Best Medicare Advantage drug plan for Prostate Cancer?

When I went on Medicare in 2019 I decided on Traditional Medicare in order to have the flexibility to go to any clinic or provider that I chose. I live in the Upper Peninsula of Michigan which is rural and so our choices here are limited.
For that reason I did not want to be in a Medicare Advantage network. If you live in a larger urban area such as NYC, metro Detroit, or the San Francisco Bay Area then your network on a Medicare Advantage plan is very broad and you’d have lots of choices within your network.

I pay $150 monthly out of pocket for Plan G for my Medigap Supplemental Plan and the Part B cost, $163.90 that is set by the federal government although the Part B cost is determined by your Social Security as it is based on income. When I add up the annual cost of Traditional Medicare I figure I pay about $4200/year including my Part D (prescription) plan and prescriptions. The deductible is also set yearly by CMS and for this year it was $223 for Part B.

What do I get for that annual out-of-pocket cost? First of all, I can afford the monthly costs for my Medigap policy and Part B cost. Secondly, I get flexibility.

In my view Medicare Advantage Plans are good if you are healthy overall. I was diagnosed with endometrial cancer in 2019 and the costs associated radiation therapy, surveillance appointments, and tests would have been far more expensive to me under a Medicare Advantage Plan. ($300,000 in one year so with a deductible and co-pays from an Advantage plan I would have paid a lot more). And, I would not have been « allowed » without prior authorization » to go to Mayo Clinic which was and is my choice.

Medicare Advantage Plans look promising at first glance. The private insurance companies that contract with the federal government in the US through CMS operate very much like the health care plans many of us were used to when we were employed.

And finally, trying to understand the rules associated with Traditional Medicare with the Medigap policies vs. Medicare Advantage Plans is truly mind boggling.

My pipe dream is that traditional Medicare would offer a Medigap supplement instead of consumers having to deal with insurance companies. I know that will never happen as insurance companies keep politicians well-lubricated with campaign contributions. I also pipe dream about Congress having to use the same insurance morass that citizens do rather than their priveleged insurance program. Maybe then we would see some meaningful reforms.

Have same insurance. Optum RX under medicare charges $100 a month for Abiratetone ($800 at CVS) and Lupron is only regular office visit fee at Dr. office.

It is amazing what gets billed. But that is not what Medicare or any insurance company pays. I read that no one knows why hospitals have such expensive billing practices, where they come from....but it explains why people without insurance go bankrupt because they get charged the "retail" price and have to bargain down.
Is the $300 per month for brand or generic?
Two years ago I was distracted with my new lung cancer so did not pay attention to the "small print" in my drug plan. They had cut my previous plan and rolled me over to the most expensive one. I thought "smarties" and I chose a middle of the road premium plan but did not notice the part about how tier 1 and tier 2 drugs would count against the deductible - almost no other plan does that. I expected to pay something like the year before BUT NO. They charged me full retail price on Tier 1 and 2 drugs until I met the deductible and only then did I get the cheap copay. Last year I paid attention in my new enrolment!!!! I AM PAYING $900 LESS IN 2023 THAN 2022 FOR THE SAME DRUGS!!!!
No one can tell me what is the difference between a drug plan with a low premium and one with a high premium. Do you get expensive cancer drugs for much less? They always put PERCENT OF COPAY in higher tier drugs but the drug plan decides what the full price is on the drug so you can't just compare.

We need to all complain LOUDLY AND WRITE CONGRESS. I too have asked why the insurance company should make the money for picking up 20%. Let Medicare make the money and be able to provide more benefits.
Complaining does work. Being retired I have more time to check on things and I have $1000 extra in my pocket for all the mistakes I have found
I was in the hospital for C-diff some 12 years ago, and when I left I went to pharmacy to pick up a compound medication so that I would not need to go back to hospital. There was one pharmacist and then "technicians" and the technician did not know what a compound medication is and sent me away. My Doctor sent me to a compound medication pharmacy. I (being me) went back a few days later to investigate more and talking to pharmacist discovered that they had a compound pharmacy closer than where I had to go. Meanwhile I am out $170 because I went out of network - had no choice. So I called the pharmacy manager for the entire State of Florida and told her my story and said I know where I can complain because they put insufficiently trained individuals behind the pharmacy counter to save money and could have caused me to go back to hospital. The pharmacy reimbursed me my $170 out of petty cash! I told my insurance company - they make these contracts with pharmacies - and the insurance company paid the whole bill again - I did return the cash to the pharmacy (a reputation for honesty is important). Later I was notified by my insurance company that all the pharmacies in Florida would receive training on what is a compound medication because of my complaint.

He's on a generic chemo drug. Retail price is $27,000 per month. After insurance, 13,000 per month! Who and the hell can afford that?
Mayo Rochester got us Minnesota Drug Card which brought it fown to $300. We do not even live in Minnesota....my thought is Mayo has a lot of pull in the state. Thank the lord for their help or he wouldn't be taking the meds he needs. We are on SS and a modest pension.

Wow. For a generic drug!!! And it is off of patent otherwise they couldn't have a generic version. Almost no one could afford that. $300/month would be difficult for many retirees - and this is a country where most people do not have enough saved for retirement.
I have followed healthcare industry for decades (it was an end market for my company). I know they like to develop blockbuster drugs - a market of $0.5 billion. Rarer things are not so interesting to them because of small market.

And if someone goes with Medicare Advantage plan and then realizes they lost choice, and have to pay a lot out of pocket and they want to go back to original Medicare and get a Medigap Policy. Guess what? The Medigap insurer no longer has to accept you ...and since you will have lots of preexisting expensive conditions, they for sure will not want you!!!
I would like to take two cases of people with similar expensive health conditions and see how much each paid one in Advantage and one in Original Medicare. And how long it took to get appointments, tests and procedures, if most modern treatment available and what they had to pay out of pocket.
And what is scary is that these big clinics are selling Medicare Advantage plans also...they seem like they have lots of doctors but beware. My local Pulmonologist was in one and she was without experience in my lung cancer and ordered dangerous needle biopsy (which also does not stage a cancer). I went to Mayo and got much safer and more informative bronchoscopy biopsy.

If you are going into Medicare with a health profile that points to serious problems down the road and/or have limited assets and income, get a Medigap policy! The Advantage plan with no premium is pretty attractive, but you have to have assets or income if something bad comes along. Most Advantage plan have an ANNUAL out of pocket limit for doctor and hospital expenses, mine is $3900. On drugs you have to be able to get through the `donut hole` to about $7500 out of pocket, then copays become minimal. I`ve been on a no premium Advantage plan for over 18 years and figure I`ve saved about $40000. I`m mid eighties now with cancer so I may or may not use that up with out of pocket $ going forward. The person trying to sell you the Advantage plan probably is only talking numbers when they should be taking a deep dive on your heaith profile.

Is it possible to just indicate if Mayo accepts ANY Medicare Advantage? I suspect they don’t. However, if you’ve reached your maximum out of pocket (MOOP) amount on your MA plan, MA plans usually allow you to go to any out of network provider,Mayo included I presume, and MA will then cover all Medicare eligible expenses in any amount. Of course, this doesn’t include separate Part D drug costs. My MA plan has a MOOP of $3400 annually.