Medicare Cancer Drugs Are Costly

Medicare cancer drugs are about to become more costly because of proposed changes in the way they are covered. CMS wants to “save money” by moving Part B drugs to Part D. GA Medicare expert Bob Vineyard breaks it down for you.

Medicare cancer drugs
Medicare Cancer Drugs Becoming More Expensive

Not only cancer drugs, but medications for rheumatoid arthritis, macular degeneration and osteoporosis. DME drugs such as insulin may become ineligible for Medicare Part B reimbursement.

Medicare Cancer Drugs Becoming More Expensive

Saving Medicare – Sort of . . .

Medicare Advantage plans are now able to make changes in the way expensive, injectable drugs are covered. Drugs administered in a clinical setting will be subject to scrutiny.

Medicare Advantage plans will be REQUIRED to try cheaper drugs which may not be as effective as cancer drugs administered in a clinical setting.

These Advantage plans will be encouraged to employ step therapy to “reduce costs and improve outcome”.

Reducing costs means saving money spent by Medicare and the insurance carrier.

Not saving YOU money.

Note, this is only a test. Using Medicare Advantage patients as guinea pigs to see if lower cost drugs result in similar outcomes as more expensive protocols. Do you really want to be a test model?

If the test works cancer drugs will be shifted away from Part B coverage to Part D. This means you, the patient, will pay MORE for your medication.

Treating Cancer is Expensive

Years ago most treatment involved extensive surgery, radiation and chemo. Most of the treatment was as a hospital inpatient.

Now cancer, like most other medical conditions, is treated on an outpatient basis.

If you have original Medicare and a supplement plan your out of pocket costs are minimal. Often less than $500 per year for health care.

Drugs are a different story . . . unless you are receiving treatment under Medicare Part B.

Also, outpatient self administered drugs are subject to copay’s or coinsurance. It doesn’t matter if you have an Advantage plan or stand alone PDP. Your cost is the same.

Cancer forces 42% of patients to exhaust life savings in 2 years. The average patient saw a loss of $92,098. Bankruptcy occurred in 38.2 percent after four or more years. – Becker Hospital Review

Finding and Choosing the Right Plan

Turning 65 many get confused about the various health insurance options. Some ask friends or relatives. Others attend seminars. And there is all the mail that arrives every day before you are Medicare eligible.

Part D is the most confusing component of Medicare.

If you or a family member have experienced cancer you know about the cost of prescription drugs.

You need help, but not from just anyone. Consider talking with an expert. A GA Medicare expert . . .

Give me 10 minutes by phone to answer your questions. Ask me anything about Medicare. Anything at all.

Either you like what you hear or you don’t. If you don’t feel I can help you then we part as friends. No hard feelings. It’s not personal, just business.

But if you want and need my help I am ready to guide you through the Medicare maze. We move forward at your pace, not mine.

All I ask is an opportunity to EARN your business.

When you allow me to be your agent you have unfettered access any time. Call or email.

And there is never any charge.

This is my offer you can’t refuse.

How to Get the Most Out of Medicare

How to get the most out of Medicare? Shop plans every year? How often should I change Medicare plans? Can I keep my doctor? Who can help me? GA Medicare expert Bob Vineyard helps.

How to get the MOST out of Medicare
How to Get the Most Out of Medicare

Get the Most for Your Medicare Dollars

How to get the most from your Medicare dollar is a popular question with close to 100 million responses from a Google search.

My clients say “Why didn’t I call you first? You answered all my questions. Never pressured me to buy.”

Do you really want to spend time searching the internet for answers? Or allowing strangers in your home. Agents who will try to SELL you something you don’t want, don’t need and can’t afford.

Here is my “pitch”. Call. Give me 10 minutes to answer your questions. Any question. Then decided if you want my help or not.

I call this “an offer you can’t refuse“.

How to Get the BEST Medicare Plan in Georgia

GA Medicare expert Bob Vineyard reviews the BEST Georgia Medicare plans, news and options. Review our videos. Bob will help you find the RIGHT plan that fits YOUR needs and budget. Call (404)252.5859 or email [email protected] Watch our Medicare videos on YouTube.

There is nothing wrong with buying a Medicare plan online as long as you are prepared for a LOT of phone calls from agents wanting to sell you something you don’t need, don’t want and can’t afford.

If you are turning 65 and enrolling in Medicare, this may be your only chance to purchase a Medicare supplement plan in Georgia. Full report with Medicare supplement rates for ALL Georgia Medigap carriers. Anthem GA Medigap rates include Silver Sneakers

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

Shop and compare Georgia Medigap rates online. Instant quote. Up to 30 plans.

FREE REPORT for over 240 different GA Medigap carriers available on request. We quote Medicare supplement rates by phone and email your custom report. No obligation.

Comprehensive Part D Medicare drug plan review for new and existing clients. Learn the secret to saving hundreds on prescription drug costs. A drug plan deductible is your friend

How Does Medicare Work?

Medicare has 4 parts. Your red, white and blue card is broadly accepted by doctors and hospitals alike. No networks! No referrals. No prior authorization.

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%.

When you have original Medicare, YOUR DOCTOR AND YOU decide on the care you need. You don’t need approval by an insurance carrier before can receive testing or treatment.

Many 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.

Here is what I tell folks Without a supplement plan 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.

Do All Doctors Take Medicare Advantage Plans?

How to get information on doctors that take Advantage policies? Did you know that some doctors and hospitals do not accept ANY Medicare Advantage plans? What happens if your claim is DENIED?

Did you know that 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. Referrals are not required.

All 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. How are Medicare Advantage plans like a store credit card?
https://youtu.be/p0j41FsfHbA

If you receive non-emergency out of network care under a PPO you may have higher copay’s and deductibles. Most importantly, 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.

Is Cancer Treatment Covered by Medicare?

Medicare DOES cover your cancer treatments. However, Advantage plans issued in Georgia have a LOT of out of pocket expenses. In other words, you will pay a lot more for treatment under an Advantage plan.

Also, many Advantage plans often require prior authorization BEFORE you can be treated for cancer. Your doctor does not decide your care, the insurance company makes those decisions for you.

ORIGINAL Medicare does not have networks. Prior approval is NOT needed for cancer treatment or any other care. Medicare and a Medigap plan have minimal out of pocket costs.

Mayo Clinic, Sloan Kettering and MD Anderson may not participate in certain Medicare Advantage plans.

#BESTMedicarePlansGeorgia #GAMedicareExpert #GAMedicareVideos

Medicare Things You Don’t Know

Medicare things you don’t know (but wish you did). Questions you never asked because no one told you. And you will pay dearly if you are not prepared.

There are things about Medicare that will trip you up when you least expect it. Not so much with Original Medicare, but there are things about Advantage plans no one mentioned. Medicare things you don’t know. Stuff like access to care and prior authorization.

Medicare Stuff About Advantage Plans

You may think you understand Advantage plans but my guess is there are things in this video that will shock you.

Almost everyone LOVES their Advantage plan until they have to use it. I get calls all year long from folks who say they can’t afford their Medicare plan and want a supplement.

Most GA Medicare Advantage premiums are $0. If they can’t afford their plan there’s a good chance they are incurring hundreds or even thousands of dollars out of pocket for claims.

I have a friend that has been bragging about his plan ever since he went on Medicare. He thought I was foolish for paying “all that money” every month for a Medigap plan.

A few years ago a cancer diagnosis was a shock. His provider had grant money to pay for his treatment so his out of pocket was minimal.

Now the Cancer is Back

Gary is learning things about Medicare he did not know. Such as prior authorization.

Before he can have a test ordered by his doctor, the carrier must APPROVE the test. It’s all about the money.

His oncologist wants him to have proton therapy but his plan will only pay for a less expensive protocol. Dollars drive many medical decisions when an insurance carrier controls your benefits.

Proton Therapy – It Helps Only a Few at a Wildly Extravagant Cost MedPage Today

All he wants to do is get well but his Advantage plan is running interference. His carrier is interested in saving money. THEIR money. Not his.

It’s all about the dollars. Just another Medicare thing he did not know.

What is Prior Authorization?

According to the Kaiser Foundation “80 percent of Medicare Advantage enrollees are in plans that require prior authorization for at least one Medicare-covered service“.https://www.kff.org/medicare/issue-brief/prior-authorization-in-medicare-advantage-plans-how-often-is-it-used/

Prior authorization is more frequently imposed for HIGHER COST services.

Reading further . . .

A potentially overlooked consideration is access to covered services; specifically, how prior authorization may affect beneficiaries’ access to covered services.

Medicare Advantage plans can require enrollees to get approval from the plan prior to receiving a service, and if approval is not granted, then the plan generally does not cover the cost of the service.

On the other hand, Original Medicare does not require prior authorization for most services.

There are probably many things about Medicare Advantage plans you did not know. Limited access to care because of prior authorization requirements is probably just one of them.

#MedicarePriorAuthorization #MedicareAdvantage #GAMedicareExpert

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: 

Why is Medicare so confusing?

Why is Medicare Confusing?

Parts, plans, gaps, deductibles, copay’s, coinsurance . . .

It doesn’t take much before your head is swimming. Where do you go for answers  . . . but without the sales pitch?

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 me a call. I would love to help. (404) 252-5859