Looking for medicare advantage program in southern oregon with great drug co erage for zytiga

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Almost a 10
Veteran Member


Date Joined Mar 2014
Total Posts : 940
   Posted 3/4/2018 10:00 AM (GMT -6)   
My wife and I are considering a move to southern Oregon and one of our considerations is Medicare advantage programs or Medicare part D programs that provide coverage for advanced therapies Such as Zytiga. Medicare plans with part D coverage vary greatly which can substancially increase out of pocket costs. For example, i just. Hecked Wlagreens Medicare advantage program and my total out of pocket expense just for Zytiga would be over $48,000 Per year. This makes the cost prohibitive and would negate any benefit we would receive by our move. Instead it would add to our out of pocket expense that is unsustainalbe. So Inthought I wouldnreach out to the board to see if there is someone here wh has experience with medicare part D ormedicare advantage. Thanks for any helpyou can provide.
11/13 psa 240
DX 10/2013 PSA 187.5
PSA HIST 07/11,3.31;3/10,1.87,3/06,.87
Biopsy 10/28/13; 11/12 cores positive gs 9 (4+5)
BNSCN 12/09/2013 2 hot spots in spine
ADT 12/17/2013 22mg lupr, 50 mg Cas
BN biopsy 01/09/2013 neg
RALP 2/19/14 NN,LVI,Path T3BNX,MX, pros size 4.2 X 4 X 3 cm, 31 grm.Post Op PSA 3/14 .6, 6/14<.1;9/8,;.6;12/8, 1.2;3/9/15 3.9;6/2/15 23
12/14 CT SCAN; 1/15 BNSC

Post Edited (Almost a 10) : 3/4/2018 8:27:00 AM (GMT-7)


JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3886
   Posted 3/4/2018 9:08 PM (GMT -6)   
Have you determined conclusively that you can not use traditional Medicare and a supplement? If you can not then you are at the mercy of the Advantage plans in your area and you can contact them to determine your coverage. Remember to use D you normally have traditional Medicare and part B. To use Advantage and add pRT d doesn’t make much sense as,Advantage includes drug coverage.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard and Jalyn started on 10-7-2010. IMRT to prostate and lymph nodes started on 11-8-2010, HDR Brachytherapy December 6 and 13, 2010.
PSA < .1 since February 2011. Located in Cumming Georgia north of Atlanta

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3886
   Posted 3/5/2018 6:13 AM (GMT -6)   
Check on www.ehealthinsurance.com. They are excellent in showing what is available and can help determine coverage by plans. The Medicare website also shows this, but doesn’t have qualified peoples to talk to regarding plans and coverage.

I use Silverscript for my D plan. I will check the online calculator to see what the drug would cost. I suggest you do the same. What plan are you on now? If you are on an Advantage plan you will have difficulty going back to tradiational Medicare and a supplement and D. If you are on Advantage, then you wouldn’t normally have a D plan.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard and Jalyn started on 10-7-2010. IMRT to prostate and lymph nodes started on 11-8-2010, HDR Brachytherapy December 6 and 13, 2010.
PSA < .1 since February 2011. Located in Cumming Georgia north of Atlanta

Almost a 10
Veteran Member


Date Joined Mar 2014
Total Posts : 940
   Posted 3/5/2018 10:52 AM (GMT -6)   
Thank you for that insight. I currently have Medicare part A and part B. I have a Medicare advantage plan that includes prescription drug coverage and it works pretty well for me. My first precription refill of the year is around $3,000 for Zytiga and thereafter I pay $12.00 per refill. I am not considering purchasing both Medicare advantage and part d, and I am not sure if I can legally do that. But since I am relocating to another state I will likely need to find a plan for that state.

Thank you for the tip about e health.I will definitely check into that. Its kind of crazy but now a. Ove like this has to take into consideration health care costs. Sigh. I wish I was iyoung and dumb again. Or at least young.
11/13 psa 240
DX 10/2013 PSA 187.5
PSA HIST 07/11,3.31;3/10,1.87,3/06,.87
Biopsy 10/28/13; 11/12 cores positive gs 9 (4+5)
BNSCN 12/09/2013 2 hot spots in spine
ADT 12/17/2013 22mg lupr, 50 mg Cas
BN biopsy 01/09/2013 neg
RALP 2/19/14 NN,LVI,Path T3BNX,MX, pros size 4.2 X 4 X 3 cm, 31 grm.Post Op PSA 3/14 .6, 6/14<.1;9/8,;.6;12/8, 1.2;3/9/15 3.9;6/2/15 23
12/14 CT SCAN; 1/15 BNSC

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3886
   Posted 3/5/2018 12:13 PM (GMT -6)   
Some clarification. If you are using traditional Medicare A and B then you will also have a private insurance company Medicare Supplement plan to pick up the 20% that Medicare doesn't cover, and a Part D private insurance drug plan for rx drugs. But you would not have an Advantage Plan.

If you want an Advantage Plan, you will leave the Medicare coverage and get all reimbursements from the private insurance company that you choose for the plan. Medicare will pay most of the premium and you will have an amount also in most plans that is less than the supplement plan. With an Advantage plan you do not also purchase Pat D for drug coverage as drugs are included in the Advantage plan.

Generally an Advantage plan will have a lower premium than a supplement plan, but will have much larger co-pays and deductibles. Plus, the Advantage Plan will have limited networks, where the supplement plan is limited only to providers that accept Medicare.

The potential problem of moving to an Advantage plan comes when you want to move back to traditional Medicare and a supplement. The supplement can be underwritten and due to your cancer will no doubt deny coverage. So be very careful about switching plans.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard and Jalyn started on 10-7-2010. IMRT to prostate and lymph nodes started on 11-8-2010, HDR Brachytherapy December 6 and 13, 2010.
PSA < .1 since February 2011. Located in Cumming Georgia north of Atlanta

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3886
   Posted 3/5/2018 12:21 PM (GMT -6)   
When you use ehealthinsurance it will ask you for the zip code where you will be covered and the type of plan (Advantage, supplement, drug). So you have to know these terms and know exactly what you currently have.

It sounds like you have traditional Medicare and a supplement and a drug plan. What companies are you using for the supplement and drug coverage? I would start by calling their customer service and confirm the coverage they offer in your new area.

With supplement plans, it is easier to use the same company rather than changing companies. If the same company provides coverage then you may have to wait until the open enrollment period in the fall to make any changes. If the company has to terminate coverage in the event they don't do business in your new area, then you have a short time window to get new coverage. If you go outside the window you will probably not get a supplement plan and be limited to Advantage plans.

This can be very tricky to do correctly and it should start with a call to your current company.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard and Jalyn started on 10-7-2010. IMRT to prostate and lymph nodes started on 11-8-2010, HDR Brachytherapy December 6 and 13, 2010.
PSA < .1 since February 2011. Located in Cumming Georgia north of Atlanta

lovif
Regular Member


Date Joined Jun 2014
Total Posts : 28
   Posted 3/5/2018 3:38 PM (GMT -6)   
If you move to another state, you will have a Guaranteed Issue Right with Medicare. That means that you can move from a Medicare Advantage Plan to a Medicare Supplement Plan and a free standing PartnD plan without any medical underwriting related to your current health status. In essence, you get a new complete enrollment period to pick the best plan for yourself without any risk of rejection due to pre-existing conditions. I strongly encourage you to explore all of your Medicare options given your current health status if you do in fact move.

As it sounds like the medication component is critical for you, you may find that a stand alone D plan works best for you rather than the embedded prescription plans that come with an advantage plan if your new area. Every area of the country is different as to options and cost. Just because an Advantage plan has been good for you where you currently live, does not mean that type of plan will still be the best option somewhere else. Again, because of the move, you could go with a supplement and free standing D without medical underwriting if that works best in your new geography.

Medicare.gov is a very user friendly website. If you go to the Part D section of that website and put in your perspective zip code, you can create a drug profile for yourself and then you can see the cost breakouts for your drugs for all advanrage plans in that marketplace as well as stand alone drug plans. It will thus provide a comprehensive drug plan shopping experience for every drug plan option available in that area That may help you decide if you want to go with an advantage plan in the new area or if you want a stand alone part D plan, at which point you would also need and be able to buy without prejudice a supplement plan.

Good luck if you move and with your continuing treatment.

Almost a 10
Veteran Member


Date Joined Mar 2014
Total Posts : 940
   Posted 3/7/2018 10:57 PM (GMT -6)   
Thanks Lovif, i have been on the road for days looking at property and having had a chance tomlook at the board. We are now concentrating on Northern Oregon since my medical provider has facilities there.
11/13 psa 240
DX 10/2013 PSA 187.5
PSA HIST 07/11,3.31;3/10,1.87,3/06,.87
Biopsy 10/28/13; 11/12 cores positive gs 9 (4+5)
BNSCN 12/09/2013 2 hot spots in spine
ADT 12/17/2013 22mg lupr, 50 mg Cas
BN biopsy 01/09/2013 neg
RALP 2/19/14 NN,LVI,Path T3BNX,MX, pros size 4.2 X 4 X 3 cm, 31 grm.Post Op PSA 3/14 .6, 6/14<.1;9/8,;.6;12/8, 1.2;3/9/15 3.9;6/2/15 23
12/14 CT SCAN; 1/15 BNSC

lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 686
   Posted 3/8/2018 2:52 AM (GMT -6)   
Portland zip 97201. Go to Medicare.gov. many options.
Born June 30, 1941
PSA 4.7 July 2006 , Nodule found during DRE
biopsy 10/06- t2c Gleason 4+4=8
DaVinci surgery, January 2007
Post Op confirms gleason 4+4=8 with no extension or margins
post surgery psa .02 until 2012
psa rise detected in 2012. slowly rising to .2 in 2015
39 IMRT sessions completed 11/15..
Bimix 30/1 still working
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