Everything you ever wanted to know about Medicare ....
... some of it possibly correct
Like everyone else in the USA legally, I qualified for Medicare on my 65th birthday. This was handy as I had lost my work-related health insurance when my boss cut my hours. As part of the deal, Medicare sent me an enormous (couple of hundred pages) document "explaining" the various bits of Medicare. It was written in no form of English with which I am familiar and my Spanish isn't up to reading the Spanish version either so I signed up for "Medicare Part A". This is basic Medicare which covers admission to hospital.Medicare Part A
As I discovered this past January, being kept in the hospital overnight doesn't constitute being admitted to hospital. So I got stuck with a decent lump of that bill. It also doesn't cover any drugs or, I imagine, anything they do to you while you're in hospital other than perform an operation.Medicare Part B
And here I quote....
If your test, item or service isn’t listed, talk to your doctor or other health care provider about why you need certain tests, items or services, and ask if Medicare will cover them.
Is that clear? In other words it covers stuff you may have done to you to see if you need to have stuff done to you. Clear as mud.
The formulary
Part of the information pack was "the formulary" which is a list of drugs, with no description as to what they are or do, that are covered by Medicare Part D. Unless you're the kind of person who records TV programs and fast forwards through the show and watches the ads intently, there's no way you'll have a clue what this is all about - I think they give you a choice of two formularies - one of the basic stuff and one with the good stuff thrown in. Which one you choose affects your monthly premium. Good luck with that.Paying for it
This is one of the many fun parts. The premiums really aren't that hefty but there are gotchas. For a start if you don't enroll as soon as you're eligible (or within 6 months), your premium goes up forever. And if you leave it until you are sick, you are out of luck - you'll get turned down so you're on the hook for 100% of the costs. I was lucky (?) as I had nothing to do one crappy day in January a couple of weeks before all my fun started and I signed up for parts B & D so they are paying 80% of my costs (I still have to pay the other 20% but more about that anon).The doughnut hole and catastrophic coverage
Once Medicare has paid a certain amount of your medical expenses, they bale out on you until you have paid close to $5,000 of your own money in the year at which point "catastrophic coverage" kicks in to pick up the whole bill for the rest of the year. Then you start all over again. I have yet to complete a year so I don't know what will happen to my premiums come next January.Medicare Part B
Once again, I quote...
Part B covers 2 types of services
- Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
- Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.
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I think that means blood tests, immunisations and so on, But because my chemo reacts with the shingles jab (which costs about $800 if you're not insured), I have to take little pills which, sor some reason, cost me $90 a month.
Supplementary insurance
If you want coverage for the 20% you have to pay with the Medicare plans, you can buy supplementary insurance which also covers the doughnut hole. But you'd better do it quickly - if you don't do it within 6 months of signing up for Medicare then you can't.
Charitable foundations and things
I have been amazed and delighted to find there are charitable foundations that will give you a grant almost instantly if you are suffering from the right thing and earn little enough. Two of them have picked up a huge chunk of my medical bills with very few questions asked - mainly "how much did you earn last year and if you lie we'll set the dogs on you" which fair enough. I think they also start afresh in the new year, too. I anticipate next year's Medicare premiums to take a job but the people at United Healthcare who handle Medicare are incredibly nice and kind and generous etc.
The costs - a bit of a ramble
I often hear from buddies in the UK, NZ and Canada bout how their healthcare doesn't cost a bean. Also heard from a friend in France that their public healthcare system will pay for a cataract op on only one eye (which probably explains how they drive). Yes, our costs are obscene / insane, largely because people like me who pay our bills also pay the bills of people who can't afford health insurance or who can't be bothered paying for it and then rock up at hospital anyway. But, other than Medicare tax, we do have much lower tax rates than those other countries so, when you save $50 tax on an iPhone, if you have any sense you should stick they $50 in the bank. Not that anyone does.
A significant percentage of the American electorate are in favour of repealing Obamacare but have no idea what, if anything, Trump intends to replace it with - probably a return to the old "death panel" system they love so much - if you're poor and sick, piss off and die. Fox "news" has done a great job of selling that one to the country. With luck, Hillary will listen to Bernie and introduce a single payer system along with a tax rate that is adequate to fund it but my breath is not held. Hillary currently has the inside running on the presidential race but her chances of achieving anything at all in the face of republican demands for a 60-40 vote on anything are just about zero. And I have wandered way off topic but I'm allowed to as I got 0 hours sleep last night.
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