Does anyone have a recommendation about Medicare/Medigap insurance providers? I know that the minimum features of the basic plans are standardized by Medicare but are any of the providers more "Parkinson's friendly" than others?
Medicare and Parkinson's: Does anyone have... - Cure Parkinson's
Medicare and Parkinson's
Written by
mdetreville
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I suggest you meet with an independent Medicare insurance broker in your area and not one of those 800#s you see on TV. Take a list of your meds and doctors with you so they can sift through the information and help you find the best plans to choose from. They get a commission from the insurance companies and you are not charged a fee for their services.
Medicare is incredibly complicated. First decision is Original Medicare (A,B, and D) or Medicare Advantage. If you go with Advantage it does what A,B,and D and supplements do, for less money, but you have to use the doctors and hospitals in their network. So check the network carefully to make sure it has the docs and hospitals you want to go to.
If you choose Original Medicare, there is no network requirement, but you still have to be careful. In the drug plan (part D) for example, you would think that if the drugs you take are in their formulary, you’d be all set. But that’s not true. When my doctor sent in a subscription for Rytary, Humana (my new part D carrier) said it needed prior approval. But they did not say what the criteria for approval were. The approval I got from my previous carrier was no good.
After a lot of shucking and jiving, i ran out of Rytary and went back to carbidopa/levodopa. My condition deteriorated and after two weeks my doc and I reported my deterioration and submitted a new Rx to the pharmacy Humana owns hoping that they’d be more likely to fill it if they got the money.
Ten days later, I got a three month supply in the mail. Each bottle was marked with the words, “three renewals.”
I figured my troubles were over with three 90-day renewals. No such luck. After three months I sent in a renewal and they rejected it. They said that my doctor had canceled all of my subscriptions (not true) and I needed to get prior approval for a new one! Back to square one. Once again I will run out of Rytary.
I also signed up for supplement plans for me and my wife. The insurer (Fallon) issued the wrong plan to my wife and it took me a full two months to straighten that out. Every one of the six or seven peopleI talked to said they would fix it. None did.
For-profit healthcare insurance is best avoided because insurers are forever attempting to find new ways to make money at your expense. That includes "Medicare" part D - I put Medicare in quotes because part D is also private for-profit insurance. I found it was cheaper to get my meds by paying cash at Costco mail order pharmacy.
As to Medicare "Advantage", with the possible exception of the Kaiser system I believe it is otherwise unsuitable for anyone:
Friend of mine had brand X Medicare Advantage from a brand X integrated healthcare provider. She went to a regularly scheduled doctor visit at their clinic debilitated with the flu. The doctor ordered her to the ER. She went to the brand X ER, whereupon she was revived with a saline IV, plus was given an MRI over her protests.
Subsequently the brand X Medicare Advantage health insurer declared the visit was "unnecessary", even though it had been mandated by one of their very own doctors. She received a bill for $19,000 - for $10 worth of saline and an unnecessary MRI. It took getting the state's commissioner of insurance involved to get this reversed.
Medicare Advantage is private insurance and they will try to screw you to increase their profits. There is no penalty for this behavior - the worst that can happen is they will be forced to make it right, as they should have done in the first place. So there is every incentive to continue.
I have a Medicare Advantage Plan through BC/BS. Nearly every doctor and clinic is in their network. I pay $0 premium, no deductible and I pay reasonable co-pays. Every State has different criteria so a lot depends on where you live. That is why I suggested an independent broker to help you sort through the plans available in your area so you get the best coverage you can afford.
Insurance brokers are not paid for selling original Medicare so they have no incentive to sign anyone up for it. Here is a heading from a page about how to be a Medicare insurance broker:
seniormarketadvisors.com/se...
"How to Sell Medicare Advantage and Medicare Supplements With Senior Market Advisors"
Notice what is absent - any mention of original Medicare. So insurance brokers are not exactly an impartial source of advice.
Original Medicare is costly. You have a deductible, you need to buy a separate supplement or drug plan which is expensive, and Medicare pays only 80% of charges and you pay the other 20% which adds up if you need lab work or other diagnostics in addition to the office visit. My dad started out with Medicare and a supplement plan . It was reasonable at first and it covered all his expenses not covered by Medicare. Then the premiums, doubled and doubled again to where he couldn't afford them any more. He switched to a Medicare Advantage Plan with a $0 premium and his copays were affordable.
No you DO NOT need a supplemental.
David Belk debunks Medicare myths.
On this video he specifically debunks the myth of needing a supplemental:
youtube.com/watch?v=DqW-wFn...
His YouTube Medicare video playlist is here:
youtube.com/playlist?list=P...
I pay $10/month for my part D.
Original Medicare is more costly. However, you can go to any doctor - not just in a network.
We have Humana Medicare Advantage and their RX too. $0 premium. Our plan requires us to stay within Network and so far we are happy with the plan. Been on for about 4 years. The plan we chose included all of our doctors and covered our current medications at no cost.
Did get rejected for a special PD med which was $2,000. a month. Something the PD doctor wanted hubby "to try."
My supplemental Insurance premium, immediately doubled, when the Insurance Company saw that I was diagnosed with PD. I signed up with my local agent, at what I thought was a lower rate, from the lowest price rated insurance company. After approval went through and I paid my first month’s premium, the Insurance company sent me a letter, doubling the rate, that my broker had given me. Adding insult to injury, I was slapped with a $250.00!deductible. What it all boiled down to, is that I see the Neurologist once or twice a year, and, usually, I pay 100% of the bill! Medicare pays NOTHING, because of the deductible, and the insurance company pays nothing. So, I pay the bill, pay $220.00 a month for Secondary Insurance. $140.00 is taken out of my social security to pay to Medicare each month. It ends up with $530.00, or so, total, for one month, when I have a Dr. Appt. The system is rigged here in the USA, against those of us, who are saddled with incurable diseases! Corruption at it’s finest!! Last year I had changed Insurance Companies, for Supplemental Insurance, and nearly the same thing happened! My rate went up about 50%! This year, prices are way too high for everything-completely out of control! Eggs, at the store, were $3.50 a dozen, as an example, when I went shopping yesterday. Gasoline-$6.50 a gallon! Inflation and price gouging is at an all time high, here in the USA!
I thought it was unlawful to increase rates for an existing condition or new conditions?
Yes, Medicare from our monthly social security went up quite a bit in the last few years. Ugh!
I thought so too, but that’s what United Health Care did to me! The price in the Medicare book, on my agent’s screen was like $120.00, and when I got my first payment notice, it had gone up to $183.00. To add insult to injury, United Health Care stated, that they were going to raise my premium again, after 4 months, to close to $200.00 per month! They did that, and now I pay nearly $200.00 a month, and my wife’s premium is $180.00 a month, for supplemental insurance! Together, it amounts to $380.00 a month. That does not include pharmacy coverage! My wife has diabetes, and is in heart failure, so, for sure, we have been discriminated against, because of our health conditions!
You should speak with a free, unbiased and confidential SHIP counselor in your state...each state has this program and you will be connected to a counselor within your region. They are trained to help with just these sorts of issues. If you have the money, it is usually best to go with a Medigap G plan and a stand alone D plan. You need the flexibility to see the best Parkinson's providers near you and if necessary, referrals to Parkinson's Centers of Excellence. If you can find a good Physical therapy practice, they will know how to code appropriately and you will be able to get lots of regular PT/OT/ST--most advantage plans will limit this to just a few visits. A friend of mine has a supplement and has been receiving PT/OT 4 times per week for the past 4 months. The Part D plans should be researched carefully as noted by others. Also, if your family income threshold is not very high (<400% of the FPL), you may qualify for free medications such as Rytary from the Amneal Foundation. if the cost of a monthly premium for a supplement and D is not financially feasible, then choose a PPO in a MA Plan.
If you have the money it is best to go with straight original Medicare and avoid any supplemental with accompanying charges. Likewise if you do not have the money. Per the linked video:
" Medicare supplemental: the concept of a Medicare supplemental is that you give an insurance company money, so they can keep it."
Like WifeofParky said meet with a Medicare consultant to see all of your options. I would also go online and do your own comparisons. medicare.gov/blog/its-time-... This way you can look at all of your State's options and see what is going to best fit you. I would use the tools to enter your existing meds and see what is covered and (especially with Advantage) what is the total amount they will cover for the year. Hitting the "donut hole" sucks b/c you have to pay 20% of the drug's cost. In my experience taking care of my mom, a lot of her Parkinson's associated meds don't have a generic. $$$
I agree with park_bear. We only have Regular Medicare. We don't even have Part D which would cover any prescription drugs because my husband who has Parkinson's takes the herb Mucuna Pruriens. He takes the whole herb in powder form with all its extra benefits. But we like going to the doctor of our own choosing who is a naturopath doctor. She is under a regular MD whose practice carries Medicare patients. We would not benefit buying additional insurance plans.
Hmmm folks are only thinking about PD. A friend got lung cancer with only regular Medicare .... $200,000 in debt for all the treatment (her 20% copay). Granted she could have said no to some of the treatments but that is not so easy when you are very sick. Her son-in-law is a banker and was able to negotiate the bill with the hospital.
I agree with other posters to do your research, and check your family history too. If significant heart disease or cancer in family histories choose wisely. Depending on state law, the medical bills could be paid from any estate before your heirs. A good doctor's office often will have staff who are knowlegable about how to meet Medicare requirements.
I asked Dr. Belk what he had to say about this. Here is his reply:
---
I can only assume that person received all of their treatment from a rural hospital. There are a certain number of small hospitals in rural areas called "Critical Access Centers'' which, unfortunately, are allowed to bill patients for 20% 0f the full billing charge for their treatment instead of 20% of Medicare's approved rate. keep in mind, this is a small number of hospitals that are only in remote areas of the U.S. by definition. Here is some more information on those hospitals:
cms.gov/Outreach-and-Educat...
If you are not being treated in such a hospital (in other words, being treated anywhere near any urban area) you are not at risk of receiving such insanely high bills should you have Medicare.
A few years ago, I did take the time to add up all of the out-of-pocket costs for a patient of mine who was treated for liver cancer (in San Francisco). She received her treatment over a course of two years, during which she received chemotherapy, radiofrequency ablation therapy, a liver transplant and even spent a total of six weeks in the hospital because of complications after her transplant.
For all of the treatment she received (both in the hospital and as an outpatient) a grand total of just over $180,000 was paid for all 330 billable medical services she endured over those two years. Of that $180,000, Medicare paid about $165,000 meaning that, without a supplement, she would have owed just over $15,000.
That's very close to the limit anyone would pay for any medical treatment should they have Medicare and not be treated at a Critical Access Center in a very rural area.
Here is the full writeup I did for that liver transplant case: truecostofhealthcare.org/li...
Here is a video summary of that case: youtube.com/watch?v=GPArapv...
As always, if you have any other questions feel free to ask.
--
David Belk MD
Thanks, she likely added treatments not covered by Medicare. My Dad was on an HMO Humana. Outrageously delayed care, his cancer was terminal but the delays BTW approvals etc expedited his death. Biggest issue was when labs were really off MD said to come back in 90 days. Should have done additional screening immediately. HMO are great for the healthy, if not it's called managed care for a reason.
Checked with my friend's daughter on the excess cost without a part B when her Mom had lung cancer. Some of the more experimental treatments are not covered by Medicare or any insurance, that can add up. If a patient is able to get into a study (they evaluate you) the cost can be nil. Overall they family was able to negiotiate with the provider to reduce the costs.
Thanks! I am doing my research!
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