Do You Want Fries With That?

Would you like fries with your Medicare plan? What do you know about those who offer advice about Medicare?

Picking a Medicare Plan is as Easy as Ordering Lunch

Picking a Medicare plan while blindfolded is what happens too often. Almost no one understands Advantage plans. Medicare drug plan deductibles? Who can explain that? Much easier to pick a plan without a deductible. You can’t go wrong there.

Medicare supplement plans are easy. All plans with the same letter are identical. Just go with the plan with the lowest premium. Right?

Maybe you will appreciate my Shop Like a Boss video, explaining how to search for Medicare information.

No need to ask an insurance agent. They cost too much.

Questions You Really Should Ask

How long has the agent or carrier rep worked the Medicare market? Maybe feel more comfortable talking with someone at Medicare.gov or a volunteer and a not-for-profit organization.

Surely they will be impartial?

Or will they?

Turning 65 Medicare Options

How does Medicare work?

Bob Vineyard explains in this Georgia Medicare Minute video

If you are turning 65 and enrolling in Medicare, this may be your only chance to purchase a Medigap plan. Here is your guide to understanding GA Medicare.

You don’t have to receive Social Security to enroll in Medicare insurance. CMS is the agency that oversees Medicare.

Senior healthcare insurance is commonly used to describe Medicare.

How to enroll in Medicare? You may sign up for Medicare 3 months before your 65th birthday, the month you turn 65, and 3 months following your 65th birthday. You may enroll online (highly recommended), by mail or by visiting a Social Security office.

Original Medicare has 4 parts.

Medicare Part A covers hospital inpatient charges and has a per admission deductible

Medicare Part B is for outpatient health care treatment. Doctor visits, labs, X-rays, MRI, CT scan (CAT scan), ambulance, ER, outpatient clinics, etc. Essentially any Medicare approved health care received outside the hospital setting. Treatment considered medically necessary under Medicare guidelines. Medicare Part B has a calendar year deductible. Once satisfied, Medicare pays 80% of the approved charge, you are responsible for the remaining 20%.

Most seniors worry about hospital stays, but your major expenses will more than likely fall under Medicare Part B outpatient expenses. Original Medicare stand alone has no cap on your out of pocket expenses.

You pay until you run out of money, get well or die.

Medicare Part C is now referred to as Medicare Advantage. More on that later.

Medicare Part D covers outpatient prescription drugs. Some Advantage plans have drug coverage built into the plan.

Medicare Supplement or Medicare Advantage?

Medigap and Advantage plans cover the same things, but what you pay out of pocket for your care, and where you receive your care, is very different.

Original Medicare does not have networks. You can use any doctor or hospital anywhere in the US. Another plus is the ABN form which is only used with Original Medicare.

Advantage plans are managed care plans. Some are PPO, some are HMO. In 2018 about half the plans are HMO with the balance being PPO.

If you receive non-emergency out of network care under a PPO you may have higher copay’s and deductibles. Your max OOP may also be higher. Some plans do not cap out of network charges.

Non-emergency out of network care charges may be denied if you have an HMO.

Medicare Questions – FAQ

How Much Does Medicare Cost?

In 2018 most Advantage plans issued in Georgia limit your out of pocket for approved in network health care expenses to $6700.

The American Cancer Society tells us that more than half the 1.4 million new cancer diagnoses occur in people age 65 and older. Roughly 20% of retiree deaths are a result of cancer. Medicare pays for almost half of the $74 billion spent on cancer treatment. The elderly account for 70% of cancer deaths each year.

Some cancer centers, such as Mayo Clinic, Sloan Kettering and MD Anderson may not participate in certain Medicare Advantage plans.

Medicare and Cancer

Not all cancer responds to chemotherapy, but 80% of cancers are treated with chemo. Those treatments occur in an outpatient setting and are covered under Medicare Part B.

Chemotherapy drugs administered in a doctor’s office or clinic normally fall under Part B. Medication from a retail pharmacy or by mail fall under your PDP.

This is why most of us chose a Medicare supplement plan in 2018. Bob Vineyard, independent Medicare insurance broker in Georgia, can explain your Georgia Medicare insurance options and will allow you to decide.

We represent several carriers including Aetna, Anthem Blue Cross, Humana and more.

According to the Mayo clinic, “new cancer treatments are routinely priced at over $100,000 per year of treatment.”

A study from the Medicare Rights discovered the number one reason for disenrolling from a Medicare Advantage plan was “provider access problems”. Number 4 on the list was “cost sharing too high”.

Who is giving you Medicare advice? An experienced agent who is enrolled in Medicare or someone that works in a fast food restaurant?

#GeorgiaMedicarePlans #GAMedigapQuotes #Turning65 https://youtu.be/uMROeyRxqEI

Answers to Common Medicare Questions

I have answers to your most common Medicare questions. Here are just a few examples of questions asked by people just like you who are turning 65.

  • How do I know which Medicare plan is right for me?
  • When should I enroll in Medicare?
  • Should I have the same plan as my spouse?
  • How much does Medicare cost?
  • Does Medicare cover (fill in the blank)?

Many of your questions can be answered by copying this into your Google search bar – site:http://www.georgia-medicareplans.com

Answers to Common Medicare Questions

 

Answers to Common Medicare Questions

Below are links that correspond to the questions shown above.

  • https://www.georgia-medicareplans.com/ufaqs/find-right-medicare-plan/
  • https://www.georgia-medicareplans.com/enroll-in-medicare-at-age-65/
  • https://www.georgia-medicareplans.com/medicare-traps-and-mistakes/
  • https://www.georgia-medicareplans.com/ufaqs/how-much-do-medicare-premiums-cost/
  • https://www.georgia-medicareplans.com/does-medicare-cover-my-cancer-treatment/

You have Medicare Questions.

I have answers.

Give Bob Vineyard a call. I would love to help. (404) 252-5859

 

Does Medicare Cover My Cancer Treatment?

Does Medicare Part B cover my cancer screening and treatment? How about chemotherapy and radiation therapy? How much will I have to pay for my cancer treatment? Does Medicare cover the rest? How can I get help paying my medical bills?

From a purely financial perspective, most people with original Medicare and a supplement (Medigap) plan will not have to worry about how they will pay for the cost of cancer treatment. Most Medigap plans cover 100% of your hospital inpatient (Medicare Part A) expenses and the bulk of your Part B outpatient care.

That’s not the case with Medicare Advantage.

 

Medicare Cover Cancer Treatment?

Your out of pocket costs for cancer treatment with an Advantage plan can run several hundred or even thousands of dollars each year. If your treatment includes chemotherapy, you are generally responsible for 20% of the cost. Your plan picks up the balance.

If you are turning 65 and going on Medicare, this may be your only chance to pick a Medigap plan. Choose wisely.

Medicare shop and compare

Your information is NEVER sold. We are happy to discuss options by phone and will give you an

instant quote for the absolute lowest Medigap rate in your area. There is never any pressure to buy.

Post summary.

  • How common is cancer?
  • Will Medicare pay for treatment from ANY doctor?
  • How much will I pay for chemo?
  • Is cancer screening covered by Medicare?
  • Medicare Advantage or original Medicare and a supplement plan? Which is better?

 

Medicare Coverage for Cancer Treatment

The American Cancer Society tells us that more than half the 1.4 million new cancer diagnoses occur in people age 65 and older. Roughly 20% of retiree deaths are a result of cancer. Medicare pays for almost half of the $74 billion spent on cancer treatment. The elderly account for 70% of cancer deaths each year.cancer treatment

Original Medicare covers about 80% of your cost of care. Most Medigap plans will pick up the remainder. You can pick your own doctor(s), hospital and treatment center and a referral is never required.

Not all cancers require or even respond to chemotherapy, but there are some things you should know about the cost of chemo.

Cancer Medication

Medicare does not pay for most prescription drugs but it does cover chemotherapy. Roughly 80% of cancer patients receive chemotherapy in their doctors office or other outpatient setting. You can easily end up in the Medicare Part D donut hole if you are not careful.

Original Medicare pays for 80% of the cost of chemotherapy. Medigap plans F, G and N pick up the remaining 20%.

If you have a Medicare Advantage plan you pay the 20% out of pocket.

The average price of cancer drugs for a year is estimated to exceed $100,000.

Even if you have health insurance, your out-of-pocket expenses may be as much as $25,000 to $30,000 a year – Mayo Clinic

Your share of these expensive medications is reduced to almost nothing with original Medicare and a supplement plan.

The American Cancer Society estimates the average out of pocket cost for cancer treatment ranges from $3500 to $4800, depending on the type of cancer you have.

 

Medicare and Cancer Screening

Medicare does cover many routine screenings for cancer. “Free” cancer screenings with Medicare include:

  • Cervical and vaginal cancers
  • Colorectal cancer
  • Prostate cancer

Other types of cancer screening are covered under Medicare Part B and may require a small charge or copay depending on the type of plan you have.

Notes from the American Cancer Society

Medicare coverage for breast cancer screening

One screening mammogram every 12 months is fully covered for all women with Medicare age 40 and older. You can get one baseline mammogram between ages 35 and 39, too. Medicare also covers newer digital mammograms.

cancer screeningOriginal Medicare coverage for cervical cancer testing

Medicare covers one Pap test and pelvic exam every 24 months if you are at average risk for cervical cancer. If you’re at high risk for cervical or vaginal cancer or are of childbearing age and have had an abnormal Pap test in the last 3 years, the tests are covered every 12 months.

You pay nothing for the Pap lab test or for collecting the Pap test and the pelvic exam, as long as your doctor accepts assignment from Medicare. As part of the pelvic exam, Medicare covers a clinical breast exam to check for breast cancer.

Medicare coverage for colorectal cancer testing

Medicare covers colorectal screening tests in people 50 and older to help find colon or rectal cancer and/or pre-cancerous polyps (growths in the colon) so they can be removed before they turn into cancer. Coverage for these tests depends on the person’s risk for colorectal cancer, when they had their last test, and whether something is found that needs to be removed during the test.

Medicare coverage for prostate cancer testing

For men over age 50 with Medicare, one digital rectal exam (DRE) and one prostate-specific antigen (PSA) blood test are covered every 12 months. This coverage starts the day after your 50th birthday.

Medicare coverage for lung cancer testing

Medicare covers lung cancer screening with a low dose CT scan once per year if you have Medicare, are 55-77 years old, have a tobacco smoking history of at least 30 pack years*, and you either continue to smoke or you have quit smoking within the last 15 years.

 

Need Help Paying Medical Bills?

There are several resources that can help cover the gaps when it comes to paying medical bills.

This list is by no means complete. If you know of a resource that should be added, please let us know.

Cancer Treatment, the Final Word

I enrolled in Medicare in September, 2015. Cancer is a word I know too well. My mothers twin sister and older sister died of cancer. My wife’s father and mother died because of cancer. All 5 of my father-in-laws siblings died of cancer. Two of my mother-in-laws siblings died of cancer.

I have seen what cancer can do to the human body and the misery that accompanies this dread illness. If you are diagnosed with cancer, the last thing on your mind should not be “How will I pay for my treatment?”

Currently my health is good. That has been true for most of my life. No chronic illness, not even high blood pressure or cholesterol.

But having spent the last 40 years in the health insurance business I know how quickly things can change. When my health changes I want to control the direction of my care. Insurance carriers are not going to give me a list of doctors and tell me this year I can only use these, and next year the list may change.

Beware of Excess Chargescancer

I am in original Medicare plus Medigap plan N.

You may not know it, but the Mayo Clinic does not participate in any Medicare Advantage plans.

M D Anderson is another cancer treatment facility that does not accept Medicare Advantage plans.

A study from the Medicare Rights discovered the number one reason for disenrolling from a Medicare Advantage plan was “provider access problems”. Number 4 on the list was “cost sharing too high”.

You may never receive a cancer diagnosis. I hope you don’t. But one thing I can tell you with certainty is this. Original Medicare and a supplement plan provides assurance the funds will be there to pay for almost all of your care.

We have rates on over 240 different Medigap plans in Georgia. We will quote you a rate over the phone and tell you who has the lowest rate.

More than that, there is no charge for our advice. No pressure. No “up-selling”.

You can also shop and compare online Medigap quotes instantly.

Medicare shop and compare

One other thing.

You don’t need a separate cancer insurance plan or a hospital plan. You can sleep well at night knowing the cost of your cancer treatment is covered in full.

Also see:

How Much Does it Cost to Treat Cancer

Cancer Treatment Resources

The Secret Life of Medicare Advantage Plans

 

 

 

#Medicare #CancerTreatment #Chemotherapy #MedicareAdvantage #MedicareSupplement

HRT ‘raises breast cancer risk up to EIGHT years after use’

New findings from the Women’s Health Initiative in Seattle, have shown women taking combined HRT of oestrogen and progesterone have an increased risk years after stopping treatment.

Source: HRT ‘raises breast cancer risk up to EIGHT years after use’

How Not to Shop for Medicare Insurance

Do you know how NOT to shop for Medicare insurance? Where is the last place to look for information? What is your most useful guide to Medicare insurance options? How do you find reliable information online about Medicare options? Why you should NOT buy direct from a carrier such as Blue Cross, Mutual of Omaha or through a marketing group such as AARP.

medicareplansgeorgia

 

How NOT to shop for Medicare coverage

Most sites and guides tell you how to shop for Medicare insurance. We will tell you how NOT to shop and why.  stop

Many seniors, especially those turning 65, will go online to look for information. Here are some warnings.

  • Most sites are data harvesting pages. They collect your information and resell it to insurance agents
  • Avoid sites that don’t have “real people” listed as their contact.
  • Look for local, real contact information, not just an 800 number.
  • Ask your friends but don’t just blindly follow their advice. They probably bought the wrong plan and paid too much,
  • Don’t be pushed into making a decision before you are ready. In most cases you have weeks or even months.
  • If an agent refuses to discuss or email rates and information, move on to someone else.
  • Most information and applications can be handled by phone. Very few require carriers the agent to come to your home.

Now some advice on how to shop for Medicare coverage.

  • Local agents that live in Georgia know more about plans and rates than someone calling from another state.
  • Make sure you understand the difference in Medicare Advantage (private insurance) and original Medicare and a supplement.
  • Look for broad coverage, including plans that allow you to keep your current doctor(s).
  • Name brand carriers are OK, but don’t discount coverage from companies that are unfamiliar
  • In some parts of Georgia there are as many as 40 different Advantage plans, 30 different drug plans and 170 Medigap plans
  • At any one site you will rarely see rates on more than 20 plans
  • Medicare.gov is useful in searching Medicare Advantage and drug plans, but only if you know how to use the site
  • There are no public or government sites with complete information on Medigap plans

 

What is the best way to shop for Medicare coverage?

Roy battled melanoma for almost 2 years before qualifying for Medicare. He had a good major medical insurance plan but with medical bills running over $100,000 happy old man in yardper year he still had out of pocket expenses of $10,000 each year.

His $600 monthly premium was a stretch but adding in another $800 monthly in out of pocket medical expenses for copay’s, deductibles and coinsurance, Roy was tapped out financially.

The low premium Advantage plans he viewed were attractive but his out of pocket costs were still projected to be over $6,000 per year. Even worse, some of his doctors did not participate in the Advantage plans he considered.

I met with Roy in April before his Medicare benefits began in June. He was very weak from a recent hospital stay, his third one of the year. I listened as Roy and his wife laid out their concerns about Medicare. Which doctors would treat him? How much would his treatment cost? Would he have to satisfy a new deductible? Could he pick a plan and keep it or does he have to go through the process every year?

After listening to their concerns and reviewing my notes, I suggested Medicare supplement plan F and a suitable drug plan. Roy’s monthly premium (including Part B) was less than $250. He could keep all his doctors and have $0 out of pocket for outpatient treatment or hospital stays.

We filled out the paper work on the spot and his application was submitted the same day. Roy’s coverage went into effect on June 1.

Two weeks later Roy was admitted to the hospital for the 4th time that year.

He died less than 3 weeks later.

All of his hospital and doctor bills were paid in full, leaving him debt free with regard to medical bills.

We made it easy for Roy and his wife to shop for Medicare coverage.

That’s what we do.

 

Roy’s legacy

Roy was a good friend and I miss him dearly. He “found” me on the internet about a year before he was diagnosed with cancer.

At the time he had a Blue Cross plan that was several years old and the premium for his family was $1300 per month. He knew there had to be something better so we had several long conversations, some lasting an hour or more.

After about a month of phone calls and emails, he was ready to make a change, but his wife didn’t want to give up their Blue Cross plan. Even though it was expensive, and going up even more on the next renewal, she felt uncomfortable making a change.

So Roy put her on the phone with me and we talked for maybe 20 minutes. I could tell she was skeptical, but I didn’t push.

She gave the phone back to Roy and we talked some more. I told him I could write a plan just on him and leave his wife with Blue, but he didn’t want to change unless she did too.

About a week later Roy called me back and said they were ready to apply for the new coverage. I took their application by phone and the new coverage was in place two weeks later.

Over the next year and a half they saved over $15,000 in premiums and out of pocket costs. Roy and his wife loved the new plan and told all their friends about the money they saved.

Then Roy got sick.

Even with the high medical bills, they still saved over $8,000 per year vs. their old Blue Cross plan.

We had a lot of conversations during that time, and I coached him on how to save money on his medical bills and prescription drugs. When Roy found out he qualified for Medicare I helped him navigate that hurdle as well.

During the almost 5 years since I first “met” Roy we never met face to face until right before he went on Medicare. Whenever he had a problem, a concern or a question, he would call. If I didn’t know the answer I would research it and get back to him. Often the same day.

Roy lived about 3 miles from my home, yet we never met until he was dying. Still, he trusted me enough to make recommendations and referred several friends my way.

And when Roy was ready to shop for Medicare there was never any hesitation about who to call.

 

Shop for Medicare coverage the right way

With more than 240 different Medicare options (including 170+ Medigap plans), finding the right plan and helpful guidance is almost impossible. But here is my offer to you.

Give me a call, send an email or get a Medigap quote online instantly. I will give you as much time as you need to get answers to your questions. There is no charge for my time but you will pay a lot more for your coverage than you would if we didn’t talk.

A 15 minute conversation will give you a greater understanding of Medicare than countless hours on the web, attending “seminars” or inviting agents into your home that only want to sell you something and won’t leave until you buy.

Petula Clark recorded the hit “Call Me” in 1965. Don’t be afraid, just call me.

I promise not to sing in your ear but I will do my best to answer your questions about how to shop for Medicare coverage.

How Much Does it Cost to Treat Cancer?

How much does it cost to treat cancer? Can I afford treatment? What if I can’t pay? What is Medicare ABN? Living and dying with cancer. Does a cancer diagnosis have to mean a death sentence? Where can I get help paying for my treatment?  treat cancer

 

Does Medicare cover the cost to treat cancer?

The good news is, routine cancer treatment is covered by Medicare. Some cancer treatments can be very expensive  . . . $5,000 to $10,000 per treatment.

If the procedure to treat cancer is administered in a doctor’s office or clinic, the good news is, that is a Medicare Part B expense. But only if your treatment is a Medicare covered expense . . . .

Martha and the Medicare ABN

Martha is a 3 year cancer survivor . . . of sorts. Two bouts with cancer in three years and now the cancer has returned.

Most of the routine medications had been tried, leading to only a temporary remission. But now her oncologist wanted to try something new. The problem was, this medication was not on the approved list for ovarian cancer.

“I’m most optimistic about this new one. It works in women who haven’t had any treatment, but prior studies have shown it works on women who have already received treatment. I would recommend we try it; if it doesn’t work, we do have other standard options available.”

“Sounds good,” she said.

“Great!” I stepped out of the room to inform our practice nurse of my plan.

She listened as I told her of my plan and after I stopped talking, asked calmly: “You realize that it’s not approved in ovarian cancer, right?”

“Yes, I realize that,” I said. “What’s your point?” I asked, with more than a little irritation in my voice.

“Well,” our nurse continued, “it’s a pretty expensive drug and she has Medicare. So if you want to give it, she has to be aware that there’s a pretty good chance it won’t be covered, and she will have to sign an ABN.”

Kevin MD

If your doctor mentions the ABN form (Advance Beneficiary Notification), do not dismiss it. In simple terms, this is what it means.

If Medicare denies payment for the procedure you are 100% liable for the cost of care.

Medicare supplement plans won’t pay either. 

What is the Medicare ABN form?

“an ABN should be issued when the clinician (or his institution, in this case) believes Medicare may not pay for it or may not consider it as medically reasonable or necessary for the patient, despite any prior record that Medicare had covered it in the past. The ABN is meant to protect the institution from nonpayment by getting the patient to accept the financial liability that comes with Medicare nonpayment. Essentially, it guarantees someone will pay for the treatment — even if it means the entire bill rests with the patient.”

If the patient refuses to sign the form, the provider is within their right to refuse treatment.

Paying to treat cancer

What happens if Medicare won’t cover your cancer treatment? What then?

Some cancer policies will step in and pay a lump sum direct to you on first diagnosis, even before your treatment begins. Of course these policies must be in place before you are diagnosed with cancer.

There are other cancer treatment resources for Georgia Medicare beneficiaries.

Sequester Cuts Medicare Funding

The Godfather movie image Al PacinoDid you know cuts in Medicare funding means cancer patients may have to forego treatment? Obama’s pick and choose sequester cuts means no White House tours, close airport control towers and no cancer treatment for you.

Medicare funding cuts are part of the sequester and as of April 1, some doctors and cancer clinics are turning away Medicare patients.

Oncologists say the reduced funding, which took effect for Medicare on April 1, makes it impossible to administer expensive chemotherapy drugs while staying afloat financially.

Patients at these clinics would need to seek treatment elsewhere, such as at hospitals that might not have the capacity to accommodate them.

“If we treated the patients receiving the most expensive drugs, we’d be out of business in six months to a year,” said Jeff Vacirca, chief executive of North Shore Hematology Oncology Associates in New York. “The drugs we’re going to lose money on we’re not going to administer right now.”

Washington Post

Those most readily affected would be patients receiving tier 4 infusion therapy.

For the clinics, it’s a choice between treating patients and staying in business.

Medications for seniors are usually covered under the optional Medicare Part D, which includes private insurance. But because cancer drugs must be administered by a physician, they are among a handful of pharmaceuticals paid for by Part B, which covers doctor visits and is subject to the sequester cut.

The federal government typically pays community oncologists for the average sales price of a chemotherapy drug, plus 6 percent to cover the cost of storing and administering the medication.

Since oncologists cannot change the drug prices, they argue that the entire 2 percent cut will have to come out of that 6 percent overhead.

If the clinic is a Medicare par provider, they cannot balance bill, so their choice is to stop treating patients or take a loss.

It’s not personal. It’s strictly business.

Expensive Prostate Cancer Treatment

 

Are Newer Prostate Cancer Treatments — Now Gaining Popularity — Worth The Extra Cost?

Reuters: Costlier Prostate Cancer Treatments Gain Popularity
Newer technologies for treating prostate cancer have surged in popularity in the last decade — and they have come with a hefty price tag, according to a report published this week. Researchers estimate that the increased use of certain prostate cancer treatments, such as less invasive surgery and advanced radiation therapy, tacked on an additional $350 million in health care spending in one year alone. The big question remains: is it worth the cost?

Broccoli Fights Cancer

Broccoli May Help Fight Cancer Growth

Study Shows Compound in Broccoli May Block Defective Gene Linked to Tumor Growth
By Jennifer Warner
WebMD Health News
Reviewed by Laura J. Martin, MD

broccoli

March 11, 2011 — Broccoli may help fight cancer by blocking a defective gene associated with tumor growth, according to new research.

Previous studies have heralded the potential cancer-fighting ability of broccoli and other cruciferous vegetables such as cauliflower and watercress. But researchers say until now they didn’t know the secret behind the vegetables’ anticancer attributes.

In a new study, researchers found compounds in broccoli and other cruciferous vegetables called isothiocyanates (ITCs) appear to target and block mutant p53 genes associated with cancer growth.

Gene p53 is known as a tumor suppressor gene and appears to play a critical role in keeping cells healthy and protecting them from cancer. When this gene is damaged or mutated, it stops offering this protection. Researchers say these mutations are found in about half of all human cancers.

In a report published in the Journal of Medicinal Chemistry, researcher Xiantao Wang of Georgetown University and colleagues analyzed the effects of ITCs on gene p53 in a variety of human cancer cells, including lung, breast, and colon cancer, in the lab.

The results showed that ITCs were capable of removing the defective p53 gene while leaving healthy versions of the gene alone.

Researchers say if further studies confirm these findings, it could lead to new therapies for preventing and treating cancer.

http://www.webmd.com/cancer/news/20110311/brocolli-may-help-fight-cancer-growth?src=RSS_PUBLIC