My Journey Begins, Cancer and Medicare, Maybe this will help some others one day

[mjk1967]

(long read but those interested might find it useful)
Well, after beating the most serious part of a family history of diabetes and heart disease (I still have some arterial disease, genetic) but no intervention of even drugs are needed unlike all the males in my family which were a train wreck and had heart by-passes 20 years before my current age. Being the youngest I decided to not let that happen to me and I pretty much beat it, even though I have High LipoProtein A which nothing can be done about. I made sure to eat healthy. I also avoided diabetes (so far)

So, what do you know? since 2017 I have had very high PSA levels it started at a 4.7 and ended 7 years later at higher and way higher than 10___. Multiple MRI's and 4 Biopsies the first 3 over the years turned up nothing the last one in Sept 2024 turned up cancer.
Out of 12 samples taken only 2 came back, that was good and most likely because I was very aggressive on insisting on Biopies. One core showed a 3/3 which really doesnt call for action at that point. The other was a 3/4 which would be considered intermediate risk. This to me was VERY early stage and I wanted it gone.

So my regular urologist calls me up to see what I want to do. Watchful waiting, Radiation or Surgery. He clearly thought Surgery was not at all called for (but read on) I couldnt make up my mind, so there was a 4th option. A referral to Duke University Cancer Clinic almost one of the top 10 in the USA. We (my wife and I) got an appointment a few days before Thanksgiving 2024 to meet with 3 specialists who spent hours with us, just for us, just to review my case and get the options, individually one on one. One Oncology Radiologist, One Surgeon and One Medical Oncologist
My wife and I made the 3 hour trip and stayed in a hotel for the meeting the next day. FREAKING wonderful experience. The entire 5th floor devoted specifically to prostate and other cancers involving that area and we were there. Just for me.

Throughout ALL of this my Medicare ADVANTAGE plan paid for everything, not one hiccup not one objection, no stipulations.

Sadly all 3 specialists were very concerned. It caught my wife and I off guard. Here I was so happy that I found out about this cancer so quickly and being so proactive, almost insisting my Dr do a biopsy. But they explained to me, even though my PSA was down to 11.5 it had to be doubled to a PSA of 23 because of a drug I was on. I found out that all three doctors were to label me "High Risk" and bumped me up from a 7 to more like 8 to 10 (10 being the worst) with favorable outcome.
Also I found out if I wanted surgery it might not be successful do to heavy scarring from an appendectomy I had in the 4th grade that couldnt be closed up at the time, I was septic and almost died. So the surgeon said if I want surgery, robotics is out and he will do it by incision but a 20% chance I will wake up only to find out he cut me open and could not proceed. I was almost relieved in the sense that radiation and drug therapy was making more sense.

Based on the 3 doctors, they ordered a PSMA PET SCAN the latest state of the art scan to see if prostate cancer spread in my body. They were very concerned on how my PSA can be 23 and only 2 cores showing cancer, they felt something great must be going on. However the earliest available appt was Jan 2nd so they offered if I could get one sooner near where I live by all means do it. I told them I want to be treated there, they offered there are many doctors good near me and mentioned one name in particular of a Radio Oncologist that they love and wanted him up at Duke that is within 1 hour from me. I arraigned though the new doctor closer to me AND instant response of the doctors at Duke to get a PSMA SCAN ordered closer to me on Dec 20th and follow up with the new doctor near me on Dec 30th. So thanks to Duke within 2 hours the order for a PSMA PET SCAN arrived at a place closer to me. I was so impressed and also impressed with the staff at what will become my new doctor. All this time, unknown to me and handled by their offices approval was needed by my Advantage Plan, I only found out because I got a letter in the mail it was approved. Once again, no hiccups at all from my plan. The retail cost of this scan was $19,000 and it was determined as far as the scan can tell, the cancer has not spread to any other part of my body.

SO that ends my journey with my medicare advantage plan 2024/ NOT ONE QUESTION, NOT ONE HOLD UP. EVERYTHING PAID FOR.
With that said the current Advantage Plan wasnt being offered in the New Year 2025 and I could care less, I just pick a new one on line on the government website and as soon as you click, you are covered for 2025.

HOWEVER since the provider had decided (Aetna) not to offer this plan for 2025 I also had the right to go into standard Medigap Plan with NO underwriting and guaranteed acceptance. SO here I am with cancer and after thinking about it for a month or so ( I knew way ahead of time) I decided for 2025 to go into private Medigap Plan N which includes Government A and B plus private plan D for drugs. The cost is only $135 extra a month and of that, they will pay a gym cost of up to $110 a month! Net would be $25 including the drug plan so why not? Here I was about to battle cancer and there would not be much to think about.

Why did I decide to go to Medigap from an Advantage plans I so loved for 3 years? Simple, chances are it will cost me less for the year and to be honest, since I am new to the area I wouldnt have to worry about who is in network. I will say, after 2025 I plan but on going back to Advantage C if this all resolves itself. But I honestly do not know right now, though as of right now my Drs are in the Advantage Plan I would choose if I did there seems to be a little turmoil from year to year. The reason for this post is I read stories about Medicare and it's a wonderful system if you take advantage of it and use it, educate yourself right on the https://www.medicare.gov/ website, you can read of days and study.

So the decision was made. Fantastic doctor here on the coast who my wife and I liked very much and they like him up at Duke that they wanted him to move up there, he didnt want too.
I am to undergo radiation and drug therapy. This doctor changed my threat designation a little bit. But he explained it means the same. From high risk favorable outcome to intermediate risk unfavorable outcome.

Yesterday, Wed, the drug was delivered to my house. I am to take one pill a day for 6 months. The drug cost is up to $3000 a month x 6 months roughly $18,000 but can be as little as $14,000 my cost is $2000 thanks to the new medicare drug out of pocket limit for 2025 or it would have been $8,000. My life as I know it will change for the next 6 months and I am not looking forward to it because of the drug but I want to live and make sure this thing is knocked out. The side effects are not going to be pleasant. However they are being aggressive in the sense they use this for high risk cases and in cases where it has spread.

Next week I am going to spend over another half day, meeting with two specialists (one of which is my new doctor) arranging and going over what will be my radiation schedule coming up which will be 5 days a week for 5 weeks as well as MRI and CT scan. This past Monday my regular urologist implanted 3 gold markers inside my body that the computer will use as markers in order to deliver the radiation to the proper area and avoid other areas as much as possible. My doctor tells me the survival rate is 90% for 15 years.

Prostate cancer sucks. The possible side effects of surgery or radiation are different but both can suck. Though immediate side effects for me with radiation will be almost none, 3 years down the road it POSSIBLY can rear its ugly head and even expose you in the future to cancers because of the radiation itself. My hope is, as time goes on medicine advances. One reason how far we have come was surgery was always preferred as late is 2006 now radiation is much more focused and that trend is almost reversed DEPENDING ON YOUR CASE>

SO FOR ALL OF YOU, MAKE SURE YOU ARE GETTING REGULAR CHECK UPS, DONT BE AFRAID OF YOUR DOCTOR, SURE EDUCATE YOURSELF, READ UP BUT ONLY SO YOU CAN TALK TO YOUR DOCTOR AND UNDERSTAND THE CONVERSATION. DO NOT RELY ON INTERNET FORUMS AND WHAT OTHER PEOPLE SAY. YOUR DOCTOR IS THE KEY. MY POST IS ABOUT BEING PRO ACTIVE IN DOING SO, DONT BE AFRAID OF TESTS, IF YOUR DOCTOR GIVES YOU THAT OPTION, TAKE IT, DONT PUT IT OFF.
From the sound of my cancer (they are all different in aggressiveness) I am so glad I was almost insistent on my 4th biopsy when my doctor gave me the choice to wait another six months or do it now.

As far as Medicare Advantage C plans and Medigap Plans plus D plan it comes down to cost and what you want and what you are willing to pay and possibly give up depending on the area you live. I loved my Advantage C plans but given the chance to go back (at least for now) Medicare A, B and private Medigap N plus private Plan D makes everything thoughtless for the extra monthly premium.

Medigap costs are pretty much fixed where the Advantage C plan can get pricey if your copays add up to many thousands and you have to stay in network. So right now, yeah, I am happy to be in Medigap the purpose of my post is to highlight my personal experience. Im sure the end result would be the same with my Advantage Plan. However should your Advantage C plan not be offered the following year, the system once again worked perfect. In the mist of a cancer diagnosis I got an unconditional acceptance into Medigap because my plan wasnt being offered and that gave me the option of choosing anything I wanted. If my plan was still offered I would think NO WAY would I have been accepted into Medigap and that is something each individual needs to know. Once you are in Advantage c you can only get out in the 1st year for guaranteed acceptance. UNLESS your Advantage C plan is no longer offered.
The system works and works very well, I am thrilled that I live in the USA and can get this latest technology, latest drug therapy that even my regular urologist never prescribed before. People trash our health care system, well, you will be thankful in cases like mine.
I was able to consult with a total of 5 specialists plus my regular urologist (who is specialist in his own right) and my cost was pennies. Making educated decisions is up to you, get opinions.

I think the gym plan is called 'Silver Sneakers' . Your generation has taken over the gyms, the last few years.
Wishin you luck on your treatment. And to add, for the younger crowd, get your Colonoscopy. I waited until 52, and had 6 polyps. One of which was 22mm -- top 1% of Polyps he has removed.

 

[Cropduster172]

And here we go

This thread is not about MA.

Why bring it up!?

Because it's relevant to the post I replied to and I have similar first hand experience as the OP.

 

[UncleDave]

Awful - Keep fighting AG. Thanks for the write up.

Renal cell carcinoma took my port kidney in 2011, but I caught it in time to skip chemo.
My modeling career took a hit for sure. (lol)

Anything I can do to support - reach out.

 

[alarmguy]

I think the gym plan is called 'Silver Sneakers' . Your generation has taken over the gyms, the last few years.
Wishin you luck on your treatment. And to add, for the younger crowd, get your Colonoscopy. I waited until 52, and had 6 polyps. One of which was 22mm -- top 1% of Polyps he has removed.

Thanks, agree, get your tests!
I’ve had a couple colonoscopies, only one polop before the last one which was clean so next time is 10 years.
Being an ex smoker, I also get an annual CT lung scan. Early detection is always the key.

As far as the gym I never used the silver sneakers program. United healthcare used to pay for me to go to Orangetheory and now my Medigap Blue Cross plan will pay up to $110 a month for a gym not on their list.

So I’ll still be able to go to Orangetheory.
But in this case, I will have to pre-pay and send in the reimbursement form every month. I really don’t know much about the silver sneakers program as I only went to Orangetheory and I liked it a lot because it was one hour rigorous coach training. I did feel a little funny at first with all the young people, but then I learned it doesn’t matter and I did pretty well with it.

I hate that name silver sneakers. It drives me crazy maybe one day if I get older and not embarrass embarrassed, I will check it out.

 

[doitmyself]

I did feel a little funny at first with all the young people, but then I learned it doesn’t matter, and I did pretty well with it.

I work at a university and have free access to the intramural gyms. I go there FOR the young people. Nearing age 69, they help keep me young in mind and heart. But, I imagine they view me similar to the creepy old guy at the beach during spring break. I do have some concerns about public gyms and spread of germs and other health things. In one sense it is good for the development of natural resistance, but still is a bit risky for us old geezers.

 

[alarmguy]

Unfortunately, Plan N is not an option with Guarantee Issue rights, it never has been. Someone or some people made mistakes along the way getting you enrolled in your supplement plan.
Because of MACRA if your Medicare coverage began before 2020 the plan F is only guarantee option and if your Medicare began in 2020 or after, plan G is the only guarantee option.
To obtain plan N it would need to be underwritten and with a recent cancer diagnosis it would be declined.
At the end of 2024, there were a lot of Advantage members that had this specific loss of coverage occur in many states and with a hand full of Insurance companies too.
Because of this, many insurance companies got backed up with an abnormal amount of guarantee issue applications. When this happens during the annual enrollment period some insurance companies will just auto approve applications without an underwriter overseeing anything. This is most likely why your plan N was approved.
I hope the insurance company does not find out during the two year incontestability period. They do have the right to rescind the policy, refund your premiums and deny any claim that has been paid.
Not trying to rain on your parade, just letting you know in case you start receiving mail from your insurance company in regards to this.
Good luck.

Good post, I found the website. Have no clue how I missed it as I researched everything Medicare for years. However I am accepted and cant be denied and if I really want to I could switch today as I have 63 days to do so.
Very helpful to others though as it would have saved me a lot of time and I would have went to plan G I debated the two for gosh weeks. Knowing this would have saved me that time.
THIS IS MY TAKE. Under my circumstances I have been issued the policy. Just because something is guaranteed doesnt mean a company cant accept you into other plans as well. It just means that they HAVE to take you into Plan G under those conditions.
With all this said, who knows, if I had the energy I would switch right now to Plan G but I already have this letter saving I am accepted along with any pre-existing conditions. What I love about Medicare is regulations are very tight. A company accepts you, you have insurance that cannot be canceled in as much as what I read.

Anyway, this is part of my letter.

 

[alarmguy]

I was under the impression if your Medicare Advantage plan was terminated for your area, a person has the right to choose any plan regardless of preexisting conditions

Yeah, me too. You KNOW how much I researched this and somehow still missed it.
https://www.medicarefaq.com/faqs/medicare-guaranteed-issue/

Im no longer concerned but would have done things differently, though as of this moment (today only) I do not think I will call to switch even though I can. I was accepted without health questions and as you can see contained in the health ins letter (in post #86) I have been given full credit for pre-existing conditions.

 

[alarmguy]

Awful - Keep fighting AG. Thanks for the write up.

Renal cell carcinoma took my port kidney in 2011, but I caught it in time to skip chemo.
My modeling career took a hit for sure. (lol)

Anything I can do to support - reach out.

Thank you!
Do to snow here on the coast my appts were canceled last Thursday. I had one (less important one the following day)
Tuesday the 28th is a big day. Called a Radiation Simulation along with an appt with my radiation oncologist and an MRI after that.

Simulation with CT from what I understand they will put me on the actual table and set up the program that will run the radiation program specifically for me every time I go once scheduled. 5 days a week for 5 weeks.
If I understand correctly, Once I start going, I can go two one of two places. They put you on the table, pull up your file and press the "start button" the computer used CT or MRI guidance along with 3 gold balls they already injected into the prostate which the machine used to align and deliver the radiation (yeah ouch but was over in 5 minutes when they did it) and in a matter of minutes you are done for that day. Never been though this before but this is what I understand. Ill know exactly after Tuesday.

 

[UncleDave]

Thank you!
Do to snow here on the coast my appts were canceled last Thursday. I had one (less important one the following day)
Tuesday the 28th is a big day. Called a Radiation Simulation along with an appt with my radiation oncologist and an MRI after that.

Simulation with CT from what I understand they will put me on the actual table and set up the program that will run the radiation program specifically for me every time I go once scheduled. 5 days a week for 5 weeks.
If I understand correctly, Once I start going, I can go two one of two places. They put you on the table, pull up your file and press the "start button" the computer used CT or MRI guidance along with 3 gold balls they already injected into the prostate which the machine used to align and deliver the radiation (yeah ouch but was over in 5 minutes when they did it) and in a matter of minutes you are done for that day. Never been though this before but this is what I understand. Ill know exactly after Tuesday.

Doesn't sound like fun, but also could be worse.
Must be super low level for 5 days a week for 5 weeks.
At least the procedure is quick.

Im visiting my parents this week, my mom had cervical cancer at 70 nailed it went through chemo and bounced back like a champ.

My half sister had both breasts proactively removed after watching her mom (my step mom) die from breast cancer.

This awful disease is a blight on humanity.

You caught it, you are on it.
We're pulling for you.
You have us as a support network.

 

[alarmguy]

Medicare Advantage plans are heavily advertised on early afternoon shows like Hot Bench, Steve Wilkos, Maury Povich, Karamo... should tell one all they need to know. People fall for the less important benefits they throw in...gym memberships, grocery allowances, Uber/Lyft reimbursement to appointments, OTC medicines, minimal dental and vision coverages, basically fluff.
When it comes to the serious claims...good luck.
I'm glad I squeaked under the wire for Plan F.
Plan G is your next best option.

Im an actual user of Medicare Advantage Plans (MA) for 3 years and never had a claim denied, easily ran up to $200,000 in bills for a year (retail not what a company actually pays) It cost me nothing compared to what I would have paid for Medigap.

A close family member left Medigap for Advantage (because of me)and he is a train wreck with heart issues. His Medigap was getting too expensive after seeing what I was paying. He has had maybe up to$500,000 in retail medical costs so far. Never a denial. He was hitting his out of pocket for those years of 3k and I do caution people to keep an eye on MA out of pocket limits as they are rising.
BUt still, it's almost premium free if you take advantage of dental, vision etc and if you want, gym too. Also Hearing Aids much of which is not covered under Medigap. He now has one implanted device replaced with the newest state of the art combination heart unit, that even reports to an agency who reports to his doctor as it monitors his heart. It's a combo pacemaker, defibrillator and some other thing that actually controls the timing between both sides of the heart. He has also traveled out of the area to get an ablation that was almost considered experimental on equipment where this was the first unit in the USA available .... never a hiccup (other stories might vary)

Anyway, his Humana MA plan was canceled for 2025 (as a lot were) but he elected to go to another MA plan even though he could have went back to Medigap. Also his wife went into that MA plan too. UHC Medicare Advantage. Once again, all the benefits you pointed out, including they get $150 (between the both of them) to spend on over the counter items every three months. So everyone is different, pick and choose what works for the individual. Plus they get free dental, vision, annual physicals and whatever else.
Bottom line is, if Medicare covers a procedure, Advantage C plans have to also.

My biggest concern as I posted, is the MA plans have been increasing your out of pocket limits. At the same time it's REALLY hard to hit those limits. But it is a valid concern and for now, I jumped into Medigap while I could with a recent cancer prognosis and being new to the area, not knowing what is up, where I would be going for treatment, yet the key was, in my case paying a premium for the year having Medigap will be the same as my out of pocket limit (possibly) for a new Advantage C plan so common sense was to go for Medigap this year and re-evaluate next year if I go back to Advantage C.

Also note, since I no longer have Advantage C I am paying extra for Vision and Dental coverage through my wife's employer because I cant get that through Medigap.

 

[Cropduster172]

Im an actual user of Medicare Advantage Plans (MA) for 3 years and never had a claim denied, easily ran up to $200,000 in bills for a year (retail not what a company actually pays) It cost me nothing compared to what I would have paid for Medigap.

A close family member left Medigap for Advantage (because of me)and he is a train wreck with heart issues. His Medigap was getting too expensive after seeing what I was paying. He has had maybe up to$500,000 in retail medical costs so far. Never a denial. He was hitting his out of pocket for those years of 3k and I do caution people to keep an eye on MA out of pocket limits as they are rising.
BUt still, it's almost premium free if you take advantage of dental, vision etc and if you want, gym too. Also Hearing Aids much of which is not covered under Medigap. He now has one implanted device replaced with the newest state of the art combination heart unit, that even reports to an agency who reports to his doctor as it monitors his heart. It's a combo pacemaker, defibrillator and some other thing that actually controls the timing between both sides of the heart. He has also traveled out of the area to get an ablation that was almost considered experimental on equipment where this was the first unit in the USA available .... never a hiccup (other stories might vary)

Anyway, his Humana MA plan was canceled for 2025 (as a lot were) but he elected to go to another MA plan even though he could have went back to Medigap. Also his wife went into that MA plan too. UHC Medicare Advantage. Once again, all the benefits you pointed out, including they get $150 (between the both of them) to spend on over the counter items every three months. So everyone is different, pick and choose what works for the individual. Plus they get free dental, vision, annual physicals and whatever else.
Bottom line is, if Medicare covers a procedure, Advantage C plans have to also.

My biggest concern as I posted, is the MA plans have been increasing your out of pocket limits. At the same time it's REALLY hard to hit those limits. But it is a valid concern and for now, I jumped into Medigap while I could with a recent cancer prognosis and being new to the area, not knowing what is up, where I would be going for treatment, yet the key was, in my case paying a premium for the year having Medigap will be the same as my out of pocket limit (possibly) for a new Advantage C plan so common sense was to go for Medigap this year and re-evaluate next year if I go back to Advantage C.

Also note, since I no longer have Advantage C I am paying extra for Vision and Dental coverage through my wife's employer because I cant get that through Medigap.

I was diagnosed with prostate cancer last April or so. PSA went from 4.3 or so to 5.6 ...my primary care doctor said any jump of .4 or more go to a urologist which I did. Biopsy revealed something 1 of 11 I believe. Follow up with the same urologist and the vibe he was giving was robotic removal by him as the primary option. I knew there were all kinds of newer technologies for treatment so I went in for the whole body bone scan as directed by him. Only thing that revealed was arthritis in my knees and feet....like I needed a full body scan to tell me that.
I dropped him ASAP and through a little research and connections( my kid graduated Penn Dental School), I found the guy that was top urologist at Johns Hopkins and is now at University of Pennsylvania Hospital. My appointment with him was great. After reviewing my biopsy, Gleason scores etc...his first words were," this will not effect your longevity". He sent me for an MRI in July...any tumor is too small to see or treat. It's the Active Surveillance route for me now. I was leaning towards HIFU( High Intensity Focused Ultrasound). He's one of the best at Penn for it but said it's simply not significant enough for treatment. So...PSA test every 6 months or so and probably a yearly biopsy and go about my life as usual. So I have. In fact, last PSA dropped to 4.8 which is perplexing but better than it increasing.
I have Plan F via AARP United Healthcare. Not a huge fan of AARP but the coverage is excellent. I've paid nothing other than premium, which is partially subsidized by my wife's former employer for both of us.
It seems you learned a similar lesson as I. You have to your own health advocate. I wonder how many dudes that saw the first guy I went to just went along with his recommendation for removal and are living with the outcome.

 

[alarmguy]

I was diagnosed with prostate cancer last April or so. PSA went from 4.3 or so to 5.6 ...my primary care doctor said any jump of .4 or more go to a urologist which I did. Biopsy revealed something 1 of 11 I believe. Follow up with the same urologist and the vibe he was giving was robotic removal by him as the primary option. I knew there were all kinds of newer technologies for treatment so I went in for the whole body bone scan as directed by him. Only thing that revealed was arthritis in my knees and feet....like I needed a full body scan to tell me that.
I dropped him ASAP and through a little research and connections( my kid graduated Penn Dental School), I found the guy that was top urologist at Johns Hopkins and is now at University of Pennsylvania Hospital. My appointment with him was great. After reviewing my biopsy, Gleason scores etc...his first words were," this will not effect your longevity". He sent me for an MRI in July...any tumor is too small to see or treat. It's the Active Surveillance route for me now. I was leaning towards HIFU( High Intensity Focused Ultrasound). He's one of the best at Penn for it but said it's simply not significant enough for treatment. So...PSA test every 6 months or so and probably a yearly biopsy and go about my life as usual. So I have. In fact, last PSA dropped to 4.8 which is perplexing but better than it increasing.
I have Plan F via AARP United Healthcare. Not a huge fan of AARP but the coverage is excellent. I've paid nothing other than premium, which is partially subsidized by my wife's former employer for both of us.
It seems you learned a similar lesson as I. You have to your own health advocate. I wonder how many dudes that saw the first guy I went to just went along with his recommendation for removal and are living with the outcome.

Great post and I wish you well. Since I posted about my own condition I'll refrain for doing it again. Gosh how I would have loved to have a PSA of 5 instead of approx 23.
I suspect 1 of 12 cores of yours came back positive for the cancer. Mine was 2 of 12, a 3/3 and a 3/4 still caught early however Duke Doctors perplexed and concerned why my PSA is so high for what little cancer is showing up. So they really ramped up my risk rating based on that.
The Medical oncologist I met on Friday was ok but I dont feel like Duke level. I was explained so much more when I was at Duke. I dont really need him now that I am taking the medicine but that is kind of convoluted, even if I have a question now I will be questioning how much he knows. Good news is he ordered a PSA and Testosterone blood test I have to get it Mon or Tuesday. Lab was already closed when we were done on Friday. He suspects my Testosterone is already close to zero in such a short period of time after what I just told him.
As posted VERY happy with my radiation oncologist. I see him Tuesday and will go over what is to take place moving forward.

Then of course if you read about me signing up for Plan N instead of G, this is the last thing I needed right now if I want to switch within the time frame allowed now is the time but not sure if I have to bother.

Prostate Cancer sucks but under a doctors care it is manageable but it still ____ as its such a vague area to treat and no hard and fast rules.

 

[1978elcamino]

.

 

[1978elcamino]

Thank you, I need to look into this obviously I found what you are talking about.
This would be the question, and I will try to get in touch with an agent today. Since not too much has taken place this month but it’s about to next week and I might have to put it off.

My guaranteed issue right last until the end of February 2025
Will an agent be able to switch me into a plan G and will that plan G be effective starting January 1, 2025

I’m also questioning in regard to your statement regarding that two year. That protects policyholder and insurers.
I’m not quite sure that would pertain to this as it does not involve fraud.

With that said this information is helpful and I am going to look into it for sure. I do have a letter of acceptance stating continuation of coverage is the reason I have been accepted.
I seriously doubt an insurance company would be allowed to give somebody healthcare coverage, find out you were sick and then tell you that you can’t have the coverage once they find out that you are sick when they never asked any questions or looked into your claims history.

I appreciate the post because I have no problem going into plan G and at this point based on what you wrote, I would prefer too however I really need to speak to a very knowledgeable agent and fast.

More or less my thinking is they accepted me without underwriting. Also, when filling out the form I typed in Aetna Medicare advantage plan is not being offered for renewal 2025. Other than that, there were no health questions at all.

Thanks again for your post. I am definitely taking this serious because that’s who I am and we’ll seek to get it clarified because as it stands, I have to the end of February to go into a guaranteed acceptance plan.

Ps.
Come to think of it, guaranteed acceptance means just that. The company cant deny you unless it’s those two plans mentioned.
One of those is G, which is a great plan and about the same cost. So anyone with guaranteed acceptance clause has to be accepted into G, but that does not bar the company from excepting you into other plans.
If you’re accepted into another plan, to me it would make sense you have to be covered in that plan, it would be their fault for accepting somebody that they did not want to. Even more so, not looking into your history or asking any questions.
Meaning I applied for plan N and I was accepted because they accepted me.

I do appreciate this and it should be a warning for others to be careful because if I had to do it all over, I would’ve simply chose G, but I seriously doubt they could take away my plan N because they gave it to me to begin with.

You certainly made a great post and will be helpful to others in the future. Thank you.
I’ll look into it, but my key contention will be. I was already accepted and there was no fraud on my part involved. All I did was apply for a plan N
Letter of acceptance came in with the wording, something like “continuation of coverage”
@Pablo

Best thing I can suggest is look at your Medicare card. If either part, A or B started before the year 2020 the guarantee issue plan is F. If the start date is 2020 or after the Guarantee issue plan is G.

I would suggest discussing this concern with the agent to see if the insurance would allow you in either the F or G depending on your Medicare start date.

 

[1978elcamino]

I was under the impression if your Medicare Advantage plan was terminated for your area, a person has the right to choose any plan regardless of preexisting conditions

For a Medicare supplement plan it is only for a Plan F or Plan G depending when your Medicare started.

 

[CKN]

Thanks, agree, get your tests!
I’ve had a couple colonoscopies, only one polop before the last one which was clean so next time is 10 years.
Being an ex smoker, I also get an annual CT lung scan. Early detection is always the key.

As far as the gym I never used the silver sneakers program. United healthcare used to pay for me to go to Orangetheory and now my Medigap Blue Cross plan will pay up to $110 a month for a gym not on their list.

So I’ll still be able to go to Orangetheory.
But in this case, I will have to pre-pay and send in the reimbursement form every month. I really don’t know much about the silver sneakers program as I only went to Orangetheory and I liked it a lot because it was one hour rigorous coach training. I did feel a little funny at first with all the young people, but then I learned it doesn’t matter and I did pretty well with it.

I hate that name silver sneakers. It drives me crazy maybe one day if I get older and not embarrass embarrassed, I will check it out.

Silver sneakers is just the name of the administrator-basically. The Salt Lake County Rec Centers is used to dealing with them. You just give them a filled out form and they take care of the rest. I would assume any national company like Vasa, Planet Fitness, etc., would be used to dealing with them. In my case my membership card looks like anybody else.
Congrats on the Orange theory, I hear that's a pretty rigors workout. There seems to be kind of a "brotherhood" with those who exercise- encouraging each other and exchanging pleasantries, etc.

https://tools.silversneakers.com/El...msaqlFjrSB2Ga7SXeiR_cgh8KvqI1dXhoCiRYQAvD_BwE

 

[andrew_j]

Hi read cancer (TLDR) and wish the best for a recovery!!!

 

[Pablo]

FWIW Regence uses Silver and Fit

 

[Pablo]

For a Medicare supplement plan it is only for a Plan F or Plan G depending when your Medicare started.

Medicare started 2023

No preexisting serious problems

My MA plan Humana shut down in this county. I had zero problems with them in 1.5 years covered dental and eye care no questions asked

I chose a Plan N from Regence. $162 month - basically the fear is now they could cancel if I get a serious health issue and I would be screwed?

 

[alarmguy]

Pablo said:
I was under the impression if your Medicare Advantage plan was terminated for your area, a person has the right to choose any plan regardless of preexisting conditions

For a Medicare supplement plan it is only for a Plan F or Plan G depending when your Medicare started.

I think the bottom line is, individual states can have their own laws on Medicare requirements. I or anyone else here is not a specialist in Medicare for you and your state OR the company I am buying insurance from. I suspect based on the photos I proved FOR my particular policy. Guaranteed means guaranteed under medicare it doesnt mean a company cant offer you other plans.

Due diligence and if in the situation as I was, understand what you are doing and if not. Be prudent call a licensed agent or the company it self who will most likely give you a licensed agent, do not rely on the internet. I am used to reading contracts, not health care though. I have read and in detail answered every question properly asked of me. 100% upfront complete with dates AND when done No health questions at the end were asked once I filled out all the information, that portion was "grayed out" and non addressable. I even, as instructed, with my application included the Advantage C non renewal form from the Advantage C plan. There is a whole section of questions to answer including to include a copy of the non renewal.

Here are just a few snap shots of what I am talking about and I will end my discussion on this particular series of posts now. Only thing I would say, call a professional and always be 100% truthful, this is serious stuff not to be taken lightly. I really lost sleep over this from @197belcamino but after reviewing every last detail I have no need to bother making a call. IN addition I am still in my window to switch should I have made a mistake which I have not in this particular case.

BOTTOM LINE - Talk to a professional and also educate yourself on Medicare.gov so you can understand the professional. @1978elcamino elcamino gives a good reason to do that if you make a mistake. I do not believe I have thought I might have done things differently because he made me nervous *LOL* but at least I examined everything all over again, and again, and again, and again.

Random snippet from my acceptance letter;

This below is a photo taken from the Plan N book that was mailed to me along with the acceptance letter, (actually all put together as a book, copy of everything I filled out and response of the insurer);