Medicare, Disability, Drug Plans, Advantage Health Plans

Hello Everyone!

I got a letter from my insurance company stating I was losing my secondary insurance, (Advantage Health Plan) on Dec. 31, 2014. I have been searching and searching for another policy. In my area, there are only 3 policies to choose from! I personally think this is ridiculous!!! People that are on disability, social security, and medicare are being treated like dirt! People don’t realize that when one is on medicare original, we have to pay $105.00 per month for that. Then on top of that we have to pay for a drug plan, so we can get help with our medications. On top of that, people with medicare have to pay 20% of all the costs that medicare does not pay for. When you take all of this out of a disability check, you have no money left for other things you need. I bought an Advantage Plan to help cover the cost that medicare does not pay, now I am losing this.

What I want people to know is that when one is on disability, social security with medicare, we do not get our healthcare for free. We pay for it every month out of our check. If one just uses the medicare original, it costs us $105.00 monthly, and we would have to pay the full price for our medications. BUT, the government says we HAVE  to buy a part D plan (Drug Coverage) to go with the original medicare or we will get a penalty. Part D plans can cost anywhere from $12.00 – $75.00 per month depending upon how much help a person needs with their medications. The majority of these plans have co-pays for each medication that one is on. If you buy a cheap plan the co-pays are higher! There is also something medicare refers to as the “Donut Hole” or Gap in coverage. When a person hits this cost, they have to pay the majority of the cost of each medication, which can be very costly and the Gap usually ends up to be the last 3-4 months of the year.
Happy Thanksgiving and Merry Christmas.. now you don’t have money for Christmas presents for the family!!

Now lets move on to the Medicare Advantage Plan, like the one I will only have for the next 2 months. The Advantage Plan is a policy you buy from a private insurance company to help what medicare does not pay. These plans help cover medications, doctor visits, and hospitalizations, but they have co-pays that one has to pay. So if you pick this plan you will be paying anywhere from $55.00-$200.00 per month, plus your co-pays for office visits, hospitalizations, and medications, but these can be cheaper than just the Plan D (Drug Coverage) in the long run, because you are getting help with the other things. My Advantage Plan was wonderful! I didn’t mind paying $155.00 for my Advantage Plan + $105.00 for my original medicare, total of $260.00 per month… (yes, even though you buy an Advantage Plan or just Plan D, you still have to pay the government the money for the original medicare too!) I had wonderful coverage, and minimal co-pays for my medications and office visits. Matter of fact, when I had my neck surgery in 2010, my co-pay for the surgery was $1000.00! That’s great when the total cost of what they did was almost $21,000.00!

Ok, so what happened!?!
Well, some of you may not like what I’m going to say, but I personally think this has to do with Obamacare. All the rules and regulations they put into Obamacare that the private insurance companies have to abide by are making it so much harder to find a plan that will help people on Disability and Social Security. All the health plans now have to include coverage for pregnancy and birth control, and you can’t buy a plan without this… which makes the cost go up for everyone, not just the people on medicare! I am 49 years old, I have 2 children. One is 26 and the other is 21. I surely don’t want anymore kids! I am too old and with my disability, I could not take care of a child 24/7…

Now don’t get me wrong, Obamacare has helped us a little, by adding some preventative care things to medicare, but, it has also made it so much harder to find policies to help people and the cost has went up twofold.

Whether you agree with me or not, that’s ok. Everyone has their own opinion.
This is just my opinion out of many.

 I hope all of you have a great day, and I hope your pain level is low.

I Love each and every one of my Chronic Pain Buddies!

Karla, LPN,
Vice President and Board Member of Dr. Patty’s CIPAY


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