Tag Archives: Medicare

Doctor Bills $1,004, Medicare Pays $143 — This Travesty Has To Stop!

by Anura Guruge


Whichever way you look at this, it is a TRAVESTY.

Why is the Doctor billing $1,004 if he is willing to settle for $143?

Wouldn’t it be better for all IF he billed say $200 & got paid $200?

Yes, having been there myself, I UNDERSTAND that this does NOT apply to the POOR UNINSURED soul. They will be hounded for the FULL $1,004. Is that FAIR? Of course NOT.

This is what is WRONG with the ENTIRE medical system in the U.S. of A.

This has to be fixed.

This was from 2019 when I busted my knee. They asked for $17,000, they got paid $5,596! CRAZY.

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by Anura Guruge

Selfies My Way — On Turning 66 (Just For The Record).

by Anura Guruge


Click picture to ENLARGE.

Yes, you are free to steal these pictures.




Another supposed milestone come and gone. But, I really am NOT fussy about birthdays — given that I am adopted. So, can’t really be sure when I was actually born. Doesn’t matter. Not a major birthday, anyway. Last year I was eligible for Medicare. That was BIG. As far as I know there is nothing else I will get beyond that.

These were taken at “Warren’s Lobster House” in Kittery, Maine. They have a fairly big mirror. I think I have taken selfies there before.



51 posts in the “Taking Selfies My Way” series.

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by Anura Guruge

Medicare Supposedly Pays $17,000 For A Knee Replacement, Only Paid $5,596 For My Knee Surgery.

by Anura Guruge


Click to ENLARGE and read here. From ‘The New York Times”.


My Bill for Knee Surgery.

Click to ENLARGE and STUDY.



I had my quadriceps tendon repair surgery,
at ‘
Frisbie Memorial Hospital‘ —
performed by Dr. Charles Blitzer
of ‘Seacoast Orthopedics
on Thursday, March 7, 2019.

There was no pain to talk about
— throughout, from surgery to now.



Knee replacement, of course, is a much more involved procedure with expensive hardware involved. In my case they only had to insert 3 small ‘fiber’ plugs. So, there was no hardware costs. But, it just goes to show.

Yes, I know of doctors that will NOT accept Medicare patients just for this reason. The lower reimbursement. Not sure whether this applies to surgeons, especially orthopedic surgeons. They must get most of their business from old codgers like I who need knee and hip replacement — though I was, of course, different.

That huge 100% price differential is NOT RIGHT. It is worse if you don’t have insurance. Hospitals really rape you. I know. Dartmouth-Hitchcock raped me — anally at that.

There has to be a middle-path. Between the Medicare amount and what other insurances pay.

This is why the U.S. healthcare system is so screwed up.

I am sure glad I have Medicare — with the Humana Advantage overlay on top of it (which costs me NOTHING).


 

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by Anura Guruge

The Bill For My Quadricep Tendon Tear Knee Surgery.

by Anura Guruge


Click to ENLARGE and STUDY.



I had my quadriceps tendon repair surgery,
at ‘
Frisbie Memorial Hospital‘ —
performed by Dr. Charles Blitzer
of ‘Seacoast Orthopedics
on Thursday, March 7, 2019.

There was no pain to talk about
— throughout, from surgery to now.



Pretty amazing. All of it. The surgery, the recovery and the bill. Overall I could NOT have been happier.

The surgery itself was near miraculous in that I essentially had no pain afterwards. Was able to stop taking Tylenol and Aleve by Day #8. Never had to take even one narcotic pill. So, that was great.

Wasn’t sure what to expect in terms of the bill.

I am amazed. Gobsmacked. I shouldn’t complain — but, I will, because I am like that. Smile.

So, who do I have for insurance. An Humana Advantage Plan (on top of my Medicare). The Plan is HumanaChoice PPO. I don’t pay a premium. They get my Medicare premium from what I gather.

That they can just write-off $12,166.56 of the bill is MIND BLOWING. If I didn’t have insurance I would be on the hook for this.

This bill is worth studying.



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by Anura Guruge

Planning Ahead: Financial Tips for Disabled Individuals — By Patrick Young.

Patrick Young is an educator and activist. He believes people with disabilities must live within a unique set of circumstances–the outside world often either underestimates them or ignores their needs altogether. He created AbleUSA.info to offer helpful resources to people with disabilities and to provide advice on navigating various aspects of life as a person with disabilities.

Click to access.


This is the 3rd guest post by Patrick Young on this blog.


Planning Ahead: Financial Tips for Disabled Individuals

Image from Pixabay.com.

Disabled individuals comprise America’s largest minority group — just under 20 percent of the population, according to the National Disability Institute. Unfortunately, those people face significant obstacles, including (but not limited to) financial stability. Stable employment is often a problem for the disabled, as well, and they may accrue living expenses and often-fragile health circumstances that non-disabled people don’t face.

Financial assistance through public benefits such as Medicaid and Social Security may be affected when disabled individuals have too much in savings or other assets. It’s important to discuss your financial options with a financial planner or someone who understands the options that are available to you. Here are some things to keep in mind.

Savings, Tax Breaks, and More

A personal savings account is one of the best ways to provide for your future. Set aside a certain amount every month, have it automatically deducted and placed in an interest-bearing savings account, though it’s important to set aside a manageable amount. Take advantage of tax credits and benefits and use them to boost your savings, and don’t undervalue the many discounts available to disabled individuals from a number of organizations and businesses.

ABLE

ABLE (Achieving a Better Life Experience) are accounts to which anyone may contribute up to a certain amount ($15,000) and can be set up by or on behalf of disabled individuals (as long as they became disabled before age 26). ABLE accounts don’t impact your eligibility for Medicaid or Supplemental Security Income, and taxes aren’t taken out of distributions provided the money

is used for qualified disability expenses involving housing, transportation, education, health care expenses, assistive technologies, or financial management.

PASS

If you’re receiving Supplemental Security Income or Social Security Disability Income and wish to save for a work-related objective, you may be eligible for funding through PASS (Plan to Achieve Self-Support). PASS allows you to save money if you’re working toward a degree, want job training, or wish to launch a new business. Note, however, that work-related goals include income that may reduce your Supplemental Security Income or SSDI benefits.

Special Needs Trust

A special needs trust offers a way to manage resources for disabled people without putting their government benefits at risk. Trust distributions have to be in the individual’s best interests and be solely for the beneficiary, who must have no other available resources.

Individual Development

Individual development accounts (IDA) are good options for disabled persons because they can earn two-to-one matches toward their savings objectives. Another benefit is that a funded IDA account allows a disabled individual to save money without worrying about losing Supplemental Security income benefits as a result.

Looking Ahead

It’s important to plan ahead and try to foresee health needs as you grow older. Medicare is a valuable resource for seniors but there are important needs/coverage gaps that can be a problem for older individuals. Supplemental coverage can help you cover expenses such as prescription medications with a Medicare Advantage plan or Medicare Supplement insurance. Medicare Advantage plans help cover vision and dental benefits along with prescription costs.

Medicare Supplement insurance helps cover Medicare Part A and B copayments, deductibles, and certain out-of-pocket costs. Medicare Advantage and Medicare Supplement plans are sold by private companies, but you can’t have a Medicare Supplement and Advantage plan concurrently.

Establishing financial stability is a lifelong endeavor, so the sooner you can get started planning and saving, the better for you and your loved ones. There are many ways for disabled individuals to save money, but it’s important to understand how different plans work and how they impact government benefits. If you’re not sure how it works, take the time to talk with a financial planner to make sure you get the most out of savings programs.

Apple Watch 4 (With ECG), For Free, To Seniors With Medicare Advantage Plans?

by Anura Guruge


Click to ENLARGE.

From CNBC.


This could be HUGE — for all sides; win-win-win. By that I mean, HUGE for: Apple, seniors who get it & the insurance companies (like Humana) that may participate.

Apple Watch 4 has 4 important HEALTH-related features, of particular pertinence to seniors. They are:

  1. ECG/EKG reading off the wrist.
    ….
  2. Fall detection using gyroscope.
    …..
  3. Emergency SOS (i.e., 911) calling.
    ….
  4. Relaxation (reduce stress) APP.

In theory, these features could help insurers safe money. So, that is what this is all about. Some Medicare Advantage plans (and I do have a Humana Plan) pay for Health Club membership. So, this along those same lines.

This would be HUGE for Apple. If Seniors start promenading around with Apple Watch 4s others will follow. Great marketing for Apple. The best.


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by Anura Guruge

‘Obamacare’ (i.e., ACA) Struck Down In Texas — Sure Glad I Just Got Out.

by Anura Guruge


Click to access MSNBC original. Google for more.


Well ACA, i.e., ObamaCare, still stands because this is sure to go the Supreme Court. But, IF I still relied on ObamaCare for our insurance I would be panicked. But, just last week the last of us got off the ACA system. WOW. What a relief.

I got Medicare in September. The wife already was on Medicare. Third daughter turned 18 in October and as such could apply for coverage on her own. That just left the 12-year old. Since both parents are on Medicare the State is going to cover both these two kids. So, for now, I am DONE with healthcare.gov. What a relief.

But, I feel for those that still have to rely on ACA. For all its faults it was better than anything we had previously.

I really hope ‘they’, i.e., Trump, doesn’t kill it.


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by Anura Guruge

When Looking At Medicare Supplemental Plans It Helps To Create A Spreadsheet.

by Anura Guruge


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At least in my case I wanted to see the total MAXIMUM yearly costs for the relevant plans.

Just the monthly premium tells you little because you have to factor in the deductibles.

I amortize the deductibles across the year and add them to the premium. That then gives me a much more representative comparison.

Creating a spreadsheet like this is trivial. I will gladly send you this … you will just have to plug in YOUR monthly premiums. The deductibles are the same for ALL OF US — and these are the 2019 deductibles.


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by Anura Guruge

Medicare Supplement High-Deductible Plan F (F+), Is Often The Better Deal.

by Anura Guruge


Click to ENLARGE.


Check out the math.

The difference between Medicare Supplemental Plan F and High-Deductible Plan F (i.e., F+) is the $2,240 (in 2018) deductible. With F+ you have to first pay the entire $2,240 deductible before ANY insurance kicks in.

Now do the math. And I did it for you above.

Assume that YOU will EXCEED the $2,240 deductible. So just factor it in as a 12-month ‘premium’. So, that is $2,240 ÷ 12 = $186.67 a month.

Add that $186.67 to the F+ premium, in this example $72. $72 + $186+67 = $258.67.

Cheaper whichever way you try to skin this cat.

OK. So you have to pay the deductible to begin with. But, you are saving $62.33 A MONTH to pay that deductible.

I am all in favor of F+. That makes sense to I.


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by Anura Guruge

Beauty Of Social Security: Payments In Arrears, Medicare Premiums In Advance!

by Anura Guruge


Click to ENLARGE and ENJOY here.


Got this letter from Social Security yesterday and its obvious irony made me smile.

That Social Security pays one month in arrears is legendary. So, the month you are due to start getting ‘Social’ you don’t get paid. You get paid the following month. I think this means that YOU miss out on a month while still alive but your estate will get that month when you die. Nothing you can do.

So, you would think that the same rule would apply to Medicare premiums, i.e., they will collect in arrears to stay lock-step with their payments. No, Siree. They collect premiums one month in advance! Talk about nickel-and-diming folks.

Only in the U.S. of A.


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by Anura Guruge