Looking ahead, financial burdens.

[camiboxer]

I hope this conversation is permitted even though it is not specifically related to treatment.

I am researching, contemplating, learning and crying. When my dad was getting ready to lose his insurance due to going on SS at age 65 I attempted to help him out with his choice on Medicare options. I guess I wasn’t quick enough or didn’t have enough knowledge (I don’t) about insurance and he opted to go with what another family member had.

He is a vet and opted to not get any type of prescription coverage via Medicare because he was told that scripts were pretty feasible when dispensed thru the VA. So far, prior to MDS dx they have been. I have heard horror stories concerning VA care as well as not providing needed meds, (not formulary). Dad was on Crestor and doing well. They don’t have that so they put him on Zocor, well low and behold his LDL has plummented terribly.

He does have a supplemental policy with United American Insurance that I found out about today. I don’t know any specifics on that coverage yet.

He has no savings and no surplus income. He and step-mother are both on SS and he gets a pension from the Teamsters Union. They survive, buy what they need and occasionally what they want.

I am literally terrified that he will FORGO treatment if he finds out that it will cost too much. He will be thinking along the lines of “Why put us into debt, only to die, leaving a heavy debt for wife to have to deal with”.

A friend in the insurance industry suggested to me that dad and step-mom sign over their owned properties to me, hence leaving them without any assets. I guess her thinking was “They can’t take from them what they don’t have”. Do people really do these type of drastic measures to ensure care?
Susi

[Neil]

Hi Susi,
Have a couple thoughts for you to think about.
Many of the high cost drugs used to treat MDS (Procrit and Aranesp) for example are covered under Medicare Part B. His supplemental will pick up the balance.
If he decides he does want Part D drug coverage, he can apply for it in Nov and Dec of 2006 and be covered as of 1/1/07. There will be a small penalty. The penalty will be 1% of the average cost of all 2007 Part D premiums. ( the penalty in Minnesota for the remainder of 2006 is about 33cents a month. 1% of $32.27). There is a possiblility congress will cancel the penalty
if they get a bill yet this session. Would not hold my breath on this
You might want to check with his docs office. They may have a specialist on insurance issues in their business office.
Contact a Senior Counseling service in your community. They no doubt have insurance counselers that can help with what is available in Ohio. Some with limited means can get financial aid for medical and drug coverage.
The VA may or may not be of value. Depends upon if they have a hematologist with experience treating MDS.
I qualify for VA benefits, but have opted to go to a doc of my choosing. Between Medicare and my supplemental coverage virtually all of my medical and drug expenses are covered.
Hope this helps you get started. The help is out there.

[Bkwits]

Hi Susi,

My husband had Medicare A & B, and he also had Blue Cross supplement insurance. He did not have any drug coverage. He was also entitled to go to a VA hospital (which he never did). He had CMML and other health problems. He had numerous transfusions, Chemo treatments, Procit shots, and other expensive treatments, as well as dialysis due to Kidney failure. He had several surgeries, even though he had very low platelets. He was transferred to a Rehab center twice, only to be sent back to the hospital. I’m sure that the total billing was over $300,000 for the last 3 months of his life. I ended up paying about $100, total. Medicare and his standard supplement paid everything. Most of the $100 was for transportation to the hospital from the rehab center.

Please don’t worry too much ahead of time. You are doing the right thing in learning as much as you can about MDS. Thank goodness I had found the forum and other info, so that I knew what the hemo Doc was saying when he said that Joe had CMMoL. I asked him if that was the same as CMML, and he said yes. Fortunately, he gave us a copy of the BMB.

My very best hopes and prayers for your family.
Barb

[camiboxer]

Thanks for your replies. I should have mentioned that he has Medicare Part A only and not B. I will have a better understanding once we speak with the Dr, I am sure.
I like to be as loaded with as much info as I can. I hate getting blind sided!
Thanks again,
Susi

[gemloyear]

Hi Susi, If he is over 65 he would qualify for part B coverage. Have him go to the S.S, office and apply for it right now. If I remember correctly one only has a certain amount of time to apply for part B after they turn 65.Also check to see if the United Amer. Ins. has prescription coverage that could be added to his policy.
Yes people do go to such drastic measures, but there is a time frame in which to do this. In our state it must be done three years in advance of applying for any assistance. Many elderly people are reluctant to do this in fear of giving up their independence or in not trusting their children or anyone with their property or assets.I worked in a nursing home for many years and there were a number of residents who had turned over assets to their families for various reasons.
I worry too, but most of the time things turn out better than I expect and hopefully they will for you too.
Take care Ellie

[Bkwits]

Susi,

Part B normally pays most of the doctor’s bills, (usually 80% of what Medicare allows) and the supplements pay the rest (depending on the supplement plan). How is his doctor being paid now?

Barb

[Terri]

Susi, We have private insurance that also includes a prescription plan, However Bob’s PRocrit and Vidaza are both administered at the doctors office so it is covered by the regular insurance part not the Prescription plan. I have an Open Access HMO which follows a lot of the MEDICARE rules. So not sure of the Medicare but you may want to check if administered at the doctors office how would it apply

[Naomi]

Susi:
I was getting all of my meds through the VA…even exjade. I saw a PA twice a year and had all of my meds as needed. The VA tried to transfer me from aciphex to priolsec. I could not tolerate it and it did no good for me. I told my PA and she changed me back and noted that I could not take the priolsec. I had no trouble and all of my meds were brand names even if they had the generic name on them. I would just notify the VA pharmacy about two weeks before running out and the drugs were mailed to me. It was $8.00 for 30 days supply.
If you have any questions, feel free to ask me.
Naomi

[franm]

Susi:

My husband who is 74 and myself who is 72 are both on Medicare. Jim get’s his heart drugs as well as anyother drugs he takes from his primary care doc. from the VA. When I found out last year that he had MDS, he got out of the HMO that we were both in and signed up for Medicare plus AARP (Untied Health). He had to pay 204.00 a month plus he signed up for Humana, which cost addtional 20.00 a month. It seems that his Vidaza that he takes 7 days a month, plus his visit to the Oncologist is covered by these insurance.

Check into what I said and see if that will help financially.

Husband and I are both on SS only. We try to get by and we have been married for only 12 years. It is hard but we will make it.

Fran

[covergirl]

Hi Susi,
My Mom is a veteran’s widow and I take care of most of her business affairs. She is covered by Tricare for Life. Sort of replaced Champus. Anyhow ALL of her meds are covered by T4L and because there coverage was so good, she did not need Part D coverage. She takes meds for renal failure. Please check to see if your father is eligible for Tricare for Life. http://www.tricareforlife.com/

–cheryl

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