I got a shock yesterday when I picked up one of my increasing number of prescriptions for what ails me. Hm. One of them had a co-pay of over $80. It had been $10 the month before. The pharmacy was mystified. They said it was an expensive medication, but in the generic form that I received it, even at full price, it shouldn't be that much.
They said I should call my insurance company and see if I can find out what's going on.
So I did, and at first I was told the medication should have a $10 co-pay. When I said it didn't, the person I was talking to looked at my record again and said, "Oh, I see! You're in the Doughnut Hole, and drug coverage is reduced until your out of pocket expenses reach..." whatever it was, I don't remember, many thousands at any rate.
OK. I asked how long this will last, and she was so chipper about it. "Oh, only until Jan 1, sir. Your policy will reset and go back to regular co-pays."
Whew, that's a relief.
My medical expenses have shot up quite a bit since I was diagnosed with rheumatoid arthritis in the spring. I don't see my primary care physician any more since I'm being monitored and treated by a raft of specialists. Each one requires a $50 co-pay each visit. This means at least $150 most months in doctor co-pays. Sometimes more. Then there are the growing number of prescriptions. I fell into the Doughnut Hole because some of these medications cost close to $500 a month at rack rates, and insurance pays the difference between that price and my co-pay. Adds up fast. I knew I was getting close but didn't think I'd actually fall in. Apparently, the newly prescribed drug to control my pulmonary symptoms pushed me over the edge.
Apparently I will now be charged 45% of full price for my medications, but only in December.
Whew!
My rheumatologist wants me to go to National Jewish Health in Denver for the most advanced treatments for my pulmonary issues.
Well, I have my reasons for being reluctant -- including the length of time it would take to get there, especially in winter -- but I'm game. Seems National Jewish is not. Not that they wouldn't like to see me, just that they can't without specific authorization for out-of-network treatment from my Medicare Advantage insurance company. I have no idea whether that's even possible. The only out-of-network care they pay for is in case of emergencies or need for urgent care when one is traveling outside the coverage area of the company. As long as I'm within the coverage area (most of northern New Mexico) I must use in-network facilities and physicians. There appears to be no exception for referrals by in-network physicians (such as my rheumatologist.)
So. Stalemate on that one.
At least I have oxygen at home and can tank up on it before I go out and about. Eventually, they say they will replace the big tanks with small ones I can carry with me. But for the moment the big tanks and the large concentrator are doing the job.
I'm off to the cardiologist this morning to see if there's any reason for alarm about increasingly frequent chest pains -- because RA can affect all kinds of organs not just joints.
I'm getting a sense of what my sister went through with lupus. I had no idea what that was, and she really never told me what it did her. All I knew was that she was in great pain from time to time, and when she wasn't in pain, she tended to be tired and stiff-jointed. It was often hard for her to get around and do things. But she endured, generally with a smile and laughter. She didn't let it get her down more than a little bit.
I'm not in pain to speak of, so that's good. If it weren't for the medications I'm taking, though, the pain would likely be intolerable. My main problem has been fatigue, but that's partially relieved by the oxygen. The issue that has my doctors worried is the now confirmed pulmonary fibrosis due to RA. It can't be reversed. It's mostly affected my right lung but could spread if not contained/controlled with immunosuppressants -- the corticosteroids and other medications I'm taking. That leaves me open to other risks from infections and pneumonia and such.
So, combined with the inherent nature of medical bureaucracies, I'm just in a whirl, I guess.
And the Ruling Clique is now intent on taking away -- "improving" -- Medicare and Social Security. Throwing more chaos into the lives, old age and deaths of the residents of Dumfukistan. They must really hate us.
Showing posts with label Medicare Advantage. Show all posts
Showing posts with label Medicare Advantage. Show all posts
Wednesday, November 30, 2016
Thursday, October 13, 2016
A Bit More on the Health Care Topic
There is growing alarm at what may be happening to Obamacare premiums with the coming year. In some jurisdictions they are predicted to rise exponentially; in other jurisdictions, carriers are pulling out of the market because -- they say -- they can't make a profit.
"They can't make a profit." Oh, too bad, so sad. In fact, this is an all-purpose but unverifiable excuse for ceasing coverage of undesirable customers, in unfashionable areas, and otherwise going back to the previous selective model of patient coverage or non-coverage as the case may be. We don't know the details of insurance companies not making a profit under Obamacare. Where does the money go?
Under Obamacare, they've been able to charge high premiums and keep raising the premiums year by year; they've been able to charge high co-pays and high deductibles too, effectively ensuring that they don't pay out anything for most patients most of the time, but they are able to collect extraordinary amounts of money from those patients month by month.
It's been a tremendous boon to the health insurance cartels, and yet they whine that they can't make a profit and must raise premiums and deductibles beyond any rational measure, or they must leave the Obamacare marketplace. Well, good riddance.
My own suspicion is that this is a pre-planned move to enable the long-delayed single payer health insurance/health care provision for most patients while reserving private insurance for the most well-off.
There are several single payer models already in operation in this country: VA-Tricare/IHS/Medicare/Medicaid/HMOs and PPOs. They all provide relatively low cost, relatively decent and accessible health care to a variety of constituencies. (HMO and PPO can be very expensive or not so much depending on which constituency category you're in.)
Expanding each of them or all of them to provide essentially universal coverage and access to health care would be a fairly simple task. It could have been done long ago, but the for-profit model of health care coverage was paramount.
And so, no. The simple fix was endlessly delayed.
But in my view, Obamacare was meant as a stop-gap at best, and it functions as something of a pre-paid payoff to the insurance cartels. They've been paid hundreds of billions of dollars over the last few years while providing little or no actual coverage for most patients who essentially pay out of pocket (subsidized or no) to the cartels, and pay extraordinarily high deductibles and co-pays, which limits insurance company exposure to essentially nothing at all for most patients. Yet they whine and whine that they can't make a profit. Well, too bad.
Except I'm sure they were quite aware of the ultimate goal: single payer and universal coverage. The private insurance market and for profit model can't provide universal coverage, and we see under Obamacare, it essentially doesn't provide any coverage for most patients most of the time. They pay the insurance cartels a monthly fee (whether subsidized or not) and they pay out of pocket for all their routine care. Thus most households actually never receive any benefit from their health insurance at all.
The definition of a scam, right?
But we see the same thing throughout the for-profit private insurance business. Most of the time, the insurers receive regular payments from their clients while paying out nothing at all on their behalf. And when they do pay something, it is generally only after the client has paid much more in premiums and deductibles.
In the for profit health care insurance model, however, everything is taken to an extreme. Monthly premiums totaling ten thousand a year or more are common; deductibles of $5,000 or $6,000 on top of premiums are also common, so for many households, out of pocket health care expenses of $15,000 to $20,000 before insurance pays a dime on their client's behalf is routine. Of course, most people won't have $15,000 or $20,000 in annual health care expenses, ever. So insurance will never pay anything on their behalf, ever. And they can't make a profit under the circumstances? Well, isn't that special....
But I think it is intentional and pre-planned. In some places, insurers have been pulling out of the market; that trend seems to be accelerating. In some places, remaining insurers are jacking up premiums by up to 60% and more. At the same time, they're cutting coverage to the barest minimum. So they're seeking greater up front payments while reducing the risk of payout (already low) to practically nothing.
Why should people even bother under those circumstances? But isn't that the intent? Make a product that costs a fortune but can't be used, and watch the customers turn their backs or complain so loudly that something must be done. Well, something can be done, and that is to jettison the for profit insurance model for the majority of people and reserve it specifically for an upscale clientèle who will cheerfully pay through the nose so long as they are assured special access and special care whenever they so desire.
Leave the Rabble to the expansion of one or another single payer system that provides basic care at relatively low cost, places limits on access, but can keep them (the Rabble) from spreading their diseases to the Overclass, and can keep them well enough long enough to be useful to their Betters.
Win-win, right?
That's where this has been headed all along, I think.
Just as a note, I've had HMO coverage for decades, first with Kaiser in California and now with Presbyterian in New Mexico. I ran into some serious issues with Kaiser when I presented at the ER with pneumonia and they suspected I had tuberculosis -- because their flow chart red-flagged New "MEXICO" when they asked where I'd traveled. Even when I explained over and over again that I had never traveled to MEXICO, it didn't matter. I was red-flagged as exposed to tuberculosis, and that was that. (Albeit, I did have some symptoms consistent with tuberculosis because I had gone untreated for pneumonia for two months...)
Kaiser HMO coverage cost about $1,100 a month, all but $400 or so was employer paid. It seemed remarkably high since I rarely used it. There were no deductibles, and co-pays were low, in the $10 range for routine care; nothing much over $75 - $100 for specialist/outpatient care. I insisted on being treated as an outpatient for pneumonia. If I had agreed to be hospitalized, there would have been no out of pocket cost. As an outpatient I was charged a co-pay of $10 each time I saw a doctor. There was one specialist I paid $100 to. There was a $4 charge for each prescription I took during the course of treatment.
It was generally quick and easy to see providers when necessary. But I rarely had a need. So, apart from the bogus tuberculosis diagnosis and very poor treatment in the ER that time, I had few complaints.
I currently have a Medicare Advantage plan through Presbyterian Healthcare in New Mexico. This requires some travel, as there is no Presbyterian facility nearby -- the closest is 17 miles away, but I use facilities in Albuquerque, 40 miles or so west since that's where my doctors are.
Doctors, plural. Right now, I have a primary health care provider -- who I haven't seen for months because I'm under specialist care: a rheumatologist, a hematologist/oncologist, and a pulmonologist.
Labs are no cost, and I get blood drawn at least once a month to monitor my condition(s). Specialist visits are $50 co-pay. That added up the first couple of months I was seeing specialists, but now it's only every three to six months for each one. There's a $5 co-pay to see my PCP. I had a CT scan which is normally billed at a $300 co-pay, but because I had it at their hospital, my co-pay was only $108, as it was billed at inpatient rates which are lower than outpatient rates.
If I need hospitalization, there is a $325 per day co-pay -- for the first three days. After that, no charge.
Prescription coverage is included, but it's hard to figure out just what the charge will be, as there are five tiers, and there is a gap in coverage when total cost for prescriptions is over $3,700 (or something) -- and I'm pretty close to that now. One of my prescriptions is over $355 a month and another is close to $600 a month of which I would pay 40%. If I take them both next year, I will be well into the coverage gap by summer, and that will increase my co-pays from about $140 a month for all prescriptions to around $700. Oh boy. After total payment for prescriptions reaches $4,950, my co-payment drops to 5% of the cost of medications or less, depending. Since it won't take that long to get there... I guess that's good.
Access to care is somewhat dicey due to communications problems between providers... yet once we figured out what the hang-up was, things smoothed out a bit, and once I saw the specialists, followup was relatively easy, and contact and communication is relatively swift and sure. Haven't used the ER, so don't know how that would work. (There's a $65 co-pay if I wind up in the ER.) Ambulance service is included ($75 co-pay) which apparently includes ground ambulance from out here in the country where I live to a hospital in Albuquerque or in a serious emergency, helicopter ambulance to ABQ at no additional charge.
I can use an out-of-network urgent care clinic here without going to Albuquerque in most cases ($65 co-pay) and without getting pre-approval. If I use the Presbyterian urgent care clinics in Albuquerque (but that's 45 minutes away, not exactly "urgent") there's no co-pay.
There are endless other charges and details, but that's the basics of it. All I pay monthly is whatever Medicare premiums are ($106 a month right now I think, what they will be next year hasn't been announced yet.)
So it's a pretty good deal all things considered, but it costs a lot more than Ms Ché's coverage which is through IHS and Medicare. She pays nothing for prescriptions, nothing for care directly through IHS, or First Nations clinics, and she pays the standard Medicare 20% co-pay for specialist care outside IHS. She has to go to Albuquerque too, because that's where the IHS facilities are, but she also gets care at UNM hospitals and clinics in ABQ, and at First Nations clinics in ABQ. This totals a few hundred dollars a year for her care in addition to Medicare premiums, whereas my care is costing a thousand or more out of pocket on top of Medicare premiums. (This year, I'm anticipating about $1,600 out of pocket.)
It's not a bad deal considering how much others are paying out of pocket with essentially no insurance contribution at all.
But it could be so much simpler for them if they were part of a single payer program that actually covered most medical expenses.
That, I think, is coming and not too long in the future. However, it will take a Nixon in China moment, and of the two candidates for president (who have a chance to win) Hillary is probably the one to do it -- because of her long-time "no you can't" and "it will never happen" statements about it. Trump says a lot of things, none of which seem to be operative for more than a few minutes, but his "plan" has always been Obamacare "repeal and replace" with no specificity of what to replace it with, just that it will be "wonderful."
The fact is private for profit insurance doesn't work for universal coverage -- it can't. The for-profit model of health care will have to be ditched if universal access and coverage is the goal. The end of the Obamacare for profit model is just about nigh. The only rational replacement is single payer, and that is what I predict will happen sooner rather than later.
"They can't make a profit." Oh, too bad, so sad. In fact, this is an all-purpose but unverifiable excuse for ceasing coverage of undesirable customers, in unfashionable areas, and otherwise going back to the previous selective model of patient coverage or non-coverage as the case may be. We don't know the details of insurance companies not making a profit under Obamacare. Where does the money go?
Under Obamacare, they've been able to charge high premiums and keep raising the premiums year by year; they've been able to charge high co-pays and high deductibles too, effectively ensuring that they don't pay out anything for most patients most of the time, but they are able to collect extraordinary amounts of money from those patients month by month.
It's been a tremendous boon to the health insurance cartels, and yet they whine that they can't make a profit and must raise premiums and deductibles beyond any rational measure, or they must leave the Obamacare marketplace. Well, good riddance.
My own suspicion is that this is a pre-planned move to enable the long-delayed single payer health insurance/health care provision for most patients while reserving private insurance for the most well-off.
There are several single payer models already in operation in this country: VA-Tricare/IHS/Medicare/Medicaid/HMOs and PPOs. They all provide relatively low cost, relatively decent and accessible health care to a variety of constituencies. (HMO and PPO can be very expensive or not so much depending on which constituency category you're in.)
Expanding each of them or all of them to provide essentially universal coverage and access to health care would be a fairly simple task. It could have been done long ago, but the for-profit model of health care coverage was paramount.
And so, no. The simple fix was endlessly delayed.
But in my view, Obamacare was meant as a stop-gap at best, and it functions as something of a pre-paid payoff to the insurance cartels. They've been paid hundreds of billions of dollars over the last few years while providing little or no actual coverage for most patients who essentially pay out of pocket (subsidized or no) to the cartels, and pay extraordinarily high deductibles and co-pays, which limits insurance company exposure to essentially nothing at all for most patients. Yet they whine and whine that they can't make a profit. Well, too bad.
Except I'm sure they were quite aware of the ultimate goal: single payer and universal coverage. The private insurance market and for profit model can't provide universal coverage, and we see under Obamacare, it essentially doesn't provide any coverage for most patients most of the time. They pay the insurance cartels a monthly fee (whether subsidized or not) and they pay out of pocket for all their routine care. Thus most households actually never receive any benefit from their health insurance at all.
The definition of a scam, right?
But we see the same thing throughout the for-profit private insurance business. Most of the time, the insurers receive regular payments from their clients while paying out nothing at all on their behalf. And when they do pay something, it is generally only after the client has paid much more in premiums and deductibles.
In the for profit health care insurance model, however, everything is taken to an extreme. Monthly premiums totaling ten thousand a year or more are common; deductibles of $5,000 or $6,000 on top of premiums are also common, so for many households, out of pocket health care expenses of $15,000 to $20,000 before insurance pays a dime on their client's behalf is routine. Of course, most people won't have $15,000 or $20,000 in annual health care expenses, ever. So insurance will never pay anything on their behalf, ever. And they can't make a profit under the circumstances? Well, isn't that special....
But I think it is intentional and pre-planned. In some places, insurers have been pulling out of the market; that trend seems to be accelerating. In some places, remaining insurers are jacking up premiums by up to 60% and more. At the same time, they're cutting coverage to the barest minimum. So they're seeking greater up front payments while reducing the risk of payout (already low) to practically nothing.
Why should people even bother under those circumstances? But isn't that the intent? Make a product that costs a fortune but can't be used, and watch the customers turn their backs or complain so loudly that something must be done. Well, something can be done, and that is to jettison the for profit insurance model for the majority of people and reserve it specifically for an upscale clientèle who will cheerfully pay through the nose so long as they are assured special access and special care whenever they so desire.
Leave the Rabble to the expansion of one or another single payer system that provides basic care at relatively low cost, places limits on access, but can keep them (the Rabble) from spreading their diseases to the Overclass, and can keep them well enough long enough to be useful to their Betters.
Win-win, right?
That's where this has been headed all along, I think.
Just as a note, I've had HMO coverage for decades, first with Kaiser in California and now with Presbyterian in New Mexico. I ran into some serious issues with Kaiser when I presented at the ER with pneumonia and they suspected I had tuberculosis -- because their flow chart red-flagged New "MEXICO" when they asked where I'd traveled. Even when I explained over and over again that I had never traveled to MEXICO, it didn't matter. I was red-flagged as exposed to tuberculosis, and that was that. (Albeit, I did have some symptoms consistent with tuberculosis because I had gone untreated for pneumonia for two months...)
Kaiser HMO coverage cost about $1,100 a month, all but $400 or so was employer paid. It seemed remarkably high since I rarely used it. There were no deductibles, and co-pays were low, in the $10 range for routine care; nothing much over $75 - $100 for specialist/outpatient care. I insisted on being treated as an outpatient for pneumonia. If I had agreed to be hospitalized, there would have been no out of pocket cost. As an outpatient I was charged a co-pay of $10 each time I saw a doctor. There was one specialist I paid $100 to. There was a $4 charge for each prescription I took during the course of treatment.
It was generally quick and easy to see providers when necessary. But I rarely had a need. So, apart from the bogus tuberculosis diagnosis and very poor treatment in the ER that time, I had few complaints.
I currently have a Medicare Advantage plan through Presbyterian Healthcare in New Mexico. This requires some travel, as there is no Presbyterian facility nearby -- the closest is 17 miles away, but I use facilities in Albuquerque, 40 miles or so west since that's where my doctors are.
Doctors, plural. Right now, I have a primary health care provider -- who I haven't seen for months because I'm under specialist care: a rheumatologist, a hematologist/oncologist, and a pulmonologist.
Labs are no cost, and I get blood drawn at least once a month to monitor my condition(s). Specialist visits are $50 co-pay. That added up the first couple of months I was seeing specialists, but now it's only every three to six months for each one. There's a $5 co-pay to see my PCP. I had a CT scan which is normally billed at a $300 co-pay, but because I had it at their hospital, my co-pay was only $108, as it was billed at inpatient rates which are lower than outpatient rates.
If I need hospitalization, there is a $325 per day co-pay -- for the first three days. After that, no charge.
Prescription coverage is included, but it's hard to figure out just what the charge will be, as there are five tiers, and there is a gap in coverage when total cost for prescriptions is over $3,700 (or something) -- and I'm pretty close to that now. One of my prescriptions is over $355 a month and another is close to $600 a month of which I would pay 40%. If I take them both next year, I will be well into the coverage gap by summer, and that will increase my co-pays from about $140 a month for all prescriptions to around $700. Oh boy. After total payment for prescriptions reaches $4,950, my co-payment drops to 5% of the cost of medications or less, depending. Since it won't take that long to get there... I guess that's good.
Access to care is somewhat dicey due to communications problems between providers... yet once we figured out what the hang-up was, things smoothed out a bit, and once I saw the specialists, followup was relatively easy, and contact and communication is relatively swift and sure. Haven't used the ER, so don't know how that would work. (There's a $65 co-pay if I wind up in the ER.) Ambulance service is included ($75 co-pay) which apparently includes ground ambulance from out here in the country where I live to a hospital in Albuquerque or in a serious emergency, helicopter ambulance to ABQ at no additional charge.
I can use an out-of-network urgent care clinic here without going to Albuquerque in most cases ($65 co-pay) and without getting pre-approval. If I use the Presbyterian urgent care clinics in Albuquerque (but that's 45 minutes away, not exactly "urgent") there's no co-pay.
There are endless other charges and details, but that's the basics of it. All I pay monthly is whatever Medicare premiums are ($106 a month right now I think, what they will be next year hasn't been announced yet.)
So it's a pretty good deal all things considered, but it costs a lot more than Ms Ché's coverage which is through IHS and Medicare. She pays nothing for prescriptions, nothing for care directly through IHS, or First Nations clinics, and she pays the standard Medicare 20% co-pay for specialist care outside IHS. She has to go to Albuquerque too, because that's where the IHS facilities are, but she also gets care at UNM hospitals and clinics in ABQ, and at First Nations clinics in ABQ. This totals a few hundred dollars a year for her care in addition to Medicare premiums, whereas my care is costing a thousand or more out of pocket on top of Medicare premiums. (This year, I'm anticipating about $1,600 out of pocket.)
It's not a bad deal considering how much others are paying out of pocket with essentially no insurance contribution at all.
But it could be so much simpler for them if they were part of a single payer program that actually covered most medical expenses.
That, I think, is coming and not too long in the future. However, it will take a Nixon in China moment, and of the two candidates for president (who have a chance to win) Hillary is probably the one to do it -- because of her long-time "no you can't" and "it will never happen" statements about it. Trump says a lot of things, none of which seem to be operative for more than a few minutes, but his "plan" has always been Obamacare "repeal and replace" with no specificity of what to replace it with, just that it will be "wonderful."
The fact is private for profit insurance doesn't work for universal coverage -- it can't. The for-profit model of health care will have to be ditched if universal access and coverage is the goal. The end of the Obamacare for profit model is just about nigh. The only rational replacement is single payer, and that is what I predict will happen sooner rather than later.
Tuesday, May 17, 2016
Re: Medical Costs with Medicare Advantage
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.
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.
Thursday, November 14, 2013
Circling the Drain Again
I don't pretend to know what's really going on with the various political disasters for the Obama Regime brewing in various corners of the world -- such as the health care thing and the Israel thing and the Iran thing and the TPP thing, but man, it's a super-storm these days. We'll take them one by one, mercifully in separate posts.
Health Care Transition: The launch of the Health Care Transition appears to have been deliberately sabotaged, apparently by the contractors hired to implement it, apparently for more money. But there's more going on as well, much more involving the perfidious insurance cartel directly in what looks for all the world like racketeering right out in the open, something they've been loathe to practice heretofore, though everyone knew it was going on, but now they don't seem to care at all about being found out. I wonder why. Hm. Needless to say, the Rs are taking full political advantage of the mess that's been made of things, but they have no interest in actually destroying the thing. Their political interests are to serve the insurance cartel as certainly as the Dems' interests are. As much as the Rs are accused of the sabotage, they aren't really the ones who did it, nor was it ever in their interests to do it. Their fussbudgeting of it is really minor compared to the rising chorus of complaints from the public -- who are being royally, fiercely screwded.
The only faction of the elites who actually have an interest in said sabotage are those who believe they aren't guaranteed enough money via the ACA/HCR/Obamacare. Given what's been going on, it's fairly easy to figure out who they are, too: the insurance providers, the IT contracting firms, and the various medical industry suppliers. They want more, lots and lots more -- guaranteed -- or they'll keep right on throwing stink bombs.
Health Care Transition: The launch of the Health Care Transition appears to have been deliberately sabotaged, apparently by the contractors hired to implement it, apparently for more money. But there's more going on as well, much more involving the perfidious insurance cartel directly in what looks for all the world like racketeering right out in the open, something they've been loathe to practice heretofore, though everyone knew it was going on, but now they don't seem to care at all about being found out. I wonder why. Hm. Needless to say, the Rs are taking full political advantage of the mess that's been made of things, but they have no interest in actually destroying the thing. Their political interests are to serve the insurance cartel as certainly as the Dems' interests are. As much as the Rs are accused of the sabotage, they aren't really the ones who did it, nor was it ever in their interests to do it. Their fussbudgeting of it is really minor compared to the rising chorus of complaints from the public -- who are being royally, fiercely screwded.
The only faction of the elites who actually have an interest in said sabotage are those who believe they aren't guaranteed enough money via the ACA/HCR/Obamacare. Given what's been going on, it's fairly easy to figure out who they are, too: the insurance providers, the IT contracting firms, and the various medical industry suppliers. They want more, lots and lots more -- guaranteed -- or they'll keep right on throwing stink bombs.
Thursday, October 31, 2013
Outrage Fatigue -- And the Question of Exemptions from Surveillance Returns
I watched a bit of the Sebelius hearing yesterday, and oh, my, weren't the bull-Rs in a high dudgeon, though? Geepers, creepers. Ms Sebelius handled it like a pro, but from what I saw of it, the whole thing was pretty scripted for the cameras, there wasn't really much of anything said that wasn't already on the pre-distributed crib sheets and talking points -- ie: the Propaganda -- from either side, so I got to wondering just what this cock up of a Health Insurance Launch was really all about.
The website is apparently somewhat functional for some people some of the time; there are alternative means of getting coverage, though, so the website issue isn't the biggest deal, certainly not as big a deal as has been made of it since the re-opening of the Government by relenting Rs.
No, the screaming about the website is for show, and it's probably less interesting than the underlying shift that I see going on, the sort of background churning, by which health insurance/health care costs are rising dramatically for many users and customers, while for others costs are being reduced, sometimes significantly. In other words, there is a cost increase and a cost shift going on simultaneously, such that profits will be guaranteed in perpetuity to the carriers and the providers, while costs for users will be distributed "fairly" among the population as a whole.
The website is apparently somewhat functional for some people some of the time; there are alternative means of getting coverage, though, so the website issue isn't the biggest deal, certainly not as big a deal as has been made of it since the re-opening of the Government by relenting Rs.
No, the screaming about the website is for show, and it's probably less interesting than the underlying shift that I see going on, the sort of background churning, by which health insurance/health care costs are rising dramatically for many users and customers, while for others costs are being reduced, sometimes significantly. In other words, there is a cost increase and a cost shift going on simultaneously, such that profits will be guaranteed in perpetuity to the carriers and the providers, while costs for users will be distributed "fairly" among the population as a whole.
Monday, September 30, 2013
Medicare Advantage Sticker Shock
Wow.
I just received my Presbyterian Senior Care (Medicare Advantage) Notice of Changes for 2014.
Ee-yikes!
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.
I just received my Presbyterian Senior Care (Medicare Advantage) Notice of Changes for 2014.
Ee-yikes!
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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