Anyone else have Medicare Advantage

Posted by paulcalif @paulcalif, Feb 11 3:43pm

I've been studying many of the various treatments for prostate cancer. Today it dawned on me that since my insurance plan will only cover a limited number of different treatment options (no idea what they will cover), it might make more sense to only look into the covered treatments. So I'm asking if anyone else here has a Medicare Advantage plan that has already been treated. If so, what type of proceedure did you have. Also, were you able to discover what alternative treatments were available to you. AND, if your insurance didn't cover your proceedure and you paid out of pocket, how much did it set you back? I know some of you will feel this is personal financial information that you won't want to share online and I respect that, but if you do care to share I would really appreciate it, and I'm sure future patients will find it helpful. Thanks in advance 🙂

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

@aiseman

I tried making an appointment at both Mayo Florida and Arizona.
I was hoping to stay with relatives there during my treatment.

Mayo Florida told me they don't have proton therapy; but that they can refer their patients to university of Florida for proton treatment. However, they don't accept any advantage insurance plans.

While Mayo Arizona does have have proton therapy, they said advantage plans are usually a problem and more difficult to approve.

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Mayo MN does accept some Advantage plans and does Proton Therapy for Prostate Cancer. They also have Hope Lodge for people undergoing transplants and cancer treatments. You might want to check them out.

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Well, I'm attempting the switch to Original Medicare with a Medigap plan G and prescription drug coverage. I hadn't realized that the Medigap plan did not include drug coverage. The drug coverage is an additional $188 a month. So, I selected Medigap G plus dental plus vision plus a drug plan. All told, $420 a month. Still cheaper than paying out of pocket for a state of the art proceedure. And better than the budget proceedure undoubtedly covered by Medicare Advantage. I went through the sign up process, which was not a simple task. I made repeated phone calls to the Blueshield representative asking questions about their menu options. I think I completed everything, but expected 2 welcoming emails (Medigap and Drug plan), but received one. I'll be back on the phone Monday.
On another subject, I confirmed that UCLA'S MRIdian is out of order and that Hoag hospital's MRIdian is up and running. Once I've confirmed that the Medicare switch is complete, I'll do a consultation with Hoag.
Does that sound reasonable?
Thanks guys!

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@paulcalif

Well, I'm attempting the switch to Original Medicare with a Medigap plan G and prescription drug coverage. I hadn't realized that the Medigap plan did not include drug coverage. The drug coverage is an additional $188 a month. So, I selected Medigap G plus dental plus vision plus a drug plan. All told, $420 a month. Still cheaper than paying out of pocket for a state of the art proceedure. And better than the budget proceedure undoubtedly covered by Medicare Advantage. I went through the sign up process, which was not a simple task. I made repeated phone calls to the Blueshield representative asking questions about their menu options. I think I completed everything, but expected 2 welcoming emails (Medigap and Drug plan), but received one. I'll be back on the phone Monday.
On another subject, I confirmed that UCLA'S MRIdian is out of order and that Hoag hospital's MRIdian is up and running. Once I've confirmed that the Medicare switch is complete, I'll do a consultation with Hoag.
Does that sound reasonable?
Thanks guys!

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Check the coverages and coverage amounts for vision and dental.
My research indicated high premiums, limited $ coverage and pre-existing condition exclusions.
I have Medicare A & B, Med Suppp G and drug Part D.
Self insuring for dental and vision.
Note that medical conditions, such as Glaucoma, are covered by Medicare.
Best wishes.

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Thanks for that info. I "think" I've already signed up. I was expecting two confirmation emails, one for Medigap and one for Part D. I only got one that doesn't say which it's for. I need to follow up tomorrow. Do you know how or if consultations are covered? I read that they are covered if referred by a physician??

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I confirmed that Hoag hospital in Newport Beach CA has an operational MRIdian. Anyone know if Hoag has expertise in Prostate Cancer treatment? I was leaning toward UCLA, but with their MRIdian down, I'm having 2nd thoughts.

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@paulcalif

Fantastic comment, thanks for the good advice and best of luck to you in your proceedure. I'm interested in knowing if any of the MRIdian machines are still online. I'm waiting for a call back from Hoag hospital her in So. Cal. I'm thinking that since Viewray is no longer in business that maybe I'll of their equipment is off line now. I know UCLA's is down

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I understand that Lee Health in Ft. Myers (near me) is also down, on a new Mridian machine that just went online last year. They're trying to hire engineers and other experts to service the machine directly and get it working again. They told me they were probably a year out.

I know Elekta has a MRI guided machine similar to the ViewRay Mridian, the Elekta Unity, but somewhat limited to locations here in the states. I know the University of Florida in Jacksonville just brought one of these machines online: https://ufhealth.org/news/2022/uf-health-unveils-imaging-machine-one-42-world-tackle-difficult-cancers. So I suppose I could choose protons or photons at UF Health in Jacksonville with my traditional Medicare, but I'm going with Protons for less extraneous radiation exposure. Moffitt in Tampa is building a proton treatment center, but it won't be online until 2026.

The thing is, with traditional Medicare, you can just call the treatment center you are interested in and inquire if they accept your insurance and go from there.

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Might be a good business opportunity for Viewray's engineers and or techs, to service the MRIdians. But parts may not be available.
I hope the woman I spoke with at Hoag was correct in that their MRIdian IS running. I’ll look more on that next week.

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@paulcalif

Pretty much what I expected with medicare advantage. I think I'm stuck with my Advantage plan at this point, so original medicare is not an option. I think I can change to a different network if that might get me to a different medical facility, but I'm not even sure about that. Tuesday I'm scheduled for a PSMA Petscan and I have a video conference scheduled the following day with my GP. I'm hoping she'll have some insight into how referrals, second opinions and available proceedures work. Having info. about traditional Medicare is eye opening and a little depressing. I'm afraid it's too late to switch for me (I'm 68). So what I'm really looking for is how to navigate within my Advantage plan. It's starting to look as though I'm stuck with whatever my network offers me.

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There are 2 periods each year when you can switch Advantage plans...you probably already know that, but just in case, there it is. Kaiser has its own limitations, but it is non-profit, and they do have many excellent MDs Kaiser here in our area does make patient referrals to the local med school clinic for certain procedures....it took an appeal, but I was one who was referred when Kaiseer had not yet puchased certain equipment required for a certain procedure. My Kaiser MD supported me in my appeal!!! I believe Kaiser MDs are primarily salaried, so less worried about having fee -driven suggestions for certain treatments!!!! Fantastic patient friendly elctronic record and provider messaging systems!!! I know that if I switch to traditional Medicare that dealing with my records and having instant access to evrything done for me, all visits, tests, etc may be very frustrating in comparison to the Kaiser system!!! Do some people talk about unhappy experinces while with Kaiser? Sure, but you probably don't hear from the many more who are very happy. There are gripes about experiences with priavte clinics, but since many more folks intereact with Kaiser than any certain private clinic, you are of course much ore likely to hear compaints about Kaiser.

As you age past 80, you may well find yourself facing total premiums for a supplement plan, dental, and drugs in excess of $500-$600. That won't happen with Advantage plans!!

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Thanks for the reply. I was with Kaiser for many years, and really have no complaints. I switched to a Blue Shield advantage plan because the large Kaiser facilities were several miles and because the maximum yealy out of pocket was 3x that of blue Shield. Though in the past I never came close to my out of pocket max. Blue Shield may have referred me to a local med school, I'm not sure, and didn't want to chance it. If I get this procedure paid for and all worked out this year, I may switch back to an advantage plan. I really appreciate your feed back, especially the fact that the Medigap fee will increase with age, I hadn't considered that!

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