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How well do you understand the details of your health insurance coverage (e.g., which medications are covered, how much a service will cost, the steps you need to take about getting a service or product covered, etc.) Please select the number or statement that best represents your knowledge.
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Maybe I am just a delicate scold who get the vapors over things like knowledge and understandability. Or maybe I simply have a brain of cinder-block denseness. I dunno.
But I am intrigued by those of you who answered 5, āfull or clear understanding.ā My medicare book alone has about 2,000 pages. My supplemental insurance has only slightly fewer pages.
The larger problem it would seem is a reminder of just how much weāve acclimated ourselves to the presence of awful legalistic hour-glass capitalists into our collective health care that choke off everything but profits and abundant CEO salaries.
Perfectly said.
Private insurance is not all that complicated to understand. Iām not looking forward to medicare and when I do my response will surely change.
#BeWell
I have been blessed with extremely good insurance and secondary to cover whatever I need.
I have Medicare as primary and almost never check to see what is covered under that plan. My secondary coverage is with federal Blue Cross Blue Shield and I know they will pick up anything that Medicare does not cover. My mother, who died in 2019 with lung cancer, had the same insurance and never paid a dime out of pocket for her medical needs.
I am turning 65 in February and will be doing the same. My husband was the Federal employee. We decided to keep Fed BC/BS instead of switch to an Advantage plan. I hope it works, it has for him!
The real trick comes when you call –in this case, a Medicare Advantage Plan company—to ask a question. THAT is a time consuming nightmare of transfers and waits to try and get someone who can figure out a possible answer. We happen to be fortunate to have an excellent local representative with the company and she has us contact her —but just how many of us does she have the time to help? The plans are all, as said above, SO complicated and they change every year. How can any phone representative keep up with the changes??? They cannot.
I feel that I have a basic understanding of my Medicare and Secondary NYS Gov’t Empire Plan. I am always surprised at how much I have to pay after my primary and secondary get through. My copays are usually larger than I expect. I’m tired of fighting with them.
Made a mistake choosing the wrong plan for me. When I was able to reenroll I researched several plans and was happy with the plan last year and will continue to use this year
I spent nearly all yesterday afternoon with the “book” and online, and on the phone when I’d finally reached a decision. There used to be a group to help seniors with this, but two years ago the person who tried to help was at much at sea as I am. So now I do it alone, with the idea that if I wind up with no coverage for the supplies needed to keep my 69 year use of needles and pumps alive, I will reinforce my whining with a scream they might be able to hear. The whole scenario is a disgrace, and the insurance companies should be mortified. But…..apparently they aren’t. Nothing really happens, and each year is torture.
Thank goodness for trees, birds, and soft breezes!
I spend a lot on Medicare and a Medicare supplement that completely covers copays and deductibles for all Medicare-approved healthcare. It took a while, but I finally have a good understanding of what Medicare approves. I also pay for a supplemental drug plan with a complicated tier coverage system, which I have to research for every new drug. My longtime endo had a problem with the Medicare requirement for face-to-face visits every 90 days so I had to find a new endo who would take me on. It also took a long time to find an insulin supplier who would/could bill Medicare Part B properly. As I said, it look a lot of effort to figure out how to use my Medicare benefits but I think I finally have things under control.
Ditto. The proper insulin supplier was a hang up for me for a year. I too think I have things under control finally.
With traditional Medicare, a Medigap (supplement) policy and a Part D plan that fixes my insulin co-pay at zero all the way through the donut hole, my annual cost is essentially fixed. Itās not cheap, but at least I donāt get surprised.
My experience: the doctor can choose which insurance to accept, the insurance can choose which doctors and medications to cover, and I the patient, have zero say in any of that. Meanwhile, I pay a fortune to have almost no rights.
I understand health insurance very well. I read the fine print. I have to fight tooth and nail for them to cover things that the policy clearly covers. I have contacted health advocates at work to get things added to the formulary. I routinely file appeals. Our current system puts the consumer at a disadvantage and the insurance companies seem to know that most people give up after the first “no” and take advantage.
Exactly. In my other career, I learned how to get insurance companies to fulfill their end of the bargain, ask the same question in different ways, etc. I apply those same principles to this now!
I have had the same basic coverage through Kaiser for 33 years! During that time I have learned the ins and outs of the coverage and where to find additional information if needed.
What I don’t understand and need clear understanding of is the Insulin Act. Does ANYONE understand it, including the lawmakers who wrote and voted on it?
I researched it a while back. My understanding is that effective January 1, 2023, if you are on Medicare the cost of insulin is $35 per month.
Unfortunately, if you are not on Medicare, there is no cap.
The political side of that I that the Democrats wanted full discounts for everyone. Almost all of the Republicans voted against it. The Medicare patient coverage was left untouched.
LMAO! They do not understand T1 is not “T2 you’re born with”…that’s it’s literally life or death for us. They are lobbied to heavily to change profit margins for pharma.
I write my reps and senators 2x per year each about it.
The U.S. system is so broken. I’m a dual citizen, and in the other country, most of what I need is free, including insulin. Unfortunately, it’s too far to ship that much insulin safely.
I understand it perfectly it is horrible when it comes to covering diabetes and it’s associated costs. I pay $350 a month to have it and it covers nothing until my $6000 deductible is met!
Every year it gets harder to understand. I’m covered under my spouse’s employer (a hospital) with primary insurance that costs a huge portion of each paycheck. Last year, without any warning, increased my cost for DME by 40%. My secondary insurance is original Medicare. Although they’re secondary, my DME orders are limited by Medicare rules, creating the constant stress of running out before the next shipment. I wouldn’t wish this very broken health CARE system on anyone.
Here’s a perfect example of what just happened to me minutes ago. My doctor prescribed Omeprazole tablet 20 mg for me in April, 2022. My drug company, CVS/Caremark, told me they are not covered, I must buy the over-the-counter. I just received the 2023 Formulary, and it shows Omeprazole as a covered drug. I called CVS/Caremark, and they said that the Omeprazole would have been covered if the doctor has written the prescription as, “Omeprazole Rx capsule 20mg.” I’ve been paying out of pocket since April, and it’s not even written in the Formulary the way they told me over the phone to have it prescribed. How could anyone possible know that. It comes down to who you talk to on the phone, and what mood they’re in. Geesh!
A follow up. I got an email from the nurse at my doctor’s office telling me that she filled the prescription the correct way previously. Now, I’m negotiating between my doctor’s office and the insurance company to get a $%^&* prescription filled. OMG!
I understand almost all the details. I’ve gotten really good at it to the point I threaten to send them a bill for my time to solve their issues.
But, they always find a way to sneak in a surprise, don’t they?
Youāre hilarious! I love it!
I understand it and I also understand that insurance companies are practicing medicine without a medical degree š”that we have to often explain what a CGM and pump is to someone who holds our life in their hands. America.
In my country the Public Insurance covers 100% all services, products etc. for diabetics (Greece)