Medi(s)care - A journey into the morass!

Note: This post is kind of long but I wanted to detail my journey into the medicare world in case it can help anyone. And, FYI, I hate the word "journey". It's very overused, but it was apropos here!

Ok, your boy is on Medicare.

"Wait, what? You're not 65!"

Nope, I am not. But one of the things that happens when you enter the magical world of cancer is that you become eligible for Social Security Disability Insurance (SSDI).

First, let's discuss how you become eligible. My friend Bryce Olson, who was a great friend (and my inspiration in many ways and for many things), gave me the tip at a coffee. He was traveling a ton, surfing, exploring etc and I asked how he was doing it. He told me about SSDI and how when they determine that you are disabled, they pay out a monthly check. He also suggested that I reach out to a company called Allsup to learn more and to find out if I was eligible. Allsup does all the work for you and takes a cut of the settlement check as payment (more on that in a minute).

I reached out to Allsup, took a 30-minute online questionnaire, and they did everything else. They reached out to all of my doctors, filed all of my paperwork with the Social Security office, answered all of my questions, and became my single point of contact. When you are dealing with government stuff, single points of contact become worth more than gold. I have never stepped foot in the Social Security office or had to meet with a Dr. about it because of Allsup. They handled it all.

SSDI works because the government determines a day you were considered disabled. They then give you a settlement for any payments that would have come from the day you were disabled until the day Social Security approved your status. So for me, that was 6 months. So, the math is that they take 6 months, multiply it by the monthly check amount and wrote me a check for that bulk amount. I paid Allsup 25% of that check. I then get monthly checks but Allsup doesn't get any of those. But, they still act as my agent and help with everything. There are more details and more programs but hopefully, this was helpful.

SO, my "disabled" date was June 1, 2022. A big benefit of SSDI is that once you are approved, the countdown begins and you become eligible for Medicare 2 years later. Hence, my Medicare effective date of June 1, 2024.

(In terms of Medicare (and a side note), if you are in favor of cutting it, I don't like you. Yes, as a person. It's a lifeline for a lot of people and being a patient is NOT cheap! 66.5% of US bankruptcies are due to healthcare. Don't take it away from people!)

When you qualify for Original Medicare, you qualify for Part A and Part B. Part A is Hospital, and Part B is Dr, tests, treatments, etc. There is a monthly premium for Part B but it's very cheap. Part A does not have a separate premium.

Now is where the fun starts. Medicare has a ton of different machinations and parts and no one really explains any of it well. You need to do a lot of research on your own.

Part C is Medicare Advantage (MA). Medicare Advantage is a program that allows a health plan to be responsible for managing your Medicare. There are usually some benefits to it. It can be free (no premium - they make their money from CMS (Center for Medicare and Medicaid Services) which runs Medicare). They manage your Part A and Part B and also cover vision/dental/hearing (depending on the MA plan you choose). They can also include Part D, which is the drug and medication coverage (for things not covered in Parts A and B). There can be some other pros as well. The big disadvantage to MA is the network. You are required to see doctors only in their network or pay a lot for those who aren't. You also have your deductible, your monthly premium (if there is one), and your out-of-pocket (OOP) maximum (the most you can pay a year out of your pocket). The OOP almost doubles the minute you see an out-of-network doctor. For me, I think the OOP was $5,300 and $9,700 for out of network.

For my type of cancer (Neuroendocrine Tumors) everyone recommends not using MA. So, I went on the hunt again (I had MA all set up and then canceled it). I found another supplement (I asked a lot of groups on social media to see what others have done) called Part G. Part G is also referred to as Medigap. And, while also run through a health plan, the only cost is your monthly premium (and your network is still all of Medicare). There is no OOP, Deductible, out-of-network, or anything else. It simplifies a lot for me. I also got a separate Part D (drugs and meds, remember?) to help offset any costs there.

Thanks Humana for the graphic!

So, I now have Medicare Parts A and B, supplemental Part D for drugs (through WellCare), and a Part G Medigap supplement through a Blue Cross Blue Shield plan. My network is anyone in the world who accepts Medicare (which means second opinions will be much easier), and all I pay is my Part B premium (under $200 a month) and my Part G supplement (about $200 a month).

Confused yet? It's pretty incredible. Yet another reason the world needs more marketing! Speaking "human being" is an art form that is highly underutilized!

Here are the downsides of Medicare and my Parts A, B, D, and G. First of all. No dependents. So Krista and the family need another plan. So even though Medicare is cheaper, we are probably close to breaking even on total cost. The other negative is that Medicare is very behind the times in terms of what they cover. For example, you can only get acupuncture if you are diagnosed with chronic lower back pain. That's it (no seriously. That's the ONLY acupuncture treatment covered by Medicare). I can't get it to help with cancer. My naturopaths are also not covered by Medicare. So it looks like all of my integrative stuff will be paid for by me, out of my pocket. I am lucky that I can do this. A lot of people can't. To my knowledge (and I am looking) there aren't any plans that cover integrative treatments (like acupuncture). There might be a great business opportunity here! All the other stuff I mentioned, Parts A,B,D,G are all based on Medicare so if original (basic) Medicare doesn't cover it, none of the parts or supplements do.

My advice is to ask a lot of people. We are all different so you have to do your homework. I almost rushed in a few times to things that wouldn't have worked for me, and every day I learn something new about the coverage, literally.

If you are in WA or OR, I have an amazing broker who can help you if you need it. If you are in other places (or in OR or WA) and want to chat, let me know and I can try to help make recommendations or give you other resources.

I hope this post helped a bit. It's really confusing but I am hoping that sharing my experience and decisions might help, at least a bit.

Good luck! This shit isn't easy. I am convinced it will make life easier, but, as we say, sometimes you have to go through some pain to heal (I might have made that up!)