Medicare: Getting Closer to the Answers

I went off this morning, in the pouring rain, to see Leah deRoulet, MSW, LCSW, at the Swedish Cancer Institute. Leah is the best social worker I know, bar none, and I'm not the only one who thinks so.

Leah just won an award that puts her among the top dozen social workers in the country: She recently won the prestigious Lane Adams Quality of Life Award from the American Cancer Society. (Applause, please.)

Anyway, back to the purpose of my visit to see Leah: Of all the people I had e-mailed about sorting out Medicare, Leah was the only one who said, "It's not as hard as it looks."

So I figured seeing her was my next step.

I had all my questions written out, and I took along a list of all my prescription drugs.

This is what I learned:

* Tykerb should indeed by covered under Medicare Part B, rather than under Part D, which is the very poor prescription drug coverage plan.

It's on Part D that you fall into the doughnut hole and have to pay more than $2,000 out of pocket before Medicare starts paying for prescriptions again. And even then, there are copays and some drugs that are not covered.

* Supplemental insurance may be a problem.

Leah said that the private companies that cheerfully sell supplemental insurance to those 65 and older on Medicare do not want to insure people like me, who are on Medicare because we are disabled.

(This is sounding familiar.)

So, Leah suggested checking to see if WSHIP (the health insurance I have now) has a Medicare supplementary plan. She points out that Medicare Part B would be paying 80 percent of the cost of my cancer care, so the supplement only has to cover the other 20 percent.

She also thought that Basic Health (a state program for low-income people) might also have a supplementary plan for disabled people on Medicare.

This was all new information.

So next I'm going to call the state Insurance Commissioner's Office to see what they can tell me, and then I'll call WSHIP.

Ideally, I'd also be able to get some prescription drug coverage as part of the supplemental package--because I have six prescription drugs that I take regularly, not counting the Tykerb. Tykerb will be covered under Medicare Part B. (Part B will cost me $98/month.)

Whether or not I sign up for Part B depends on whether or not I can get supplemental insurance that provides reasonable coverage at a reasonable cost. Otherwise, I'm better off staying with WSHIP.

Even if I do get this all worked out, it's not likely to save me more than $200-$300 a month, but that's a lot when you're on Social Security Disability as I am.

So: Phone calls next.

Read about: Leah deRoulet

Read more:

Medicare Questions

Medicare Help

Tykerb and Medicare

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@ Jeanne Sather 2008.

Comments

[jessica]

how great that you found someone to help you sort this out! that in itself but have been some sort of relief... she sounds like a gem.

i agree. $200 bucks a month is no small change. think of the groceries you could get for that! or dog food! or chocolate!

[jeanne]

Jessica--still too soon to tell, but it looks like I might save a little more than that, maybe $300+ by going on Medicare plus supplemental insurance. Still working on it.

When I went on SS Disability two years ago, I went through my budget with the proverbial fine toothed comb, looking for fat I could trim (mixed metaphors there).

There wasn't very much, but even things like getting three months' worth of a prescription drug at one time to save on co-pays ...

How are you doing?