I haven't really got a handle on what all the tests and treatments I've had cost -- along with an ever-growing list of medications -- but it is a good deal more than I anticipated with a Medicare Advantage plan.
I've seen my co-pays go up 50% to 100% over the few years I've had the plan. As long as I'm not using it for medical care, it doesn't really matter how much the co-pays are, but once you start using it, some of the costs can be surprising, even shocking.
And yet, it seems like a lot of costs are very low, such as doctor visits with a $5 co-pay. Labs ordered by the doctor are no charge. Many medications have a very low co-pay -- $4 or so. But many others do not. I paid $100 co-pay for 10 days of antibiotic treatment for pneumonia, after paying $14 for a 5 day antibiotic treatment that didn't work. I have eight different prescription drugs to take indefinitely. Co-pays range from $4 a month to $45, so I'm paying a total of about $160 a month in medication co-pays. I know that some of these meds retail for a great deal more.
Once I get to see specialists, their visits will run $50 each, but pulmonary treatment -- which I may need due to chronic lung inflammation -- will be no charge except for medications, much as it appears RA treatment will be.
Medical imaging, such as CT scans, have a $300 co-pay. Hospital stays are $325 per day for the first 3 days. Beyond that, no charge.
There is a $3,400 cap on annual out of pocket costs for members -- which for me is manageable, but I know that for many seniors it's way more than they can reasonably afford. And yet, if they don't qualify for Medicaid and they don't have Advantage coverage or some other Medicare supplement, they'd be looking at potentially much higher costs.
Medicare is good, but it doesn't cover everything. Far from it.
Medicare Advantage has its good points -- and its surprises. One of the surprises is just how high some of the co-pays are. On the other hand, the cap on out-of-pocket costs keeps medical expenses within some bounds.
Ms. Ché has medical coverage through the Indian Health Service which means that for most services and medications she pays nothing. However, she used her Medicare Part D drug coverage to pick up insulin injection pens at the local pharmacy (since the IHS pharmacy in Albuquerque didn't carry them) and she was charged a $380 co-pay -- which was her annual deductible plus the regular co-pay for the pens. Come to find out later, though, that the pharmacy at the First Nations clinic she use carries the pens and they are provided to Natives at no charge. They had been prescribed at the clinic and were on hold for her pickup, but she didn't know that because no one told her. That's been one of the issues with the clinic -- inadequate communications. On the other hand, she's been able to see specialists for various medical issues, and she has undergone a number of tests and other procedures that ordinarily would cost thousands and she has had to pay only a very small charge. Right now, for example, she has a bill for $32 for a number of tests she had a couple of months ago.
In the end, they are both more complex than they need to be.
But at least it's something.