Best Medicare Advantage drug plan for Prostate Cancer?

Posted by josgen @josgen, Sep 28, 2023

I am switching Medicare Advantage plans this year and have pC treatment pending in 2024. I am concerned about the high cost of drugs and whether the standard drug plan that comes with the policy will cover the drugs I may need, and/or at what cost. Would love to hear how others fared with this situation. Thank you.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

MA plans contract with a provider network and that is one of the ways that they keep their premiums low and can provide additional (minor) benefits. .
If you are not in network, you need an exception to be treated out of network.
MA plans try to "squeeze" providers on reimbursement, and some top line facilities will not accept the reduced payments.
Traditional Medicare together with a comprehensive Med Supp (G) provides the most coverage and choice available, if you can afford the Med Supp premium.
Nothing wrong with MAs per se, just understand that they are private insurance companies marketing a profitable product, with network restrictions.

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@michaelcharles

MA plans contract with a provider network and that is one of the ways that they keep their premiums low and can provide additional (minor) benefits. .
If you are not in network, you need an exception to be treated out of network.
MA plans try to "squeeze" providers on reimbursement, and some top line facilities will not accept the reduced payments.
Traditional Medicare together with a comprehensive Med Supp (G) provides the most coverage and choice available, if you can afford the Med Supp premium.
Nothing wrong with MAs per se, just understand that they are private insurance companies marketing a profitable product, with network restrictions.

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For instance, a company starting with the first letter of the alphabet refused to cover my mpMRI. When I appealed I never heard a thing back...ever! Fortunately, I could afford to pay for that MRI, even though it turned out the in-network provider had less than up-to-date equipment and I had to redo it. Further, the redo, to guide the transperineal biopsy, found a more advanced node of cancer that the first MRI missed in either the view or the analysis.
And, fortunately for me, I was within the initial window after age 65 that allowed me to switch back to traditional medicare with a high-deductible plan G supplement, and not to deal with the medicare advantage squeeze for people who actually need expensive care.

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When switching or picking a Medicare supplement it is best to review costs, benefits, including part d drug plans with a qualified agent that can help pick the plan best for you. They are independent and cost you nothing.
The details of your costs and most importantly the availability of providers are best reviewed with the agent who will give you the best analysis of plan’s available. And MA is likely not your best choice and plan G may be your best supplement.
Good luck but rely on an expert not associated with any insurance company.

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Some time ago this came up and a lot of discussion about Medicare and difference with Medicare Advantage. I had mentioned a yearly letter put out by Mayo Jacksonville on this subject each year. I recently got this for 2023 and have pasted it for review. It covers Jacksonville Mayo not Phoenix or Rochester but explains that Medicare Advantage is NOT traditional Medicare that Mayo Clinic will take.
_________________________________________________________________________________________________________
At Mayo Clinic, our patients are at the center of everything we do, and your trust is very important to us. Sharing information is one way to help ensure we continue to be trusted partners for your health care needs.

As you may be aware, beginning in mid-October, it will be time to select health care coverage for 2024. Mayo Clinic in Florida is not in-network with most Medicare Advantage Plans. We want to be sure that you are aware that Mayo Clinic in Florida will not schedule appointments for patients with out-of-network Medicare Advantage Plans.

Many patients are making elections for their coverage in 2024, including Medicare. Marketing for Medicare Advantage Plans may indicate that you can be seen at any facility that accepts Medicare, however Mayo Clinic in Florida is out of network on these plans.

Medicare Advantage Plans are managed by commercial insurance companies on behalf of Medicare and offer a specific network of contracted medical providers and hospitals, which may not include Mayo Clinic in Florida. These plans are required to have a substantial network of qualified providers to accommodate their members' medical needs.

As you consider your options for health coverage, you can confirm Mayo Clinic's participation by providing the insurance plan under consideration the Tax ID information below:

Mayo Clinic Florida Hospital 59-0714831
Mayo Clinic Florida Outpatient Clinic Services 59-3337028

We do accept Original Medicare (Parts A and B), and supplement plans, sometimes referred to as Traditional Medicare. If you choose to enroll in a Medicare Advantage Plan, we can provide your medical records to the next in-network facility you select for your care.

Learn more about your Medicare options online, or by calling Medicare (1-800-MEDICARE), or a State Health Insurance Assistance Program (locate a local resource by calling 877-839-2675). Mayo Clinic is not authorized to assist with Medicare enrollment decisions.

Please continue to update Mayo Clinic on any changes to your health care coverage.

Sincerely,

Mayo Clinic in Florida Leadership

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