Ask MetaFilter questions tagged with medicare

Is Medicare going to hurt my Mom?

amanda — Sun, 08 Nov 2009 08:16:19 -0800

My mom is TERRIFIED about the recent Health Care Reform Bill. She is on Medicare and is certain that she will no longer have the access to health coverage that she feels she needs. It sounds like changes to Medicare could have consequences for her... what might those be? I tried searching around for real answers but, of course, some of those answers lay in what the market will do when faced with these changes. She watches a lot of Fox news and Fox news is absolutely drumming the beat that Obama is going to kill your grandma. But, sorry news orgs, having trouble finding an equally compelling (so hard to beat FEAR) news source who is explaining things in way that could reassure her.

Best Medicare Choice?

Elsie — Thu, 05 Mar 2009 03:45:06 -0800

Too many time-sucking choices--need to cut to the Medicare chase if anyone knows the drill out there. What are the best, most reasonably priced types of Medicare plans in the alphabet soup for: --a first time enrollee, fit male 65
--great cholesterol, blood pressure, weight
--non-smoking
--oops--the pacemaker (two years old & good for another ten years). Except for pacemaker phone monitoring visits every two months only sees the doctor for checkups.
--has never been on prescription drugs.
--will be living in western Massachusetts
--willing to take high deductible to keep down monthly premiums provided basic preventive care is well covered, i.e. check-ups; recommended tests such as colonoscopies, PSA, etc.
--willing to be in a good HMO and will revisit the decision once enrolled in the best program for a first-timer with this profile.

Bonus question: Can anyone recommend the name of the best network that takes Medicare in the Amherst/Northampton, MA area?

Will I be able to go from medicare to private insurance?

TigerCrane — Thu, 26 Feb 2009 10:48:42 -0800

If I lose medicare, will I qualify for private insurance? I am on medicare due to disability. I am now well enough to work, so i may be losing medicare. But due to my disability, I have a preexisting condition which exludes me from buying private coverage.

I live in california.

I understand that as long as I have continuous coverage, I can get insurance even if I have a pre-existing condition.

I have heard, however, that medicare does not qualify. Does medicare qualify? Will I be able to get insurance?

List of Medicare rates?

twiggy32 — Sun, 14 Dec 2008 11:01:54 -0800

Where do I get a list of Medicare payment rates for surgical procedures? I am currently involved in an insurance appeal over a robotic excision of a tumor in my pelvis. My insurance company only wants to pay a small fraction of the cost of the surgery, saying that since I was out of network, they only have to pay Medicare rates for the surgery. It would be helpful in my appeal if I could find a list of Medicare rates for various surgeries, and see if Medicare even has rates for robotic excision. Can anyone point me in the direction of a list of rates? Google hasn't provided any results that tell me what I need to know.

In the name of Michael Moore: No free clinics in Dallas?

Unicorn on the cob — Tue, 18 Dec 2007 09:51:37 -0800

Is there a free clinic in Dallas? Or any kind of reduced-payment medical facility, more specifically, for treating injuries vs. illness? I have of course Googled and called about 30 numbers that came up from Yahoo Answers and Free Medical Camps. I also called Parkland Hospital and even called 311 to ask the city directly. I pretty much got no answer; the numbers were old, or I was told to arrive at 7 a.m. after filling out loads of unemployment paperwork and even then, no guarantee that Parkland could see anyone for up to 24 hours. Is there ANY place to go without being billed later for a huge emergency room fee? If Parkland is the only option, can the bill be covered by Medicare or Medicaid if the injured/sick party is unemployed? I'm hoping for first-hand experiences or medical personnel who might have an inside track on this. Thanks in advance!

Difference between rural and urban Medicare reimbursement

ikkyu2 — Mon, 04 Jun 2007 14:26:58 -0800

What is the difference between urban and rural Medicare physician reimbursements? Medicare/HCFA classifies service areas into "urban" and "rural." Rural services are reimbursed at a lower rate, but I am having trouble discovering how much lower that lower rate actually is, either as a percent or as an absolute value to compare. I'm most interested in neurologist services (new consultation, EEG/EMG, LP), but would be interested in learning about other medical and surgical specialties too.

Non-physician services such as rehab, hospital days, radiology tests, etc., are not the numbers I'm looking for. In fact, they seem to be the chaff that is preventing me from getting anywhere when Googling this topic.

I have $50K from insurance proceeds but I'm on SSI/Medicaid, what should I do??

pikaboy202 — Tue, 06 Mar 2007 08:23:13 -0800

What can I do to continue recieivng SSI and Medicaid benefits if I received a lump sum insurance proceeds? I know someone who's elderly and disabled. She is receiving SSI benefits and is on Medicaid. Recently, her husband was involved in an auto accident and he died. The other person involved was wrong and their insurance company paid out a wrongful death benefit to the wife in the amount of $50K.

She has the check but hasn't cashed it yet because she's afraid that it'll make her lose her SSI and/or Medicaid benefits.

I know of 2 options: spend down the money or put it into a "pooled trust." I know the drawbacks of a pooled trust is that you have no control over the dispursement of funds and also, after the death of the wife, the funds are used to payback medicaid.

My questions to the hive are:
1. If she spends down, what would be the best ways to spend down the funds? What should she do with the money to maximize usage (either for her or her beneficiaries when she dies) and also not jeopardize her SSI or medicaid benefits?

2. Would the pooled trust be a better option?

3. Are there any other ingenious ways to shield the $50K?

Help me learn more about osteoarthritis, its treatment and its associated costs.

Effigy2000 — Mon, 05 Feb 2007 15:04:14 -0800

My fiancée has just been told by her chiropractor that she has osteoarthritis. I have questions about the condition and, more specifically, how we can mimimise the cost of treating it under Australian Medicare. My fiancée, who is 23 years old, has long complained of back problems. Late last month we finally managed to get ourselves into a financial position where we were able to afford to go see a chiropractor, who did some tests and subsequently had some x-rays ordered. Yesterday, during the follow up consultation, he told her she has osteoarthritis. He's now telling us she needs to see him 4 times a week to fix the problem.

I've done my googling and wikipedia research and already I've learned much about it. But I'd like to know more, perhaps specifically some personal stories of people who have it and how they've coped with it and treated it.

On the money side of things, we're happy to pay whatever needs to be payed, but the problem is that at $45 a pop, this is going to cost some serious money. One estimate we've come up with puts the total cost around $2000. Now as I've said, it's money we know we have to spend (its for her health, after all) but it's still going to hurt us finacially at a time when we just started to talk about the possibility of saving some money.

I've done my research and found out that chiropractors aren't covered by Australia's Medicare system, so that isn't a possibility. But I wonder if there are any other avenues we, as a couple living in Queensland, Australia, can do to perhaps minimise the cost.

And yes, we've looked into private health insurance but with a minimum 2 month waiting period and a limit of what appears to be around $400 per year on chiro work, that dosen't seem to be something worth persuing.

So my questions therefore are as follows;

1) Are there are other ways that osteoarthritis can be treated by the public health system under Medicare, hopefully in a timely manner (we don't want to wait weeks/months/years to get it fixed) and preferably at a relatively small cost?

2) If not, can any Australian MeFites reccommend any ways we can go about minimising the cost of the treatment?

3) Can you please give me any more general advice about osteoarthritis, its treatment and the likelihood of my fiancée being one day cured of the disease (or at least, I understand it is a disease, so correct me if I'm wrong there too)?

It's all early days yet, and I'm still learning about the whole thing as I go along, but any and all advice you might all be able to provide me would be greatly appreciated.

CFS and Disability: To Do or Not To Do

Anonymous — Sat, 28 Oct 2006 10:58:15 -0800

A few years back I was diagnosed with Chronic Fatigue Syndrome. For a while I was fairly dubious of this diagnosis but now that it has been confirmed as a genetic disorder I feel maybe I should get over my pride and start treating this like the life-affecting problem it is. I have had to make lots of compromises with my life in order to keep working and supporting myself. I stay on a strict sleep schedule even though this makes a social life largely impossible because I know I need to to stay "on the ball". I have screwed up before and feel I'm at the end of my nine lives, so to speak. I am completely sure that the problem is CFS and not competency; when I am on the ball I perform very, very well and when I'm not, I sleep through multiple alarms for days on end, fall asleep at the drop of a hat, can't focus, etc.

Anyways, I'm not insured and I really think I should be. Because I can't really handle standard full-time work (I have 2-3 part time jobs and make sure one allows me to work at home) I don't really see finding a job with benefits in my future (I also tend to end up with small companies and nonprofits, due to the flexibility and I guess I am a bleeding heart). I think I should try to get on disability for the Medicare.

But I'm worried it will be a huge resource-sapping endeavor with no pay off. I really can't afford to spiral down because of something to help myself. I also can't afford a lawyer. Hivemind, any experience with getting disability insurance for such a borderline-legitimate illness?

My doctor’s office is becoming a medial boutique!

Robert Angelo — Sat, 16 Sep 2006 15:05:00 -0800

Our doctor is dropping all insurance and Medicare participation but isn’t telling his patients until they show up at his office, or if they just happen to read his web site. Should we do anything about it? My partner had a doctor’s appointment Thursday, and the doctor refused to see him. This is the primary care physician in Houston that we both have seen since early 2003.

I'll call him Dr. Voldemort; he’s a prominent local physician whose practice combines internal medicine, primary care, and HIV-related care. He has advertised for many years in the Houston Voice and OutSmart (gay rags) and has a number of patients with AIDS/HIV who are dependent wholly or partially on government assistance with their health care.

My partner has been HIV-positive since the early 1980s; he does not have full-blown AIDS. He has, for unrelated reasons, been on Social Security Disability with Medicare and Medicaid since the early 1990s. His medical problems and issues are legion. Since we moved to Galveston in 2002, he started seeking care locally at the UT-Medical Branch, then switched to private doctors in Houston seeking more proactive and less bureaucratic care.

We both have been seeing Dr. Voldemort since 2003. I am HIV-negative and basically healthy, fwiw, although I have occasional health-care needs. Voldemort and his staff have been generally helpful and have referred us to a number of incredible and gracious specialists in Houston who have provided some of the best care my partner has received in years.

Anyhow, it seems that during the summer of this year, Dr, Voldemort decided that he will be dropping all insurance, PPO, and Medicare participation. Instead, he is choosing to require patients to pay in full for services at the time of the office visit, and pay according to his fee schedule.

Although those changes go into effect October 1, his office staff would have required my partner to make a payment for the visit because the doctor has already stopped participating in Medicaid, which is his supplemental coverage for his Medicare. My partner could not pay the money, so he was turned away. Starting October 1, patients will have to pay up front and then submit claims to their own insurance. Under Federal rules, the ones who have Medicare will not be able to submit their claims to be paid, since Dr. Voldemort no longer participates in Medicare and does not accept the Medicare reimbursement level.

Although the doctor has a right to run his business this way, essentially turning it into a medical boutique, what we really can't understand is why he didn't notify his existing patients. When my partner was there Thursday, they were pretty rude about it. The doctor would not speak with him at all, and the office manager said that it was too expensive to notify their patients that the changes were happening. "This isn't a free clinic! We are salaried here!" What a snob.

So, my partner left. He was so upset that he got lost driving home. It's at least a two and a half hour round trip from here to that part of Houston, gone to waste, that could have been avoided. When he got home, I checked the doctor's web site and found a notice from July about these changes. They had weeks to let us know. At a minimum, his receptionist could have told my partner this was going on when he made the appointment. yes, I know I'm ranting...

The bottom line from all of this is that my partner will be able to continue with his existing specialists, just as before. One of them, the HIV specialist, will probably be able to pick up his primary care, although we need to check that out. We're still just stunned to see a business decision in a so-called "caring profession" communicated and handled in such a callous way. I can't imagine what the rest of Voldemort's Medicare patients will do, especially if they come in for an appointment after October 1 and suddenly discover that they won't be cared for.

So if you’ve made it this far, here’s the question: Should I do anything about this? Call the Houston Chronicle? The Houston Voice? Marvin Zindler? Anybody? I keep thinking of other people who will show up at Voldemort’s office seeking care, especially after October 1. They will be turned away because they can’t or won’t pay for the office visit. Especially the ones on Medicare, who are probably on a fixed income… I’m hoping that the ones who may have an HMO have received a notice from the HMO that their doctor will be “out of network” on that date. As a Voldemort patient, I have a PPO, and I have not received anything like that.

It troubles me. Do I have a moral obligation to tell someone? If so, who do I tell? Or is it o.k. to tell myself that with my partner’s poor health and many issues in our lives, that it is better to keep the obligation to ourselves to preserve our privacy? I especially do not want to identify my partner to others in the medical community as a potentially “difficult patient” who would make waves or get them “in trouble.” His medical needs are so pressing that maintaining the best relationship with his care providers is essential.

I want to make it clear that I think the doctor has a right to conduct his business as he sees best and make changes to his insurance affiliations or have none at all, if he wants. According to his web site, he believes that the U.S. medical system in broken, and he is opting out because he wants to provide a higher standard of care for his patients. That’s fine, if that’s what he wants to do, even if the only patients he will eventually care for live in River Oaks or West.U and drive Mercedes and Jaguars… My bone of contention is that he is not telling his patients in advance of doing so, and many will be left in the lurch.

What level of medical insurance should I get?

lorimer — Fri, 15 Sep 2006 07:40:31 -0800

MEDICAL INSURANCE: I'm getting some for the first time in 8 years. Clearly I should have at least catastrophic, but help me decide whether having more is worth the cost. Also: any opinions about HealthyNY insurance? This year I'll have a little more money than usual (i.e., I won't be scraping by exactly day-to-day), so it's time to get some (very low-cost) medical insurance. I'm trying to decide whether to have just catastrophic/accident coverage or have basic general coverage. I live in NY and my income is definitely low enough to qualify for HealthyNY (about $180/mo without prescription coverage), but not low enough for Medicare.

I'm female, late 20s, in excellent health except that I'm 30% over my median ideal weight. Low blood pressure, low cholesterol, have never smoked, no drugs & little alcohol, no STDs and very careful about preventing them, very careful/healthy in general. Over my entire life I've had no medical issues, no mental health issues, & virtually no medical expenses (just preventive care plus a few one-time prescriptions for things like chicken pox as a kid). My only risk factor I can think of is that I was exposed to a fair amount of 9/11 dust (but I've shown no signs at all of lung or breathing trouble).

My current preventive-care costs are just an annual gyn exam + pap smear (very cheap at Planned Parenthood) and dental exams. So, under $200 a year.

Also: If I couldn't afford it some months, are you generally allowed to "hop on and off" and just be covered at the times when you did pay that month -- or do you lose your coverage as soon as you can't pay and have to re-apply when you can afford it again?

Thanks for any insights!!

Is a Radiologist Required Under Medicaid?

whitebird — Wed, 02 Aug 2006 09:37:12 -0800

Is a radiologist required to be in the office during an MRI, according to Medicaid regulations? According to the Medicare National Coverage Determinations Manual, in a hospital setting for a CT scan, you need a "radiologist or other qualified physician...in charge of the procedure," while for a non-hospital health care facility, "the diagnostic procedure must be performed by or under the direct personal supervision of a radiologist or other qualified physician." Do the same rules apply to MRI? Bonus points given for a link to specific Medicaid/Medicare regulations applicable.

Medicare-Part D

sandra194 — Sat, 25 Mar 2006 18:42:09 -0800

MedicarePart-D:North Carolina Plans--any suggestions? Hello I have been looking at the Medicare-PartD drug plans for NC as listed on Medicare website. Other than going for the cheapest premium or cheapest out of pocket plan that covers my Mom's meds., I have no idea how to judge these plans. Anyone have experiences with plans in North Carolina? Thanks.

Medicare drug plans

sandra194 — Thu, 16 Feb 2006 06:20:46 -0800

I need to pick a Medicare drug plan for Mom. Is there a resource that explains the plans in relatively easy to understand language?

Two questions about American culture: Pledge of Allegiance and Medicare

dash_slot- — Sat, 27 Mar 2004 06:04:55 -0800

Explaining American culture to the world:

a) Is the pledge of allegiance a compulsory thing each schoolday?

b) If funding for medicare is pro-social security, why did a Republican president push for it so hard?

Genuine enquiry: please no flames, just the facts, ma'am, just the facts. a) What if a child of say 15 years old refused to recite it ever? Is there a sanction against it? Could he be excluded from class? Is it a crime? What if the student was 18, or 11 - would that make any difference?

b) This one really only makes sense to me in a partisan sense [The president wanted to enrich the drug manufacturers, at the expense of the taxpayer] - but surely there's something more to it, right?