Medicare question and insurance

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 9/3/2010 10:42 AM (GMT -6)   
In another thread, James mentioned the possibility of waiting until MediCare kicks in before pursuing SRT. He indicated this might save him some money.
 
Forgetting about the efficacy health-wise of doing this, I am curious if MediCare does save one some money. Doesn't it depend on one's primary insurance?
 
I have very good insurance through my job and I recently found out that when I sign up for Medicare (I will be 65 in June) my work insurance will still be the primary insurance. I was surprised since I thought it would automatically become a supplement to MediCare.
 
Comments about your insurance situation pre-Medicare and post-Medicare?
 
Mel
PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (PSAf: 24%), PCA3 =75 .
Biopsy 11/30/09. Gleason 4+3. Stage: T1C. Current Age: 64
Surgery: Dr. Menon @Ford Hospital, 1/26/10.
Pathology Report: G 4+3. Nodes: Clear. PNI: yes. SVI: No. EPE: yes. Pos. Margin: Yes-- focal-- 1 spot .5mm. 100% continent by 3/10. ED- in progress. First post-op PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. Next PSA late Sept.

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 9/3/2010 12:05 PM (GMT -6)   
Wow, I appreciate this thread, Mel. I was hoping and sorta trying to get a response going about that issue without adding more off topic questions to that thread. Thanks for asking.... smilewinkgrin

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7082
   Posted 9/3/2010 12:19 PM (GMT -6)   
Having been through the "we don't take Medicare" routine with several doctors. and knowing that when I turn 65 my employee insurance terminates immediately, I would have to investigate two areas:
 
1) would the doctors treating me, and those to be doing the RT continue to treat me once under Medicare?
 
2) if I were in mid treatment or just into followup, what would be the transition of coverage? Would Medicare just fall in and continue to pay on a process started under another coverage?  

Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2448
   Posted 9/3/2010 12:44 PM (GMT -6)   
Try this link for the answers you guys are looking for. It is a Medicare Publication titled, "Who Pays First".

I think you'll like this one.

www.medicare.gov/publications/pubs/pdf/02179.pdf

Sonny
60 years old when diagnosed
PSA 11/07 3.0
PSA 5/09 6.4
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5%
positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy

2/24/10 FIRST POST RAD PSA 1.0---CARRRP --waiting for the next test.
3/22/10 Second Post RAD PSA 1.5 Dammmmnnn stubborn son of a gun
4/19/10 YAHOO PSA dropped to 1.2 Moving in the right direction.
5/7/10 PSA test 1.3 Sodium Fluoride PET Scan & CT SCAN -performed
5/20/10 PSA test 1.2 Holding off on future tests for 3 months- single lytic lesion found and scheduling radiation.
7/22/10 PSA test 1.3 - Begin radiation for MET on leg
8/9/10 - Met radiation completed

Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2448
   Posted 9/3/2010 12:47 PM (GMT -6)   
142,

Check this guide out about what happens when you turn 65. I just glanced through it quickly, but with the law changes about insurance lately I believe it said something about companies having to maintain the insurance under certain circumstances. You may fit into one of the categories and your company can't terminate your insurance. Good luck.

Sonny
60 years old when diagnosed
PSA 11/07 3.0
PSA 5/09 6.4
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5%
positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy

2/24/10 FIRST POST RAD PSA 1.0---CARRRP --waiting for the next test.
3/22/10 Second Post RAD PSA 1.5 Dammmmnnn stubborn son of a gun
4/19/10 YAHOO PSA dropped to 1.2 Moving in the right direction.
5/7/10 PSA test 1.3 Sodium Fluoride PET Scan & CT SCAN -performed
5/20/10 PSA test 1.2 Holding off on future tests for 3 months- single lytic lesion found and scheduling radiation.
7/22/10 PSA test 1.3 - Begin radiation for MET on leg
8/9/10 - Met radiation completed

Opa N
Regular Member


Date Joined Sep 2009
Total Posts : 150
   Posted 9/3/2010 1:10 PM (GMT -6)   
Before I turned 65 I had individual catastrophic coverage only for my wife and self, at a monthly premium of $1000+, and a $10,000 out-of-pocket before 80/20 coverage kicked in. Can you spell SUCKS? Went into Medicare at 65, and found out about Medicare Advantage plans. I picked one that's an HMO, no monthly premium, free gym membership, $3200 max annual out-of-pocket, free annual physical. That last is how I discovered my PCa. My RP cost me $925 out of pocket. My RT was fully covered ($0 to me.) Lupron injections were $200 co-insurance. My Uro and other specialists Get a co-pay of $45 each visit. My GP gets $25 co-pay. Without Medicare Advantage I would have had to turn down the PCa, as I would not have been able to afford it. Ha!
Roger
68; Biopsy 4/20/09; G 4+3 in 2/2 cores, G 3+3 in 5/10 cores. CT & Bone Scan negative. Stage T2C. psa 4.02. DaVinci RP 8/27/09; Gleason 3+3 w/tertiary 4. Pos. margins L & R posterior, seminal vesicle invasion. Stage PT3b. 4 wk psa <0.01.
10/21/09 begin 8 months of HT w/Lupron. 1/14/10 begin IMRT 32 treatments. All psa tests return <0.01. Continent 5/1/10.

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 9/3/2010 1:21 PM (GMT -6)   

Sonny:

Thanks -- that is a good source.

 

Hope all is well with you amd Lynn.

 

Mel

 


PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (PSAf: 24%), PCA3 =75 .
Biopsy 11/30/09. Gleason 4+3. Stage: T1C. Current Age: 64
Surgery: Dr. Menon @Ford Hospital, 1/26/10.
Pathology Report: G 4+3. Nodes: Clear. PNI: yes. SVI: No. EPE: yes. Pos. Margin: Yes-- focal-- 1 spot .5mm. 100% continent by 3/10. ED- in progress. First post-op PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. Next PSA late Sept.

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 9/3/2010 1:33 PM (GMT -6)   
Here's what my company retiree package says concerning Medicare:

Non-Active Employees and Survivors
When non-active employees or any covered dependent becomes Medicare eligible, they are no longer eligible for the Company Sponsored Group health care and dental coverage and their coverage will be terminated.

In order to receive company provided benefit dollars toward your health care expenses, you must enroll in a plan through Extend Health. Extend Health manages the retiree Medicare/Health Benefits for the company.

Medicare will notify you of your eligibility for Medicare coverage as described below:

* Retired and Survivors—If you are receiving Social Security benefits, you normally will be notified of your Medicare eligibility by the Social Security Administration three months prior to reaching age 65. You will automatically be enrolled for Part A (hospital) and Part B (medical/surgical) coverage. You will be required to pay for Medicare Part B coverage through a deduction from your Social Security check. If you decline Medicare Part B, you will not be able to enroll in a Medicare supplemental insurance policy through Extend Health.

Bottom line for me? I don't know who pays first and who takes up the slack of the rest. smilewinkgrin

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 9/3/2010 1:57 PM (GMT -6)   

James:

 

Check the source that Sonny mentioned.

 

I mentioned that my employer's (a University) group plan will be primary when Medicare kicks in (assuming I am still working -- I intend to; I'm still enjoying my job greatly).

I now see form the document that it is required by law that this be the case. Here I thought they were just being great!

 

Mel


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2461
   Posted 9/3/2010 2:52 PM (GMT -6)   
Mel,
Many doctors don't take medicare advantage which has its own set of doctors. However, I haven't had any problems finding doctors who take medicare. Medicare saves you money because they set a price for every procedure, hospital and office visits. They pay a percentage of that price (80%) after reaching a deductible and you are responsible for the rest. You can get medicare supplement (called plan F) which covers the deductible and the 20% that they don't pay. Typically medicare supplement will run between $130 and $200 depending on the person. I pay $185 for myself and $140 for my wife.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm in circumference.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 5 months
2 months PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1
11 months PSA test 1/21/10 result 0.004
14 months PSA test 4/19/10 result 0.005

Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 9/4/2010 10:02 AM (GMT -6)   
 
I have medicare and AARP supplement C I pay $253 a month for the supplement but have not paid anything, no co-pay, deductible, etc during my surgery, SRT or ongoing treatments with Oncologist.  I was also told that if I decide to do HT the treatment it will be covered.  Also when I was looking for a sugeon I was told they do not accept any medicare HMO's but had no problem with my coverage on any of the doctors I choose and can go to anyone.
 
Jerry1 
New Topic Post Reply Printable Version
Forum Information
Currently it is Friday, September 21, 2018 6:56 AM (GMT -6)
There are a total of 3,005,371 posts in 329,222 threads.
View Active Threads


Who's Online
This forum has 161773 registered members. Please welcome our newest member, Audreyli.
259 Guest(s), 4 Registered Member(s) are currently online.  Details
Artist Mark, Gemlin, IamCurious, rockyfords