Four years ago I made the choice to stay on my wife’s Cigna medical insurance at work and not go on Medicare. There were some very good reasons why.
I was in pretty bad shape when I was diagnosed with multiple myeloma in 2007. My wife, Pattie, filled-out an application for Social Security Disability (SSDI) for me, making sure that she enclosed all of the required docs, including an all important letter from my medical oncologist, confirming my diagnosis and debilitating symptoms. She must have done an excellent job, because I was approved in less than a month. As promised, I became eligible for Medicare coverage two years later. Good news, but I had some concerns. After researching it and comparing my options, I made the decision to stick with my wife’s insurance where she worked
Circumstances may be different for you. You may be over 65 and on Medicare already. Or you may be on a private insurance plan that works in one state, but hope to move to another. I did that, too.
Whether you are shopping for a Medicare supplement, or selecting a plan from one of the new marketplace exchanges, a number of the things I have researched over the years may help–and several could be vitally important.
1) Stem cell transplant coverage. One of the reasons I didn’t want to sign-up for Medicare was the restrictive stem cell transplant rules. For example, Medicare will currently only pay for a single stem cell transplant. And allogeneic (donor) transplants are not covered at all; they’re considered experimental. Knowing that, you can see why excitedly signing-up for Medicare–if you have other options–may not be the best choice for a multiple myeloma patient under the age of 75.
2) Oral chemotherapy medications. The IMF and LLS are feverishly lobbying states–and the Federal Government–to pass laws that restrict insurance companies and Medicare from charging us more for oral chemo like Thalomid, Revlimid, Pomalyst and Cytoxan. Carefully check the drug plan you’re considering to see how much the co-pay would be for these drugs. Considering Medicare? Don’t forget the infamous doughnut hole! Thanks to the Affordable Care Act, it started closing this year. But significant charges still apply until the end of the decade.
3) How portable is the insurance? Here, Medicare has a big advantage, since it’s accepted in all fifty states. Traveling overseas? Sorry; you’re out of luck if you only have Medicare.
4) Cost. Those of you that qualify for LLS co-pay assistance get a break here. You can select more expensive insurance, knowing that the LLS will reimburse you for the premiums. My tip for everyone else? Don’t be penny wise and pound foolish. Saving $100 a month isn’t worth being stuck with a plan that forces you to pay several hundred dollars (or more) a month if you’re using Revlimid.
5) Will it cover second opinions out-of-state? Will Mayo Clinic, Dana-Farber, UAMS or other large, specialty cancer centers accept the insurance that you’re planning to use? For example, Mayo Clinic wont’ accept one of the most popular Medicare supplemental plans, Medicare Select. Again, you may save monthly by choosing a plan like this, but get stuck with 20% of the bills at Mayo Clinic for three days of testing, and you may need to sell your home to pay for it.
Did I forget any? Performing due diligence when making health insurance decisions may not only save you money; it could help save your life! I hate to see someone who’s first stem cell transplant worked for a half dozen years have the option of repeating it taken off the table because insurance or Medicare won’t pay for it. Shop carefully, my friends.
Feel good and keep smiling! Pat