I stepped from Plank to Plank
A slow and cautious way
The Stars about my Head I felt
About my feet the Sea.

I knew not but the next
Would be my final inch -
This gave me that precarious Gait
Some call Experience.

Emily Dickinson, c. 1864

Sunday, October 24, 2010

Thinking out loud

Today I am struggling to write in my usual Sunday morning fashion. Last week I was lamenting my folly about possibly hurting my ears by skydiving with a cold, and this week I have been tossing and turning at night thinking about Medicare and the lack of dental insurance. When I was employed, I had both health and dental coverage, and I never thought much about it. Today it's a whole different story. I waited until I was 65 to retire so that I could be covered by Medicare. And Medicare doesn't care anything about your teeth or your eyes, so you are left to cover that yourself.

If you aren't yet of Medicare age, hopefully by the time you get there the situation will be improved, or at least changed, from what it is today. The confusing number of options and how they affect you is astounding. I don't know how somebody whose mental faculties are diminished can cope. I consider myself smart and with all my faculties, and I am completely flummoxed.

It all started when I received a letter in the mail this week from my primary care doctor that he will no longer accept the Medicare Advantage plan I am currently on. If you only carry straight Medicare, only 80% of your costs are covered, and you have to find a prescription drug plan anyway. The Advantage plans cover both. Medicare has four parts: A covers your hospitalization; B covers medical insurance; C the Advantage plans, and D is drug coverage. Then there are private insurance companies who sell "Medigap" plans that cover the parts of A and B that Medicare doesn't cover. These costs together than be totally crippling. But, as many of us know, illnesses these days can bankrupt you forever, if you end up in a hospital for any length of time.

If you watch any doctor and hospital shows (like House or Grey's Anatomy), they never seem to consider the costs of all the tests and operations they perform at the drop of a hat. That's not the way it works in our country, for sure. You don't opt for expensive treatments, and if you have no insurance at all, you don't even get regular examinations. I cannot believe how much I took for granted in my employment: I was completely covered at no cost to myself in the early 1980s; at a very small cost to me in the late 1980s, but before I retired in 2008, the costs were horrendous. I was paying more than $400 every month out of my paycheck for MY portion of health insurance costs. My employer paid the rest and was busy trying to get everyone to move to something that required you to deposit $5,000 for each person into an account and draw from it.

I didn't worry; I was ready for Medicare, and I thought all my problems would be solved. NOT! At first, in Boulder, I enrolled in a Humana Advantage plan that only cost me $20 a month, and I would pay a co-pay at my doctor's office of $15 for each visit, $30 if I needed to see a specialist. It worked great, but then we moved to Washington state, where the same plan cost five times as much and was not accepted by most doctors around here. Humana is not very popular up here. You can only change your plan once a year, November 15 to December 31, but since I was in my initial enrollment period, I was able to change to something else. I spent countless hours on the phone trying to work all this out, but I finally decided to stay on regular Medicare with a Medigap plan, and a separate prescription drug plan. Even if you don't take any drugs, you are penalized for the rest of your life if you don't sign up right away with Part D.

It worked quite well for that first year, except that I was paying $200 a month (plus the $100 that Medicare deducts from your benefits for Part B), and I never saw the doctor except for a checkup. It seemed to be too much to me, so last year I moved to the Medicare Advantage plan that was accepted by my doctor and covered drugs, too. It worked so well... until now. Being forced to go back into the morass and figure out how to proceed has kept me awake so many nights. And the real problem is that there is nothing for couples, so if you figure that Smart Guy also needs coverage, and we have only our Social Security and annuities, you can see that the costs can spiral out of control very quickly.

Then there's the dentist. After checking into dental insurance, which is ridiculous in both its costs and coverage, I decided to just bite the bullet, pay all the costs myself. Of course not long after finding a new dentist, I needed to have orthodontic surgery and an old crown replaced. We are talking thousands of dollars here. I have also reluctantly concluded that the aforesaid crowned tooth is going to require a root canal, because in four months it still bothers me daily. Another thousand dollars into my mouth. All my savings are dwindling in order to keep myself from going into debt.

Now I know that there are so many people who have absolutely no recourse, no job and no insurance, so I should count my blessings. But the reality is that as I get older, my teeth will continue to cost me more; my health needs cannot be counted on to remain static; and I am approaching my 68th birthday. Not far from there to seventy.

Old age is not for sissies. It not only requires more determination to stay fit, but it also requires assistance from the health community. And the ability and income to access it.


Grandmother Mary said...

This is why more and more US citizens are moving to other countries.

Linda Reeder said...

It's very unfortunate that your doctor has chosen to bail out on your Medicare plan. Many will blame Health Insurance Reform, "Obama Care", because it will bring a decrease in payments to doctors covering medicare patients. Whether small clinics will really struggle under this new plan, or just not make as much money, I don't know. I do know that Japan is considered to have the best health care in the world, and there, doctors are not rich. They are middle class, and as a matter of fact teachers are even more highly honored. And the Japanese go to the doctor as often as they want, much more frequently than we do here. But that gets into ecomomics and politics, and your problem is health care.
I feel very fortunate as a retired teacher to have a pension as well as social security, and to be carried with the Public Employees Benefits Board. Through this agency, we are free to choose our life long provider, Group Health. GH has an advantage plan, but it also has its own doctors and medical facillities, as well as contracting out to other providers. Vision is part of the package. Yes, it costs, but with a small copay, most everything is covered. We also have a dental plan that costs us about $45 each a month. That adds up, but as you said, now is the time when we need dental work.
I don't know how we would have managed if we had had to shop for Medicare plans. GH just handled everything and switched us over to the advantage plan. We signed one form to notify the state. I wish you well in your search for the right solution.

Anonymous said...

DJan, have you considered Kaiser Permanente? Copay is $15 per visit. My 94 year old mother is a Kaiser member and likes it.

Good Luck!

Norma Jean said...

There seems to be no solution to the mess we have in this country about healthcare. We are mired so deep in the current system we will not see any changes in our lifetime. "Obamacare" didn't even make a dent in the system (except to be a windfall for the insurance companies) because of all the concessions that were made to appease the Republicans. I'm sure they would be happy if they could just get rid of all the help for people, including Medicare and Social Security. It makes me glad I am old and probably won't be here to see the implosion that is inevitable.

PeterDeMan said...

Oh GAWD Jan, how can you possibly complain!?!?! We live in a country with the best health care system in the world. Me knows. Me is educated. Rush has told me, John Boehner has told me and that's just the way it is. Deal!

Stella Jones said...

Oh dear, it sounds awful. I am so lucky to be in England and taking advantage of our health system here. I am also lucky that I am covered in the U.S. as well, thanks to my husband, but as you rightly say, as we get older, it gets harder, especially as bits keep falling off! I have recently had root canal and a new crown here in England. It cost the equivalent of 640 U.S dollars and I thought that was expensive but after reading your post, I'm not so sure. Also, my dentist does all the work himself so all I have to do is sit in the chair and listen to the music he chooses for me, wear my eye mask and think of something nice and voila, it's done.
Am I lucky or what.
VOTE FOR OBAMA and you could have the same! Trust me.
In the past, people used to have their teeth out when they were past it but now it seems important to keep them all. Why? so the dentists can get rich of course. Do we really need 32 teeth and a big white smile? No, not really. We can get by just fine on half that number.
Blessings, Star

CiCi said...

Hi DJan, we can relate to the Medicare quandary you describe. Hubby and I are both on Social Security and he has Medicare and I will have Medicare in Feb. I am opting to take just the hospital part of Medicare. I don't go to the doctor maybe once a year and it won't hurt my feelings if I don't ever go to a doctor. I have not had medical insurance for most of my life so I am so used to figuring things out for myself. My mother on the other hand, needs all the help she can get with her diabetes and other medical problems. As things come up we all have to make decisions that if we had medical insurance, real help, we would not make. My crown fell out over a year ago. No dentist visit. Just live with it. There are lots and lots of people like this. Hugs to you as you make wise decisions for you and I am so glad you are basically healthy.

gayle said...

This really scares me!! My insurance is free now but who knows when it will change. My husbands was like yours free, then a small fee and now it's even larger. When he was first hired and for many years after we knew that when he retired it would be free but then one day they just changed it. I felt so sorry for all those that had already retired and had their insurance for free and then all of a sudden had to start paying for it. Who knows what it will be like when we retire!!...which I want to do today!!:)

Linda said...

For so many years, we were self employed, so we paid for our insurance...all of it. It was over $700/month, with a $10K deductible per occurrence, and then 80/20%. We went on MC 2 years ago, and I haven't had a complaint with it. The hubs was DX with prostate cancer this past May. We went to the city for the cyberknife treatment. 5 treatments over a 10 day period, and it was over $120K. This didn't count the urologist, the family DR, the lab tests, etc. So far, everyone has accepted MC assignment, so we haven't been out of pocked yet, except gas, and 3 nights of a motel. Our MC is $96/mo each, secondary is $111/mo each, and our Rx plan is around $40/mo each. Our secondary pays our $100 deductible each year. I'm sure glad we have these plans. He is on a lot of medication too, and for a healthy man...well he was. I did hear that all of the plans are going up this year, so he'd better get back to normal and continue working.

As far dental, we pay out of our pocket. We have them cleaned 2x/year. I have had more work done than him, but so far we've been able to pay it. A crown is usually around $1K, and a root canal is $600. Cleaning is $92. We make a trip to Denver each time. I asked the dentist why MC doesn't cover dental. He told me the gov't doesn't consider dental health impt. My sis has dentures. She had to have them relined this year and it was about $1K. She had 2 dental implants done a few years ago and it cost her around $5K.

We have been fortunate so far that we've been able to pay these expenses, but the older we get, who knows. I'm sure we won't have enough $. I guess the kids will have to take us in.

I don't think Obamacare is the answer either. He and his congress have put our country in so deep our great-grandkids will never get out. As to the plans in England and Canada, we hear of many people coming here because we DO have the best medical care around.

Surely there is someone out there that has the answer, but I sure don't. We just keep plugging along.

Gigi said...

Can I just put my head in the sand and pretend insurance isn't a major problem for everyone?

No? I thought not.

Nancy/BLissed-Out Grandma said...

I have to choose my Medicare plan(s) in the next few weeks. There are so many choices and variations it's crazy. Like so many others, we're keeping our fingers crossed that we make the right choices and then stay more-or-less healthy.

#1Nana said...

I've got a few more years before I have to make a decision and my previous employer paid insurance goes away...now you've given me something to worry about!

Donna B. said...

DJan...I just found out my HMO health plan (Pacificare) is no longer contracting in the state of Nevada, so during my open season 11-2-10 to 12-31-10, I must pick another. So far, from what I can gather from some research, the only HMO is Nevada Health Plan. It is cheap, but everyone says it is HORRIBLE. My health plan is through the Federal Government as a retired former federal employee. It cost me $95 per month this year. Vision and Dental were included.

My husband has Medicare and his supplemental is Humana Gold. He does not pay any co-pay for doctor visits. $5 for generic medications.
He pays $96 a month for it.

I know each state is different which is BS to me. All United States should be the same. Nevada is cheaper than what I paid in California.

I happen to get lucky. One day outside my doctor's office a woman had a table for Medicare supplements. She was so helpful and informative. Through her, my husband switched from the plan he was on (Secure Horizons) to Humana Gold. Way better plan. She told me there were two Humana Plans, but they automatically enroll you in the more expensive one with less coverage. We would have never known about Gold and it was cheaper with better coverage!

I just hope and pray the insurance I pick, will still allow me to see the doctor it took almost five years to find!

You ain't kiddin' old age is NOT for sissies!!

The Retired One said...

That is awful. My husband is a state retiree from the State of Michigan and we hear at every retirees meeting that they are raising costs or threatening cuts..and a national health plan isn't neccessarily the answer either!

Robert the Skeptic said...

My wife and I are retired from the State of Oregon, we are 4 years from Medicare eligibility. When we retired 5 years ago our medical premium alone was just under $800, today it is $1,200 and it will go up to $1,300-something next year. Medical premiums are our largest expense, more than our house payment. That does not include the copays and deductibles which are extra.

I like to point out to my Republican friends that his is $15,000 per year that me, AND THOUSANDS LIKE ME are NOT spending in their small local businesses, restaurants and stores.

We opted for no dental plan either as the maximum it pays out is 1/2 anyway, so the premiums would likely cost more than any major dental costs.

"Obamacard" did nothing to help us at all. But I would like to remind Linda that the country, now $13 trillion in debt, was already $11 trillion in debt when Obama took office! I guess Obama is a total failure for not IMMEDIATELY turning around an economy which is in it's worst slide since the Great Depression. Reality check, needed, my dear.

Retired One A national health plan is not the answer? As opposed to what, the current spiraling costs and half our citizens with no insurance... and growing? Odd, national plans seem to work in Sweden, Denmark, England, China, Canada, Italy... but we are Americans, we have to re-invent the wheel.

We spend $17 trillion of our GDP on health care, the next one down the list is Switzerland which spends $11 trillion. The cost is even less for the other countries. But try to explain that to most Americans and their eyes glaze over like Homer Simpson.. "The what with the what now..??"

Nance said...

Don't forget to add that many of us are scraping up the means to pay for individual coverage for our adult children who lost jobs. Or for treatment of their uncovered pre-existing conditions. To me, it often feels like the actual healthcare our generation will receive won't be much better than what our grandparents knew. Then, it was science; now, it is money.

Nancy said...

It is absolutely a nightmare. We were paying $1,400 per month for insurance before my husband went back to work. And this only covered major medical. It is a nightmare.

Linda Myers said...

DJan, consider Group Health Cooperative if you haven't yet.