Legal Threats to Medical Insurance?
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travelaround
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I'm planning to go full-nomad so I opted for the Medigap - F plan through AARP... 196/monthly this year and starting in December 2019, 206/monthly. If it goes up like that every year what will it be in twenty years?
Full cost for the year: $3982. (Medicare A + B, plus Medigap F)
I don't have to pay for part D until next year because I qualified for something I can't remember the name of. But then in 2020 I will have to pay for that.
My usual medical expenses for the year prior to Medicare: less than $200. I was going to a sliding-fee clinic and have inexpensive medications.
Full cost for the year: $3982. (Medicare A + B, plus Medigap F)
I don't have to pay for part D until next year because I qualified for something I can't remember the name of. But then in 2020 I will have to pay for that.
My usual medical expenses for the year prior to Medicare: less than $200. I was going to a sliding-fee clinic and have inexpensive medications.
@travelaround
"My usual medical expenses for the year prior to Medicare: less than $200. I was going to a sliding-fee clinic and have inexpensive medications." That sounds great. I begin Medicare early in 2019 but my health insurance premium for January 2019 is almost $1200; this is for one month of coverage. Your solution to health care costs sounds much better than mine; props to you. My situation might be different than your situation, however. I have had "surgical" procedures somewhat frequently. (If you have GERD, my story below might be of value to you.)
I have Barrett's esophagus ("Barrett's esophagus is associated with an increased risk of developing esophageal cancer. Although the risk is small, it's important to have regular checkups for precancerous cells (dysplasia). If precancerous cells are discovered, they can be treated to prevent esophageal cancer." https://www.mayoclinic.org/diseases-conditions/barretts-esophagus/symptoms-causes/syc-20352841 ). My gastroenterologist told me a couple years ago that I had a choice; have frequent endoscopies to check on the Barrett's or have treatment to get rid of it. He also said we could check your Barrett's every couple years with a clean report each time and then one time, maybe 20 years from now, we could discover that you have advanced esophageal cancer. I decided to have radiofrequency ablation (RFA) to get rid of "the pink areas." My first follow-up endoscopy (in 2017) after the RFA procedure found 95+% of the "Barrett's" tissue was gone. My second follow-up endoscopy last week found that almost no "Barrett's" tissue was remaining and my gastroenterologist biopsied the small remaining region of concern; he said my esophagus looks great (smooth, etc.).
One of my mom's cousins died of esophageal cancer in his 40s or 50s. One of my brothers discovered in the 1990s that he has Barrett's esophagus; I had never heard of it until he told me about it and suggested that I get checked. He wears lots of hats and one of these is as a firefighter; he fought many of the fires in northern California including the Camp fire. He has fought fires for decades for the federal government and the state of California. He has not had his Barrett's esophagus treated but I told him about my experience and he will look into treatment. Damage to the lungs and esophagus is a serious problem for people fighting house, forest, etc. fires and the Camp fire was especially bad for the firefighters; many (most?) of the older, experienced firefighters who fought the Camp fire are having difficulty completely recovering. (The psychological damage from things like driving every day past burnt cars which could not be removed because human remains were found in the cars is an additional burden many of the firefighters carry.)
I have had other surgical procedures (e.g. sinus surgery, bypass for an aneurysm in one leg) over the last five years but overall I am extremely healthy. However health insurance has been necessary for me. I think every medical issue that has arisen for me has been treated or managed (e.g. very mild asthma). I am free to exercise, go running, hike, etc.
"My usual medical expenses for the year prior to Medicare: less than $200. I was going to a sliding-fee clinic and have inexpensive medications." That sounds great. I begin Medicare early in 2019 but my health insurance premium for January 2019 is almost $1200; this is for one month of coverage. Your solution to health care costs sounds much better than mine; props to you. My situation might be different than your situation, however. I have had "surgical" procedures somewhat frequently. (If you have GERD, my story below might be of value to you.)
I have Barrett's esophagus ("Barrett's esophagus is associated with an increased risk of developing esophageal cancer. Although the risk is small, it's important to have regular checkups for precancerous cells (dysplasia). If precancerous cells are discovered, they can be treated to prevent esophageal cancer." https://www.mayoclinic.org/diseases-conditions/barretts-esophagus/symptoms-causes/syc-20352841 ). My gastroenterologist told me a couple years ago that I had a choice; have frequent endoscopies to check on the Barrett's or have treatment to get rid of it. He also said we could check your Barrett's every couple years with a clean report each time and then one time, maybe 20 years from now, we could discover that you have advanced esophageal cancer. I decided to have radiofrequency ablation (RFA) to get rid of "the pink areas." My first follow-up endoscopy (in 2017) after the RFA procedure found 95+% of the "Barrett's" tissue was gone. My second follow-up endoscopy last week found that almost no "Barrett's" tissue was remaining and my gastroenterologist biopsied the small remaining region of concern; he said my esophagus looks great (smooth, etc.).
One of my mom's cousins died of esophageal cancer in his 40s or 50s. One of my brothers discovered in the 1990s that he has Barrett's esophagus; I had never heard of it until he told me about it and suggested that I get checked. He wears lots of hats and one of these is as a firefighter; he fought many of the fires in northern California including the Camp fire. He has fought fires for decades for the federal government and the state of California. He has not had his Barrett's esophagus treated but I told him about my experience and he will look into treatment. Damage to the lungs and esophagus is a serious problem for people fighting house, forest, etc. fires and the Camp fire was especially bad for the firefighters; many (most?) of the older, experienced firefighters who fought the Camp fire are having difficulty completely recovering. (The psychological damage from things like driving every day past burnt cars which could not be removed because human remains were found in the cars is an additional burden many of the firefighters carry.)
I have had other surgical procedures (e.g. sinus surgery, bypass for an aneurysm in one leg) over the last five years but overall I am extremely healthy. However health insurance has been necessary for me. I think every medical issue that has arisen for me has been treated or managed (e.g. very mild asthma). I am free to exercise, go running, hike, etc.
I have a hard time understanding medical insurance because of what seems to me the so many different options in different states. Add to that my retirement covers additional insurance but not medicare which has several options. Add to that I am a veteran and recieve my treatment in system. Add to that my spouse has health insurance coverage which is basied on my retirement but we pay monthly payments. Add to that we both take seasonal jobs that may or may not provide health coverage possibly in different states than our resident domicile. Add to that vision,dental and prescriptions are different policies. Add to that my spouse has several health problems while I am fairly healthy. Our poiicies have maxium out of pocket limits of $5,000. You would think that with all these options our health costs would be low but we end up with it being our highest expense with us being billed more than $10,000 some years. Hospitals,doctors and insurance companies are notified and questioned in advance of treatment as to what will be covered and billed but it seems they cann't get it right either and we continually get bills we shouldn't or charges that appear incorrect. We have never been refused treatment and have paid bills promptly and in advance we know are correct and have had a good explanation in advance. The bills that have we recieve "out of the blue" , one for over $8,000 last year, we cann't paid and just don't until they get resolved to our satisfaction. Surprizingly many never rebill or disappear as I get very few notices from our insurance companies. What kind of a way is that to run a business? My credit score is crazy good even though I could care less. I don't think a normal person can or would be able to understand or deal with the system we have even if they worked at it full time as I used to see advertisements for medical advocates, advisors and bill reviewing services that no longer appear, or maybe they have so much work they no longer advertise
Goodness, it is all a mess. My SUV was t-boned by a truck, last month. I was taken by ambulance to the ER. I've had BCBS for thirty-plus years and so I believed it was taken care of. Nope! Human Resources, through a clerical error, had cancelled my BCBS, last April and never notified me. I didnt know this until I received a Bill for $20,000 from the hospital, the doctor and EMS, combined. The thing is te insurance premiums were taken out of my retirement check each month...Now, I'm fighting this. That was enough to land me back into hospital. My BCBS was reinstated once I objected but I am still on he hook for the $20,000- which I cannot and even if I could, on principle, will not pay.
Dealing with Insurance is mystifying. And nerve-wracking.
Dealing with Insurance is mystifying. And nerve-wracking.
Willy said:
How does it work in Canada? Are you fairly satisfied? The care I received at hospital was stellar. It's the rigamarole with insurance and billing that devastates so.
On top of it all, when I complained to Human Resources, due to my shock and terror over this Bill, she replied, "well, we can just cancel your policy completely and you won';t have this to worry about." She said that! Her supervisor heard her say it, got on the phone and apologized to me. She said she was going to pray for the woman. That's nice but, er, what about this BILL!
I'm guessing you don't have this drama in Canada...
Take it easy LivGolden, you'll have more problems related to stress if you don't. My grandpa always said "You cann't get blood out of a turnip!" If you don't have the money to pay a bill you shouldn't owe, they sure are not gonna get any from you. Don't worry yourself sick and get another hospital bill that you will probably have to pay. Sometimes it pays to be poor. Best wishes on your recovery.
Thanks, Bullfrog - I agree. My husband use to tell me on occasion I felt overwhelmed about something that all I really needed was a change of attitude. He was always right about that, too. And I started that, today. I'm going to take care of myself, let go of whatever and whoever I don't want or need and get back on the Road. It's only been 12 hours but, hey, so far, so good...
@LivGolden
Best of luck with insurance. My son worked at a big multinational company. After he got sick, they put him on company disability. It wasn't until after we had been to the Mayo Clinic twice (which was a long, long drive) that we found out that the company had quit paying for his health insurance. His bills came to $100,000-$200,000. In the end, he paid $20,000 of his own money and he took out a $20,000 loan from his grandma and the "medical establishment" accepted this as payment in full.
Best of luck with insurance. My son worked at a big multinational company. After he got sick, they put him on company disability. It wasn't until after we had been to the Mayo Clinic twice (which was a long, long drive) that we found out that the company had quit paying for his health insurance. His bills came to $100,000-$200,000. In the end, he paid $20,000 of his own money and he took out a $20,000 loan from his grandma and the "medical establishment" accepted this as payment in full.
Here is a happier story; it is a dog in court story. https://narratively.com/the-dog-who-took-the-witness-stand/
In Canada, afaik, everyone above the poverty line pays into medical, but not a large amount like in the USA. I never made more than the poverty line, which is set at around $24,000 in BC, so never had to pay. Despite that, I get the same quality of medical as anyone else. Even if I DID have to pay, it would be around $37.50/mo or $75/mo for a family. This is in Canadian dollars, so even cheaper if converted to USD. ..Willy.
https://www.npr.org/sections/health...-act-could-upend-the-entire-u-s-health-system
1. "If the law were reversed, federal funding for Medicaid and individual insurance subsidies would stop, and insurers could once again refuse coverage to or charge more for people who have health problems."
2. "Elimination of the federal health law would take away some popular benefits the ACA conferred — everything from free preventive care to the closing of the "doughnut hole" in Medicare's prescription drug coverage. The doughnut hole refers to a coverage gap that had previously exposed large numbers of beneficiaries to thousands of dollars in drug costs."
3. "However, when Congress wrote the ACA, it incorporated HIPAA safeguards into the pre-existing condition provision. That means if the ACA is struck down, the HIPAA protections might disappear as well."
4. "Much of the president's effort to limit drug prices flows through the Center for Medicare & Medicaid Innovation (CMMI), which was created by the ACA and would lose its legal authority if the law became invalid."
1. "If the law were reversed, federal funding for Medicaid and individual insurance subsidies would stop, and insurers could once again refuse coverage to or charge more for people who have health problems."
2. "Elimination of the federal health law would take away some popular benefits the ACA conferred — everything from free preventive care to the closing of the "doughnut hole" in Medicare's prescription drug coverage. The doughnut hole refers to a coverage gap that had previously exposed large numbers of beneficiaries to thousands of dollars in drug costs."
3. "However, when Congress wrote the ACA, it incorporated HIPAA safeguards into the pre-existing condition provision. That means if the ACA is struck down, the HIPAA protections might disappear as well."
4. "Much of the president's effort to limit drug prices flows through the Center for Medicare & Medicaid Innovation (CMMI), which was created by the ACA and would lose its legal authority if the law became invalid."
I do not know the consequences of this court ruling and I pay attention to news articles which discuss the "addition" consequences of this ruling. In particular, companies that offer Medicare Advantage policies receive about $10,000 per years per MA policyholder. If this subsidy is eliminated, then I do not believe MA policies will survive; if they do, they will probably be much more expensive. I need to choose between medigap and medicare advantage; after a year (or so), switching between them becomes difficult. If I was the only person in the world who had to make this choice, then why would I bother people here? 10,000 people per day turn 65 in the US.
I am not holding a partisan position here; I am not certain why you claim this is political. I need to make a choice and many other people need to make a similar choice. In addition, the other consequences of this ruling may affect medicare and may be of interest to people here.
I am not holding a partisan position here; I am not certain why you claim this is political. I need to make a choice and many other people need to make a similar choice. In addition, the other consequences of this ruling may affect medicare and may be of interest to people here.
lenny flank said:I didn't --- you are not the person I responded to.
EDIT: I have reported my own post to the mods so that it (and the one it responded to) will get swept out the door by the mods. Political crapola has no place here.
Maybe this part of the thread went off the tracks but I think the information is important. Most people here are not millionaires; I'm certainly not. Lots of people here have limited resources. If adverse change might occur, isn't it better to have time to plan than to be surprised? I know from personal experience that medical bills can "suddenly" amount to hundreds of thousands of dollars. Going to Mexico to get cheap drugs is a good idea for lots of people. Maybe surgery in Mexico is a good idea too?
What about diagnostic exams which discover medical problems before they are critical? How many people here go to Mexico for routine healthcare? My sister was having a pap smear when her family doctor thought something was odd and scheduled a colonoscopy the next week. She had stage 3 colon cancer. She beat that cancer but only because it was caught early enough.
Knowing the facts, making a plan and following your plan is important. Your plan could be "I die when I die" and ignore doctors; that is fine with me if it is your plan. If you don't know the facts and you don't know of possible changes to the laws and regulations, how can you plan?
lenny flank
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^^ I do not at all disagree.
Moxadox
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It's much, MUCH better than **no care.**RVTravel said:
The Dire Wolfess
Moxadox
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I lived in Israel for 6 years. I was hospitalized twice: once after being attacked by a street cat, and once when I developed Crohn's Disease. Israel has a unique form of socialized medicine that is often frustrating to navigate. But...other than my monthly premium, which came out to around $8 (yes, EIGHT dollars) a month, and small copays for my outpatient medicines, I paid exactly NOTHING for my medical care. I did have to utilize their 2nd tier private pay system one time when I had broken my wrist in a bizarre way and couldn't get in to see a hand surgeon through the normal channels. That cost a few hundred, including an MRI. I'll take that over forking over hundreds every single month whether I use the system or not, with "pre-existing conditions" not even covered. I came back to the States for family, but I dunno.
The Dire Wolfess
The Dire Wolfess
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