I have to sing the praises of Medicare (govt. run program) and Kaiser in particular.
At every step of the way I have had nothing but outstanding service. Best doctors, nursing care (had 2 surgeries simultaneously), now orthotics, and soon physical medicine and rehab.
My GI sucks, but he's no different from most. Everyone else is super.
I am hoping Adam will be able to sign up with Kaiser on Oct 1. I can't wait for him to be covered. I will feel SO much easier when he is.
Health Care
Moderators: Rosie, Stanz, Jean, CAMary, moremuscle, JFR, Dee, xet, Peggy, Matthew, Gabes-Apg, grannyh, Gloria, Mars, starfire, Polly, Joefnh
Great to hear, Lesley.
DH had bad experiences in the hospital and the Rehab place. It was sometimes as much as an hour before they could bother getting his pain medicine to him in the hospital (he called several times) and 45 minutes at the Rehab place. He got to the Rehab place on Thursday and left on Monday.....he couldn't stand it there.
DH had bad experiences in the hospital and the Rehab place. It was sometimes as much as an hour before they could bother getting his pain medicine to him in the hospital (he called several times) and 45 minutes at the Rehab place. He got to the Rehab place on Thursday and left on Monday.....he couldn't stand it there.
DISCLAIMER: I am not a doctor and don't play one on TV.
LDN July 18, 2014
Joan
LDN July 18, 2014
Joan
who's your provider? I know lots of people who have trouble with their providers. When I see what they go through I am SO glad I am with Kaiser. I have had SO much luck with them Most of my doctors are superb, and caring. All the adjunct professionals have been terrific. I will soon know how they are with rehab. And being a rehab professional myself I will know soon enough how well they do.
Sorry hubby had a bad experience. Who is helping him now? The recovery is at least as important as the surgery itself.
Sorry hubby had a bad experience. Who is helping him now? The recovery is at least as important as the surgery itself.
Glad someone is happy with Medicare. I just got a letter from my doctor stating she would not be taking Medicare anymore after December 31st. She is a great doctor. I pay over $700 a month for Medicare, supplemental and Prescription D. Don't think I want to pay cash to her for a visit. I think this is going to be happening more and more.
Vandolyn
Vandolyn
Part D costs me my copays, and that depends on what meds I take. I can only take Nexium for 1/2 of the year because I get into the donut hole and can't afford it. This year it happened later than usual because other copays have gone down.
I have no supplemental because I have Medicare Advantage and it's not allowed. I do pay copays and it adds up.
I never expected it to be free. Did you? There's always something to pay. It's just a HELL of a lot better than the alternative. Especially in the states where the cost of everything health care is way more expensive than anywhere else in the world. Which is why they can afford to take less, or nothing as copays when you get sick.
I have no supplemental because I have Medicare Advantage and it's not allowed. I do pay copays and it adds up.
I never expected it to be free. Did you? There's always something to pay. It's just a HELL of a lot better than the alternative. Especially in the states where the cost of everything health care is way more expensive than anywhere else in the world. Which is why they can afford to take less, or nothing as copays when you get sick.
Vandolyn, you posted:
The Annual Enrollment Period starts Oct 15 and ends Dec 7 to sign up for an Advantage plan to start Jan 1 of next year. Each state has SHIP counselors to help out with advising people with Medicare issues and here is the contact info for Texas: http://www.tdi.texas.gov/consumer/hicap/hicaphme.html
Feel free to pm me if you want.
Rosie
I am a trained Medicare counselor with the Oregon SHIP program, and I just had to respond when seeing how much you are paying for your Supplement plan. That's waaaay too much and there are other alternatives out there. The http://www.medicare.gov website has tools to evaluate Medicare Advantage plans in your area, and you might want to look into them. I put in the zip code for Keller, TX and found 21 plans in your area. The Advantage plans include the Part D Prescription drug plans in their premium. For example, I found an Advantage Plan with a premium of $75 per month with an annual out-of-pocket limit of $2500. This means that your maximum yearly medical costs (excluding drug co-pays) should be around $3400 (Advantage plan premium plus out-of-pocket-limit). And it should be a lot less if you don’t reach the out-of-pocket-limit. With your Supplement plan plus Part D drug plan it looks like you are paying about $600/month after subtracting the $104 Medicare Part B premium. That’s $7200 per year! So you would save at least $3800 per year with an Advantage plan. Another benefit is that there is a good chance that your doctor who said she wasn’t taking Medicare anymore may be in the network for some of the Advantage plans. This is because the Advantage plans usually have a higher reimbursement rate than Medicare, while Supplement plans use the Medicare reimbursement rate. You would need to call your doctor’s office and find out.Glad someone is happy with Medicare. I just got a letter from my doctor stating she would not be taking Medicare anymore after December 31st. She is a great doctor. I pay over $700 a month for Medicare, supplemental and Prescription D. Don't think I want to pay cash to her for a visit. I think this is going to be happening more and more.
The Annual Enrollment Period starts Oct 15 and ends Dec 7 to sign up for an Advantage plan to start Jan 1 of next year. Each state has SHIP counselors to help out with advising people with Medicare issues and here is the contact info for Texas: http://www.tdi.texas.gov/consumer/hicap/hicaphme.html
Feel free to pm me if you want.
Rosie
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time………Thomas Edison
I always get into the donut hole because of a couple of expensive meds. I try to get as many cheaper, generic meds as I can via other pharmacies, such as Walgreen's and Ralph's. My docs are always willing to make the call for me.
They all have lists of the drugs they provide, so it's easy to check. I do all sorts of shenanigans (legal!) to save money. And the docs always help!
Rosie, I don't think Vandolyn said she was paying $700 for her supplemental only. There's a comma there, and she might mean she is paying for her prescription meds and her Medicare part B if I am not mistaken. I think my meds cost me anywhere between $2-400 a year, tests I do add at least a couple of hundred, and of course Medicare part B. So I could be getting to $700.
Had I NOT done the MRI through the ER it would have cost me $170. Urgent Care cost $150. And I need an expensive walker because I regular one does not have back wheels, brakes or a seat. I couldn't take Licorice down without it.
So yeah, it costs, but as I said - it's a heck of a lot better than the alternative.
They all have lists of the drugs they provide, so it's easy to check. I do all sorts of shenanigans (legal!) to save money. And the docs always help!
Rosie, I don't think Vandolyn said she was paying $700 for her supplemental only. There's a comma there, and she might mean she is paying for her prescription meds and her Medicare part B if I am not mistaken. I think my meds cost me anywhere between $2-400 a year, tests I do add at least a couple of hundred, and of course Medicare part B. So I could be getting to $700.
Had I NOT done the MRI through the ER it would have cost me $170. Urgent Care cost $150. And I need an expensive walker because I regular one does not have back wheels, brakes or a seat. I couldn't take Licorice down without it.
So yeah, it costs, but as I said - it's a heck of a lot better than the alternative.
Rosie,
Perhaps you can answer this question for me. Many people get Supplemental plan F, which has no deductible nor copay for office visits. After reviewing all the plans, I realized that Plan N, which has a $147 deductible and a small copay ($15.60 - $20) for office visits, also has a much lower monthly premium. In a year's time, we save a substantial amount of money with Plan N because we don't visit the doctor more than 6 or so times a year.
I know that many states don't offer Plan N, so you might not be familiar with it. If you are, am I correct in saying that Plan F and Plan N are identical in their coverage other than the deductible and copays?
It's also true that the coverage under all plans is initially determined by Medicare. The supplementals will only cover the amount that Medicare has approved, but not fully paid. Therefore, within each category (A,F,N, etc.) no one plan has any advantage in coverage over another, other than their service and monthly cost. Am I correct in my assumption?
Prescription coverage is completely different. Some plans have deductibles, some pay for meds even during the donut hole, and of course the cost of the meds and the amount patients need to pay varies widely.
This is one of the problems with people having to find coverage in the exchanges and Medicare. It's maddenly confusing. After having insurance through DH's company for our entire marriage, I was exasperated at having to investigate all of the plans, and I have a master's degree. I wondered what the average person did. I think most people pick Plan F simply because it's comprehensive and they don't need to worry about deductibles and copays, even though it can be more expensive. The Advantage Plans offer similar simplicity.
There is definitely a need for persons such as yourself to assist others.
Gloria
Perhaps you can answer this question for me. Many people get Supplemental plan F, which has no deductible nor copay for office visits. After reviewing all the plans, I realized that Plan N, which has a $147 deductible and a small copay ($15.60 - $20) for office visits, also has a much lower monthly premium. In a year's time, we save a substantial amount of money with Plan N because we don't visit the doctor more than 6 or so times a year.
I know that many states don't offer Plan N, so you might not be familiar with it. If you are, am I correct in saying that Plan F and Plan N are identical in their coverage other than the deductible and copays?
It's also true that the coverage under all plans is initially determined by Medicare. The supplementals will only cover the amount that Medicare has approved, but not fully paid. Therefore, within each category (A,F,N, etc.) no one plan has any advantage in coverage over another, other than their service and monthly cost. Am I correct in my assumption?
Prescription coverage is completely different. Some plans have deductibles, some pay for meds even during the donut hole, and of course the cost of the meds and the amount patients need to pay varies widely.
This is one of the problems with people having to find coverage in the exchanges and Medicare. It's maddenly confusing. After having insurance through DH's company for our entire marriage, I was exasperated at having to investigate all of the plans, and I have a master's degree. I wondered what the average person did. I think most people pick Plan F simply because it's comprehensive and they don't need to worry about deductibles and copays, even though it can be more expensive. The Advantage Plans offer similar simplicity.
There is definitely a need for persons such as yourself to assist others.
Gloria
You never know what you can do until you have to do it.
Marie,
Poor people have Medicaid. Ordinary people - Yes it's expensive, but in this country NO health care is going to be free. Actually, it's not really free in any other country. You pay for it via your taxes, but when you go to the doctor there are no, or very low co-pays. I have lived in Europe and in Israel. Every working person pays a certain amount per month, and it is NOT cheap. No one complains because EVERYBODY gets healthcare "for free". In some countries their healthcare systems are over burdened, and there are stories of long waits for elective treatments, but the people I know seem to be well treated. My closest friend had cancer, and was fantastically treated. Her mother is 95 and ditto. Only her aunt, at almost 100, had a hard time her last day. She only went to hospital 24 hours before she died, and Doris seemed to think she wasn't made as comfortable as she should have been.
In Germany and France the treatment is incredible, hospitals are state of the art, and the wellness treatment s fantastic.
In Israel there are lots of complaints about overfull hospitals (true!) and long waits (depends for what), but treatment is superb, and there are very low copays.
BUT - in all these countries you pay via your taxes on a monthly basis.
So it's NEVER free. However there are no uninsured people in other countries, and no one goes broke because they are ill.
Poor people have Medicaid. Ordinary people - Yes it's expensive, but in this country NO health care is going to be free. Actually, it's not really free in any other country. You pay for it via your taxes, but when you go to the doctor there are no, or very low co-pays. I have lived in Europe and in Israel. Every working person pays a certain amount per month, and it is NOT cheap. No one complains because EVERYBODY gets healthcare "for free". In some countries their healthcare systems are over burdened, and there are stories of long waits for elective treatments, but the people I know seem to be well treated. My closest friend had cancer, and was fantastically treated. Her mother is 95 and ditto. Only her aunt, at almost 100, had a hard time her last day. She only went to hospital 24 hours before she died, and Doris seemed to think she wasn't made as comfortable as she should have been.
In Germany and France the treatment is incredible, hospitals are state of the art, and the wellness treatment s fantastic.
In Israel there are lots of complaints about overfull hospitals (true!) and long waits (depends for what), but treatment is superb, and there are very low copays.
BUT - in all these countries you pay via your taxes on a monthly basis.
So it's NEVER free. However there are no uninsured people in other countries, and no one goes broke because they are ill.
Gloria, here are some answers to your questions:
I hope I'm clear with this, as some of these Medicare rules can be pretty complicated.
Rosie
I'm familiar with Plan N. I think that all states have Plan N, but not all Supplement insurance companies offer it as it is relatively new. I say this because Supplement plans are portable and go with you if you move to a different state. Oregon has Plan N. There is one additional difference between Plan F and N besides the deductible and co-pays for doctor visits. That is a 15% copay if you use a doctor accepts Medicare assignment but doesn't accept the Medicare reimbursement rate as payment in full. In a case like this, you would be responsible for the additional 15% under Plan N but not Plan F. This situation is pretty rare, and I can't say I've encountered it personally in my counselling. This is different from a doctor that doesn't accept Medicare assignment at all. In that case, Medicare doesn't pay anything and you would be responsible for the entire bill if you chose to use that doctor.I know that many states don't offer Plan N, so you might not be familiar with it. If you are, am I correct in saying that Plan F and Plan N are identical in their coverage other than the deductible and copays?
Yes, that's correct. The coverage is exactly the same, no matter what company is offering it.It's also true that the coverage under all plans is initially determined by Medicare. The supplementals will only cover the amount that Medicare has approved, but not fully paid. Therefore, within each category (A,F,N, etc.) no one plan has any advantage in coverage over another, other than their service and monthly cost. Am I correct in my assumption?
I hope I'm clear with this, as some of these Medicare rules can be pretty complicated.
Rosie
Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time………Thomas Edison
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MaggieRedwings
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Rosie, thank you for your responses. It sounds like I've correctly evaluated my options. I did know about the 15%, but as you noted, I've never had the fee.
An update on Entocort/Budesonide pricing:
I've checked all of the Medicare part D drug plans in my area for the cost of Budesonide. Only one company, CIGNA, offers coverage through the donut hole or gap. It looks like I can get Budesonide by paying a monthly premium of $123 and order the drug through mail order. This price remains the same through the donut hole. My total annual cost for the premium comes to $1476.
CIGNA and Advantage-Plus Meridian seem to be the only providers that classify Budesonide as a tier 2 drug. All of the other companies now classify it as a tier 5 drug. There's nothing to prevent companies from changing the tier level of the drug during the year, as far as I know. It's possible that the level could change and the drug would skyrocket at these two companies like the other company's prices.
This year my monthly premium is $35.10 a month, annually, $421.20. I pay $40 for a 3-month prescription of Budesonide. After getting another 15 or so pills, I end up in the donut hole.
Anyone who is on Medicare Part D and taking Entocort should check their drug company's formulary for 2014. It's beginning to look like the cheapest option is to order from India. Next we have to consider that this administration may have agreed to begin enforcing the law against ordering drugs outside of the country in order to get the support of pharmaceutical companies for ObamaCare.
Gloria
An update on Entocort/Budesonide pricing:
I've checked all of the Medicare part D drug plans in my area for the cost of Budesonide. Only one company, CIGNA, offers coverage through the donut hole or gap. It looks like I can get Budesonide by paying a monthly premium of $123 and order the drug through mail order. This price remains the same through the donut hole. My total annual cost for the premium comes to $1476.
CIGNA and Advantage-Plus Meridian seem to be the only providers that classify Budesonide as a tier 2 drug. All of the other companies now classify it as a tier 5 drug. There's nothing to prevent companies from changing the tier level of the drug during the year, as far as I know. It's possible that the level could change and the drug would skyrocket at these two companies like the other company's prices.
This year my monthly premium is $35.10 a month, annually, $421.20. I pay $40 for a 3-month prescription of Budesonide. After getting another 15 or so pills, I end up in the donut hole.
Anyone who is on Medicare Part D and taking Entocort should check their drug company's formulary for 2014. It's beginning to look like the cheapest option is to order from India. Next we have to consider that this administration may have agreed to begin enforcing the law against ordering drugs outside of the country in order to get the support of pharmaceutical companies for ObamaCare.
Gloria
You never know what you can do until you have to do it.
The pharmaceutical countries only support themselves. ANYTHING that takes away from their bottom line and the bonuses they pay their top executives is not even considered. They couldn't care less who they hurt.
I have some pills I got from India. Would you like them Gloria? Or anyone else who needs them? I can't take them They make me too constipated.
I have some pills I got from India. Would you like them Gloria? Or anyone else who needs them? I can't take them They make me too constipated.
Thank you for your offer, Lesley, but I'll be able to pay for my own. I'm just trying to get the best price right now, and they all look expensive. My PCP got his medical degree in India, though he was born in the U.S. His parents are from India. When I told him I was considering getting Entocort from there, he said he wouldn't do it. That's why I've been hesitant. But others here have ordered it from there with satisfaction. I just have to bite the bullet and do it.
There are probably others here who could use your pills and will appreciate your offer.
Gloria
There are probably others here who could use your pills and will appreciate your offer.
Gloria
You never know what you can do until you have to do it.