tag:blogger.com,1999:blog-4320479736034351430.post7828535860167037549..comments2023-10-03T07:01:41.144-05:00Comments on Always On Watch: Semper Vigilans: The Medicare MazeAlways On Watchhttp://www.blogger.com/profile/08192688822955022541noreply@blogger.comBlogger27125tag:blogger.com,1999:blog-4320479736034351430.post-79157393918494692142011-11-24T03:28:58.220-06:002011-11-24T03:28:58.220-06:00Indigo Red,
I've had those same reactions from...Indigo Red,<br />I've had those same reactions from my conservative and liberal friends. They don't have a clue about the realities of disability! <br /><br />Most people also don't seem to realize what a Herculean task it is for Mr. AOW and me to attend even a short social event. Such visits are of the crisis management type -- not to mention the prep for going out.<br /><br />Also, people seem to think that once Social Security Disability/Medicare kick in (They have no clue as to the waiting period of six months for SSDI and 30 months for Medicare), "someone" will come in "for free" to help with activities of daily living. It ain't so! "For free" happens only under Medicaid, which requires pauper status.<br /><br />Mr. AOW and I never imagined how dependent we could become on government help -- until the unthinkable happened.<br /><br />As you pointed out, the disabled must accept government help to stay alive.Always On Watchhttps://www.blogger.com/profile/08192688822955022541noreply@blogger.comtag:blogger.com,1999:blog-4320479736034351430.post-7318817878689214032011-11-24T03:14:53.835-06:002011-11-24T03:14:53.835-06:00Black Sheep,
BCBS didn't mention any such plan...Black Sheep,<br />BCBS didn't mention any such plan to me. Maybe because Mr. AOW isn't 65 yet?<br /><br />Several Medigap insurers do not cover those under 65 for a decent cost.Always On Watchhttps://www.blogger.com/profile/08192688822955022541noreply@blogger.comtag:blogger.com,1999:blog-4320479736034351430.post-43486092342272921042011-11-24T00:22:42.565-06:002011-11-24T00:22:42.565-06:00I'm under 60, disabled, unable to work, new to...I'm under 60, disabled, unable to work, new to Federal aid, and my conservative friends think I'm a hypocrite for obtaining SS disability/Medicare and my liberal friends think all my problems are solved as the gov't will take care of everything. I have never felt so helpless and endangered in my life. The practicality is that when one is starving and the only food offered is steak and arrugala, you eat the damned steak and arrugala no matter how much one dislikes the force used.Indigo Redhttps://www.blogger.com/profile/07488424336985581412noreply@blogger.comtag:blogger.com,1999:blog-4320479736034351430.post-34702333276806534522011-11-23T23:29:28.959-06:002011-11-23T23:29:28.959-06:00I have Regence Blue Shield plan J, which so far ha...I have Regence Blue Shield plan J, which so far has covered all the charges and deductibles I would otherwise have to pay. It's $206.00 a month and it's auto-deducted from my checking account. Since my SS is auto-deposited there, I just figure that it's being taken off my SS and is therefor paid for by the government. Likewise I have Humana drug insurance, which IS taken directly out of my SS payment before the bank gets it. Humana covers most of my drug costs although there is one hell of a donut hole after a certain point. But it's those visits to the doctor that really eat the dollars, and Blue Shield Plan J is the way to go.Black Sheephttp://www.newsbleat.comnoreply@blogger.comtag:blogger.com,1999:blog-4320479736034351430.post-61525893140570546322011-11-22T12:26:53.995-06:002011-11-22T12:26:53.995-06:00AOW I can appreciate your plight. Most healthcare ...AOW I can appreciate your plight. Most healthcare providers do not want to forclose or otherwise bankrupt individuals. The important thing is to contact the provider as soon as the bill arrives, and try and work out an aceptable payment. It is when people disregard the bill that they run into trouble. Even if folks send $10 or $20 a month after the arrangement, most will be left alone. It is the disregarding that causes the problemAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-4320479736034351430.post-77638094523803537892011-11-22T04:00:55.262-06:002011-11-22T04:00:55.262-06:00No One of Any Import,
I had NO IDEA that there is ...No One of Any Import,<br /><i>I had NO IDEA that there is no cap on yearly expenses on medicare, like most health insurance.</i><br /><br />Here's another zinger for you: Medicare doesn't pay for a residential nursing home either. Oh, Medicare does pay for some rehab in a nursing home and does pay actual medical bills. But residential care (room, board, etc.)? Nope.<br /><br />Medicaid does pay for a nursing home, but one has to be a pauper for Medicaid to kick in.<br /><br />I again refer you to the book I mentioned near the end of the post. A must read for us all!Always On Watchhttps://www.blogger.com/profile/08192688822955022541noreply@blogger.comtag:blogger.com,1999:blog-4320479736034351430.post-67756576860910450312011-11-22T03:58:03.583-06:002011-11-22T03:58:03.583-06:00Grouch,
I will definitely ask about "allowed ...Grouch,<br />I will definitely ask about "allowed charges." Great tip!<br /><br />You said: <i>frighten seniors into buying there expensive products</i><br /><br />The AARP's commercials do indeed do that!Always On Watchhttps://www.blogger.com/profile/08192688822955022541noreply@blogger.comtag:blogger.com,1999:blog-4320479736034351430.post-18355701217230342052011-11-22T03:56:22.370-06:002011-11-22T03:56:22.370-06:00Leticia,
Humana doesn't even offer Medigap ins...Leticia,<br />Humana doesn't even offer Medigap insurance for those under age 62 and on Social Security Disability.Always On Watchhttps://www.blogger.com/profile/08192688822955022541noreply@blogger.comtag:blogger.com,1999:blog-4320479736034351430.post-67544705056163055112011-11-22T03:51:38.381-06:002011-11-22T03:51:38.381-06:00A $250 deductible is a drop in the bucket compared...A $250 deductible is a drop in the bucket compared to what Mr. AOW pays for his private health insurance policy ($700/month right now and rising to $908/month in June). Not to mention the $2500 deductible he presently has.<br /><br />Questions:<br /><br />(1) Is that $250 deductible for Medicare B only?<br /><br />(2) Is there a Medicare A deductible for hospital admission? At some point, Medicare.gov mentioned to me over the phone something about $1300 for each admission separated by either 61 or 91 days.Always On Watchhttps://www.blogger.com/profile/08192688822955022541noreply@blogger.comtag:blogger.com,1999:blog-4320479736034351430.post-5333084537155941892011-11-21T23:11:09.821-06:002011-11-21T23:11:09.821-06:00Yes, ma'am there is a deductible. $250 I think...Yes, ma'am there is a deductible. $250 I think.<br /><br />There are "observation" type admissions, supposed to be 24 hours, which are billed as an outpatient service. The hospital is usually reimbursed a lot less for these than inpatient. As far as patient responsibility it would still be 20% of the "Medicare allowed charge", only a fraction of the actual hospital charge.<br /><br />I would be willing to bet that some of the people selling these medigap policies do not make clear the concept of Medicare allowed charges and frighten seniors into buying there expensive products. If the salesman leads you to believe you'll be stuck with 20% of the hospital's actual charge, go find another company. Force them to explain ALLOWED CHARGES.....BIG DIFFERENCE!<br /><br />GROUCHGrouchhttps://www.blogger.com/profile/03317721398943007973noreply@blogger.comtag:blogger.com,1999:blog-4320479736034351430.post-1080189117570991942011-11-21T16:32:14.153-06:002011-11-21T16:32:14.153-06:00oh, man, what a mess. I had NO IDEA that there is...oh, man, what a mess. I had NO IDEA that there is no cap on yearly expenses on medicare, like most health insurance.<br /><br />I wonder why it is most conservatives don't want to discuss this problem? I guess b/c we are so far removed from any free market solutions. Ever since we started using insurance packages as part of employee benefits, which we did because they aren't subject to the payroll tax, we have been distorting the medical care market.<br /><br />Folks ignored the rising costs of medical care first, and then health insurance seond, because they didn't bear the brunt in most cases: the insurance company pays the medical bills, and the employer pays the insurance company.<br /><br />Meanwhile, we've steadily grown used to the idea of not being on the hook for medical costs, to the point that most Dems feel confident asserting that health care should be a "right."<br /><br />Add in the baby boomer tsunami you mentioned, and woo boy. We are in for a hurtin. I fear we will go the way of Great Britian, where the hospitals deprive elderly of care if they think the person is too old and sick to be worth it.<br /><br />And I don't know how to fix this collossal problem, either. I know how to start, though: with the idea that noncatastrophic care be paid out of pocket by the patient himself. If we could only bring this culture back to the idea of being in charge of their own non-catastrophic healthcare, maybe, just maybe, costs would start to lower.<br /><br />my best to you and the Mr. as you weave thru this minefield. just keep us abreast of developments. <br /><br />LindaAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-4320479736034351430.post-54020170185349069902011-11-21T16:28:08.112-06:002011-11-21T16:28:08.112-06:00Medicare usually has a $250 deductible, AOW and wi...Medicare usually has a $250 deductible, AOW and with a few visits to your PCP it will be met.<br /><br />Let me caution, DO NOT let them switch you to Humana, it is great coverage for prescriptions, but horrid for medical coverage. If there is any way, stick with Medicare most doctors, including Chiropractors, accept it. And co-payments can be as low as $4, instead of $30 if you have Humana.<br /><br />I hope this helped a bit.Trekkie4Everhttps://www.blogger.com/profile/03226981394122557804noreply@blogger.comtag:blogger.com,1999:blog-4320479736034351430.post-19109285789026444932011-11-21T15:29:06.963-06:002011-11-21T15:29:06.963-06:00Grouch,
Thank you, thank you for stopping me by an...Grouch,<br />Thank you, thank you for stopping me by and cluing me in!<br /><br />This is something I understand as Mr. AOW and I have BCBS and use the provider network and know about the BCBS "discount" with providers:<br /><br /><i>It is the same with private insurance. The insurance won't pay the hospital $45,000 (50K minus your 5K deductible) but rather some "negotiated amount" which is a lot less.</i><br /><br />Questions:<br /><br />(1) Doesn't Medicare also have some kind of deductible?<br /><br />(2) Also, isn't there something about an admission-requirement length? I've read that patients can actually be in the hospital for two days but not actually admitted? <br /><br />As you can see, I am brand new to this maze!Always On Watchhttps://www.blogger.com/profile/08192688822955022541noreply@blogger.comtag:blogger.com,1999:blog-4320479736034351430.post-56746970495687062152011-11-21T15:02:31.063-06:002011-11-21T15:02:31.063-06:00I think you may be over simplifying things a bit. ...I think you may be over simplifying things a bit. You have to understand that a hospital's charge for a hospitalization is meaningless as far as a Medicare patient is concerned. If a Hospital charges say $50,000 for a hospital stay, the hospital will not be payed $40,000 or 80 percent of the $50,000. Instead they will be payed on a thing called a DRG (diagnosis related group) which is more or less a lump sum payment based on the discharge diagnosis. The DRG is usually drastically less that the hospital charge. This is why hospitals try and get Medicare patients out as soon as possible. No matter how long or how short the stay, they will only be payed the DRG amount.<br /><br />In like fashion, the patient would not be responsible for 20 percent of $50,000. There is a rather nebulous figure called the "Medicare Allowed Charge" which is applied to each diagnosis. The Medicare allowed charge is once again usually drastically less than the original charge. Even though the original charge might be $50,000, the Medicare allowed charge (determined by the gubment) might only be $20,000. So instead of the patient owing $10,000. The patient would actually owe $4,000. Still a tidy sum, yes, but much less than it would appear at face value.<br /><br />Complicated? You bet! And it is by design. The gubment wants you to think you're getting a real deal with Medicare when in fact they are cutting payments to the bone for hospitals and providers trying to take care of you. It won't last forever in its present state. Many providers are retiring or otherwise bailing out of Medicare.<br /><br />It is the same with private insurance. The insurance won't pay the hospital $45,000 (50K minus your 5K deductible) but rather some "negotiated amount" which is a lot less.<br /><br />Hope Mr. AOW makes progress.<br /><br />Grouch at Right TruthGrouchhttps://www.blogger.com/profile/03317721398943007973noreply@blogger.comtag:blogger.com,1999:blog-4320479736034351430.post-75499951936202575852011-11-20T08:47:54.314-06:002011-11-20T08:47:54.314-06:00I just got mine a month ago too.I just got mine a month ago too.Woodsterman (Odie)https://www.blogger.com/profile/00423574390748358762noreply@blogger.comtag:blogger.com,1999:blog-4320479736034351430.post-47018777793248974932011-11-20T03:48:52.647-06:002011-11-20T03:48:52.647-06:00FJ,
I suppose that ultimately, I'd rather have...FJ,<br /><i>I suppose that ultimately, I'd rather have my health, than my wealth. </i><br /><br />True enough.<br /><br />It seems to me that medical bankruptcy should include only 1/2 of a couple's assets (Everything is "on the table"). Otherwise, you end up with two people on Medicaid.Always On Watchhttps://www.blogger.com/profile/08192688822955022541noreply@blogger.comtag:blogger.com,1999:blog-4320479736034351430.post-54952808100798846162011-11-19T19:01:42.997-06:002011-11-19T19:01:42.997-06:00Farmer, yes you can.
Consult an attorney.Farmer, yes you can.<br /><br />Consult an attorney.Ducky's herehttps://www.blogger.com/profile/14608115001116619877noreply@blogger.comtag:blogger.com,1999:blog-4320479736034351430.post-79291300503442552642011-11-19T16:10:12.578-06:002011-11-19T16:10:12.578-06:00I'm afraid I don't know enough about it. ...I'm afraid I don't know enough about it. The situation is scary. Let us know what you find out about the packet you receive.<br /><br />Debbie<br />Right Truth<br />http://www.righttruth.typepad.comRight Truthhttps://www.blogger.com/profile/18274108313586611205noreply@blogger.comtag:blogger.com,1999:blog-4320479736034351430.post-88046928031126991402011-11-19T15:00:46.568-06:002011-11-19T15:00:46.568-06:00That's discouraging. But then I suppose that ...That's discouraging. But then I suppose that ultimately, I'd rather have my health, than my wealth.-FJ the Dangerous and Extreme MAGA Jewhttps://www.blogger.com/profile/16745768408538827278noreply@blogger.comtag:blogger.com,1999:blog-4320479736034351430.post-68201313242493497552011-11-19T11:20:29.471-06:002011-11-19T11:20:29.471-06:00FJ,
I consulted an attorney well before Mr. AOW ha...FJ,<br />I consulted an attorney well before Mr. AOW had his life-changing medical event. Why? Because he had had brain surgery some 14 years before, and we always knew that he was at significant risk of having a brain event. My attorney told me that a trust would be of no use as far as sheltering my inherited assets goes.<br /><br />If one is cash rich, one can give annual gifts of over $10,000 to any number of trusted individuals. Problem is that once the money is given, the capital is gone and cannot be legally tapped in a catastrophic medical situation.Always On Watchhttps://www.blogger.com/profile/08192688822955022541noreply@blogger.comtag:blogger.com,1999:blog-4320479736034351430.post-33428615262333747422011-11-19T11:20:02.658-06:002011-11-19T11:20:02.658-06:00@FJ - I believe that would be considered fraud.
...@FJ - I believe that would be considered fraud. <br /><br />I have no answer. Hubby and I hate Medicare. I feel like a welfare person every time I go to the doctor. And the only reason we even have a doctor (no one wants to take Medicare patients) is because one of my hubbies long time students (20+ years) is a doctor who accepts Medicare patients.Adriennehttps://www.blogger.com/profile/01562944653624224107noreply@blogger.comtag:blogger.com,1999:blog-4320479736034351430.post-21535601068743457472011-11-19T11:18:03.183-06:002011-11-19T11:18:03.183-06:00The only "solution" I've ever been a...The only "solution" I've ever been able to come up with: that adult children and adult grandchildren become financially and legally responsible for their elders. Of course, such a requirement would mean that these adult children and grandchildren would (1) have to step out of the work force to do caregiving and (2) lose their own homes and (3) lost their own opportunity for advancement via employment and education. All three of these were the case when the time came to caregive my paternal grandmother, who did up in a nursing home because of severe dementia and her need for IV-administered vasodilators. Her two living children -- my father and my uncle, as well as their children -- took a significant financial hit over a period of the four years that Grandma was in the nursing home.Always On Watchhttps://www.blogger.com/profile/08192688822955022541noreply@blogger.comtag:blogger.com,1999:blog-4320479736034351430.post-5655373157350433392011-11-19T11:17:19.194-06:002011-11-19T11:17:19.194-06:00Epa,
My conservative friends have fits when I bri...Epa, <br />My conservative friends have fits when I bring up this important topic in conversation. <br /><br />Or, they stick their heads in the sand. They're going to have a huge wake-up call one of these days.Always On Watchhttps://www.blogger.com/profile/08192688822955022541noreply@blogger.comtag:blogger.com,1999:blog-4320479736034351430.post-11301178028503047942011-11-19T08:31:33.008-06:002011-11-19T08:31:33.008-06:00A terrible dilemma, AOW. I wish I had an intellige...A terrible dilemma, AOW. I wish I had an intelligent answer, but I don't.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4320479736034351430.post-15281586373427161572011-11-19T08:16:30.632-06:002011-11-19T08:16:30.632-06:00This has nothing to do with ideology. Practicaliti...This has nothing to do with ideology. Practicalities must be observed and dealt with whether we are progressive or conservative.<br /><br />We have a problem caused by increasing active ages, it's a good problem.<br /><br />No one wants to deal with it in a forthright manner because every outcome envisioned deals with sacred cows, and they are afraid they will not get reelected to positions from which they enrich themselves with legal but unethical and immoral inside trading?<br /><br />It inspires individuals OUTSIDE that group to consider and some to commit acts otherwise unacceptable to SURVIVE.<br /><br />Having a life of work made pointless by lack of proper govt policy is as obnoxious as having it stolen by MF Global.Epaminondashttps://www.blogger.com/profile/04811906954763827459noreply@blogger.com