Best Medicare Advantage drug plan for Prostate Cancer?

Q a bit broad.
In general: Most/many MA plans dictate Part D drug plan coverage option(s).
Initial ADT is available by injection (covered by Part B Medicare). Orgovyx (ADT med) covered by Part D and may have significant out of pocket costs.
Hope this is helpful.

You can enter your drugs into a Medicare site and it will tell you the total cost of premiums, deductibles, and copays for the year based on your drugs and your pharmacy. Some insurance or financial advisors will help you with this as well.

@josgen, I'm tagging @naturegirl5 on this discussion to share more about medicare and Advantage and how they differ. You might also be interested in these discussions:
- Does Mayo Clinic take Medicare?
https://connect.mayoclinic.org/discussion/does-mayo-clinic-take-medicare/
- Medicare and Mayo Clinic: What does Medicare cover?
https://connect.mayoclinic.org/discussion/medicare-and-mayo-clinic/
Have you checked with the cancer center where you receive care to be sure they accept the insurance plan you're considering?

@josgen Medicare Advantage plans and what the copays and deductibles are differ between companies and also among plans within the same company. Think of Medicare Advantage plans in this way. You sign up with say a private insurance company, Aetna (as an example) for your Medicare Advantage plan. The US government through Medicare pays Aetna to administer your plan. Under the Aetna plan you are required to see medical providers that are part of their network “in network”. If you see a provider outside their network, you pay more for “out of network”.

Here is something that is useful. If Medicare covers the medications then the Medicare Advantage Plan is also required to cover the medication. How your Plan covers the medication may be a percentage of the cost or a co-pay. If Medicare does not cover the medication then the Advantage Plan is not required to cover the medication.

Do you know the names of the medications that will be prescribed? If yes, then I suggest you call the Medicare Advantage company that administers your plan and ask how these medications are covered. You can also find out information by submitting the names of the medications to the Plan you are considering and see if costs can be calculated.

Medicare

— https://www.medicare.gov/

Some medications such as chemotherapy that are administered in a hospital infusion center are covered differently than an outpatient prescription medication. Like @colleenyoung suggests, I also suggest that you call the cancer center where you receive your treatment and make sure that they will take your new Medicare Advantage plan that you are considering.

Does this help to answer your questions?

Thanks everyone for your replies. I've since learned a lot about the drug situation and have decided to stay with Medicare Advantage for now and hope for the best!

You can run your drugs through the medicare website to find the best plans to cover your drugs. Most drug companies will give you free or reduced drugs based on your income. If your income is really low you may be eligible for a free drug plan. If you are a Veteran you may be eligible for drugs through the VA. Find yourself an agent that works in this area that is contracted with most of the plans.

I live in the DFW area and currently have the AARP United Healthcare Medicare Advantage plan.

I recently received 45 Radiotherapy treatments for my PC. My share for these treatments was $3,010. This included the initial onocologist consultation and 2 examinations as well as the simulation and setup.

The initial estimate from the oncologist was $6k ish. During the whole insurance billing process the oncologist billing department kept trying to get their orginal $6k from them but denied most of the charges. Basically the oncologist only got the $60 per treatment, which was the co-pay for each radiation treatment.

As far as the drugs goes the ADT (lupron) was a different story. The urologist said my copays was $300. But when they billed the insurance company they said my share was 20% of the allowable amount which came out to about $800. But the interesting thing was the urologist sent me $150 check and also credited me the rest as a good gesture.

Haven't gotten my second dose of the ADT yet so I don't know what the actual charge will be going forward.

So with all that said I am very pleased with the insurance I currently have.

Thanks for those specific numbers especially for Lupron. If $800 is 20% that means its (allowable) price is 4k. Whew! It appears that Lupron is Drug Tier 5 which has a 33% cost sharing in my area so you got a deal at 20%.

Yes, it is very important to understand the difference in Medicare traditional (Part A, Part B, Part D) and Medicare Advantage plans (Part C) where a private insurance company takes over and approval is required for visits and tests and you must stay in their network.
One does well to check the Medicare site each year and compare plans. Because insurance companies make small changes that impact final price!
And the plans available depend on where you live.
Many years ago, I fortunately went with traditional Medicare and bought a Medigap policy to pay the 80% not covered by Medicare. Then less than 2 years ago I was diagnosed with multifocal lung cancer, and so far have had two surgeries and one radiation treatment and more are planned as this cancer is like "chronic". I also had a cardiac blockage and needed a stent. Traditional Medicare allows me to self-refer so I said goodby to local doctors (and they lacked experience with my type of cancer and could not have offered latest in surgery options) and I went to Mayo Clinic (a 2-hour drive). I have never had to get insurance company permission for a test or to see any kind of specialist. In 2011 I needed ear surgery. I was living in Florida at the itme so I just went to the best place. I have never seen a bill for all the expensive treatments, not for any visit of any kind. If I think I need to see a specialist I just make an appointment. I pay $300/month premium for my Medigap policy but I can go anywhere in the US that accepts Medicare so good for vacation. I would never change plans. I have a simple Part D plan $17/mo premium. I have not needed any cancer drugs so I can't address that. But I can aways change the Part D plan if I should need any. From what I know about Medicare Advantage plans, I think they should be eliminated, and not offered.

We have tradition medicare and Aetna suppliment plan.
Radiation and multiple tests early this year. Total billed by Mayo was approx 250,000. We have not paid a dime out of pocket.
Zytiga --we pay $300 per month. Other scripts $5.00 per month on part D plan.