans.
When looking at "Advantage" plans look at the deductible and the "maximum out of pocket costs" Add these 2 together to know what you will be paying out each year to cover your medical costs if you have a lot of medical expenses. Then look at original parts A&B with a medigap G policy. Your total out of pocket for the year will be 233.00 plus the Medigap G premium.
Also, her initial enrollment is a guaranteed acceptance, this only happens once and that is this one time in her lifetime. After initial enrollment all bets are off on how much they can charge you and even offer you insurance. Be VERY VERY careful what you do this one time. They can and will assess penalties each year and ask health questions etc. It's a bit of a now or never scenario.
Hope some of this helps!!

I would not recommend Medicare Advantage. I picked part G. And yes - the premiums are tied to income. I got slammed this year - because I withdrew some IRA monies for home remodeling in 2021. So I'm paying almost double Medicare premiums this year. My sister who worked in medical insurance - said she knew more people who regretted picking part C (Medicare Advantage), as it does not pay well. It is hard to convert from part C to part G in the future - you WOULD have to answer health questions at that time. And they can turn you down.

In my state SHINE programs at senior centers and city halls, as well as financial counselors at hospital financial resource centers, help us decide. I went to 4 and followed their unanimous advice. I agree with @dlmdinia that seeking that kind of help is best.

48% of Americans are on Advantage plans but in this thread, it seems more like 10%. I would not want anyone to trust me or others on this. It is very individual. There is a lot of help out there. Otherwise I think the default that makes people feel safe is "regular" Medicare.

Hi Jackiestack, I have recently been diagnosed with MBC after my initial BC diagnosis is 2018. My onc prescribed Verzenio but my PartD plan with BC/BS in Kansas denied it. They approved Ibrance and, after numerous appeals, I recently switched to Ibrance. Do you have experience with either of these drugs? What has your onc recommended as an immunotherapy? Have you tried holistic approaches? Sorry about all the q's, this is new territory for me.
Thanks in advance!