Monday, September 30, 2013

Medicare Advantage Sticker Shock


I just received my Presbyterian Senior Care (Medicare Advantage) Notice of Changes for 2014.


My co-pays are going wayyyyy up. Many have doubled, others are up 50%-70%. These are huge increases for people on limited incomes, though Presbyterian claims that the maximum out of pocket expense for patients on this plan will only go up by $400 -- which still isn't chicken feed for a lot of folks.

I assume this is happening because some of the excessive payments and reimbursements for Medicare Advantage providers are being reduced, and so the providers seek to recover from their patients. I don't know though.

We had no warning, no hint at all that co-pays were going up so steeply.

Of course even with these increases, out of pocket expenses are still a good deal less than with Medicare alone, there's no additional charge for drug coverage (though the co-pays are much higher than they were), and all in all, except for some higher rates for the first three days of hospitalization, patient co-pays are similar to or lower than the Kaiser coverage we had in California -- that cost $800 a month.

We're lucky enough to be able to pay these higher costs, but what of old folks who are just able to handle the out-of-pocket costs imposed by Presbyterian now but do not have -- and won't have -- an additional $400 for medical care? They're not poor enough for Medicaid, but don't have any additional flexibility in  their budgets, either. What are they supposed to do?

(I can hear it now: "Do you really need a dog? What you pay in dog food alone, not to mention the vet and stuff, would easily pay for the higher medical co-pays. Priorities. You know?")

It's gonna be a tough year for a lot of folks come January.

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