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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I don't have either of those, instead have PV. However, in the past I had an Advantage plan when I lived in Houston. I found it very limiting having to go thru doctors for referrals and difficulty getting appointments quickly. You would think in a big city there would not be that issue. You also have to use their doctors which is like going to a HMO. My brother was going to change but found none of his doctors were on the Advantage plan.
I live in a small town now and would not have access to many doctors if I was still on that plan. I have also been told by my insurance agent that once you are on the Advantage plans, you will have trouble changing to anything else in the future. As it is, with the supplemental that I have I cannot change policy holders since I have PV since I will be limited in companies that would pick me up and insured me. Hope that helps, but this is only my experience.

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@casevin7

I don't have either of those, instead have PV. However, in the past I had an Advantage plan when I lived in Houston. I found it very limiting having to go thru doctors for referrals and difficulty getting appointments quickly. You would think in a big city there would not be that issue. You also have to use their doctors which is like going to a HMO. My brother was going to change but found none of his doctors were on the Advantage plan.
I live in a small town now and would not have access to many doctors if I was still on that plan. I have also been told by my insurance agent that once you are on the Advantage plans, you will have trouble changing to anything else in the future. As it is, with the supplemental that I have I cannot change policy holders since I have PV since I will be limited in companies that would pick me up and insured me. Hope that helps, but this is only my experience.

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Thank you! Your comments are helpful! Blessings.

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I am an active multiple myeloma patient, but also a kidney dialysis patient. For the last 5 years I have been under a Plan F for my supplement, but premiums are getting outrageous. While looking into alternatives, my dialysis clinic told me they will only work with a supplement plan, not a Medicare Advantage plan.

So, I have a lot of things to look in to. sigh....
Ginger

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Oh my...I am so sorry. This is a concern I was wondering about. I have discovered that there are community-based Medicare supplements that only go up for inflation but not each year with age. (AARP/United Healthcare is one of those and there are a handful of states that require that as an option).

Thank you for your reply--this is exactly what I was wondering.

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@gingerw

I am an active multiple myeloma patient, but also a kidney dialysis patient. For the last 5 years I have been under a Plan F for my supplement, but premiums are getting outrageous. While looking into alternatives, my dialysis clinic told me they will only work with a supplement plan, not a Medicare Advantage plan.

So, I have a lot of things to look in to. sigh....
Ginger

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Also, reducing to a Plan G can reduce premiums for a while, but you have to pay the deductible each year (I think about $244 for 2024). Then everything else is covered. Considering changing my F husband to a G plan.

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@agatha679

Also, reducing to a Plan G can reduce premiums for a while, but you have to pay the deductible each year (I think about $244 for 2024). Then everything else is covered. Considering changing my F husband to a G plan.

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@agathat679 I live in Oregon, and have a United Healthcare Plan F. My premium each month start at about $240. I will be looking in to a Plan G, thanks!
Ginger

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Wow! $240. Plan G could help at least for a while until they keep raising it too.

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I haven't researched this topic, but I know that the only Advantage plan that Mayo Clinic in Phoenix/Scottsdale accepts is the one that's affiliated with Arizona State University. I know this because my husband has that one, and keeps getting weirded out about getting dropped. Don't know if that would happen, but I do know that he's been told that it's the only Advantage plan they accept. Good luck!

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@nancyworld

I haven't researched this topic, but I know that the only Advantage plan that Mayo Clinic in Phoenix/Scottsdale accepts is the one that's affiliated with Arizona State University. I know this because my husband has that one, and keeps getting weirded out about getting dropped. Don't know if that would happen, but I do know that he's been told that it's the only Advantage plan they accept. Good luck!

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Yikes! That would weird me out too! Seems those Advantage plans are all too variable. Thanks!

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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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