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healyje
Trad climber
Portland, Oregon
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Topic Author's Original Post - Jun 23, 2017 - 11:18pm PT
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Crikey, I have grocery store bag full of that sh#t and no time to sit down and sort it through it at the moment. Does anyone have some recent, short cliff notes on this shite for a reasonably healthy, if now old, human?
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Reilly
Mountain climber
The Other Monrovia- CA
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Jun 24, 2017 - 05:17am PT
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Healy, I wish I could help, but the whole point of bureaucracy is to prevent a short version of
anything. Why don't you ask the Medicare person on the phone, if you have that much patience,
why they think they need 10,000 ICD codes? It certainly isn't to prevent fraud because that is
skyrocketing. The ICD code for being sucked into a jet engine is a medical diagnosis? No,
it is an accident classification pertinent only to OSHA. The wife retired earlier than she planned
because she wanted out before the newly expanded ICD codes came into effect. And how is
some faceless Medicare code checker, who likely only possesses a high school diploma, qualified
to pass judgement on a doctor's diagnosis? They are only qualified to check whether said
doctor, or doctor's newly employed highly paid coder person, correctly crossed all her T's and
ticked the right boxes. It's an insane system that only benefits the bureaucrats.
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healyje
Trad climber
Portland, Oregon
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Topic Author's Reply - Jul 10, 2017 - 01:33am PT
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Yeah, yeah, yeah - government sucks - got it.
Not really trying to cure healthcare in this thread, just trying to get the Cliff Notes on what the f*#k is the deal with all this is, hopefully from someone who's done it recently.
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monolith
climber
state of being
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Jul 10, 2017 - 05:13am PT
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I had to take my Mother to the ER. Turned out to be a UTI. The medicare supplemental health insurance premiums jumped 5% on next billing. Maybe it was just a coincidence.
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NutAgain!
Trad climber
South Pasadena, CA
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Jul 10, 2017 - 10:48am PT
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I wonder what dynamics in the USA make this so much more paper-work intensive. I still fondly remember Spain in part because of a medical incident while I was vacationing there about 15-20 years ago.
My wife at the time had a sudden serious pain in her hip or something, no apparent accident, but it was enough that basically stopped her from walking. We went to the hospital, they gave her an Xray and a doctor (or some type of clinician) spent some time examining her, she ended up with a pain-killer prescription, and we didn't have to deal with any paperwork. I might have had to sign my name on a piece of paper, but that was it. No payment, no paperwork.
Then again, the financially better off among us would probably not hold Spain as a role model.
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monolith
climber
state of being
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Jul 10, 2017 - 11:55am PT
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Right Fear, it's Obummers fault. Trumpcare will fix it all.
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Lorenzo
Trad climber
Portland Oregon
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Jul 10, 2017 - 12:08pm PT
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I wonder what dynamics in the USA make this so much more paper-work intensive.
It has little to do with any special dynamics in the USA.
The first letter in ICD stands for INTERNATIONAL. It's the same coding system promoted by the World Health organization and used in most civilized countries since about 1967 - you know- the ones that actually provide health care at low cost.
These include all of the EU where virtually every major country has a higher health care and efficiency rating, and our neighbors North and South.
By using the same coding system we can finally see how USA health care compares to the rest of the World and why.
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fear
Ice climber
hartford, ct
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Jul 10, 2017 - 12:13pm PT
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Right Fear, it's Obummers fault. Trumpcare will fix it all.
Nope, it'll be just as bad, if not worse.
Moar regulations and Moar laws cannot fix an inherently broken complex system, but they can make it worse.
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monolith
climber
state of being
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Jul 10, 2017 - 12:17pm PT
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Like it was before Obummer. Stop blaming Obummer or we'll wonder if you have memory issues.
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Reilly
Mountain climber
The Other Monrovia- CA
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Jul 10, 2017 - 01:17pm PT
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Lorenzo, you talk like you work in the health care 'industry' and that
anything with 'international' in the name makes it worthy. Now maybe you
do work in the health care biz but don't bother to answer unless yer an
actual 'provider'. I defy you to find one provider who thinks those ICD
codes help them to provide better care for their patients. My wife retired
early just to avoid the onslaught of the latest 40,000 new codes. It is
bureaucratic insanity taken to the nth degree. Yes, it provides a lot of
people with jobs, none of which help patients one whit.
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monolith
climber
state of being
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Jul 10, 2017 - 01:37pm PT
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It's the same coding system promoted by the World Health organization and used in most civilized countries since about 1967 - you know- the ones that actually provide health care at low cost.
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healyje
Trad climber
Portland, Oregon
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Topic Author's Reply - Jul 10, 2017 - 01:52pm PT
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There's nothing particularly wrong with the codes themselves - it's what U.S. insurance companies make providers do with them that is the problem. Our doc just went cash-only July 1st due to the insanity that the insurers have become - she'll give you all the codes so you can do it yourself, but she's out strictly due to the insurers.
So - no one has the cliff notes on the medicare bullshit and I'm going to have to slog through all that bullsh#t? Sigh. Maybe just a statement of what you folks ended up doing for it? This part, that part, etc...
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phylp
Trad climber
Upland, CA
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Jul 10, 2017 - 04:52pm PT
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OK, I'll take the time to do it for you.
First - you need to sign up for Medicare parts A and B sometime within three months of the month you turn 65. It's very simple to do thru the Medicare site. If you are collecting SS or disability payments etc, they will deduct the monthly cost from that automatically. If not they will bill you monthly. After you get a bill, you can sign up for automatic withdrawals from a checking account. The cost will be about $150 a month.
After you get a notice from Medicare that you are approved for Medicare (pretty automatic as long as you have a SS # and they verify that you are turning 65). It takes about a week to ten days to get the verification by email, then they send it hard copy, then they send you Medicare card.
After you get the email verification you can sign up for either a Medigap plan or a Medicare Supplement plan thru a private carrier.
Continued next post...
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phylp
Trad climber
Upland, CA
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Jul 10, 2017 - 04:56pm PT
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So I should probably add that this is how I understand it all, and I don't guarantee that it's 100% accurate.
The easiest way to understand the difference if that Medigap is kind of like a HMO and Medicare Supplements (The A - K things) are kind of like PPOs.
Medigap plans are generally cheaper, but once you sign up for one you have to use that plan's network for care. Also, they will take over the billing for Medicare, so your bill is all rolled into one.
I didn't like this option, I hate having the private carriers as Gatekeepers so that is the extent of my knowledge about it.
TBC next post...
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healyje
Trad climber
Portland, Oregon
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Topic Author's Reply - Jul 10, 2017 - 04:59pm PT
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Phylp - thanks, really appreciate it...
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phylp
Trad climber
Upland, CA
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Jul 10, 2017 - 05:05pm PT
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So if you decide you want a Supplement plan, first decide which one you want.
You probably want a Part D, for RXs
and one of the other Parts (A, B, C, E, F, G, K) for all the rest of the coverage. More on these next post.
Part D, Even if you don't take any Rxs currently, it's probably wise to sign up for a Part D plan because if you decide a few years from now that you need one, there are penalties for not signing up when you turn 65.
I take no Rx medications so I opted for the cheapest plan I could find. It's about $20 a month thru Humana. It has a $200 per year deductible for covered drugs.
If you do have a list of medications you have to be careful whose plan you choose, because all Part D plans vary in which drugs they cover and how much the copay is for them. You can find this info on the individual websites. You plug in the name of the Rx drugs you are taking and it tells you the info.
You can find out who offers Part Ds in your zipcode on the Medicare website. There is a page where you just follow the links and it will spit of who the providers are in your zip. Pretty fast and easy to find. Then if you want the drug info you have to drill deeper on the other sites.
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phylp
Trad climber
Upland, CA
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Jul 10, 2017 - 05:13pm PT
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The Alphabet soup, as my sister calls it.
There is a page on the Medicare website with a good summary chart that describes the differences among the letters. If you want the most complete coverage, you will see that that is either plan G or F.
It's a question of cost. The more benefits you want the more the monthly cost is.
I choose a plan G plan, which has the most complete coverage with a small annual deductible.
Once you choose a plan letter, you can use the same Medicare page to see who offers that plan in your zipcode. There will probably by 3 or 4 choices for a Plan F and fewer for a plan G.
The important thing to understand at this point is that ALL carriers must provide IDENTICAL coverage for that letter plan. The only difference will be the cost. Whether you coose Anthem, United Health Care, Humana, Blue Shild, the policy coverage will be IDENTICAL, and you can see whatever provider you want.
So if the policies are identical why are the prices different.
This is where it gets a little complicated. TBC
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healyje
Trad climber
Portland, Oregon
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Topic Author's Reply - Jul 10, 2017 - 05:18pm PT
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Wow, thanks much - just applied for parts A and B on their website...
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phylp
Trad climber
Upland, CA
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Jul 10, 2017 - 05:22pm PT
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One of the things that determines prices is if it's an:
attained age rated plan
issue age rated plan
community rated plan
I'm not going to take the time to go into this but you can find a description on the web. This will affect the starting monthly price and how fast you might see increases to your cost over the years.
I ultimately decided to go with the United Health plan G offered thru the AARP. That is a community rated plan. Everybody in the plan pays the same price. It's the largest carrier of any of them, with 30% of the market. You have to be a member of AARP to sign up for it and you do it thru their website. Right now my cost is $138 per month.
Hope this answers some of your questions.
Phyl
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phylp
Trad climber
Upland, CA
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Jul 10, 2017 - 05:26pm PT
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You are welcome. It's insanely complicated isn't it!
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healyje
Trad climber
Portland, Oregon
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Topic Author's Reply - Jul 10, 2017 - 05:29pm PT
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Phylp, that was exactly what I was looking for as I'm just over-the-top slammed with work...again, really appreciate it.
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jstan
climber
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Jul 10, 2017 - 05:33pm PT
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1. As Phylp says, to avoid penalties you have to join Medicare on schedule. 65
2. If you figure on living a long time, you can get a higher SS benefit/mo and total benefit by waiting to go on SS until you are older than 65. Go on at 62 if you are going to die soon. Doing so costs. Get info either off the net or from an office of the SSA. The SSA runs on only 3% overhead so you will need to make an appointment to talk to their office in person.
3. I found being a member of the AARP to be cheap and very helpful.
4. I did not go thru all of the bureaucracy of trying to compare gap plans. When I need a doctor and have to wait and get denied I figured I would have a stroke. So thru the AARP I got UH's plan F. Go to any doctor accepting medicare you choose. You do have to check whether a doctor accepts medicare.
5. You get financial accounting paper work from both the SSA/CMS and the insurer. To have any chance of tracking what is going on I keep a spreadsheet tying all the reports together. The first thing it makes clear is that without medicare you might as well just die. Doing so will be far easier. The spread sheet also allows you to track directly how much profit is going to your insurer. When that profit goes down, then is when you can begin to expect funny work.
6. Since 1978 I have kept all receipts and financial records in chronological spiral note books. When a problem comes up it does not become a research project lasting months. No risk of apoplexy. I copy the relevant receipt and my redacted bank statement. Legal proof. Problem solved. Immediately.
Edit:
Line up you medical care people early. I go to Cottage Hospital in Santa Barbara. On Dec. 24 at 2AM Cottage had me on the table for heart surgery by 6 AM with a surgeon recently teaching at the University of Chicago. Just before the anesthesiologist did his job I asked the doctor what my odds were. He said 98%. Two seconds after I replied, "Let's do it" I was gone. Those were exactly the same odds I required when climbing.
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Reilly
Mountain climber
The Other Monrovia- CA
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Jul 10, 2017 - 05:36pm PT
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My mom has United Healthcare. Their coverage is OK but finding a doctor with
less than fourteen consonants or vowels in their name that went to a reputable
medical school is really hard. I'm sorry but UCLA, USC, or any US school,
trumps East Jibip Medical School any day of the week.
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Lynne Leichtfuss
Trad climber
Will know soon
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Jul 10, 2017 - 06:08pm PT
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Phylp is right on. I have Medicare Part A and Blue Shield Part B. I pay $160 a month for BS and to my way of thinking it is well worth it. I can choose who I can go to and so far in nearly 4 years everything is covered by A and B. I too have an inexpensive RX plan as I take no RX meds. Mine is more expensive than Phylp's so I will check into that. Medicare is the only thing that getting older is good for....oh yeah, and the forever National Park pass at $10 that is soon going up to $80 I hear.
Phylp, great job!
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feralfae
Boulder climber
in the midst of a metaphysical mystery
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Jul 10, 2017 - 06:29pm PT
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Yes, I love my Park Pass, too! Hoping to use it more these next few years as I slowly retire.
I have a Plan F, and the lowest cost Rx plan, since I don't take any pharmaceuticals or other corporate medications. But I do set aside the cost of an Rx plan in my savings account just in case I ever need some exotic drug to cure some rare something. :)
Phylp, that was a great explanation, clear and concise. Thank you.
feralfae
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phylp
Trad climber
Upland, CA
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Jul 10, 2017 - 06:49pm PT
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A lot of the carriers don't offer the plan G. I'm not sure why. It's exactly the same as Plan F except for the deductible. Plan F is by far the most popular plan.
I'm also not sure why different carriers will offer a plan in one zipcode and not another. It's probably because they can make a profit in one area that they don't make in another.
In my zipcode AARP was the only carrier that even offered the plan G. If I had chosen plan F, I would have had the choice of 5 or 6 carriers.
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TLP
climber
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Jul 10, 2017 - 07:00pm PT
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Healy, it's actually incredibly simple to deal with. Seems that you might already have done, but I took the stack of stuff I'd gotten from the company I had my pre-65 health coverage from, found the 800 number, and phoned. They explained what the options were, circumstances each would be advantageous for, and what I needed to do in like 5 or 10 minutes. I can't remember if I did it on line or a simple paper form, but it took just about zero time. I did part A and B and a gap policy, passed on part D (prescription drugs) for now, and I was done. Relatively cheap, worked really really well the two times I had any medical care. No muss no fuss. Maybe for some weird specialty in a rural or small-city market you might have to look for a provider who takes Medicare, but my experience has been a cruise; way easier than it seemed when I looked at the incredibly confusing stuff at first.
Hope you get it sorted but most of all, need as little medical stuff as possible! Good luck.
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zBrown
Ice climber
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Jul 10, 2017 - 09:11pm PT
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Costs go up each year
Medicare deductible
Medicare premium
Gap insurance premium
Faster than inflation?
Are you covered Ina "foreign" country?
If you travel
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jgill
Boulder climber
The high prairie of southern Colorado
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Jul 10, 2017 - 09:45pm PT
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On Medicare for 15 years. A little paperwork at first, but it has treated me very well. I have an Anthem supplemental through my state retirement system, and its premiums have gone up. I think strong means-testing will be essential for Medicare viability.
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healyje
Trad climber
Portland, Oregon
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Topic Author's Reply - Aug 2, 2017 - 10:43pm PT
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Got the officially old card...thanks again for your help.
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