jointers

Mar 12, 2021 Last reply: 5 years ago 149 Replies

I have a couple (three?) of drugs that are $1000 to $1500 for 90days. Now, I have discount cards that pay much of the cost that my insurance doesn't cover. For one, the cost is $1500/90 days, my co-pay is $120, and it costs me $30 out of pocket. With Medicare all of that goes away. Medicare Part-D helps until the donut-hole, which for me is about March. Then it's going to cost about $5K for the next quarter. My choices get real, fast.

I'm certainly not interested in an HMO. Not a chance. I am considering a PPO Advantage plan but, again, that only works if I never plan on moving. I'm in my employer's PPO now but while I'm working I would take that wherever they would move me.

The problem with Medicare is that the decision is pretty much a one time thing. Sure you "can change at any time" but the fine print says "underwriting may be necessary". IOW, forget it.

Why do you feel that a blanket CYA statement that uses the word "may" is actually a "forget it" clause?

Lots of contracts have verbiage that protects one party or the other against that one-off case that just doesn't fit the norm. All it does is give them an out under certain, usually limited, circumstances.

Have you actually been told - by someone official - that you can't make changes over the years? Any stats as to what percentage of change requests end up being denied by an underwriter?

I know people that use Medicare plan brokers who hold seminars before every open enrollment period - for their existing clients - presenting the options available for the upcoming year. Why would they do that if everyone is simply going to be told "forget it"?

It may (or not) require underwriting. "Forget it" means that there is no way to get underwritten if you have any health issues. Insurance companies aren't in the business to lose money.

No, it gives them a choice of writing a policy, or not. Their choice.

I know others in similar circumstances. I know the payouts that my current insurance has made. The other insurance companies know it too.

Advantage and Medigap are very different. Advantage plans are "managed healthcare" options with features and costs pretty much decided by the insurance companies. The insurance company gets a chunk of money from the Feds and manages your healthcare with that money. You may pay additional, or not. That's primarily what the brokers sift through. Which of the _many_ plans is best for you. You are limited to doctors and facilities and med costs vary. The brokers go through your list of doctors, meds, and excess costs and figure out which is best for you.

Medigap is a whole different kettle. There are only a dozen Medigap plans (labeled A through N with some holes and options). All plans (pools, really) with the same letter are exactly the same. The only difference between insurers is the price. One price for everyone in the plan/pool. Once in the pool, you can't be denied coverage IN THAT pool and everyone pays the same price. In theory, you can change plans during the enrolment period but it is subject to underwriting. You're entering a new pool of insured so if your history is worse than that of the rest of the pool, you aren't getting in. The better plans, of course, have the least risk so are more choosy. Going to a lesser plan probably isn't an issue but a better one is more difficult because those wanting to upgrade tend to be those needing better coverage. The better plans cover everything, for any doctor/hospital that takes any Medicare patients. I know several people who travel to the best specialists in the country for surgery, for instance. They can't be denied coverage.

Drugs aren't covered under Medigap so a Medicare Part-D policy is needed. This is where the "donut hole" comes in. Part-D only pays up to a cap, then you're on your own until you've paid your annual maximum for healthcare for the year. In the meantime, you're on your own, paying out of pocket for everything. Manufacturer's discount cards aren't allowed so for that one drug, I'd be out that $500/mo. I'm on three with similar costs. These aren't exotic drugs, either. Many are in this situation.

This is only the basics. The minutiae is far more complicated. It's almost like the US government put it all together. THAT'S why plan brokers are needed. ...just as enrolled agents, accountants, and tax lawyers are needed.

I forgot to add, that all of this (plan availability, cost, insurance company, and coverage) varies by zip code. It really is a huge mess.

Indeed. A single pool, single payer system with mandatory enrollment for all seems far easier to manage, far better outcomes and better for the mental and physical health of retirees. No holes, there aren't 51 million different plans, no hidden bills and universal coverage within the entire country.

Not buying it. Our government would screw up a wet dream. NO chance I want a takeover of healthcare or even insurance. They gave us Medicare. What makes you think they'll do any better with a plan for "everyone" (except them). Look at the VA, a few years back. No thanks! It's bad enough now.

Pessimist: "Well, it can't get any worse." Optimist: "Oh, yes it can!" - Madeleine Urban

Medicare was just fine until the Republicans started dismantling it a couple decades ago. Leading to the current mess.

Universal health care works quite well in Canada, the UK, Down Under, and in many other countries; I don't see why it can't work here as well. Can't be worse than the current system.

Oh, horseshit. It was a mess from day one. It's not Medicare that's the problem, idiot. It's government and everyone of you socialists who think it's the answer to all that ales us. It's *not*.

They don't have the corruption to the level of the US congress, which just got massively worse, BTW.

Now stuff it, lefty.

You have a pretty active imagination.

And you clearly don't understand the meaning of the term 'socialist' which has zero to do with a single-payer insurance pool.

But that's par for the course, it seems, for trump supporters.

Like all lefties, you're simply a liar. Nothing new here.

This is really weird.

My newsreader says I?m reading rec.woodworking but it seems like I?m reading alt.home.repair. Strange. Must be a bug.

On 4/7/2021 9:01 AM, Scott Lurndal wrote: Snip

According to an update posted to the CDC'S travel notices page on April

2, the agency has listed Canada as a Level 4 health risk due to the infection high rate of more than 100 new cases per 100,000 people over the past 28 days. The advisory warns: "Because of the current situation in Canada, even fully vaccinated travelers may be at risk for getting and spreading COVID-19 variants and should avoid all travel to Canada."

I'm not sure if this would be an endorsement for health care in Canada.

I don't see anything there related to health care in Canada. They have ignorant rednecks that won't mask just like we do.

[SNIP]

No problem, DerbyDad. Just wait un til the Demorats get around to their Medicare single-payer system. You'll likely wait 8 to 10 months to read about all this stuff but it will be mixed in articles on gardening and fairy tales. LOL!

Every country has theirs. :~)

But I would think a better health system would have a better inoculation ratio, easier to get inoculated, therefore fewer infections.

BUT! being inoculated does not prevent you from contaminating some one else. It just means you personally will probably not get sick when you are exposed again.

Actually, Leon, there was a study just report over the weekend or early this week claiming that if you're fully inoculated with the Covid-19 vaccine you are highly unlikely to be a carrier of the virus. Personally, I'm following the masking and washing guidelines until a lot more time has passed. Take it all with a grain of salt.

If Universal Health care is so great in Canada, why do our neighbors to the north continue to come to the States for treatment. Might the average (most recent I found) 20.9 weeks between the time their Canadian GP refers them to a specialist and when the specialist sees them have something to do with it? The last two occasions where I was referred to a specialist it was 3 weeks and 1 day respectively.

I never did. Pretty much Everything opened up here last June/July. Before that we used curbside service at restaurants and inside dining since. I would never have worn a mask if businesses didn't require it. ...and I see fools driving down the road, alone, wearing masks. It's really too funny.

Having healthcare insurance is not the same has having health care.

The vaccine manufacturers have prioritized deliveries to the US over other countries, including Canada.

<snip>

My Candian colleagues tell me that such statements are inaccurate for most healthcare (including non-emergency care). Elective procedures and cosmetic procedures may take a bit longer depending on the procedure.

My next door neighbor spends significant time in Italy. Two years ago, his wife had a minor fall. She had an MRI -and- a CT that day, and when her husband went to settle the bill, he was told that it's all covered - they had purchased ($200 annual) visitors medical coverage.

Do you have a citation for this?

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