Best Medicare Insurance for MGUS and Multiple Myeloma?

Posted by agatha679 @agatha679, Nov 18, 2023

As it is time for Medicare insurance decisions I was wondering what kind of experience some of you have had with the Medicare Advantage plans versus original Medicare and a supplement when it comes to treating MGUS or Multiple Myeloma?
Do Advantage plans (Part C) give enough coverage for drugs and procedures, such as chemo or bone marrow transplants?

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@1oldsoul

I have MGUS and also considered an Advantage Plan but decided to stay with original Medicare+Medigap for the following reasons:
Once you are in an Advantage plan and decide you want to go back to Orig Medicare+supplement after one year, you will most likely have to go through underwriting with new Medigap insurer and they are under no obligation to accept you based on diagnosis and past medical needs.
2. Many Advantage plans have PPO plans where you can go to any doctor within their network without a referral (unless specialist requires a referral from GP which many do) however, this will necessitate making sure that each doctor you are referred to (including pathologists who read lab studies) are in network or you will pay a higher out of network cost.
3. There is a co-pay for most services including doctor visits, tests, ambulance, hospital etc so it can add up.
4. Most have a catastrophic out of pocket limit around $6500-$7,000 per year however that means if you ended up with a serious condition and had to pay a lot of out of pocket let’s say in December and then had more out of pocket expenses in Jan due to illness or accident you could potentially be spending $14,000 in a period of two months. (But then your catastrophic out of pocket limit would be paid for the rest of the year )
My husband and I have Mutual of Omaha plan F and pay around $146 per month each (I know that varies by state) which covers the Medicare annual deductible so we never have to worry about out of pocket costs unless it is something that Medicare doesn’t cover.
They have 100% US based customer service which is a HUGE factor for me as I absolutely hate calling the insurance company and taking with someone in a foreign country with an accent I can’t understand and hearing their kids yelling in the background or dogs barking while they work from home! (I am hard of hearing and accents make it more difficult for me to understand)
Hope this helps!

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Thank you so much you have given me a wealth of information! I appreciate you taking the time.

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Hi Agatha,

I have never had a Medicare Advantage. I have the good fortune to have an employer sponsored Medicare G plan and excellent drug plan at no cost to me. You can see any doctor or facility who accepts Medicare which is almost all. We used to spend winters in Florida so this was really important.

AT&T is stopping my husband’s $2700 a year Health Reimbursement Account and only offering an Advantage PPO Plan, We feel so strongly about this we are refusing my husband’s free AT&T PPO plan. We will now pay all costs for his Blue Cross plan G and drug plan. By the way, so far his Blue Cross G plan has had very modest yearly increases.

I have suggestions for you:

1. Look online for Christopher Westfall, Senior Savings Network. He gives all the pros and cons of Medicare supplements versus Advantage Plans. He has many videos with a wealth of information.

2. Call Garrett Ball directly at 877-506-3378. He is the owner of Secure Medicare Solutions. They are registered in almost every state. He will offer you the lowest premium at the highest rated company. He advises on companies that have a history of lower increases. There is no pressure dealing with him.

3. You could consider High Deductible G Plan.

One thing to remember is once you are on an Advantage Plan you would need to go through Medical Underwriting to change to a Supplement, With your medical condition you would most likely not be accepted.

After saying all this some people love their Advantage Plan. In my opinion they are wonderful until they are not!

Best wishes, Eileen

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Hi Agatha,

I have had & been treated for MM for several months now. I do have a Medicare Advantage plan with Excellus/BCBS and have been happy with it.

I did have to go into Medicare’s ‘donut hole’, but then got into its catastrophic phase where drugs’ cost to me was 5%.

One suggestion would be to contact your state’s SHIP (State Health Insurance Assistance Program) or to your county’s HIICAP (Health Ins Info Counseling & Assistance Program) Medicare counseling volunteers, sometimes based at an Area Agency on Aging.

To your health & best wishes!

Sue M

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@nsm52

Hi Agatha,

I have had & been treated for MM for several months now. I do have a Medicare Advantage plan with Excellus/BCBS and have been happy with it.

I did have to go into Medicare’s ‘donut hole’, but then got into its catastrophic phase where drugs’ cost to me was 5%.

One suggestion would be to contact your state’s SHIP (State Health Insurance Assistance Program) or to your county’s HIICAP (Health Ins Info Counseling & Assistance Program) Medicare counseling volunteers, sometimes based at an Area Agency on Aging.

To your health & best wishes!

Sue M

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Thank you so much. I'm glad your advantage plan works for you.
I was a little scared of how from one year to the next doctors might not be in network.
I appreciate your feedback.

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Thank you all for your feedback it was all very very helpful. I have made my decision to go with original Medicare and a Medigap plan mostly because I wanted to make sure I could keep my same doctors from year to year and that the out-of-pocket limits didn't cripple my finances since many of them were over $7,000!

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@1oldsoul
Yes! You and I are on the same wave length as far as your reasoning for a Medicare supplement rather than an advantage plan. As a matter fact, we also use Mutual of Omaha for our plan F. So far, I have paid nothing to my cancer center out of pocket.
Fingers crossed that this continues.
Before I chose a supplemental policy, I called my cancer center and talked to the billing department. They were very reluctant to recommend one policy over another, but I asked questions about several of the policies I was researching. They would answer the question “if I had X policy… Would this likely cover me if I had to receive treatment for multiple myeloma?“
Every provider that I see, had hesitation about the advantage plans. They are definitely cheaper. In the long term however, I thought it best to stay away from them.
Fingers crossed that we all find the most affordable plan.

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Thank you! You are very encouraging and though I am signed up for Plan G which is cheaper--I only have to pay for the $236 Medicare deductible and then everything else is paid for.
You expressed what my fears have been about the Advantage plans, thank you for re-affirming those thoughts.

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I’m very glad to have Medicare with a medigap (also called supplement) plan from BCBS of MN. My plan D is also thru them. I pay nothing for doctor appointments and testing. Also, I can receive care anywhere if I’m traveling.
After reading thru the responses I’m very glad I don’t have advantage plan.

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While not specific to MGUS or multiple myeloma, people in this discussion may also appreciate the helpful information shared in these 2 related 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/

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@colleenyoung

While not specific to MGUS or multiple myeloma, people in this discussion may also appreciate the helpful information shared in these 2 related 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/

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Thanks!

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