supplementing Medicare for bc issues

abbadoodles

supplementing Medicare for bc issues

abbadoodles

Okay, I'm nowhere near 65.  Not for another 5 years.   I am, however starting to think about planning for the Medicare years and am trying to educate myself.  Of course, Medicare, like all insurances, seems to change annually.

However, for you ladies that have been on Medicare, what kind of supplemental insurance have you found necessary for living with a diagnosis of bc.  What things *WON'T* Medicare cover?

Fortunately, at this time I am not on any meds and have no reason to believe I will have a recurrence, but it's always good to be prepared and have no surprises.  Also, I have an implant which may need replacing or revisions in the future.

Tina

Binney4

Hi, Tina,

Sorry I can't address your question directly, but I do know that at present, should you develop lymphedema (which is a life-long risk for literally all of us who have been treated for breast cancer) Medicare will NOT presently cover ANY compression garments, and out-of-pocket these are very expensive. (Typically, a custom measured day-time glove and sleeve will be over $300, night-time garments closer to $600. The day garments need to be replaced every 6 months on average, and you need two sets in order to have one to wash and one to wear.)

Medicare does cover therapy for lymphedema, but only if the therapy is done by a PT or OT. In many areas the only trained lymphedema therapists are RNs or MTs, and if so, you're out of luck.

Needless to say, those of us who know we will eventually be affected by this non-pay nonsense are busy advocating for changes, but the wheels of bureaucracy move mighty slow.

Any of you sharp gals who'd like to help with advocacy to make the necessary changes in Medicare policy, please PM me and I'll direct you to advocacy information. Thanks!

Binney 

LoriFL

I am very intgersted in the supplemental issue of Medicard. Any thing else we should know about?

saluki

I'm not anywhere near Medicare age either but due to RSD I am on SSD

and after waiting the 2 years went on Medicare June 1st.

I am trying to keep Medicare as my primary since I am a medically complicated patient---

As a result I elected Medigap  secondary insurance which leaves Medicare my primary.  It is very expensive but, I feel it is necessary right now.

I am welcomed with open arms by all Doctors everywhere- LOL.  As long as the Doctor is a Medicare participant --I'm safe. --And I don't have to go through the horror of referrals.

You have to consider Medigap very carefully because if you change to a HMO managed Medicare plan --you can never switch back to a Medigap plan again.

You have to be aware that many Doctors won't take certain M/C HMO's

--Many Psycologists, Podiatrists, on and on.  And if you need something like Dialysis you are limited to certain places as well.

It is a very big decision to consider.---It is up to you to make sure your

Doctors are participants in the plans you are considering.

Anonymous

Working in health care, believe it or not, medicare actually covers more than alot of private insurance companies do.  Secondary health insurance is really important.  I try to stay away from HMO's - never did like them from their onset into healthcare.  Im 57 so I think about this alot too.  I get magazines from AARP and they seem to work very hard with United health care and Aetna as secondary insurance.  I get my car insurance through them and its by Hartford.  As least with AARP you hae a voice representing you.

I think the biggest thing I am seeing with medicare right now is that they are making hospitals and physicians more accountable.  As of January 1, 2008 there are certain things they will not cover and they are making the hospital absorb the cost instead of putting in on the individuals.  A couple of examples of this are

...if you get an infection like MRSA in the hospital, medicare will no longer cover it.  They feel the hospital has to take more accountability towards nocosomial (hospital based) infections.

...If you go to the hospital lets say with pneumonia and during your stay you fall and break a hip.  Medicare is saying the hospital will have to absorb the cost of the treatment for the hip.

I dont know if these changes are good or not.  But to tell the truth, I will be so glad when Im not dealing with private insurance - as they seem to deny so much.

Nicki (aka chemosabi)

anneshirley

I was eligible for Medicare just a few months before my diagnosis.  I joined a Medicare HMO (Oxford) and, for me, it's been wonderful.  My first year of treatment: surgeon, chemotherapy, radiation, and herceptin (very expensive) were all covered.  The plan I elected had a deductiible, which cost me $750 for that year.  This is beyond what is deducted from SS, and the $20 out-of-pocket for specialists visits.  My costs for my first year were well over $100,000, so I find it incredible that I only spent $750.  However, I live in New York City, so I have access to many, many doctors. And I'm treated at a well regarded cancer center.

If I had gone with straight Medicare my expenses, I believe, would have been about $20,000.  I don't have an in-between plan.  This is not to say I don't worry, as Oxford was recently purchased by United Health, not as highly regarded as Oxford, and things could change. Before deciding on any plan you should read all the literature very carefully, check out the doctors who participate in an HMO and which doctors in your area accept Medicare, and make sure they are doctors you can work with.  My friend from HS, who lives in Colorado, is having an awful time finding doctors there to accept Medicare.  Each area is different!  And New York State has enacted certain laws that some of the other states have not, on what must be covered for cancer patients. So it's a good idea to also find out what the laws are in your state.  You can do this by calling the State Insurance Department, probably located in the state capital.

iodine

My major concern is that docs are closing their practices to new medicare patients due to the congress cutting their pay to see us.

Yeah, we'll have "great" coverage if we can find a doc who takes it.

Sorta like Tenncare, medicaid for TN, hardly a doc in town takes it, so the hospital had to hire docs and NPs to see Tenncare patients.

I also see the effects of these companies who manage payments:  they pay or deny payment according to the weather, or something.  Will pay one month and refuse the next, even after authorizing it.  Demand more and more paper and repeat of the same forms, again and again.

I will be glad to quit paying as much as I do for health ins, but I dread fighting with the payors.

Anonymous

Dotti:  Something weird is happening out there in health care.  Here in Illinois, now there is a problem with BCBS - private insurance.  In the past, always known as the best, now hospitals and doctors are dropping BCBS like its a hot potato!

It concerns me that our physicians are having to practice medicine based on what medicare and insurance companies are telling them.

Nicki (aka chemosabi)