What to look for in a MAPD plan with cancer?

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.
 
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.
 
My assistant had cancer with her WellCare MAPD. She said from start to finish she spent a few hundred dollars. Well under her moop.
 
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.
 
I have a client on a MAPD now, who just got diagnosed with leukemia. What should I be looking for in a plan to best suit him for next year's coverage? Obviously the network and making sure the cancer docs are all in network is top priority. His current plan is good, but knowing he has cancer there are better options.

I was thinking of finding the lowest MOOP plan would help even if that means going to an HMO plan. He's not planning to go to Johns Hopkins or other top hospital, he will stay local. He's most likely going to have quite a large expense, so figuring a low MOOP would also be a priority.

Anything else? Not sure what to expect with this. Thanks!
I was just looking around trying to get a nod towards the best cancer policy in case of chemo ... obviously, this person isn't going to qualify for one ... which carrier? I heard about one that is 15 dollars per 5K benefit ... yes, I am doing "research" here and now if that's o.k ...?
 
I was just looking around trying to get a nod towards the best cancer policy in case of chemo ... obviously, this person isn't going to qualify for one ... which carrier? I heard about one that is 15 dollars per 5K benefit ... yes, I am doing "research" here and now if that's o.k ...?
5K of benefits isn't much depending on what their MOOP for A, B and D is or MAPD is, surgery, radiation, etc. Also affecting which MOOP is if the chemo is being infused (covered by B) or is a pill (covered by D, and many aren't covered). Typically cancer patients have at least one ER visit, many have the cost to get a port put in, other meds (anti nausea, Neulasta to drive their white count back up, pain meds when at home after surgery, etc.).

Most cancer policies do not cover some expenses that can cost a cancer patient a lot of money - transportation (and some patients get at least some of their cancer care out of state or at least second opinions), home health care, rehab, etc.

Some cancer plans only cover hospital charges. The thing is much of the care is outpatient - for example scans, chemo, radiation, some surgeries (for example many breast cancer patients the entire surgery is outpatient), etc. are outpatient. Some get shingles or get sick from something else while their immune system is compromised which may not be covered.

EDIT - I didn't make it clear that the plans I am talking about were sold by my work places and apparently, as I now know but didn't know when I wrote this (I don't sell these), are unusual in that they aren't the indemnity version that the person was asking about. I am not sure (since my work place was self insured for employee insurance) who sold these or if they were "special" for the university systems. I chose not to buy (obviously in retrospect a bad choice since I then have had 3 cancers) since I was making enough to handle the copays, etc. if I needed to pay them as our insurance was otherwise pretty good.
 
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5K of benefits isn't much depending on what their MOOP for A, B and D is or MAPD is, surgery, radiation, etc. Also affecting which MOOP is if the chemo is being infused (covered by B) or is a pill (covered by D, and many aren't covered). Typically cancer patients have at least one ER visit, many have the cost to get a port put in, other meds (anti nausea, Neulasta to drive their white count back up, pain meds when at home after surgery, etc.).

Most cancer policies do not cover some expenses that can cost a cancer patient a lot of money - transportation (and some patients get at least some of their cancer care out of state or at least second opinions), home health care, rehab, etc.

Some cancer plans only cover hospital charges. The thing is much of the care is outpatient - for example scans, chemo, radiation, some surgeries (for example many breast cancer patients the entire surgery is outpatient), etc. are outpatient. Some get shingles or get sick from something else while their immune system is compromised which may not be covered.
My understanding is that the cancer benefit is indemnity based. Paid to the insured to be used as they wish. It's units of 5K ... they can buy more than 1 unit ...
 
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5K of benefits isn't much depending on what their MOOP for A, B and D is or MAPD is, surgery, radiation, etc. Also affecting which MOOP is if the chemo is being infused (covered by B) or is a pill (covered by D, and many aren't covered). Typically cancer patients have at least one ER visit, many have the cost to get a port put in, other meds (anti nausea, Neulasta to drive their white count back up, pain meds when at home after surgery, etc.).

Most cancer policies do not cover some expenses that can cost a cancer patient a lot of money - transportation (and some patients get at least some of their cancer care out of state or at least second opinions), home health care, rehab, etc.

Some cancer plans only cover hospital charges. The thing is much of the care is outpatient - for example scans, chemo, radiation, some surgeries (for example many breast cancer patients the entire surgery is outpatient), etc. are outpatient. Some get shingles or get sick from something else while their immune system is compromised which may not be covered.

It's an indemnity product you can use it on whatever you want… shit you could yolo it all red and spend the winnings on coke and hookers.
 
Finally, someone is make'n sense on here ...
I was only familiar with a couple of plans that aren't of the indemnity kind that are paid to supplement what is paid to providers and not me - these were offered through work. I don't sell them and hadn't looked into them beyond what two work places I had worked at had offered.
 
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