u/Buck169

Briefly, my wife was diagnosed with Stage 4 HGSOC just over four years ago.  Primary taxol/platinum treatment and surgery went well; CA125 in single digits, and maintained for a year on Avastin.  After less than another year, CA125 went up (to about 350 over four or five months) and three lymph nodes seen on PET, knocked back down by Gemcitabine + platinum over six months, but not for long.  Lymph nodes again became hot in PET within a few months after that treatment ended.

Seven weeks ago with a CA125 of 350, she started Keytruda and got five shots of stereotactic gamma radiation directed at the lymph nodes.  A couple of weeks later, CA125 was 250.  At her next Keytruda infusion last week CA125 was 32.

Of course, we're happy about this.  Her CA125 never dropped by more than 50% in three weeks during previous chemo, so this looks like an unprecedentedly good response.  But we're also apprehensive.  Her medical team is never willing to make any predictions about the future.  So, I'm left wondering how hopeful we should be after this sequence of results.  Have you seen improvements like this which lasted for a time, or do recurrences tend to be quick? 

I'm sure "your milage may vary" is the inevitable answer, but I'd like to know what the range of outcomes is likely to be, rather than go forward with blissful (or otherwise) ignorance.

I typically make a big, strong mug of "wake up" tea in the evening and leave it steeping overnight on the kitchen counter. It is usually pretty cloudy in the morning, but if I warm it in the microwave or by brewing only about half the volume of the mug and adding some more hot water before drinking, the turbidity goes away.

Chemically, what is this reversible precipitate made of?

I would say that Assam is particularly prone to this, and other single variety black teas maybe less so, but I haven't really done that comparison carefully. At the moment, I'm drinking a "British Breakfast" blend from the bulk jars at my local supermarket and I didn't make a note of the brand name, if it was listed, so I don't have any specifics...

Clearly, if you own bonds, you own debt. Looking at my ETFs, they have some Wells Fargo, Citi, JP Morgan, BOA, Goldman, etc. Is this also "owning debt," or are these guys doing everything but actually holding loans?

Just curious because I was reading "The Psychology of Money" and in the last chapter he was writing about who benefited from owning debt during the bailout of the 2008 financial crisis. I have a pretty modest fraction of my allocation in bonds, so I was wondering if that was all the debt I owned.

My wife's TIAA contributions have had a slice going into their QREARX Real Estate fund for a long time (fortunately, not a large fraction of her contributions). This has been a complete dog, as far as I can see, in terms of long-term performance. She is close to retirement. Is there a case for real estate today?

My (adult) kid is going to Sweden to study for two semesters. Probably flying on Iceland Air from US to Stockholm then SAS to Umeå. Since exact timing is not critical (meaning she doesn't need the bike the day she arrives, but would want it within a week), is shipping it sensible or is it best to take it as extra baggage on the flight?

Presumably, she'd have to collect the bike and drag it through Customs while changing flights if it's part of her luggage, which sounds like a pain...

Any suggestions on details are appreciated!

What's your favorite bond ETF, assuming interest rates will be rising in the next year or two and a near-decade horizon on needing the money?

What's your favorite bond ETF, presumably Vanguard but not limited to them, assuming interest rates will be rising in the next year or two and a near-decade horizon on needing the money?

My wife, age 66, is still employed full time (large Washington State PEBB insurance system) but is considering applying to start Medicare Part B immediately due to denial of claims for chemotherapy treatment by Regence (see my other thread started yesterday for details).

Our AGI from 2024 would put us in the second-lowest premium bracket for Part B. However, due to some taxable inheritance last year, our 2025 tax return has a one-time increase that will bump us up a couple of brackets. Our 2026 tax year and later should be no more than our 2024 income.

Three questions:

1. If she signs up this month, my understanding is that premiums this year will be based on our 2024 tax return. If that's correct, does this mean they will bump up in January 2027 for that year only, then drop to whatever our 2026 tax return indicates in 2028?

2. Can she maintain employer-sponsored insurance and temporarily cancel Part B again if she is still employed and decides that the double coverage isn't working out?

tl:dr If you go on Medicare Part B at age 66, does it start covering chemotherapy at 80% immediately? Is there any advantage to starting a Medigap Plan G immediately, since they can deny pre-existing conditions for six months?

Background: My wife is 66 and works full-time for a state agency in Washington State. I am 62 and work hourly part time for the same agency, without benefits, so we both get health insurance through her job, with coverage from Regence Blue Shield "Classic." She signed up for Medicare Part A around her 65th birthday, and we have otherwise ignored Medicare.

Four years ago this week, she was diagnosed with stage 4 ovarian cancer. She had paclitaxel/carboplatin chemo though the rest of 2022 (and surgery in September), with a good response: her CA125 (cancer antigen blood test) went back down to single digits. She had secondary treatment with bevacizumab all during 2023. CA125 stayed low until August 2024. In late fall 2024, she started a study of one dose of carboplatin followed by pembro (Keytruda) but her CA125 seemed to go up faster after going on pembro, so she withdrew from the study and her usual oncologist put her on gemcitibine/carboplatin from Feb to Oct 2025. CA125 went down but came up again soon after treatment ended. PET scan shows three lymph nodes that went down during gem/carbo but came back up after. She went on topotecan for a couple of months but CA125 did not respond, so her oncologist wanted to switch to paclitaxel/pembro (which was just approved for ovarian cancer a few months ago) for a while and look at radiation of the lymph nodes.

She got a denial by Regence for pembro coverage almost a month ago, which the clinic said they could get around by tweaking the plan. We just got another denial letter Thursday afternoon. Re-reading it a couple of times (there is at least one sentence with an annoying double negative), it seems that the denial is based on the fact that in the study leading to drug approval, patients had to have 1 or 2 prior "systemic" therapies. My wife has had either 3 or 4, depending on whether the bevacizumab counts, which I think it does, so they are never going to approve her by that criterion.

So, three questions:

1. It looks like if she signed up immediately for Medicare Part B, it would start covering chemo at 80%. Is that correct? And how long would that take to kick in? While 20% of these treatments is still quite a bit of money (like, several thousand dollars per month), we have enough savings that this would not be out of the question. It would be worth it if the treatment worked well (or well-ish).
2. Does a Medigap Plan G cover that 20% of chemo expenses?
3. Should she sign up for a Medigap Plan G immediately, or wait until Open Enrollment this fall? If she starts now, my reading of the deal is that they can deny covering pre-existing conditions for at least six months, so at best, coverage would kick in for December. She'd pay almost $400 per month all year and not get much for it. If she signs up during Open Enrollment, coverage would start January 1, despite pre-existing condition? Or do I not understand that correctly?

Edit: Looks like Plan G providers in Washington include First Health, Humana, Premera, Regence, United Healthcare, State Farm, and Transamerica (to include only the names I immediately recognize). The next obvious question is that if we choose Regence, based on the "better the devil you know" principle, will they be able to deny covering the 20% on Medigap they same way they're denying it on our current insurance?

And if so, is there any reason to think other insurers will not also deny coverage on a technicality?

tl:dr If you go on Medicare Part B at age 66, does it start covering chemotherapy at 80% immediately? Is there any advantage to starting a Medigap Plan G immediately, since they can deny pre-existing conditions for six months?

Background: My wife is 66 and works full-time for a state agency in Washington State. I am 62 and work hourly part time for the same agency, without benefits, so we both get health insurance through her job, with coverage from Regence Blue Shield "Classic." She signed up for Medicare Part A around her 65th birthday, and we have otherwise ignored Medicare.

Four years ago this week, she was diagnosed with stage 4 ovarian cancer. She had paclitaxel/carboplatin chemo though the rest of 2022 (and surgery in September), with a good response: her CA125 (cancer antigen blood test) went back down to single digits. She had secondary treatment with bevacizumab all during 2023. CA125 stayed low until August 2024. In late fall 2024, she started a study of one dose of carboplatin followed by pembro (Keytruda) but her CA125 seemed to go up faster after going on pembro, so she withdrew from the study and her usual oncologist put her on gemcitibine/carboplatin from Feb to Oct 2025. CA125 went down but came up again soon after treatment ended. PET scan shows three lymph nodes that went down during gem/carbo but came back up after. She went on topotecan for a couple of months but CA125 did not respond, so her oncologist wanted to switch to paclitaxel/pembro (which was just approved for ovarian cancer a few months ago) for a while and look at radiation of the lymph nodes.

She got a denial by Regence for pembro coverage almost a month ago, which the clinic said they could get around by tweaking the plan. We just got another denial letter Thursday afternoon. Re-reading it a couple of times (there is at least one sentence with an annoying double negative), it seems that the denial is based on the fact that in the study leading to drug approval, patients had to have 1 or 2 prior "systemic" therapies. My wife has had either 3 or 4, depending on whether the bevacizumab counts, which I think it does, so they are never going to approve her by that criterion.

So, three questions:

1. It looks like if she signed up immediately for Medicare Part B, it would start covering chemo at 80%. Is that correct? And how long would that take to kick in? While 20% of these treatments is still quite a bit of money (like, several thousand dollars per month), we have enough savings that this would not be out of the question. It would be worth it if the treatment worked well (or well-ish).

2. Does a Medigap Plan G cover that 20% of chemo expenses?

3. Should she sign up for a Medigap Plan G immediately, or wait until Open Enrollment this fall? If she starts now, my reading of the deal is that they can deny covering pre-existing conditions for at least six months, so at best, coverage would kick in for December. She'd pay almost $400 per month all year and not get much for it. If she signs up during Open Enrollment, coverage would start January 1, despite pre-existing condition? Or do I not understand that correctly?

tl:dr If you go on Medicare Part B at age 66, does it start covering chemotherapy at 80% immediately? Is there any advantage to starting a Medigap Plan G immediately, since they can deny pre-existing conditions for six months?

Background: My wife is 66 and works full-time for a state agency in Washington State. I am 62 and work hourly part time for the same agency, without benefits, so we both get health insurance through her job, with coverage from Regence Blue Shield "Classic." She signed up for Medicare Part A around her 65th birthday, and we have otherwise ignored Medicare.

Four years ago this week, she was diagnosed with stage 4 ovarian cancer. She had paclitaxel/carboplatin chemo though the rest of 2022 (and surgery in September), with a good response: her CA125 (cancer antigen blood test) went back down to single digits. She had secondary treatment with bevacizumab all during 2023. CA125 stayed low until August 2024. In late fall 2024, she started a study of one dose of carboplatin followed by pembro (Keytruda) but her CA125 seemed to go up faster after going on pembro, so she withdrew from the study and her usual oncologist put her on gemcitibine/carboplatin from Feb to Oct 2025. CA125 went down but came up again soon after treatment ended. PET scan shows three lymph nodes that went down during gem/carbo but came back up after. She went on topotecan for a couple of months but CA125 did not respond, so her oncologist wanted to switch to paclitaxel/pembro (which was just approved for ovarian cancer a few months ago) for a while and look at radiation of the lymph nodes.

She got a denial by Regence for pembro coverage almost a month ago, which the clinic said they could get around by tweaking the plan. We just got another denial letter Thursday afternoon. Re-reading it a couple of times (there is at least one sentence with an annoying double negative), it seems that the denial is based on the fact that in the study leading to drug approval, patients had to have 1 or 2 prior "systemic" therapies. My wife has had either 3 or 4, depending on whether the bevacizumab counts, which I think it does, so they are never going to approve her by that criterion.

So, three questions:

1. It looks like if she signed up immediately for Medicare Part B, it would start covering chemo at 80%. Is that correct? And how long would that take to kick in? While 20% of these treatments is still quite a bit of money (like, several thousand dollars per month), we have enough savings that this would not be out of the question. It would be worth it if the treatment worked well (or well-ish).

2. Does a Medigap Plan G cover that 20% of chemo expenses?

3. Should she sign up for a Medigap Plan G immediately, or wait until Open Enrollment this fall? If she starts now, my reading of the deal is that they can deny covering pre-existing conditions for at least six months, so at best, coverage would kick in for December. She'd pay almost $400 per month all year and not get much for it. If she signs up during Open Enrollment, coverage would start January 1, despite pre-existing condition? Or do I not understand that correctly?

Got a new road bike, need pedals. Not for racing.

Wants: Not too heavy, pretty good road clearance angle.

Nice to have but not absolutely required: a cleat that can somewhat reasonably be walked on when used with a non-racy shoe (e.g. a MTB shoe or something like that with an actual sole).

Not gonna say "cost is no object," but rock-bottom price is not required. I'm only gonna by them once. Well, maybe twice, for the other bike, too...