Medicare stinks....I'm stuck with 20% copay

brend

Hospital is threating to send 5 bills to collections already! I have 10 more chemo's to go, and operation, then they will run something through the port to kill some gene for 6 months.

I've ALWAYS paid my bills. I've been paying $10 a month on 4 of the bills, they haven't even given me a chance to send my first payment on the 5th one at all.

I did qualify for copay.org. Right now, trying to get hospital to send what I need for the paper work to send to copay. Ugggh.

I live alone, and don't have help. I'm on SSDI, and only have Medicare. Today, I'm drowning in paper work.

Been digging all weekend to see if I qualify for help with another program. Seems, one link leads to another, then another, then they don't cover breast cancer, or either I don't qualify for help, or they are out of funds.

Medicare only pays 80%. I'm stuck with the other 20% of each bill. Every test, is billed separately. Every chemo is billed separately! So you can imagine the pile of bills I have. I did my first chemo in January, 2015.

I really don't need the added stress, of letters threatening to send to collections, while I'm trying to get through chemo alone.

Thanks for listening.

Spookiesmom

I'm in sort of the same boat, my rad copay went to collections. Stupid hospital!

But for you next year check into getting a Medicare Advantage plan. DH and I have Humana, neither of us pays a cent for it. All my generic drugs don't have copays.

My Specalists co pays are $35. This all really helps!!

brend

I checked in to those plans, before the start of the year. They cost so much I couldn't afford it. I think they wanted $600 a month. Now being diagnosed with Breast Cancer, I doubt I'll qualify next year.

Spookiesmom

No, the ADVANTAGE plans. My DH and I DO NOT PAY FOR THEM.

gypsyjo

Hi Brend,

Every state has an agency that helps seniors with Medicare and plans that are available. I found out about them when my mother in Indiana had billing issues post hip replacement. You might want to check into them for the future. In some cases, they might be able to help with existing billing. Good luck in resolving the issues. The system is very complex and continually changing. Contact information for the state of Alabama is below.

Alabama SHIP Website: www.adss.alabama.gov/ship.cfm
      Phone: 800-243-5463
      Program Name: State Health Insurance Assistance Program (SHIP)
    About: The state of Alabama has SHIP coordinators and a crew of insurance counselors ready to assist you in making informed choices about your insurance. SHIP counselors are committed volunteers many of whom face the same issues you do as Medicare beneficiaries. They will provide you with information that will help you make informed choices for yourself regarding your insurance benefits. The counselors are not affiliated with any insurance companies and will not attempt to sell you insurance. All counseling records are strictly confidential. SHIP is a partnership with the Centers for Medicare and Medicaid Services, the Alabama Department of Senior Services and the Area Agencies on Aging.

brend

thanks gypsyjo. Actually I have dealt with SHIP here before, a few years ago.

Spookiesmom, I'm on SSDI, (disability). I think there may be a difference in social security, and disability, and what they charge. I don't know.

Spookiesmom

shouldn't be. If you were looking at SUPPLEMENTS, you pay an arm & leg. Advantage plans have 0 monthly payments. Are you 65?

flatnfab54

I also have SSDI and on my own. I signed up for an advantage plan (healthspring) no extra monthly cost. My doctor is $10 and specialist is $35 copayment. Also call medicare and see if you qualify for extra help. This helps you with your part b premium payment and presciptions. Also find out if you qualify for medicaid. I have both Medicare and medicaid. Also some hospitals let you fill out a medical hardship paperwork and reduce your bill but you have to call and ask

Hope this helps

flatnfab54

I also have SSDI and on my own. I signed up for an advantage plan (healthspring) no extra monthly cost. My doctor is $10 and specialist is $35 copayment. Also call medicare and see if you qualify for extra help. This helps you with your part b premium payment and presciptions. Also find out if you qualify for medicaid. I have both Medicare and medicaid. Also some hospitals let you fill out a medical hardship paperwork and reduce your bill but you have to call and ask

Hope this helps

Warrior_Woman

I know nothing about this and don't know if this will help or not. Has anyone contacted the American Cancer Society? They called me last year and asked if I needed financial assistance; help with co-pays, etc. My bills recently passed the one million dollar line. Cancer treatment is VERY expensive.

Zillsnot4me

My hospital sends to collections quick too. But it's internal collections, shouldn't affect your credit. But doesn't make you feel any better.

Talk to social worker at the oncology unit. They can help you navigate this nightmare.

Spookiesmom

Hey Z. My stupid hospital waited almost 2 years, with no bills or calls, to give it to collections in Texas. What IS it about that state?

Michele2013

I have been crying all day. April 1st I was placed on Medicare. On ssdi, work part time, live on my own and 48. My ssdi is above the state guide lines for the state help me. I was on the breast and cervical cancer program through my state. I feel like I was driven out to the middle of nowhere and left. I am on ssdi because of all my dr appts, now I can't afford to see one. Feeling lost!

Before I was diagnosed, I worked 2 jobs.

brend

I don't qualify for any extra help. They sent one bill to a collection agency. Ah the fun begins. I was going to take a loan out, when treatment was done to pay it off, but looks like they will mess my credit up so bad, I won't be able to do that. So much for non profit, University hospitals.

MNLinda

Spookiesmom - how are you qualifying for a free Medicare Advantage plan?  You really don't have a premium for it?  Everything I have seen has a hefty price tag on it.

flatnfab54

I have medicare and have an advantage plan at no extra cost. Also qualify for extra help that pay my plan b premium and reduced perscripton costs.

MNLinda

flatnfab54 - how did you qualify?  Did you apply for a state or county program?

edwards750

Brend - just read your post. I think the vast majority of us can relate to the frustration in trying to pay all the medical bills from BC. I was blessed because DH still works and we are covered by BCBS. We still have balances to pay but at least they are manageable level. We reached our deductible of 5k right before I had to do Rads. Thank God or don't know how we would have paid for the treatment.

I thought if you made payments they wouldn't turn it over although I did have one who did that. What do they expect you to do? I would tell the CA if they call just what you can do - no more and no less. Don't let them bully you.

We all have enough stress as it is and good grief treatments are so expensive. My sister has to have scans so she has that added expense.

Do the best you can. That's all you can and should do.

Diane

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flatnfab54

MNLinda- The advantage plans are in the back of your Medicare book you should get every year. All the plans are listed and the monthly rate and if a prescription plan is included. I am enrolled in Cigna Healthspring and I think someone else here ins enrolled in Humana. For the extra help I called Medicare. They asked about my income which is just disability, I am single and I qualified for it. Medicare will also help you enroll in an advantage plan.

flatnfab54

Income below $1360 qualifies for help with premiums, deductables and perscription co payments are $2-3 for generics and $6 for name brand meds.

Lynn1234

flatnfab54-I am going to be signing up for Medicare soon, due to SSDI (it will be two years soon).but I'm only 59.

Can you sign up for the Advantage plans if you're under 65? Also, how does Medigap fit in to all this?

Thanks!

Lynn

flatnfab54

Yes you can sign up for the avantage plans at 59. I am 55 and had them for several years. Do not know about the medigap plans. Think they are for higher incomes. My income is so low that I qualify for medicaid too.

MNLinda

I had a $5000 deductible at my initial diagnosis, and I asked all my providers if they had a hardship application.  My income is a little above Medicaid eligibility, but not high enough to make medical costs affordable.  Fortunately for me, the Allina system of clinics in my home city has a program for people with low-to-moderate incomes, and they wrote off all the expenses that insurance didn't cover - about $25,000 total over the first five years.  That covered office visits, most of the surgeries, most lab tests, physical therapy, and most of the imaging.  I filled out separate hardship applications for contract firms that were not part of the Allina system.  That included anesthiology (the anesthesioligists' bills were separate from the hospital and surgeons' charges for my surgeries), pathology and radiology reports (the hospitals contract with outside firms for these services).  Lots and lots of paperwork.  Only one company stonewalled me.  They sent a bill for about $400 to a collection agency while I was still in chemotherapy and hadn't even had the mastectomy yet.

When I talked to the collections people, I would just tell them "Look, I'm not someone who bought a big screen TV they couldn't afford.  I have cancer.  I didn't have a choice about getting treatment.  I also wasn't uninsured, I had a high deductible because that was all I could afford.  So do your worst, but I can't pay."  For whatever reason, that bill never showed up on my credit report.  For the most part the collections agents were sympathetic, and stopped calling after a few months.

I'm still struggling with financial issues.  Although I'm getting on Medicare in September, Medicare doesn't cover lymphedema compression garments, and won't allow me to purchase a marketplace plan that would cover them.  Prescriptions can easily run into thousands of dollars.

Brend, I hope you can get into a Medicare cost plan soon.  Whatever the premium is, it would likely be worth it.

KleeKai

Medigap plans are Medicare supplemental products sold by private insurance companies.  AARP has one with UnitedHealthCare, many Blue Cross/BlueShield plans have them as well as other insurers.  They pick up the 20% not covered by Medicare.  There is a standard list of plans that Medicare requires to be uniform when private insurers sell these products, and the benefits can vary a little.  Generally speaking, so long as Medicare pays for the service, the Medigap plan is required to pick up the balance (there are subtle differences, such as some plans can have an additional coinsurance on that 20%, others may restrict your network).  The prices differ - they do not include pharmacy benefits.  My parents were on a direct pay Medigap plan for years - their annual cost was $2800/year for each.  You would need to contact a few companies to find out the plans they offer, what the premium is, can you be billed monthly or quarterly, and when are you eligible to enroll.  Some companies have age-in premiums, where for the first three years the premium starts out low until you reach the threshold and then you are charged the same rate as all others.

Medicare advantage plans are different - they replace traditional Medicare.  Medicare Advantage Plans must offer the same services and benefits that traditional Medicare covers.  They usually have copays and coinsurances, but no deductible.  Each plan has out of pocket maximums, after reaching the OOP there are typically no additional costs.  The plans change yearly (it depends on how much money the government dispenses to the insurance companies as to how they'll package the products and what premiums they'll charge).  Some plans are packaged with pharmacy coverage; others package minimal dental services too.  You should check out what plans are offered in your state.  Go to: https://mymedicare.gov/  There is a tab a the top of the page Sign Up/Change Plans - you can search for Medicare Advantage plans on this website for your area.  All rates must be filed with CMS so CMS knows what each insurer for each plan offered is going to pay.

For anyone needing assistance, there are agencies that will help you navigate this. UnitedWay is one, sometimes your state will run a program to assist people in the options available to them. Look around for someone to assist you as needed. 

Good luck!

Zillsnot4me

thanks for the info!

Spookiesmom

Z you aren't even close to 65 yet are you

djatsw47

I am already worrying about the financial end, too. I am retired and covered by Medicare. Also have a crappy insurance policy for retirees through my former employer (70/30 plan). The deducticle and out of pocket costs will be more than I can handle easily. So, am waiting to see what happens. Have not received a first bill from anyone yet.

djatsw47

I think there are different levels of the Medicare Advantage plans. There is a no cost option and then there is a better plant that charges a small monthly premium.

brend

dijatsw47 I joined a clinical trial. It has helped tremendously! They are paying for 2 medications, that I'd be getting ANYWAY!!!! As well as I did qualify for copays.org with my income. That was the only program I did qualify for, due to my income. They have finally started to pay! I didn't get one of my bills last month, called to see if they'd sent it to a collection agency, and they said nope, it was paid in full!

Copays.org granted me $5K a year this year. Said I was guaranteed over $2K, and if the funds were available, I could get the other part. They do go by donations, so funds may run out before the end of the year. I make close to $1,800 a month. It was the only one I actually qualified for.

If you have a clinical trial at your treatment place of treatment, they will explain what they cover, and what they don't. I was told by my surgeon this would save me a bundle. Those 2 meds aren't cheap by no means. And the extra tests they have sent me for, that the clinical trial requires, they have covered those tests 100%. But watch your billing. Hospital tried to bill me for 2 test, that were supposed to be covered by the clinical trial. My clinical trial lady has been more than WONDERFUL in explaining, and even getting in touch with my Dr's when I couldn't!

So far, they only sent 1 bill to a collection agency. I was paying $10 a month, on 7 different bills. I'd paid 5 months on one bill, and that is the one they sent to a collection agency.

I'm now through wtih the first 6 months of treatment, and just had my surgery June 25th. I still have another 6 months (HER2+) of Herceptin and Perjetta. I really hope to come out of it all, with the exact same excellent credit rating, than before I started. Here's hoping the next 6 months, they won't send anything else to a collection agency! I do plan on taking a loan out when I'm DONE with all this to pay them off, if they don't mess my credit up.

It hasn't been near as bad as I was expecting, with the clinical trial, as well as qualifying for copays.org.

imisswine

Like Linda, have high deductible insurance (thru employer) which so far has eliminated me from almost any assistance program I've found. That plus age, I have a job, etc.. and there's nothing out there. Luckily a SW at the Onc had a program to help w/ the chemo meds, that's been good. Will keep at it, negotiating payments and try to have this not wreck my credit. Thx.