Medicare versus Private Insurance--Advice please?

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BeckyH
Posts: 13
Joined: Sat Nov 26, 2016 12:19 pm

Medicare versus Private Insurance--Advice please?

Postby BeckyH » Wed Dec 13, 2017 10:58 pm

Hello Colon Friends,

When I was diagnosed with cancer in January 2016 and had surgery in February 2016, it became very apparent that for the current time I would not be able to physically work as a Physical Therapist. Because this was my third major abdominal surgery plus significant low back issues from 30 years of lifting heavy patients and neuropathies and balance issues from the Oxaliplatin, I applied and received disability.

Today, I got notification that I now qualify for Medicare Part A, B, C, and D. Actually, I believe I have been automatically enrolled in Medicare part A and B. I am currently covered insurance wise by a private plan through the small business we own. Believe it or not, the premiums we pay for our family of 4 are $22,000/year. I have Anthem BC/BS. The coverage is very good as it should be at that price. Do any of you know if Medicare and its supplements compare? My concern is that if I have a recurrence, will Medicare pay for options like HIPEC? Because my cancer is of the Signet Ring Cell type, if I have a recurrence it is most likely to be in the peritoneum. Does anyone else out there have any experience or suggestions? Right now, I have no evidence of disease. At the same time, I fully expect a recurrence because of my type of cancer and the fact that it was in 35 out of 56 lymph nodes. I plan on contacting the Cancer Center and making an appointment with a social worker. But then I remembered all of you wonderful people and thought I would ask. I have found that my fellow warriors have been the most supportive and helpful through every stage of this crazy game.

Thank You,
Becky
DX: Suspected Colon Cancer January 29, 2016
2/8/16: Removed 17" Colon (Sigmoid area) & 1"Rectum & 58 lymph nodes
2/12/16: CA in 35/58 lymph nodes
Cancer: Stage 3C T3N2B
Path: Signet Ring Cell Adenocarcinoma
Chemo: 12 rounds of FOLFOX, (3/17/16 to August, 2016) Leukovorin DC'd after WBC decrease.
Scans: F/U scans every 3 months; last one 8/2017--All NED.
CEA: Stable b/t 1 and 2

zephyr
Posts: 363
Joined: Thu Aug 18, 2016 7:31 am

Re: Medicare versus Private Insurance--Advice please?

Postby zephyr » Thu Dec 14, 2017 8:13 am

I don't have an answer for you but wanted to thank you for posting this question. I've been wondering the same thing - different diagnosis but same insurance concerns. Medicare kicks in next year for me. I've heard but not verified that the only supplement available to people receiving early Medicare because of a disability will be something along the lines of an HMO, which scares me. I also have good private insurance and sure would like to keep it if my other choice is an HMO.
Nov-2009 Early stage CRC, routine colonoscopy
2010-2014 F/U colonoscopies, all clear
Jun-2016 CRC during F/U colonoscopy, surgery, Stage 4, KRAS, MSS
Aug-2016-May-2018 Folfox, 5FU, Folfiri & Avastin
Aug/Sep-2018 YAG laser surgeries (Germany), 11 nodules removed
Nov-2018 clean CT scan
Mar-2019 New lung nodules
Apr-2019 Dec-2020 Xeloda/Avastin, SBRT, cont. Xeloda/Avastin
Mar-2021 Forfiri/Avastin
Mar-2022 Ablation & Thoracotomy
Feb-2023 Folfiri & Avastin
Nov-2023 Xeloda & Avastin

WarriorSpouse
Posts: 220
Joined: Tue Aug 16, 2016 9:02 pm

Re: Medicare versus Private Insurance--Advice please?

Postby WarriorSpouse » Thu Dec 14, 2017 10:13 am

I am sorry to read what you are going through, but I have some experience with this issue, so I thought it appropriate to share it with the group.

The way I understand it, Social Security Administration, notifies Medicare of your disability status, and after a year (or maybe two), Medicare will send you your Part A and Part B cards. If Part B is an option, most definitely take it, do not waive this option.

If you are not in a retired status at work, your BC/BS plan will still be primary coverage, but your Medicare will now become secondary coverage to help cover your copays. I am not certain how this works because I am currently retired.

For my wife, as a retired employee / family, her primary coverage is Medicare, and my retired BC/BS benefit is secondary and helps pick up the Medicare copays. While the patient has this co-pay back-up coverage for this type of extended care, the rest of the family is unaffected and maintains the quality coverage that your BC/BS policy also provides as primary.

If you become retired from your business, then Medicare becomes your primary and BC/BS is secondary. Both Medicare and BC/BS communicate behind the scenes. Once it gets rolling you can call BC/BS and they will tell you what Medicare is active and paying for. The big help comes with reduced copay expenses, because one plan will supplement the other. The order of precedence is based on if you are considered still working or retired. If you are already making a lower income because of your disability status, it may be beneficial to just be retired too and have your spouse run the business as the fulltime manager. Talk to your accountant / business attorney to see what makes better sense.

If you have a supplemental business BC/BS plan, there is no need to have Part C and Part D plans. Your private plan will cover drugs and acts as a Medicare supplemental policy. Make sure your spouse keeps you on a retired BC/BS plan or you will need part C and D. Good luck!
WS
D/H 47 years old, 10/2014, Stage IV M/CRC, nodes 12/15, para-aortic, 5 cm sigmoid resection, positive Virchow. KRAS mut, MSS, Highly Differentiated, Lynch Neg, 5FU/LV and Avastin 1 YR (Oxi for 5 months), Zeloda/Bev since 01/2016. 02/2019 recurrence para-nodes, back to 5FU/LV Oxy/Bev. It is working again. "...Perseverance is not a long race; it is many short races one after the other."-Walter Elliot

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mypinkheaven
Posts: 459
Joined: Fri May 20, 2016 4:29 pm
Facebook Username: Sally Cunningham
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Re: Medicare versus Private Insurance--Advice please?

Postby mypinkheaven » Sat Dec 16, 2017 1:34 pm

When you're on SSDI, you're automatically enrolled in Medicare after 2 years. Medicare will cover 80% of your medical costs. You'll need to enroll in a prescription plan - you can find them on the Medicare website.

You should have some supplemental insurance to cover the 20% that Medicare doesn't cover. The 20% would be configured from the Medicare approved amount which is less than what the doctor or hospital normally charges for most visits, procedures, etc.

HIPEC isn't covered, but it would be if it was charged as chemotherapy rather than a procedure. That's pretty iffy. But hopefully you'll never have to find out!

If you meet certain income levels, you could be eligible for Medicaid. That would be your secondary insurance that would take care of the 20%.

Good luck - it can be confusing at first. 8)
MSS, KRAS Wild NRAS Mutated
9/2012 CRC IIB Lft Colectomy 0 lymph nodes 0 Chemo
10/2013 CT clear
11/15 CEA 2.7 to 4.6
11/15 Spread to uterus. Hysterectomy
2/16 Pelvic radiation 25, brachytherapy 3
4/16 - 6/16 Xeloda
6/16 CT Several lung nodules 5 mm
8/16 CT Nodules still present. Most stable. Some growth
11/16 Transfer to UCSD Moores
12/16 Folfox + Avastin failed
2/17 Folfiri + Erbitux
8/17 5FU+Erbitux No 5FU bolus
7/18 Spread to vagina
6/18 Folfiri + Avastin + Trametinib
6/18 CEA dropping

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ocstacy
Posts: 264
Joined: Mon Jun 19, 2017 11:29 pm
Facebook Username: stacy

Re: Medicare versus Private Insurance--Advice please?

Postby ocstacy » Tue Dec 19, 2017 3:05 am

I'm not a social worker but my friend is and she has a FB page and I can share that with you.
I switched my mom's insurance to Medi-Medi (Medicare and Medi-CAL) cause she qualified due to her low income status and she is covered for life. I worked my butt off to switch her insurance from standard medicare to medi-cal within 15 days due to her diagnosis. I wanted her to be taken care of with zero medical bills for my family to stress about. I never thought in a million years that my mom would get CA. If you priv message me I can share her page with you. :-)
Caregiver/daughter to dear mother age 78, dx 5/09/17 because of me!! :wink:
Rectal CA Stage 3 low-grade adenocarcinoma- 6 cm
Neoadjuvant start 7/10/17 ended 08/16/17
3D Lap. surgery @ Keck USC, Dr. Sang Lee 10/17/17 temp ileostomy
11/1 hospitalized abscess/hernia - home 11/06/17 antibiotics
NO LYMPHS INVOLVED! NEAR PATHOLOGICAL RESPONSE! YAY! :shock:
Took her last chemo med 05/10/18! Ileo reversal 07/24/18
1st BM after reversal 07/25/18 Anal Fissure 8/15/18
Me:1st Colonoscopy age 38. 08/17 Benign polp.


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