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I have Medicare, as I am on disability. I am working on finishing my education, as I only have 1 year left of engineering school, in electrical engineering, be

I have Medicare, as I am on disability. I am working on finishing my education, as I only have 1 year left of engineering school, in electrical engineering, before I enter the workforce. I require a blood product in order to survive. If I ONLY had Medicare (I don't--I also have employer-based insurance through a family member), I can expect to pay around $50,000/year for my care, due to Part D catastrophic coverage levels. I can definitely expect to have to pay $50,000/year soon if the Affordable Care Act is abolished. Fortunately, I am a European Union citizen, but it would be tremendously sad to have to leave the United States, my homeland, over this. I really cannot go on a Medicare Advantage plan, which might resolve this issue, as I have a very rare condition that only a few doctors in my area are qualified to treat. Most Medicare Advantage plans are HMOs too. You also cannot switch back to traditional Medicare ever, once you get a Medicare Advantage plan. I live in one of the largest metropolitan areas by population too. It puts me in a strange place where I can almost be guaranteed not to get the care I need. My care is unbelievably complex. It is very common to be admitted to the hospital by Medicare under observational status. I am surprised that the person writing this article was unaware of this, but almost everybody outside the healthcare field is unaware of it. There are also some really, really strange rules with respect to emergency room visits and being admitted under observational status by Medicare. It also takes a lot of time to look them up and understand them. The Medicare Part B premium is typically $135/month for most Americans. This covers 80% of your costs for outpatient care, doctors visits, medical supplies, etc., under traditional Medicare (not a Medicare Advantage plan). To cover for the remaining 20% (which you should get coverage for--you are foolish not to) you need to get a Medigap plan. Those can be expensive. I know this is unbelievably complex, and is a huge waste of time to have to go and understand, to prevent yourself from getting in trouble, if you have Medicare. It is ridiculous. However, the author was being penny-wise and dollar foolish. It is very, very common for people to explicitly elect to have Medicare Parts A and B if they have traditional Medicare. Saving $135/month over something that could get you in trouble is not smart in the American healthcare system. Yes, his situation should have never happened, in a decent healthcare system. It is sad. But he did make some pretty big mistakes, especially considering he is a doctor. But, he did not deserve this.

omgwtfbyobbq 7y ago
>You also cannot switch back to traditional Medicare ever, once you get a Medicare Advantage plan. You can change plans during the annual enrollment period, from October 15 through December 7. You can enroll in or switch advantage plans or just go back to plain Medicare. If you're on plain Medicare, you can also switch to a 5-star advantage plan between December 8 and November 30. https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/5-star-special-enrollment-period https://www.medicare.gov/sign-up-change-plans/when-can-i-joi...
- disabled 7y ago
  No. This is not well known, but what I stated was absolutely true. There are endless unbelievably insidious tricks and rules like these: If I were to switch from a Medicare Advantage Plan back to Traditional Medicare, I could never get a Medigap (or supplemental plan) which covers the 20% that Medicare Part B does not cover. This is due to the fact that I have a pre-existing condition. Actually, I probably have 50+ pre-existing conditions from a medical insurance underwriter standpoint, but that is beside the point. See: https://www.kff.org/medicare/press-release/in-all-but-four-states-seniors-on-medicare-can-be-denied-a-medigap-policy-due-to-pre-existing-conditions-except-during-specified-windows-of-opportunity/ https://www.kff.org/medicare/press-release/in-all-but-four-s... > Depending on their state, Medicare beneficiaries who miss these windows of opportunity may unwittingly forgo the chance to purchase a Medigap policy later in life if their needs or priorities change, OR IF THEY CHOOSE TO SWITCH TO TRADITIONAL MEDICARE AFTER SEVERAL YEARS OF BEING IN A MEDICARE ADVANTAGE PLAN. This is a huge deal. I have type 1 diabetes plus 2 rare immune-mediated diseases that affect my peripheral nervous system. My insulin pump supplies are covered under Part B. A couple of my hospitalizations were covered under Part B under an "observational status". I used to receive infusions of a blood product in the hospital every 2 weeks that cost my insurance about $10,000 each time, under contract. I also need a couple of different infusions, although far less frequently, to stay alive. So for me, unless I totally uproot my life and move to one of those 4 states that does not allow the pre-existing condition clause to preclude me from Medigap coverage, I am stuck on a Medicare Advantage plan. I am screwed. These plans only become more hardcore and strict. I cannot be on an HMO, which many Medicare Advantage plans are. I have a very rare disease that maybe a few doctors can treat, even though I live in a huge, very populous city. I also need the doctors I currently have, which work like a team. I cannot afford the several prior authorizations and the delays that will happen from switching insurance. I cannot afford to make a mistake. Switching to a Medicare Advantage Plan can be extremely problematic for somebody like me, due to logistical issues. They could cost me my life too, and that is no exaggeration. I may have to switch to a Medicare Advantage Plan, as costs are capped and I have an exorbitantly expensive medication that I must take to survive. Under Traditional Medicare, under Medicare Part D, I am subjected to catastrophic coverage levels. I can expect to pay $50,000/year for my healthcare, if I lose employer based coverage through a family member via Affordable Care Act partial or full overturn. In the case that I am forced to switch to a Medicare Advantage Plan, there is no going back to Traditional Medicare, due to pre-exisiting condition clauses in Medigap plans. That is extremely problemsome as it limits my access to doctors and other care, as I have a very rare disease. Fortunately, I am a European Union citizen, so I can just leave. But, it makes me profoundly sad. What I mean is that I no longer feel welcome in my own country, my homeland. I have been in remission for a year now and I am close to completing my degree so I can work. I really want to work! But the United States makes it extremely hard for me. There are just way too many things tied to working, especially health insurance. It is really sad. My family is here, but I know I would be better off in Europe. Right now, I have been focused on language learning non-stop. Obviously you learn one language at a time. I am currently working on Croatian. All I can do is try to move on.

omgwtfbyobbq 7y ago

>You also cannot switch back to traditional Medicare ever, once you get a Medicare Advantage plan. You can change plans during the annual enrollment period, from October 15 through December 7. You can enroll in or switch advantage plans or just go back to plain Medicare. If you're on plain Medicare, you can also switch to a 5-star advantage plan between December 8 and November 30. https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/5-star-special-enrollment-period https://www.medicare.gov/sign-up-change-plans/when-can-i-joi...

disabled 7y ago
No. This is not well known, but what I stated was absolutely true. There are endless unbelievably insidious tricks and rules like these: If I were to switch from a Medicare Advantage Plan back to Traditional Medicare, I could never get a Medigap (or supplemental plan) which covers the 20% that Medicare Part B does not cover. This is due to the fact that I have a pre-existing condition. Actually, I probably have 50+ pre-existing conditions from a medical insurance underwriter standpoint, but that is beside the point. See: https://www.kff.org/medicare/press-release/in-all-but-four-states-seniors-on-medicare-can-be-denied-a-medigap-policy-due-to-pre-existing-conditions-except-during-specified-windows-of-opportunity/ https://www.kff.org/medicare/press-release/in-all-but-four-s... > Depending on their state, Medicare beneficiaries who miss these windows of opportunity may unwittingly forgo the chance to purchase a Medigap policy later in life if their needs or priorities change, OR IF THEY CHOOSE TO SWITCH TO TRADITIONAL MEDICARE AFTER SEVERAL YEARS OF BEING IN A MEDICARE ADVANTAGE PLAN. This is a huge deal. I have type 1 diabetes plus 2 rare immune-mediated diseases that affect my peripheral nervous system. My insulin pump supplies are covered under Part B. A couple of my hospitalizations were covered under Part B under an "observational status". I used to receive infusions of a blood product in the hospital every 2 weeks that cost my insurance about $10,000 each time, under contract. I also need a couple of different infusions, although far less frequently, to stay alive. So for me, unless I totally uproot my life and move to one of those 4 states that does not allow the pre-existing condition clause to preclude me from Medigap coverage, I am stuck on a Medicare Advantage plan. I am screwed. These plans only become more hardcore and strict. I cannot be on an HMO, which many Medicare Advantage plans are. I have a very rare disease that maybe a few doctors can treat, even though I live in a huge, very populous city. I also need the doctors I currently have, which work like a team. I cannot afford the several prior authorizations and the delays that will happen from switching insurance. I cannot afford to make a mistake. Switching to a Medicare Advantage Plan can be extremely problematic for somebody like me, due to logistical issues. They could cost me my life too, and that is no exaggeration. I may have to switch to a Medicare Advantage Plan, as costs are capped and I have an exorbitantly expensive medication that I must take to survive. Under Traditional Medicare, under Medicare Part D, I am subjected to catastrophic coverage levels. I can expect to pay $50,000/year for my healthcare, if I lose employer based coverage through a family member via Affordable Care Act partial or full overturn. In the case that I am forced to switch to a Medicare Advantage Plan, there is no going back to Traditional Medicare, due to pre-exisiting condition clauses in Medigap plans. That is extremely problemsome as it limits my access to doctors and other care, as I have a very rare disease. Fortunately, I am a European Union citizen, so I can just leave. But, it makes me profoundly sad. What I mean is that I no longer feel welcome in my own country, my homeland. I have been in remission for a year now and I am close to completing my degree so I can work. I really want to work! But the United States makes it extremely hard for me. There are just way too many things tied to working, especially health insurance. It is really sad. My family is here, but I know I would be better off in Europe. Right now, I have been focused on language learning non-stop. Obviously you learn one language at a time. I am currently working on Croatian. All I can do is try to move on.