What to look for in a MAPD plan with cancer?

[Packerland]

Adding on - when you looking up chemo costs (eg B ones) be aware that 10% of chemo can still be astronomical so they are likely going to max out their out of pocket likely in the first chemo visit.

Check what ER coverage it as well (eg do they limit the number of times you can go and how hard is it to get an exception after the fact). People undergoing chemo often have multiple ER visits.

Good points, but regardless 10% or 20% they are going to hit their MOOP.

 

[annon123]

Good points, but regardless 10% or 20% they are going to hit their MOOP.

If they can't afford that all in one bill they need to find out what the facility's policy and time frame is on sending someone to collection. Many places cut off care if you end up in collection which is the last thing that person needs. If they can't they need to be proactive about setting up a payment plan they can handle.

Also (if the person/family is 400-600% of the poverty line for their family size there are foundations/non-profits that offer grants, typically $4000-5000 that can be used for copays on drugs and treatment and on premiums. In the case of the original poster, the Leukemia and Lymphoma Society has some (each disease they cover opens around 4 times a year and once it is open they need to drop everything to apply as many of them close quickly). There are other foundations out there that cover cancer (and other expensive diseases). I listed some of them in another thread.

 

[Chazm]

My assistant had cancer with her WellCare MAPD. She said from start to finish she spent a few hundred dollars. Well under her moop.

 

[annon123]

My assistant had cancer with her WellCare MAPD. She said from start to finish she spent a few hundred dollars. Well under her moop.

Not specific to you but I see a lot of comments of "I know someone or one of my clients paid X on a MAP" (insert some very low amount). Testimonials are not generalizable to every one. How much people will need to spend will be dependent on their cancer (or other major disease), what the norm is for treatment, and the details of their specific plan.

For example breast cancer that is node negative where the tumor has a low Oncotype Dx doesn't require chemo so surgery is the major cost. On the other hand if the Oncotype Dx is higher then chemo will add to the costs. If this same node negative person had a mastectomy instead of a lumpectomy they won't require outpatient radiation... Typically if they are ER pos (one of the markers) they take tamoxifen or an aromatase inhibitor. For that there are plenty of generics and on some plans it is really inexpensive.

Chemo is incredibly expensive and so regardless of their plan (supplement or a MAP) they are going to hit their out of pocket, often when the bill comes in for the first or second round of chemo depending on what the chemo is and how surgery is covered (sometimes chemo is done before surgery to shrink the tumor so the surgery doesn't have to be as "invasive". If this were to happen hopefully the client has G or F as usually premiums plus MOOP for either of those is less than the combined premiums and MOOP on a MAP.