As I turned 65, 12 years ago, many doctors, including my own, refused to accept Medicare. But they did accept Medicare Advantage. I was healthy at the time and signed up for a "free" (no extra cost) HMO type plan offered by ARRP through United Health Care. Living in Denver, the "in network" providers were many and the plan worked well for us for these 12 years especially when you consider its low cost..I must admit, when the Zytiga / Xtandi costs became difficult, I discovered I was eligible for care at the VA ! What a Godsend! From that point on, my Medicare insurance became secondary and was seldom used..Until this interesting clinical trial opened up and I discovered the trial provider was "out of network". As the wheels are turning, I think I'm going to be granted approval to see the out of network provider and all these problems go away..Wish me luck..
You just mentioned the VA so I'll add a couple of things to what I said earlier. I'm also VA eligible, which means the VA is an additional potential medical provider beyond my "civilian" providers at Dana-Farber and UMass Medical Center. This adds another potential area of treatment and medication coverage. My present situation - a clinical trial and Degarelix (Firmagon) -- is covered by Medicare and my Blue Cross/Blue Shield Medicare Advantage. But I have also discussed with my MO at Dana-Farber what would happen next when Degarelix ultimately fails, namely moving on to Zytiga, Xtandi or similar with a cost of $100,000 plus for which I could be on the hook for maybe 20 percent or more. I could get this for free from the VA. He said that when the time comes Dana-Farber can coordinate with the VA as it has done for other patients to have the prescript
ion filled by the VA.
My VA doctor says that any time I ask her she can refer me to a VA oncologist. I would need to have regular appointments with the VA oncologist in addition to my appointments with my Dana-Farber team but the VA would then provide my medications as long as my VA oncologist agreed this was appropriate treatment.
Here is a second VA-related issue. I don't know if this applies to you and I hesitate to raise it here because most of us are not eligible. But if you were boots on the ground in Vietnam, you also qualify for VA disability pay for prostate cancer due to Agent Orange exposure. And if you are acknowledged by the VA as permanently disabled for service-related prostate cancer (as opposed to just in remission) your spouse is also eligible for VA supplemental insurance. This means s/he could leave an Advantage plan and return to original Medicare and the VA would become the co-insurer for the 20% not paid by Medicare.