Which Medicare plan is the best?

[DonnaNY]

Hi all, My moms Oncologist wants to put her on Tykerb. She has medical coverage through my father.Prescriptions are through CVS/Caremark, but Oncologist told her she had to get Medicare, which she is able to now ,she turned 65 last month. But he said to be careful of which plan she picked because some will cover cost of medicine for awhile then dump you then maybe pick it up again a few months later, we need a plan that wont do that, that will keep covering cost of medicine like Tykerb. Anyone here have any info or advice,we would really appreciate it . Thanks ! God Bless




Donna

[Lani]

of acting on misinformation can be significant.

Is your mother treated at a private oncologist's clinic or a cancer center. If the latter, see if they have a social worker at least and perhaps a financial counsellor in addition and check out everything they tell you once again before acting.

Your local Cancer Society may have advice as to those with expertise in this issue.

I would not rely on the oncologists advice that she "has to get medicare" as your oncologist went to school to be an expert on cancer, not an expert on the changing rules on how to have insurance coverage once you turn 65. I assume your mother does not work (that opens issues as to whether medicare is her primary or secondary). I am not certain how spouse coverage affects one's Medicare coverage, but at least I know what I don't know and know enough to tell you to get knowledgeable people to inform you and even then check out what they tell you. There can be many variables that go into play in how medicare A and B and medicare drug coverage (D) work in different scenarios AND the rules are subject to change.

Do your homework and then double check your homework.

Maybe Joe can suggest some other resources--AARP comes to mind, but you want someone with a cancer-bent to think through the implications of your proposed actions. Again, I wouldn't rely on the anecdotal accounts of any one person or even one "financial services expert from a medical center" or even one social worker. Check it out and double check it and ...your mother is one lucky lady to have you looking out after her best interests!


Sorry to sound so cautionary, but the implications of a wrong decision might be huge financially.

PS I believe you have to sign up for but not necessarily take Medicare benefits when you are 65 and there is a difference here between A B and D
but I know WHAT I DON"T KNOW and know that what I thought I knew may have changed. People in the field may even know what changes have been proposed and may be pending in Congress, so it is probably most wise to widen your field when you seek the answers.

Best of luck identifying the right information-giver and again BE sure you double check their info.

[hutchibk]

There is no such thing as a Part D prescription program that will pay for all of it. Part D will pay for (per year) up to $2250. Then you fall into what they call the 'donut hole' - where you pay 100% until you reach $3600, then it will kick in again. This is a scary proposition on Tykerb. (Beware of Medicare Advantage plans... they are NOT the good option if you are in cancer treatment when you turn 65, much too limiting on ceilings and caps). Standard Medicare Part A and B with a supplement and with a Part D prescription plan is much better if you go the Medicare route.

Read this for more info on Part D: http://www.medicareadvocacy.org/PartD_DoughnutHole.htm

There are ways through the donut hole if you qualify financially... the pharma company (Glaxo Smith Kline) offers an access program so that you can access Tykerb from them for free. Find out if there is an oncology prescription advocate nurse at your cancer clinic or office who can help you with this.

Also, you can apply for SSI assistance - and if you qualify financially, they will pick up the cost of Tykerb through the donut hole (SSI prescription assistance). I am not sure how it works, but my nurse advocate told me to apply for it a couple of years ago and it has worked for me.