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.
Um, no.
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.
#BureaucraticLogic
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.
Miscellaneous
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.
Mom-promotion
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!
Those ACA plans sound expensive for you – geez! I hope you get approved for Medicare and don’t have to pay it for too long.
Haha, well to be fair Medicare is going to be $550ish a month. So it ain’t great either. I’m going to keep an eye on this year’s costs even once I get on Medicare so I can do the math. Maybe a plan that does co-pays for some things will turn out to be cheaper. I can’t imagine that’s the case, but with Medicare premiums this high, I figure it’s worth double-checking.
Ugh, I’m so sorry you’re dealing with all that. Health insurance is such a nightmare. I’m on a high-deductible health plan now and I’ve got the deductible in my health savings account. It’s not fun paying out of pocket for stuff, but at least there are tax benefits.
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Do you have a self-employed HSA account? Are those pricey/difficult to set up? I’ve thought about it before, but thought it might be too much of a headache.
I’m so infuriated hearing about this. It pisses me off to no end that all these bureaucrats have jobs and insurance but it takes them 6-9 months to process you? Now that they have all the facts straight? Is there a healthcare ombudsperson in your town, city or county? You need one tenacious person with a little bit of clout to cut through this nonsense. If you want to do any brainstorming please contact me. Seriously, I’ve got the time. This is an unacceptable situation. I would continue looking at ACA so that you’ve got something but I’d try to get a politician to fight like hell for me.
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Thank you for your offer. It’s very kind. I think there’s not much to be done. The lady at the SSA said we can hope it goes faster, but they’re told to tell people 6-9 months. Whee.
I’ll definitely be signing up for a marketplace plan. I can’t imagine it’ll be cheaper in the long run, even with a plan that has co-pays for certain doctors. Tests and such still would be out of pocket. But I’m definitely going to keep an eye on expenses and make sure that Medicare — which will be $550 a month for Parts A and B combined — is still a better deal. But I’m pretty sure it will be.
If you can manage it, I strongly recommend going to an insurance broker to help you find the best possible plan. I was skeptical, but a friend of ours sent mrH to a broker who was able to find him a really good plan that didn’t show up on the Marketplace. And our friend was really helpful in sorting out and explaining the best plan for me. Both saved us a lot of time and brainwork.
Good luck finding a plan that works for you until you can get Medicare sorted!
I’m sorry you’re going through this. One of my biggest frustrations with the ACA is that it gave states way too much power to limit benefits their residents receive. California has some pretty strict regulations on what insurance companies can and can’t get away with. We also have dental and vision care available through our health care exchange.
Admittedly, my health coverage does cost a pretty penny (430 a month including dental and vision), but it’s a PPO plan that has a low deductible and low copay (7 for regular, 25 for specialist, 50 for an ER). It would be $60 cheaper if I didn’t have the best dental plan they offer (no copay for preventatives, my prescription coverage covers my fluoride gel and nightguard, etc). My biggest health related “ouch!” expense is my long term care insurance, which I’m stuck paying out the nose for because nobody things to regulate it along with regular health insurance.
I’m sorry that you’re going through all this.
I will say that while going through the ACA for now makes tons of sense while your Medicare situation is cleared up, you might want to go with Medicare if eligible even if the ACA calculations for this year end up ahead. The new administration may or may not change Medicare rules (it would be highly unpopular with core voting constituencies, no matter what Ryan et al propose) but they will almost certainly change ACA rules for 2018.
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Excellent point! Because yeah, looking at it right now, the ACA may actually be cheaper than the Medicare option. But until we see what this administration plans to do with the marketplace, perhaps we’re better safe than sorry.
Health care is the biggest mess ever in this country, even without the insurance piece.
Find an in-person navigator for the ACA. You can find one here. https://localhelp.healthcare.gov/#intro.
Medicare is likely to be a better deal because it has a bigger provider network and lower co-pays and deductibles. If you have a disability lawyer, you may find he or she can get things accomplished more quickly. The advice to people on Social Security is to never get advice from the SS office.
Also, don’t trust any of the online directories. You will need to call each doctor separately to see if they are in the networks, and they might not know yet, which is tricky. If you have expensive drugs, you might want to verify coverage with the insurance company directly.
And, when you estimate income, make sure you use net (AGI), not gross. (I have never checked to see whether you are supposed to include income from disability, but that i sa question to ask.) Anything you put in an IRA, for example, plus deductions come off your income for ACA purposes. If your net income number is below 250% of the poverty level, you see discounted Silver plans you don’t see if you estimate a higher income level. Those plans have lower deductibles and co-pays. I found some this year with 0 deductible.
Only certain plans are HSA-eligible, and those are usually Bronze plans, which I suspect would not be the right choice for you, but you can do the math. My HSA options in Florida were not good this year. And the account costs $4.25 a month in fees.
This is the latest thing I wrote, updated for this year: http://livingonthecheap.com/how-to-pick-the-right….
I have not picked my plan yet, but most years I don’t use it at all, so it’s less important for me to get the right plan.
Every year I do two or three stories on health insurance, and I learn more.
Good luck. I haven’t actually signed up yet either.
Teresa
Medicare generally has no deductibles, which is why it’s pretty much automatically a better deal. Though I think one of my meds will actually be cheaper via ACA. I pay around $37 now, and generics are $20 under most of the plans I’m looking at. That said, my other generic meds will go up, so it’ll be more than balanced out. According to the online database, all three of my drugs are covered (and really, one is optional if absolutely necessary). Still yes, it wouldn’t hurt to call the plan directly to be sure.
I’ll be sure to check with my therapist when I see him tomorrow, but I’m 99% positive he takes ACA plans. The rest… Well, I’m not wed to any specific doctor or specialist. I like my current PCP, but I can go elsewhere. I know I’ll have to find a new OB/GYN, unfortunately. None of the plans take her. Probably because they’re all through the same company.
Also, I can’t be on silver plans. I end up getting too many tests done and definitely more than “$300 more in medical costs for the year” which is what the silver plan predicts.
I definitely don’t qualify for discounts. I did have to account for Tim’s disability payments, so I’m pretty sure they’re counted. Even if they weren’t, I make too much to get subsidies. Which, much as I hate to pay extra, seems fair to me. If I only counted my W-2 income I could qualify, but that seems very sketchy to me. Save the subsidies for people who truly need them, eh?
I don’t have any recommendations on health care plans, but if you are stuck wearing glasses for a while you may want to get some of those sunglasses that fit *over* your glasses. They sell them at CVS and Walgreens near the reading glasses and they work very well!
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No advice, Abby, just my sympathy.
Re the glasses thing. I have a very cheap pair of clip on sunglasses for driving because my photogray lenses do not darken in the car. Windshield has UV protection that prevents them from working. If you are stuck with the glasses a while, might be worth a try.
Navigating medicare is so frustrating. None of it makes sense and all of it takes up so much time and energy, which many people with disabilities are in short supply of. Solidarity, friend!
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I’m sorry to say that this post confuses me but I wanted to say hi abby .
You have to persist with the SS/Medicare people. The rules are so FREAKING complex that even the employees don’t understand them. Especially not the ones who answer the phone. Over the phone, half the time they’ll give you an incorrect answer or just tell you they don’t know.
I’ve found you often get a better and usually more accurate answer by going in person to the Social Security office. The one in Glendale is badly reviewed, but at the one on Tatum north of Greenway, the staff have always been very helpful and polite to me.
Sorry you’re having to navigate all the shoals of bureaucracy!
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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.
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