Yeah COBRA is insanely expensive, my dad kept my mom on it for like 11 years while they waited for her to get Medicare and I know it was over $1000 month. I recommended checking the exchanges but they said it was all around the same.
Recently got a bill for my $350 anesthesia from a colonoscopy/endoscopy a year ago. Insurance company wouldnāt cover because I should be ok with just being āsleepyā with a huge tube shoved into both ends (hopefully not the same tube). Funny thing is insurance approved the same thing for endoscopy only a few months later.
So now Iām in the fun position of trying to nail jello to a wall and force them to face the basic logic that thereās no reason to approve just an endoscopy but not a combo procedure.
I know the gastro place was appealing it but now they donāt want to be involved. So the anesthesia place is appealing now. Next step is me calling the insurance company trying to get them to acknowledge that 2+2=4. Fun times.
I might just give up and pay it at some point, which Iām sure is the whole idea.
Jman?
So if Iām understanding this right, your parents have voluntarily switched over to Medicare because theyāre eligible, which is like a well duh thing to doā¦ and now supplemental insurers, who make a profit by selling supplemental insurance, are refusing to sell this supplemental insurance because they voluntarily went onto Medicare?
I never cease to be amazed that we get bomb threats and shooting threats at newspapers and news channels, and not a one to the NRA or a healthcare insurance company engaging in bullshit cartel behavior like this or flat out denying claims they owe. Like this just has to be flat out collusion right? Because they all make more money selling on the regular plans so they want to force people to stay on them by denying supplemental coverage with Medicare?
Meanwhile 40% of the country wants to blow up Medicare and Medicaid so we can have more private insurance, and like 20-30% doesnāt want single payer because they like the insurance they already have.
This fucking place man.
This is exactly they idea. They pay someone $8 an hour to harass everyone on the phone for stuff they ultimately shouldnāt have to pay, because most people ultimately pay it and they make > $8 an hour out of this exercise. They also have lawyers on retainer to fight the people who want to fight, and the average Joe isnāt going to want to pay a lawyer to deal with it because it would usually cost more than just paying them.
Aināt leverage in a capitalist healthcare system a blast?
As an independent contractor doing web design work about 9 years ago, I had a client flat out refuse to pay 2/3 of what they owed me on the last invoice. They laughed at me and dared me to sue them, and threatened to try to ruin my business reputation in both web design and broadcasting. I called a lawyer, we talked for less than five minutes and he told me that he could guarantee me Iād win and he could also guarantee me Iād spend more on his services, or even a cheap lawyerās services, than they were scamming me out of. He suggested just accepting whatever I could get from them.
I took what I could get, and gave all the info needed over to their new web developer. They didnāt remove me as the primary contact on one of their domains and after reminding them every couple of months, I finally just gave up and set it up to go to my junk mail whenever I got an e-mail about it. Fuck sending e-mails to those assholes every month to help them out, right? About a year later, they threatened to sue me for still having my contact info on one of the domains and said they had already reported me to the FBIās Internet Crime division over it lolā¦
Hereās the best part: these motherfuckers have the gall to try to add me on LinkedIn every couple of years now, like Iām going to want to network with those cocksuckers.
As Iāve been saying a lot lately, our entire country is built around just getting whatever you can, itās all a big zero sum game, and if youāre not fucking people over every chance, youāre offering up freerolls left and right. It sucks so much. Like, if youāre an intelligent person who has good morals, you just have to constantly be in CYA mode when dealing with anyone on any matter like that. Itās one reason I kind of prefer poker, at least all I have to worry about are angle shots at the tableā¦ but you still get people screwing you in every day life whenever they can.
With stuff like my web design story or these insurance companies, itās just an example of the big guys having leverage to exert on everyone else. They need a lawyer on retainer anyway, so they monetize it as much as they can by just fucking people over for every little bit they can, knowing nobody can fight them on it. Even when they get caught and punished for it, the fine is less than the profits they made off it and nobody ever goes to jail.
I never updated but it ended up being even dumber. My dad is older than my mom, so heās been eligible for for 2 years. However, he only signed up for Part A and Part B at the time and kept his retiree plan as a secondary payer to keep my mom insured. Prescription drugs (Part D) have enrollment windows every year, but the good supplements (i.e., Plan F) have a one time window thatās, iirc, 6 months rolling after you first become eligible.
So cut to the way this is all defined in the Social Security Act: If you miss the initial window but lose other creditable coverage voluntarily, then you qualify for a guaranteed issue for the traditional supplement if and only if the other coverage was the primary payer. If you miss the initial window but lose other creditable coverage involuntarily, then you still qualify for a guaranteed issue if the other coverage was second payer.
Voluntary/involuntary loss of coverage is so loosely interpreted that CMS had to release a memo a decade or so ago so that insurance companies would stop incorrectly over-classifying situations as voluntary loss of coverage. Without guaranteed issue, you become subject to the underwriting process. If youāre lucky enough to pass it, then youāll most likely be charged a higher rate than the GI rate you would have paid. Weāre talking about people who are least 65 years old here getting a āfree marketā rate tailored to their current health status.
Doing this from memory so probably left some of the very extra important Byzantine details out. In the end, we called his retiree coverage and I talked to some dude on their behalf. He claimed the drop was not involuntarily because my dad had the option to not drop. I asked why they were never presented with that option and he couldnāt answer. They went back and played the tapes. So I said put him back on the plan since he hasnāt actually been dropped yet, and then there was awkward silence, and then he came back and said ok. That fucked up the Rx plan and my mom did about a dozen more calls before it was fixed.
So, disaster averted for now with who knows how many man hours invested on our side. But thatās socialism for ya.
1 Like
That sucks, sorry you guys had to deal with it. What a country. Maybe in another 30 years we can get a public option.
1 Like
This is what I have been wondering. And Iām not saying people should be issuing threats against those targets, but Iām wondering how bad it has to get before some outliers reach that breaking point.
My suspicion is that it requires the same level of outrage that leads to the sort of mass non-violent protest that we believe might actually make a difference and you wonāt get one without the other.
So because Iām stupid - what is the thing(s) to absolutely not do when you turn 65?
1 Like
Well, considering my familyās COBRA payment would be over $2,000 a month and even a shitty plan would be over $1,000 a month, getting a subsidy from the government for an ACA plan to bring it down to a reasonable price is pretty good.
The guy who was helping us said some people heās worked with are paying $20 a month. Sure, the plan is shit, but at least they have something to protect them against a $100,000 hospital bill. Obviously, sweeping changes need to be made to the entire healthcare system, but the ACA is helping a lot of people right now.
People donāt know shit about healthcare until it directly affects them or somebody they love.
As far as theyāre concerned, health insurance = everything covered. Itās only when they get terminal cancer or diabetes that they realize how hard insurers fuck people. By then, itās too late.
3 Likes
Great question. That is why Iām writing the posts with all of the inane details. I hope they donāt come off as whine posts. Itās more complicated and riddled with contradictions than I could have ever imagined. A hugely underrated aspect of Bernieās M4A is that itās not the same Medicare architecture afaict. In fact, it is way better.
Individual circumstances matter so much that I canāt give you a good answer though. There is one thing I think is probably always good advice: do not have a lapse in creditable coverage.
1 Like
Wife called the company, who said the bill went out by mistake and to disregard it. Iām sure they send money straight back to all the people who pay without looking at their bills further, right? There was also a notification on the back that people in my state could appeal bills over $1000 if you had been treated in an in network facility. Iām sure they make it a needless boondoggle but the fact that it exists at all might be a slight positive.
I think the ridiculous part is expecting retirement-age people to come up with the perfect series of chess moves. You have to see several moves ahead in some of these Medicare scenarios that seem to come up frequently. Lots of specific terms of art and if/then or/else logic to work through. Itās not going to change for the better in our lifetimes though.
But basically - donāt have a gap in coverage from say 63-65 is what youāre saying?
Or is there also a component where as long as you go on it when youāre 65 youāre good no matter what?
It starts mattering after you become eligible which is 3 months before your 65th birth month. If youāre keeping score, thatās a 7-month enrollment period that is not to be confused with the 6-month enrollment period for Medigap triggered by enrollment in Part B or the 63-day lapse in creditable coverage that triggers Part D penalties. Welcome to Medicare!
This article is pretty good at enumerating ways you can get lol trixed in the rules matrix:
Once you reach age 65 and are eligible for Medicare, sorting through your options can be tricky. Add in any layer of complexity to the maze ā i.e., jumping in and out of the workforce, dropping and picking up coverage ā and look out.
The program comes with rules ā lots of them. And if you donāt follow those guidelines, you might end up paying a price for it.
āYou could be accruing late-enrollment penalties that last your lifetime,ā said Elizabeth Gavino, founder of Lewin & Gavino in New York and an independent broker and general agent for Medicare plans.
So an even more basic answer is absolutely do not fuck up your initial enrollments when you first become eligible. Youāll pay for it forever in penalties and could get denied Medigap, which means youād be on the hook for the 20%. To make all correct choices in the first stage of the game you need a crystal ball.
1 Like
Iāve been thinking about the reported potential damage to the heart, lungs, and other organs and how that seems like the sort of thing insurance companies would want to treat as a pre-existing condition.
1 Like
I may just hire an expert to help me navigate. I assume those exist. Sounds like I need to start worrying about it a year before eligibility.