If you're in a big city with big-time cancer experts right there and in-network with a good Advantage plan, then you're okay. If not, then you will have to pay huge amounts to any experts you want to see who are out of network.
Here's our negative experience with a Medicare Advantage plan.
My husband switched to regular Medicare and a very good gap plan and drug plan after being in a Medicare Advantage plan for five years. (He was very healthy during that time.) Why did he switch? We had a horrendous time with our Medicare Advantage Plan, which was considered a very good one. We ran into some real headaches and expenses while we were traveling. An out-of-town physican told my husband to get a CT scan to determine the cause of increasing abdominal distress. Initially this was not an emergency, so we paid out of pocket at an imagining center plus paid two doctor visits out of pocket. Our Advantage plan said it would take two weeks to get approval for a CT. Well, the CT showed he had a ruptured appendix! He spent eight days in the hospital, and I spent eight days and much more fighting with the insurer over various things to make sure it fell under the "emergency" provision, which Advantage plans are supposed to pay. It's been a nightmare.
Fast forward. My husband was diagnosed in October, 2014 with Gleason 9 prostate cancer. We live in a university town in Massachusetts far away from Boston or New York. My husband's urologist said our options were limited to our area. He suggested to pay out of pocket for Dana Farber or Sloan Kettering for second opinions, or just get regular Medicare and a good gap plan and a good drug plan so we could go anywhere. Luckily, because we are in Massachusetts, my husband was able to change to regular Medicare+gap+drug without penalty. In most other states if you go from an Advantage plan to regular Medicare+gap+drug plan six months after you sign up for Medicare, rates the insurance company can charge for the gap plan are not regulated in the future. We had absolutely no problem getting our new insurance accepted at Dana Farber and Sloan Kettering for their consultations. At DF, the intake person told us the Advantage plan we'd had was horrible. (We had the "best" level.) Every doctor we've seen anywhere has accepted regular Medicare+gap+drug plans.
My suggestion, based on our experience, is that regular Medicare plus the best gap plan and drug plan you can afford will give you the most flexibility. Do find out if the doctors you see accept Medicare. Unlike Fairwind above, all the local and big cancer doctors we've visited prefer Medicare and a good gap/drug policy over the Advantage plans that give them a hard time. If you go the regular Medicare/gap/drug route at the get go, the gap plan will always be subject to some regulation in terms of premiums increases. But if you make the switch after the first six months after reaching Medicare age, your insurance company's gap plan premium may be higher basically for the whole time you have it depending on what state you're in. We've not had a single problem getting any of our docs to accept Medicare. As I said, Dana Farber prefers regular Medicare, plus gap, plus drug plan over Advantage plans. Your mileage may vary. Good luck with your treatments.
I found this NY Times article informative about
the pros and cons of different Medicare options. In particular, read the comments section to see what patients' real-life experiences are.
Husband 70 years old with pacemaker; Agent Orange exp. otherwise fit
June, 2014: urinary symptoms
Sept. 2014: blood in urine
Oct . 2014: DRE suspicious
Dec. 2015 bx G 9, PSA: 3.32 (high Gleason, low PSA)
(3 @ 90% 5 @ 80% 2 @ 70% 1 @ 60%, 40%) PNI involved
Nov. 2014: Zoladex, Casodex, Flomax
Feb. 2015: Lupron for 2-3 years; .03 PSA
June 2015: 9 wks IMRT completed; PSA .175
Post Edited (spouse21) : 6/18/2015 7:38:17 AM (GMT-6)