Paying my own way

Posted on Posted in Asthma, asthma advocacy, Asthma exacerbations, Asthma medical tests, Asthma Medications, Hospitals

After 12 and half years of receiving free healthcare benefits from my partner’s employer, the ridiculously increasing costs to maintain those benefits became unsustainable for the small company, forcing them to ditch the premium plan for a bare bones plan with such high deductibles, that the plan is virtually useless for someone like me. So, with less than 3 weeks notice, Im forced to find and pay for own medical insurance. To make things more stressful, I just got out of the hospital and Im in the in the middle of an expensive lung transplant evaluation, which has to be completed before I loose my current coverage at the end of the month.

Luckily I have Medicare to fall back on, but as we all know Medicare doesn’t cover everything. There are still pretty steep deductibles for hospitalizations ( about $1300 ), and unlike most private insurances where hospital deductibles are applied annually, Medicare deductibles re-start again every 60 days after discharge from a hospital. This means that if you’re unfortunate enough to have to be hospitalized every few months, your Part A deductible for that year could exceed $5000. And that’s just for the inpatient hospital bills. All of your doctor bills and outpatient stuff is covered under Medicare part B, which has its own monthly premium ( for me it’s $121) , and an annual deductible. Currently that deductible is only $166 per year, but along with that you’re also responsible for 20% of the outpatient bills. Hey Medicare is great, but it still costs a lot of money, and when you’re on a fixed low budget, it’s not easy.
Because my variety of asthma is super expensive ( over 1 million dollars last year alone), having Medicare by itself is just not enough. The only two options I have left, is to sign up with a Medicare Advantage Plan or a Medigap plan.

Medicare Advantage plans are a pretty good deal for people who have moderately good health. The month premiums are very low, and some are even free, but the major stumbling block , at least for me, is that all of these plans have extremely high co-pays for hospital admissions. Most charge $300- 500 per day when you’re in the hospital. For someone like me who’s in the hospital a lot, I simply couldnt afford it.

That leaves me with only one other option, and that’s to purchase what is known as a Medigap plan. Medigap plans are federally regulated insurance policies sold on the open market that help pay for what Medicare doesn’t. Depending on the specific plan you pick ( there are 5 or 6 of them), Medigap can cover some or ALL of those extra expenses, including those nasty deductibles and the 20% co pays associated with Medicare part B. Some plans even provide out of country emergency medical. You also have the freedom to see any doctor or specialist you want without a preauthorization as long as that provider accepts medicare. The problem is, these plans are a lot more expensive than the Medicare Advantage plans and are available primarily to those age 65 and over. There are some insurance companies who offer these plans to people under the age of 65 if they are disabled and already receiving Medicare benefits, but the monthly premiums are up to 4 times higher.
Fortunately I live in a state where the Medigap “F” plan ( the best Medigap plan there is) is offered to people under 65. It cost me several hundred dollars per month for the plan, but I have no other choice and it covers everything, with virtually no additional out of pocket expenses.

Ok, so the doctors and hospital portion is hopefully taken care of, but how about medications? Traditional Medicare A&B an most Medigap plans don’t cover prescription meds, so you have to buy a separate Medicare part D approved drug plan to help with those costs.Depending on the medications you take, you could easily spend several thousand dollars out of pocket, before the benefits of the drug plan kick in. Unfortunately asthma inhalers are expensive and have high co pays too, so Im screwed in that regard.

So tallying up these new medical insurance costs that I had the luxury of not having to pay for the past 12 years, Im up to about $600 per month out of pocket and that’s not including my co pays and deductibles for drug coverage. Obviously it’s better than having bad coverage or no coverage at all, but that $600 represents a sizable portion of my income.
In order to pay that $600 I have to take a little from somewhere else. Have already started to cut back on necessities such as food and household supplies in order to pay for healthcare.

I guess the message here is to explore all your healthcare options and have a back up plan in place, because the way things are going you’re eventually gonna need it.

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One thought on “Paying my own way

  1. I feel your pain. I, too, have Medicare part A, B, D and the F supplement. Even with all that coverage, I live in fear of having to go to the hospital. As you pointed out about the part D drug benefit, deductibles can lead to making the choice between buying your prescriptions, or paying for other of life’s necessities. It angers me that although most of these drugs are developed in this country by American companies, they are offered in other countries for a fraction of the price! How is that fair? I have COPD, and currently, a horrible head cold. And, I feel like hell! I do have an appointment with my Doctor tomorrow and I’m hoping he won’t want me to go to the ER.

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