Medicare Questions

Well, in my usual fashion, I e-mailed god and everyone looking for help with Medicare. This approach is also known as "throwing all the balls in the air"--in other words, it's a shotgun approach to finding information.

I often do this when I'm writing a story on a topic I know nothing about.

And it works. I'm a lot closer to sorting out Medicare and deciding what I should do--drop WSHIP ($800/month premiums plus $2,000/year deductibles)? Join Medicare (a huge unknown)? Or keep both?

The people I e-mailed included a smart friend who is on Medicare, a bankruptcy attorney (and friend), a friend at WashingtonCAN, and a social worker at Swedish. I also had info from readers of my blog. I asked BOTH of my therapists for input.

And I went to the AARP and government Web sites and started reading. As I expected, this info causes the brain to shut off after about 20 minutes. Too complex. Too much information. Too many decisions. And too many unknowns. Not to mention the jargon, although I've learned most of that during my nine years with cancer.

I want to move to Canada!

I wish I had kept track of my time from the beginning, just so I'd know how much time I spent sorting this mess out.

I'm getting closer to getting the help I need, however. The social worker at Swedish said, "It's really not as hard as it looks." !!!! She's the first person to say that, so I figure she probably has a handle on it.

My Questions
So these are the questions I have to start with. It mainly comes down to a cost comparision between Medicare and WSHIP, plus a comparison of what each plan covers.

WSHIP gives me 12 massage therapy visits a year ($840), and 10 talk therapy visits ($800).

Medicare doesn't cover massage therapy, and has limited benefits (I need to find out exactly how much) for talk therapy.

I believe WSHIP covers some household help, although I don't know much about this because I haven't needed it till recently. So I need to call and find out more about this benefit.

Medicare does not cover household help except for some personal care services--help with dressing and so on and nursing care at home. (This is a question, actually, I need to ask the social worker.)

Tykerb, my new chemo drug, is a pill. I've been told by other cancer patients that this will be covered under Medicare Part B, so I won't fall into the infamous "doughnut hole" with Part D, which is the optional prescription drug coverage. Right now, I pay just a copay to get Tykerb, I think the copay is $15 for three months' worth of Tykerb.

Enrollment
According to the government Web site, I will be enrolled in Medicare Part A and Part B this month, as I've been on Social Security Disability for two years as of mid-January. My Medicare cards will come in the mail sometime soon, and the $98 premium for Part B will be deducted from my Disability check every month.

OK, that's good. I don't have to talk to the government to get this started.

Extras
The really big, confusing questions are WHICH Part D plan to enroll in. This is prescription drug coverage, which I definitely need. I have six or eight prescription drugs at any one time, not counting the Tykerb, and they are expensive.

What I need to do is make a list of all the drugs I am taking and take that list with me to the social worker. She may be able to help me decide which Plan D will give me the most coverage. Some drug stores also can figure this out for you, I am told by my savvy friend.

The next huge question is supplemental insurance--which plan, how much will it cost, and what will it cover. Because if I am reading this correctly, Medicare Part B will only pay 80 percent of the cost of my cancer care. For the past couple of years, my care has cost about $300,000/year.

At that rate, roughly, my share would be $60,000.

I think my treatment is going to be less expensive this year, because I went off Avastin (very expensive) and Herceptin (also very expensive) and substituted Tykerb ($3,500/month). But even if my care costs $100,000 this year, without a supplemental plan, my share would be $20,000/year or more on Medicare.

Obviously, I'm better off with WSHIP, which costs me about $11,600/year in premiums and deductibles.

My friend who is on Medicare pays about $450/month for supplemental insurance. My first question is whether companies that offer supplemental insurance are allowed to reject people--because they sure wouldn't want me.

The second is what, exactly, supplemental insurance covers, and if I would be left with any surprise bills. The answer to this is, I don't know yet, but I hope to by Monday afternoon.

Based on what I know now, I'm better off staying with WSHIP.

Then the question I have is whether or not Medicare Part A and Part B, which I am going to get automatically, will cover some of the bills that WSHIP doesn't. Like the deductibles and copays.

And the government expects OLD PEOPLE to figure this out? This is cruel.

@ Jeanne Sather 2008.

Comments

[Renee Fox]

Jeanne,

I have been in Medicare sales for the last three years. I resigned from a large insurance company in September and I'm now an Independent agent.

However, I spend most of my time trying to help people navigate this extremely complicated and yes, often cruel, system. These efforts don't pay the bills, but the satisfaction I get from helping is more important than money.

I live in Branson, MO but through the internet I have access to all states qualifications. You should be able to get a supplement with no medical questions or pre-exsisting limitations depending on the county you live in as well as the plans that are available in your area.

If you haven't gotten answers to your questions, please feel free to call or e-mail me and I'll do some research for you. If I have your zip code and county, I'll be able to tell you which plans are available, what they cover and what you need to look out for.

There also others sources of assistance. Mybenefitscheckup.com has some great tools for finding programs you might qualify for.

Please feel free to e-mail me at reneefox@suddenlink.net or you can call me at 417-849-5000. I'll be happy to help if I can.

Take care,

Renee

[jeanne]

Renee--thanks for the offer, I may take you up on it. Apparently, because I am going on Medicare as a result of being disabled (on SS DIsability for two years) I will have trouble buying a supplementary insurance plan. I certainly can't go on Medicare without supplementary insurance, so this is the piece I'm working on now.

I live in King County, and my zip is 98115.

Jeanne