Pick a Drug Plan

Pick a drug plan, Medicare 101. Finding the RIGHT Part D plan is the most challenging part of Medicare. Experienced agents often get it wrong.

Medicare 101 - Picking a drug plan

Medicare Part D has a lot of moving parts. Formulary’s. Deductibles. Copay’s. Coinsurance. Preferred pharmacy’s. Brand name drugs. Generics. Which drugs are less expensive if you pay CASH.

It usually takes me anywhere from 5 to 20 minutes to run a drug report. Add another 10 to 30 minutes to explain to my Medigap client how to properly use the plan.

Very few people, including agents, understand drug plan deductibles.

Choosing Part D Isn’t Easy

Many think choosing a Part D plan is simple. Look for the plan that does not have a deductible and pick the one with the lowest premium.

That is the WRONG way to pick a drug plan . . . unless you enjoy OVERPAYING for your drug coverage.

Whether you pick a drug plan or you allow someone to help , at least make sure you get it right.

Do you want to DIY? Here is where you start.

Let me know how this works for you.

I have been running Medicare drug plan reports since 2010. The first few years I had no idea what I was doing. I made mistakes but fortunately they weren’t costly.

Showing clients how their copay changed once the plan deductible was satisfied was impossible. A few years ago Medicare reworked their software so now they can see month to month how their OOP changes.

When you use these new reports it is very obvious why a deductible plan produces lower OOP costs.

Why is Medicare Part D so Confusing?

Seniors often buy the wrong drug plan and spend too much on their prescription plan. Seniors on Medicare spend an average of $263 per month on prescription medications.

Lower your medication bill by only using your drug card when necessary. The right drug plan will save a lot on brand names but you will almost always pay MORE for generics.

Consider paying cash or using GoodRx instead for maximum savings. Also pick a drug plan that has a deductible.

This report compares a $17 plan with a deductible vs a $79 plan with no deductible. Not only is the premium for the no deductible plan considerably higher but so are the copay’s.

This is not an aberration. No deductible drug plans are more difficult to find. Also the premiums AND copay’s are noticeably higher than plans with a deductible.

Why not let my Pharmacist Help me Pick a Plan?

Your druggist probably has no idea how to run a Medicare drug plan report. Even if they do know how, they will not have the time. He or she will simply recommend a plan they see most often.

That means you may not know how much you could have saved compared to the other 2019 Medicare Part D plans.

Have you bought something recommended by a friend then later discovered you PAID TOO MUCH?

Sometimes you can return the item for a refund.

Medicare drug plans don’t work that way.

Your copay can range dramatically from one plan to the next. Copay’s are even further impacted by using the wrong pharmacy.

Last year I ran a report for a client. Had he kept his existing plan and pharmacy his total annual out of pocket (premiums + copay’s) would have been $13,000. By switching plans AND pharmacy’s he cut his OOP to $6,000.

You Can Pick Your Own Drug Plan

Some folks don’t want help with Part D. They have done it for their parents or other relatives. The plan they found worked so no need to make a change.

As one who runs hundreds of Medicare Part D reports every year I can tell you this. Picking a drug plan is not easy.

Sometimes I will run the report several times to find the lowest possible combination of premiums and copay’s.

Most folks who take the DIY approach only run the report once.

I tell my clients to run their own report, then let me generate a report. Almost without exception my total out of pocket is less.

This is all about saving money by picking the best drug plan. And that is the way it should be.

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 MOST Medicare Advantage plans.

M D Anderson is another cancer treatment facility that does not accept MOST 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