Jharad
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Jharad, September 14,  2019  11:59am EST

Insurance

Has anyone had to change insurance companies because of the costs associated with heart failure? I'm on a Medicare Advantage policy already, but I'm finding even just the copays (for cardiologists, EP, advanced heart failure specialist, specialized tests, hospital stays, medications) are more than my budget can handle. We're coming up on the window for changing, for Medicare, and I'm wondering if I shoukd take advantage.

5 Replies
  • JamesPL
    JamesPL, September 15,  2019  3:40pm EST

    Before you consider changing, I would have a discussion with your doctor to see what would be covered under a new plan. Some doctors don't accept medicare so verify that yours does.

    Jim

  • Jharad
    Jharad, September 16,  2019  12:58pm EST

    Oh, yeah, I've already checked all that. The specialists I see, in particular, are all part of this insurance network, so it would be particularly handy. And waaaaay cheaper on copays. Problem is, I'd have to get a Part D separately. And three of my meds are just so expensive. Blech.

  • dawnaclare
    dawnaclare, September 20,  2019  2:48am EST

    Yes, I have a simular problem. I do not have a secondary Insurance for my Medicare coverage. I must wait for my birthday in June to invoke the birthday rule, where I can enroll in a PPO secondary insurance without answering any medical questions. I was diagnosed with CHF and went to the hospital for about 30 hours, came in to emergency, put on Lasix due to fluid on the lungs, then the next day had a heart catherazation, echocartiogram which got my diagnosis. The only good news is that all my heart arteries are clear so I had no stent placed. But I have stenosis of the aorta severe and of the mitro valve, so I need them both replaced. Anything I have had done I have to pay the 20%, so since I live on Social Security I am apply for Medi-Cal that will be retroactive to my hospital stay Aug. 19-20.I should get some help financially. I live in California and I am 72.

    My choices are do nothing and manage it with diet, medication, exercise and see the Dr regularly. My cardiologist wants me to go to Stanford for a consult and do the valve replacements there. They are sometimes able to replace both valves without open heart surgery, otherwise it will be open heart surgery.

  • Jharad
    Jharad, September 23,  2019  4:45pm EST

    Oooh, good luck with that, DawnaClare. Sounds like you've got a lot happening all at once.

    I got the e-booklet for the 2020 plans and found a part B & D combo that will work well together, I think, and save me significantly in the copay/coinsurance department. Specialists, in particular, are at a far lower copay, and since that's what I see primarily now, it seems prudent.

  • jerzeycate
    jerzeycate, October 3,  2019  6:56am EST

    If a doctor participates in a Medicare Advantage Plan they Mustaccept traditional Medicare. There are Very, Very few doctors who do not accept traditional Medicare. According to government websites, 96% of US doctors accept Medicare Assignment.  As for the costs of your medications, there is a Federal program that offers assistance with prescription costs for people who have limited income, but not low enough for Medicaid Programs. It is called Extra Help with Prescription Costs. You can find all of the information on this site... https://www.ssa.gov/benefits/medicare/prescriptionhelp/

    It's A Great Day to be Alive...

    Cathy

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