Category: Healthcare costs

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Medicare and Reload

Today is the first day of treatment since my Medicare kicked in. I wasn’t sure how it would work out, so I checked in early with high hopes to manage expectations. They assured me, it’s all taken care of. They assured me. there’s no charge for today’s visits. Whew! I’m still keeping my fingers crossed.

I also saw my oncologist this morning. I had a nice chat with the nurse about our recent motorcycle trip up north, and we talked about my mother-in-law’s passing. I also learned that my doctor recently had covid, so we aren’t the only ones. It’s going around, even amongst those who have been vaccinated. He apparently caught it at a conference. We laughed about how he holed up in a hotel to quarantine from his family. Since he couldn’t go out for food, his wife would bring him meals and leave it on the floor outside the door “like I had leprosy.” The quarantine is worse than the virus, in some cases. My caregivers have been with me for more than five years now. We have developed a good rapport, so it’s always pleasant when I go and see them.

My doc said he has to reload both of my infusions during this treatment, because it’s been more than six weeks since my last treatment (thanks Covid 🙄). Yesterday was exactly six weeks. If I had come in on Tuesday, we could have just reloaded the one. Herceptin has to be reloaded after four weeks, and Perjeta after six weeks. We try not to do that, but times like these it’s hard to avoid.

It’s going to be a long wait. I have 90 minutes of Herceptin and 60 minutes of Perjeta. Usually it is 30 and 30. I’m going to hit The Woodlands during rush hour. Oy vey…

My computer is full of juice, I have my Diet Coke by my side, and a warm blanket is on my legs. I’m ready to go!

I forgot to put on my port cream, but Warren is a good nurse. I didn’t feel a thing. He got good blood return and no problems with the port. Thumbs up…👍.

While sitting here, I received a text from a friend, whose friend was just diagnosed with breast cancer. They found it on her first mammogram. Fortunately they caught it early, and she can have a lumpectomy. It doesn’t matter the stage, it’s still hard to hear.

I am always empathic toward those who are newly diagnosed. The emotions are overwhelming. If ever you have heard a doctor say the “c” word, you know what I’m talking about. I pray for these women, as it’s a tough road. It’s a change in identity. We are part of a club we never wanted to join. Fortunately, there are lots of treatment options and we are living longer than we ever have in the past. God has blessed some amazing people with great knowledge and skills to treat and even cure the worse of cancers.

À la prochaine…hasta la próxima vez…until next time!

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The Medicare Dance

Two more days and I’ll be switching to Medicare from my safe and secure insurance policy that has brought me thus far. It’s a bit daunting learning all the Medicare language. And because I’m not 65 yet, my options are more limited. Apparently, once I turn 65 I will have more options and insurance will be cheaper. Apparently.

In case you are trying to dance 💃🏻 through this maze as well, maybe this will help you out. Here’s what I have learned so far as it pertains to me.

Medicare has three main parts. Part A covers in-patient, with a $1,550 deductible. Part B covers doctors, tests, and specialists with a monthly premium based on your income, a $233 deductible, then Medicare pays 80% of all costs. Part D covers drugs. (There is a Part C, but that’s basically a combination of A and B in what’s called an Advantage Plan. I’ve been told to steer clear of those, and my doctor isn’t sure they would be covered, so I ruled out Advantage.)

In order to avoid paying the $1,550 deductible for Part A, and the 20% coinsurance for Part B, you have to have a supplemental insurance plan. I wish the letters aligned with the stars, as it can get confusing. Basically, to cover Part A deductibles, you have to get Plan B or higher. To cover the Part B coinsurance, you have to get Plan A (or higher). In Texas, you can only get Plan A if you are under 65. There was some disagreement about this, but I’ve double and triple and quadruple checked. The Medicare.gov website even says State Farm provides Plan G, but in reality they don’t. My local State Farm said they don’t provide any supplements, but it’s probably because she didn’t want to quote $20,000 per year for Plan A. Yikes! 😳😳 No thanks.

I will have to pay Part A $1,550 deductible if ever I go into the hospital. We are praying that doesn’t happen. This last surgery was hopefully the last one for me. I don’t know if I could handle another, to be honest. This is part of the reason we opted to do it now rather than later. If ever I’m in an accident and have to go to the hospital, I may be reaching out to my friends in a GoFundMe account. 🤪😁

All insurance companies provide the exact same supplements. Plan A is Plan A regardless of who provides it. And the doctors take it no matter whose plan it is. Insurance companies can charge whatever they want, however. That may range anywhere from $300 to $1700 per month. So basically, whoever provides the insurance for the lowest premium wins. It is up to the consumer to do the research.

I set out calling multiple insurance companies, then I discovered the Medicare.gov website also lists insurance companies and how much they charge. TransAmerica had the least expensive premium at $336.18, so I sent off the application today, and they confirmed they received it. They are a solid company, with a good reputation, and met my insurance friend’s approval test as well.

Something else I learned. Once I pick an insurance company, I’m pretty much stuck with that company. So I am praying I chose wisely. The reason is because I am currently in what is considered a “one time only guaranteed issue.” I don’t have to pass any medical tests or underwriting questions since I’m new to Medicare. If ever I decided to switch, I would have to go through underwriting. Guess what, I won’t be switching!

Plan D will be through Cigna. After multiple calls to brokers and Medicare, they were the best option at $23.10 per month. You can input your medications into the Medicare.gov website and their formula shows you how much it will cost by different insurance companies. Again, Plan D is the same for all companies, but their cost isn’t necessarily the same. Cigna won. There is a hefty deductible for most companies (which I won’t meet by the end of the year), but it will save me some money over paying for my medications out of pocket.

I kinda chuckled when I chose Cigna, because that’s who currently provides my insurance. They have been really good to me, although they tried to send me out of the MD Anderson network to get my chemo. They won’t have any say in that because infusions fall under Part B, not Part D, since it’s given in the infusion center. I will likely be moving to a mail-order pharmacy for drugs as it is cheaper. Honestly, this seems like it would be easier anyway.

I’m still crossing my fingers and toes as we wait to see if all this pans out the way they say it should. We might have to pay over $500 premiums per month plus deductibles, but at least we won’t be paying $2,500 per month for Cobra any more, in addition to coinsurance. (We still have to pay for Cobra for Tim until the end of the year, but thankfully my part is removed.) I’ll keep you posted as I discover more about this whole Medicare dance that I am now a part of.

À la prochaine…until next time.

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Chemo, not chemo, and Surgery, Oh!

Dr. Kovitz, my medical oncologist, called me today. Apparently he spoke with my surgeon and they decided I can go ahead with my infusion on Thursday. The surgeon was following her regular protocol which is to stop all chemotherapy infusions before surgery. But Dr. Kovitz reminded her this is not chemotherapy (even though we call it chemo and it’s infused in the chemo infusion center). It’s immunotherapy. Dr. Kovitz said we really don’t know how long we would have to wait for it to get out of my system anyway. So…we are back on schedule for treatment this week.

Oh, did I forget to tell you I’m scheduled for surgery? 🙄

It’s been a busy week. We helped move our daughter’s family out of their apartment into a storage unit until their next place is ready. They can move in tomorrow. She has been staying with us (and her two kids) in the meantime. The kids are feeling the transition. They are five and three, and they are good at it. 😂 Did I say they can move in tomorrow? 😂🤪😂 She also starts a new job tomorrow. But that’s a whole other story for a different blog.

Surgery, oh yeah.

My colorectal surgeon, Dr. You (not to be mistaken for Dr. Who), called me after the failed polyp procedure. She said we have two options. Since the biopsies did not show cancer (they are precancerous adenomas which may or may not turn into cancer), we can “wait and see.” In other words, go in every year or so and take more biopsies to see if progresses to something more. If it does, we will do surgery then.

OR …

If I “can’t sleep at night” because I’m concerned about it, or I just want to be certain, we can go ahead and do the surgery. Remove part of my colon, appendix, and of course the polyp.

I weighed the options. Hmmm. I don’t like the idea of waiting and watching something grow. We did that with my breast cancer the first time, and look where it got me.

And then Dr. You gave me the blueberry pancake analogy, a/k/a her “caveat.” That sealed the deal for me. After talking with hubby and friends, we all agreed.

What is the blueberry pancake analogy? I’m glad you asked.

Basically, when they do biopsies it’s like pulling pieces from a blueberry pancake. If they find blueberries, we know they exist. However, there is no guarantee there are no blueberries just because they didn’t find any in the biopsy. Her caveat is that. Unless we remove the whole pancake, we don’t know if we missed any blueberries. But don’t worry, she added. There are several stages before it hits the cancer stage. 😳😳

I like blueberries, but not when they are compared to cancerous growths. I didn’t like the idea of the slightest possibility that something could still be lurking underneath this giant thing. The only way to know for sure is to remove the whole pancake, er, I mean, polyp.

Besides, my insurance is changing to Medicare in July and we still don’t know what all that means. All my out of pocket expenses are currently met for the year with my current insurance, so we can let Cigna pay for it.

All that to say…we decided to go ahead and do the surgery. It’s scheduled for Tuesday June 7th at the downtown MD Anderson Cancer Center. I have pre-op in The Woodlands on Friday May 27th, a Covid test and labs on Sunday June 5th, bowel prep (of course), and then I’ll be in the hospital from June 7th until after surgery for 3-5 days (depending on how quickly I poop💩). It looks like recovery is about 6 weeks but she said I should be feeling pretty good after 2-4 weeks.

This surgery is called by the following name. Here’s a WebMD link if you are super curious. SURGICAL LAPAROSCOPY WITH PARTIAL COLECTOMY, REMOVAL OF TERMINAL ILEUM, AND ILEOCOLOSTOMY. Looks like walking is a good thing, so I plan to do some of that after I get out. I’m sure I’ll know more after the pre-op visit, but that’s the gist of it.

À la prochaine … until next time!

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Medicare Miseries

I don’t talk about our finances very often; that seems to make people uncomfortable. If that describes you, please stop reading and move on to the next blog. Don’t worry, I’m not asking for money. Just reporting on our situation.

I went on disability so I wouldn’t be so stressed trying to work full-time while doing all the treatment, scans, doctor’s visits, etc. I’m pretty sure I blogged about this decision already; if you want to know more, you can go back and look for the whole disability conversation. Or, let me know and I will fill in the details.

Anyway. Here’s how it works. You have to be on disability five months before SSDI will kick in. After that, you must wait another 24 months before you can get on Medicare. I was fortunate enough to have a good job, so my health insurance (COBRA) has been hanging on in the interim. Tim has always been on my insurance, as he has been unable to get group coverage on any of his jobs.

Since leaving my employment, COBRA has gotten quite expensive to the tune of $2,500 per month (yes, you read that right), especially after they extended us past the original COBRA period. It’s a lot better than paying more than $30K per treatment. Yikes! Needless to say, we were looking forward to getting on Medicare. (Now we just have to find insurance for Tim.)

Finally, after waiting 30 months, (Woo hoo??) I got my card in the mail a couple of weeks ago, it’s official. I will be on Medicare starting in July.

For some reason, we thought this would be the “answer” to our insurance dilemmas. It’s all very confusing, however. I have not taken any action as I have been waiting for more information. Then we saw an ad for a Medicare specialist in the Impact, a freebie magazine with updates about our local area. He’s been doing this for a long time, so we scheduled a meeting.

The first thing he helped us understand is that Medicare does cost money. First of all, you have premiums to pay (based on your income). He also said that people typically purchase a supp[lement because even with the government plans there are many costs that are not covered. If you purchase “medigap” supplements, it helps fill in the gap.

Bad new. He said my options were limited until I reach 65. He said I could not get medigap supplements to cover all the additional costs. He seemed knowledgeable, and based on the information he shared, we got a bit discouraged. It looked like we were going to be out a LOT of money to pay for my healthcare costs.

I paused after starting this blog, and prayed. God, please help us discern your will. Help me understand all the ins and outs of Medicare, and help me find someone who can give me some good news.

The next thing I did was reach out to Medicare directly. It’s a government entity, so I was expecting long wait times with little support. As it turned out, my wait time was reasonable and the lady I spoke with spent nearly an hour helping me understand all our options. She didn’t seem to be in a hurry, and she provided me with some other numbers to call as well. As it turns out, we have lots more options than the other guy shared. Yes, I do qualify for Medigap insurance, and there is a number I can call to help me figure out the best plan and insurance company for me.

Here’s the interesting part. Insurance companies are not required to provide Medicare supplements to persons under 65. But some of them choose to do so. Maybe the companies the other guy sells for don’t do it, so that’s why he thought I couldn’t get it. I don’t know. But the Medicare lady gave me a list of possible providers. We just have to make sure my doctors are on all the plans.

Here’s another interesting part. The supplement you choose (for example, Medigap Part G) is the exact same coverage with each insurance company. You might pay $300 with one and over $1,000 with another. But you don’t get anything different from the more expensive company. No wonder people get discouraged! Apparently insurance companies are not limited to charging the same amount as the next guy.

So, it’s time to go shopping.

I’m still trying to matriculate through this Medicare maze, understand what they cover and what they don’t, and how to keep from going bankrupt in the process. I will spend more time on it next week. Some things can’t happen until at least June, so there’s still time to make decisions. But at least now I feel a bit more hopeful than when I first started writing this blog. Thanks to the Lord for answering my prayer.

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