Can I just stop dealing with insurance for a while?
No? Okay, fair ’nuff. But here’s why I’m pissy about it.
The headache worsens
As you may recall, I was applying to get my Medicare coverage extended. I was eligible, the letter said, as long as I was still disabled and only losing my Medicare coverage because I was working.
But when my phone appointment happened, the woman informed me that I didn’t qualify because I was working and made too much. I pointed out that the letter says nothing about income and it does specifically reference working people as being eligible.
But she insisted I wasn’t eligible.
I freaked out for a bit, then decided her answer made no sense. So I called the main SSA line.
This time, I barely finished explaining the letter before the woman told me flat-out that I wasn’t eligible. I’ve been working and am, therefore, no longer considered disabled.
Ooookaaay, but what about the reference to working in the damn letter?!
She didn’t really explain why it was in the letter and just kept telling me I couldn’t get Medicare.
Spurred to action
So then I really freaked out and started an Healthcare.gov application. When I saw that my costs will be around $13,000 this year, I decided to give the Medicare thing one more try.
This time, I patiently and carefully explained the situation to the SSA employee. I read from the letter and explained why I didn’t think the other women’s answers could be right.
Because, to recap, I was being told that, since I’m disabled but can work, I’m not eligible for an extension designed for disabled people who work.
The employee had to check with two different supervisors, but they all eventually confirmed that I was right. Then they had to call the local office and tell them to help me.
Apparently, this situation never comes up, which is why I kept getting the wrong information. Presumably, people who are able to go back to work are able to get on employer plans. Alas, I don’t have that option.
Good news/bad news
So the good news is that I was technically eligible. The bad news: Nothing’s ever that simple with the government.
It turns out that I’m filling out an application, which will be sent to a processing center. Someone there will review my medical records to verify that I’m still disabled.
Even ignoring how hard it is to explain the limitations of fatigue, there’s a huge problem. According to the lady helping me, the processing time can be as long as six to nine months.
They send you the notification letter three months before your coverage is set to end.
The worst of both worlds
I asked whether, ala Tim’s appeal process, my coverage is extended during the review. Nope.
I’m getting the paperwork sent off Monday, but there’s really no way this will be dealt with by the end of the month.
So I’m going to have to go on a marketplace plan while I wait. And knowing my luck, I’ll finally get approved to extend Medicare right around the time I’m close to fulfilling my plan’s deductible.
But in the long-run Medicare is a better deal, so I’m still going to fight for it.
Figuring the odds
I need to choose a plan in the next 10 days, and there’s still some comparisons that need to be made. I thought they all had the “Pay til you hit your deductible” setup. But it looks like some have basic copay for PCPs and specialists.
That would make more sense — especially if I’m probably switching to Medicare partway through the year — so I’m willing to pay a bit more for one of those plans. But I still need to figure out how much more I’m willing to pay to keep costs lower.
For example, on a $490 monthly plan, I’d pay $50 for specialist visits and $400 for ER visits. But with a $690 premium, I’d pay $30 for a specialist and $150 for the ER. I see a specialist at least three times a month (including therapy) and generally end up in the ER at least once a year.*
So I need to run some numbers, assess likelihoods and… probably flip a coin. Because there’s really no way of predicting health care costs. All I can do is try to be more on the ball about seeing doctors at the onset of symptoms.
I saw my optometrist last week for my annual eye exam. I mentioned that my left eye seemed to have gotten much worse the week before.
Turns out I was right. It was apparently startlingly worse. To the point that the doctor thinks it may just be some swelling from wearing my contacts too much.
So I’ve been banished to Glasses-land for now. I hate Glasses-land. I like having non-blurry peripheral vision. Also: Driving in Arizona without sunglasses. Blech.
At any rate, I have another appointment on Thursday, so let’s just hope things have improved by then.
Meanwhile, Tim is now refusing to take his sleep meds. He’s been taking Seroquel, but it’s making him loopy. He’ll take it around 11 p.m. one night and not truly feel awake until about 7 p.m. the following day. In the meantime, he cycles between just being logey and feeling out-and-out drunk.
He can barely think straight. He can’t drive himself anywhere.
And he can’t do much interacting with Pandora during the day. In fact, in the mornings he can barely stumble over to the backdoor to let her out. He said it’s like he’s plastered and has the bedspins. But standing up.
The medication doctor tried halving the dose, but the last two nights have been just as bad as before. I think his body might adjust with a few more days, but I agreed not to press the issue.
So I guess we’ll see what the doc suggests next.
Wise Bread did a review of Mom’s book, so go check it out!
What have you guys been grappling with lately? Anyone want to choose my health plan for me?
*I miss the plan that had an urgent care center open from 7 a.m. to midnight. That really cut down on ER trips!