Monday, January 12, 2009

Medicare and existing insurance rant

Damn, because I'm drawing disability (arthritis and back problems), I'm now eligible for Medicare. And because I have insurance through TriCare (DH is retired from the Navy, 20 years and 20 days), I don't have a choice about enrolling for Part B if I want to keep my TriCare coverage. Which means Medicare is going to take almost $100 a month out of my SSDI. So now my doctor will bill Medicare, and what Medicare doesn't pay, TriCare will pay (I wonder if I'll still have to reach TriCare's deductible and then take care of co-pays?). And this is going to cost me $1200 a year, for two federal government agencies to pay for medical care I very seldom use. Thank you very much, government assholes. It's not bad enough that I'm paying around $300 a year for my medical care, now the federal government wants to add $1200 to that annual sum, and I probably won't use it any more than I do now. Well......then again, maybe I will. Maybe I'll go in every 4 months for cortisone shots when my arthritis gets really bad, instead of once a year and dealing with the pain the rest of the time. Maybe I'll push my doctor for a referral to a specialist to treat my fibromyalgia instead of pushing past the pain and fatigue all the time. Maybe this is my opportunity to try for a less pain-filled life (and let me tell you, the amount of pain I deal with on a daily basis would have most people refusing to get out of bed, let alone get out of bed and cook/clean/do laundry/do dishes/take care of pets/grocery shop/etc/etc).
Maybe this is the push I need to get off my ass and do something about the pain I've been living with for the last 20 years. At least I don't have to worry whether my doctor will dump me because I'm now on Medicare (I called the clinic to check, I've seen the horror stories of people on Medicare being dropped by their doctors because Medicare reimbursements are so low, and the difficulty they have finding another PCP). They have other patients who are on Medicare/TriCare, so I'm safe, as far as that goes (for now, anyway).

13 comments:

  1. OMG no, jump on this like a trampoline! If you're going to be paying out the nose for this anyway, squeeze every damn last drop out of it! I really really hope you can lead a less pain filled life and soon.

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  2. I made some calls right after I posted this, and found out that I will still have to meet the $150 a year deductible and the 20% co-pay for TriCare on what they pay after Medicare pays its portion. So, since I'm going to have to meet those anyway, and still pay $1200 a year, I'll be seeing my doctor more often when I'm in pain, instead of blowing it off and dealing with it.
    Hell, who knows, if I can get rid of the pain, maybe I'll finally be able to exercise more than 15 minutes a day without being in severe pain from it. That would be worth every penny of that $1200.

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  3. If you don't control your pain, it will control you. I learned this after extensive cancer surgery. 4 years later and I am still on pain killers and probably will be the rest of my life. Don't let your pain rule your life. There are so many pain meds and other forms of pain control out there that there must be something that will work for you. It may take a while to find out what exactly does work for you, but like everything else, when you finally find the right drug or combo of drugs you will wonder why you didn't try this before. People who do not suffer from chronic pain have no idea how debillitating it can truly be. I applaud you for getting up everyday and doing what you need to do despite your pain. I know that feeling.
    Be Well
    KatesCousinNancy

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  4. serendopeity - thanks :) Pain doesn't rule my life, it just limits how much I can do at one time. I learned early on that as long as I paced myself, I could everything I needed to do (might take me longer, but it does get done eventually). I just can't always do all the things I want to do because of the pain. If I can control the pain, I should be able to do more of the things I want to do, as well as do the things I need to do in less time (what a concept.....LOL).

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  5. Actually you hit the medical jackpot. Medicare is the best insurance available in the US and with tricare as your secondary insurance you should pay absolutely NOTHING other than the $1200 and your $125 deductible. EVERYTHING else will be at no charge to you. This is a GREAT thing. I recommend that you take action to have every health problem you have looked into, it will improve your life and cost you nothing. I would happily pay ten times what you pay to have medicare with tricare as a secondary. For only $1200 a year you have the best insurance money can buy and will have to pay almost nothing over your $1200 premium for healthcare for the rest of your life.

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  6. James - I'll still have the $150 a year deductible and the 20% co-pay on what TriCare pays (I called to double-check that). I'll also have any co-pays for meds I'm prescribed unless I have them sent to a VA pharmacy and then mailed to me (if I have prescriptions sent to a VA pharmacy and mailed, they are free of charge, just may have to wait a week to get the meds). So I suppose it is a good deal, I just don't like being told I have to spend that money in order to keep my insurance, which I don't use that often. I'm not one to bitch about being in pain all the time, it's something I'm used to and bitching doesn't make the pain go away. I'm not too sure that any doctors I see are going to be able to make it any better either, but I won't know that until I see them.

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  7. I am on SSD with Medicare as primary and UHC/COBRA as secondary. It is the PITS. Besides the premiums, out-of-pocket and deductible, there is a $35 co-pay each time to see a doctor, and of course Rx co-pays. And don't forget my UHC only covers 80-90%. I happen to be blessed with poor genes and stuck with several chronic, debilitating disorders, couple orphan diseases, and also require several surgeries each year. Life is complicated enough without Medicare throwing the wrench in the picture. I also need gammaglobulin infusions on a regular basis, which Medicare does not cover at all. I am about to learn whether my new policy of 2009 will pick this up as in the past, otherwise will have to forego this life-sustaining treatment.

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  8. joanne - that sucks big time. Maybe I'm lucky that I have TriCare instead of any other insurance (I had BCBS when I was working, before I got married, and couldn't afford to use it). I just got the notification yesterday that I'm eligible for Medicare (probably because I've been on SSDI for almost 2 years now and just turned 55 a couple of months ago) so I haven't gotten their book that explains everything in depth. That should be getting here soon. At least my doctor's office is good about sending the bill to TriCare and then sending me a bill for my co-pay (they don't demand it at the time of service). So I would imagine it's going to take them even longer now to bill me, since they have to bill Medicare first, get paid, then bill TriCare, get paid, and then bill me (and TriCare can take up to 6 months to pay on submitted bills). It's going to be a learning experience, that's for sure, on how long it's going to take them to finally bill me and how much I'm going to have to pay. At least I don't have to worry about getting the prescription coverage and running into that gap (I don't take any meds right now, but that may change if I get my fibro formally diagnosed and treated).

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  9. You have touched on a sore spot with me Vesta....the scourge that is "health care insurance". Now, I say this, though I am the mother of an RN, sister of a PhD RN Professor, and very happy with my current gyno (she called me AT HOME to check up on me!).

    The health care insurance field has too much power, in my opinion. Turning down people for treatments requested by valid, educated doctors, limiting one's ability to see a doctor outside of their network unless willing to pay full price, and the latest kicker, the prescription drug federal program for medicare that PROHIBITS price negotiations with the drug companies, as is the common practice of private health insurance companies.

    I believe the high cost of health care is directly related to the privatization of hospitals and deregulation of insurance companies. Not that the public facilities and government was doing a great job either. The system needed an overhaul, but who would have thought it would get so bad that more families would be in such financial distress from "their portion" of the medical costs that many would need to file bankruptcy (over 70% of all bankruptcies are due to medical expenses).

    I am sure you are aware of all these statistics, yet, as is true for most people, are between a rock and a hard place. I think you are better off than most people in that you have double coverage, sort of. The killer for most people is, once you age out of one coverage, you get picked up by another more costly insurance program. I saw it happen with my parents, my inlaws and even my older siblings spouses. You were basically told, "Happy birthday! Now get the f*** out!".

    So good luck to you as you navigate once again a system that puts profits and eligibility first over true health care. You might as well get AT LEAST 1200$ worth of medical care since you are forced to pay for it anyway.

    Regina

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  10. It's not much help but check with your state medicaid office to find out if they have a buy-in program. In Pennsylvania, if you meet income and resource guidelines, Medical Assistance will pick up your Medicare premium. It's worth a look.

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  11. Jamie - I knew about that program, my daughter-in-law has MS, fibro, lost her vision in one eye (from a sinus surgery), and is losing the vision in her other eye (Parrs (sp?) plenitis) so she draws SSI/SSD and the state pays part of her Medicare premiums (my son doesn't make a lot of money, plus pays child support, so she qualifies for the help). I wouldn't qualify for the help because my husband is retired from the Navy (and his disability benefits put us just above the guidelines for help). He also works (if he didn't, we couldn't afford groceries, repairs/tires/gas for the vehicles, or clothes).
    It's not that we can't afford to lose that $100 a month right now, it's that if the economy gets any worse and he loses his job, or our mortgage company decides to up the interest rate on the house (that was due to reset in August, and hasn't, yet), we're screwed. We're trying to save as much as we can, just in case, but it's shit like this coming up that throws a monkey wrench in the machinery.

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  12. Admittedly, not perfect, but the programs you benefit from need funding. Childless and elderly taxpayers contribute to public school funds. In 2008, I paid federal taxes of $6700 that paid in part for a war I don't want and military pensions; $4700 to SS that I may never benefit from if I die young or it goes bankrupt by 2027; $1100 to Medicare to fund medical care for you and others. I believe in these programs, and hope our newly elected officials can run them more efficiently, but at the end of the day, there's no free lunch.

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  13. alinakaren - it's not like I'm asking for a free lunch. I worked and paid taxes, I shop and pay taxes, my husband works and pays taxes (and he spent 20 years and 20 days in the Navy, part of that time in the Persian Gulf in the 1980's). So I know that there is no free lunch, it all has to be paid for, one way or another. What I don't understand is why I have to have two government programs to pay for my health care. It's all coming out of taxpayer dollars, one way or another. Two programs just means more paperwork and more administrative costs, not to mention that it will take longer for the doctor's office to be able to bill me for my share (it already takes them a couple of months after an appointment before they can bill me with my share, how long is it going to be now that they're going to have to bill Medicare and then TriCare before they bill me?). Seems like the extra administrative costs are a waste of taxpayer dollars (and some of those dollars are mine and my husband's).

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