Age 63 - Disabled - Chemo - Arizona

[lifeismylife76]

Hello. I have a lady in Arizona who is going through chemotherapy.
She can’t get a Medicare Supplement and so we chose UnitedHealthCare Plan 3 HMO for Maricopa County to begin January 1. $2500 MOOP.
She’s concerned because we don’t have any way to know if she will have any obligation beyond the MOOP.
Below is her exact Chemo situation.
Does anyone have any advice or knowledge about this?

“I have infusion chemotherapy every 3 weeks for 268 mg of the enhertu , every 4 weeks of the zometa performance as Iv in net work at enology dr curley office
Zometa is 4 mg
During the chemotherapy with enhertu add 12 mg of the Dex, 8 mg of zofin”.

 

[Bob L]

Hello. I have a lady in Arizona who is going through chemotherapy.
She can’t get a Medicare Supplement and so we chose UnitedHealthCare Plan 3 HMO for Maricopa County to begin January 1. $2500 MOOP.
She’s concerned because we don’t have any way to know if she will have any obligation beyond the MOOP.
Below is her exact Chemo situation.
Does anyone have any advice or knowledge about this?

“I have infusion chemotherapy every 3 weeks for 268 mg of the enhertu , every 4 weeks of the zometa performance as Iv in net work at enology dr curley office
Zometa is 4 mg
During the chemotherapy with enhertu add 12 mg of the Dex, 8 mg of zofin”.

That Plan 3 is an awesome plan. Wish we had something like that here in Tennessee.

Her chemo would be 20% coinsurance, like most other Advantage plans. Once she has hit $2500 she's done for the year for all approved Part A and Part B services.

Best results are when all the chemotherapy is done within one calendar year, of course, to avoid dealing with two MOOPs.

I thought my own UHC Plan 1 $3700 MOOP was good. $2500 is excellent.

 

[lifeismylife76]

That Plan 3 is an awesome plan. Wish we had something like that here in Tennessee.

Her chemo would be 20% coinsurance, like most other Advantage plans. Once she has hit $2500 she's done for the year for all approved Part A and Part B services.

Best results are when all the chemotherapy is done within one calendar year, of course, to avoid dealing with two MOOPs.

I thought my own UHC Plan 1 $3700 MOOP was good. $2500 is excellent.

Thank you for your thoughtful reply. I may not have posed the question correctly. I agree that I believe the $2500 is the most she will pay and that’s she is lucky to have such a low MOOP.

However, she is quite stressed to know if there is a limiting to the amount of chemotherapy drugs and what her patient responsibility would be at every visit. I had my assistant call UHC to try to find out but no one has any definitive answers.

I think she’ll kind of just have to wait to see what the responsibility is once her plan becomes effective in January and just be prepared with that totally awesome MOOP.

I can’t imagine facing chemo and I believe this is a very simple answer, I just don’t know how to figure it out in advance. And she wants very specific information about chemo drugs and dosages which is not available anywhere I’ve seen yet.

I’d offer her a Plan G and we’d have no worries, but shes under 65 and that’s not an option in Arizona for her until shes 65.

I have explained that Insurance is a contract and the MOOP is the tops for the year as long as Medically Necessary, but she seems unsatisfied with that and wants something more precise about per visit Patient Responsibility and limits on chemo drugs.
help!.

 

[goillini52]

Thank you for your thoughtful reply. I may not have posed the question correctly. I agree that I believe the $2500 is the most she will pay and that’s she is lucky to have such a low MOOP.

However, she is quite stressed to know if there is a limiting to the amount of chemotherapy drugs and what her patient responsibility would be at every visit. I had my assistant call UHC to try to find out but no one has any definitive answers.

I think she’ll kind of just have to wait to see what the responsibility is once her plan becomes effective in January and just be prepared with that totally awesome MOOP.

I can’t imagine facing chemo and I believe this is a very simple answer, I just don’t know how to figure it out in advance. And she wants very specific information about chemo drugs and dosages which is not available anywhere I’ve seen yet.

I’d offer her a Plan G and we’d have no worries, but shes under 65 and that’s not an option in Arizona for her until shes 65.

I have explained that Insurance is a contract and the MOOP is the tops for the year as long as Medically Necessary, but she seems unsatisfied with that and wants something more precise about per visit Patient Responsibility and limits on chemo drugs.
help!.

Have you tried calling UHC and asking them?

 

[lifeismylife76]

Have you tried calling UHC and asking them?

Yes.

 

[goillini52]

Yes.

I know this lady has no other options, but this is a prime example of Medicare Disadvantage...too much uncertainty...too many surprizes.

 

[lifeismylife76]

I’m this case, I agree. I’m a MAPD Queen and in my area, it’s the only way to go for most people. I only sell Med Supps when basically the client doesn’t give me an option so, ONE all year.
It just seems extremely unfair that Arizona doesn’t give her a Med Supp option due to her age.

 

[LostDollar]

Caveat, not an agent.

Wouldn't the doctors office be able to provide her with the amount of the copayment due each visit?

 

[AZSHIS]

I’m this case, I agree. I’m a MAPD Queen and in my area, it’s the only way to go for most people. I only sell Med Supps when basically the client doesn’t give me an option so, ONE all year.
It just seems extremely unfair that Arizona doesn’t give her a Med Supp option due to her age.

Why is it "unfair" ? People that are under 65 on Medicare have high utilization. The plans can be priced accordingly and fairly at 600 plus a month or aggregated into an existing block at 300 a month as many states do which raises everyone else's premium, or states can be like Arizona and not offer them at all. Do you have any idea if Plan 3 aligns with your client's providers?? Am I being "fair"?