Some SHINE and a Little Gratitude Too

Medicare and those who rock my medical world

As you, my dear readers and friends know, I have faced some medical trials of late.  On top of the whole MS nightmare I’ve dealt with breast cancer and, perhaps most bizarre of all, hives!  I’m frustratingly itchy (again,) and directly in between the whole MRI workup for an MS follow up.

But I’m also cancer free!

And more than anything, I’m grateful.

Grateful that the cancer is gone.

Grateful that God helps me through.

Grateful that I have my sense of humor and my classic rock CD collection to also help in the bad times.

Here are some other specific things for which I’m also grateful-

My plastic surgeon who is so proud of his work he practically dances when I show him my chest.  (I’ve said it before and I’ll say it again; I really, really think he’s a boob man.)

The MRI technologist who actually gave me a leg massage while her colleague shot me up with dye after I said my leg was spasming.

My friends and family who were there for all kinds of support, visits, keeping me fed after my surgery and not bringing anything made with broccoli, mushrooms or hard boiled eggs.  Double shout out to the ones who really cared and brought chocolate!

The home health aid who took out my trash, did my dishes and compassionately helped me with a sponge bath, in the reverse order, thankfully.

My friend/cousin/sister who became my personal chauffeur, medical adviser and top pillow provider. Actually, she was my only pillow provider.  How many pillow providers does one really need?

One friend in particular who made me a boob cake and another who wrote me a boob poem. I have very weird friends for which I am also super grateful.

The friend in another state who sang her support in front of many, many strangers and killed it despite the technical difficulties.

All the cool people who gave me other super fun gifts over the last few months- fruit, cough drops, puzzle books, reading materials, medical supplies, cash and all kinds of other fun things.

The sweet canine who gifted me a DVD of a rare movie that I was eager to see.  I already knew dogs were kind and smart but who knew they could also use Google and credit cards!

My mom who hung out at my apartment just to flirt with the rental chair guy and the alarm guys who happened to be hanging around.

The CNA at the hospital who took time out of her busy morning to make me a real cup of tea!  It was like heaven!

The friend in another state who sang her support in front of many, many strangers and killed, it despite the technical difficulties.

Speaking of singing, I’m grateful to the handsome night nurse who sang me love songs at 3 AM.  Unfortunately, I was too out of it to find out if he was single.

My local hospital that just built a wing that offers a view of the harbor and the patient before me who luckily healed just in time for me to be the bearer of their cool room.  Nothing says pain relief like the watching of fishing boats at sunrise heading out to make a living in the chilly March waters.

You, my awesome readers who have kept me company these months even if you were laughing at my experiences- rude!

And through all this, I’m grateful to the taxpayers of the USA who helped me considerably by keeping my out of pocket costs down.

Several years ago, when I became eligible for Medicare, I was grateful then too, but it was all so overwhelming.

What did I know about deductibles, tiers, enrollment periods and formularies?  Somehow, I discovered a SHINE person. SHINE stands for (Serving Health Insurance Needs of Elderly) and they hang out at the local senior center.  And while I wasn’t quite elderly, not yet anyway, seems like they help the disabled too.

The amazing lady I worked with took all my RXS, diagnosis, doctors, specialists and questions and rolled them into a specific Medicare and secondary insurance plan.

I don’t often work with guest bloggers on my website unless they are very funny or want to give me a lot of money.  But I’m so grateful to all of you and think this is relevant information, that when I was contacted by Danielle K. Roberts, I wanted to share her very helpful post.

Read on to learn some things you might not have known about Medicare.

And, if I haven’t said it already, thank you!

Multiple Sclerosis and Medicare – How are Your Covered?

 

People who have been diagnosed with Multiple Sclerosis (MS) may feel nervous about leaving employer group coverage and enrolling in Medicare. MS is a chronic and progressive condition for which there is no cure. However, Medicare does provide coverage for the treatment of MS and there are no pre-existing condition exclusions when you first enroll in Medicare either.

Understanding what Medicare costs and how Medicare works to cover treatment of MS will help you to feel reassured about the level of coverage you can achieve with Medicare.

Original Medicare Benefits

When Medicare was first created back in the 1960s, they modelled its coverage after the traditional Blue Cross and Blue Shield where there was two distinct parts that cover hospital and medical care.

Part A pays for your inpatient hospitals stays, some home health care services provided in the hospital and any skilled nursing that you may need after a hospital stay.

All other non-hospital related healthcare services will be covered by Part B. This includes preventive care, doctor appointments. It also covers pretty much everything else that isn’t performed as part of an inpatient stay. Medicare Part B will cover your lab testing, diagnostic scans, physical therapy, speech and occupational therapy, medical equipment and supplies and urgent and emergency care too.

There are several injectable medications that are used in the treatment of MS. Part B covers these too if they are administered by your physician in a doctor office setting.

Outpatient Medicare Benefits

Medicare Part B is the part that most of your treatments for MS will fall under. For example, if your physician orders blood tests to rule out other medical conditions or a spinal tap to verify a potential diagnosis of MS, Part B pays for this.

He may also order physical therapy to help you maintain your mobility and Part B covers this as well.

There are several prescription drugs that are commonly prescribed to treat MS. If your physician administers these himself, then Part B pays for these as well.

Your Medicare Part B Costs

Most people enrolled in Medicare Part B pay a monthly premium for this coverage. In 2019, that standard base premium is $135.50/month, but some people with higher incomes will pay more.

Social Security will deduct this Part B premium directly from your income benefits monthly, or if you are not yet taking SS income benefits, then they will bill you quarterly.

You will also have some cost-sharing as you use your benefits. There is an annual deductible ($185 in 2019) that you must satisfy up front each calendar year, and then Part B will pay for 80% of covered services.

After the deductible is satisfied, Medicare Part B will pay for 80% of the cost of your medically necessary covered services. You will pay the other 20% of Medicare’s allowed amount.

Fortunately, Medicare negotiates competitive rates to keep costs down. You can also enroll in supplemental coverage to help you pay for these deductibles and coinsurance.

Covering the Gaps in Medicare

Many Medicare beneficiaries enroll in supplemental coverage to fill in the gaps. Medicare supplements, also called Medigap plans, allow you to see any physician nationwide. There are no networks or referrals needed and most physicians do accept Medicare.

Back in 1990, Medicare standardized supplement plans to make your supplement comparison easier. You can enroll in a plan that meets your needs and budget. Since Original Medicare doesn’t cover outpatient medications, you would add on a voluntary Part D drug plan to help you reduce the costs of your prescriptions.

Another option is to enroll in a Medicare Advantage plan. These plans often have lower premiums than Medigap plans but you will have to use a smaller local network of providers and pay for your share of services as you go along.

Speak with a Medicare insurance broker to help you compare plan options and decide on the coverage that is right for you.

Do you have questions about Medicare coverage with MS? Boomer Benefits is a Medicare brokerage licensed in 48 states, representing over 30 insurance companies. You can reach out to our team at 855-732-9055 or through our website at https://boomerbenefits.com.

 

Danielle K Roberts is the co-founder of Boomer Benefits where she and her team help baby boomers navigate Medicare. She is a member of the Forbes Finance Council and writes frequently about Medicare, retirement and personal finance.