A couple of days ago, Rick posted some information on Canada’s Universal Health Care system. I am not here to debate which system is better, although on the surface, it sure sounds like Canada has it all over Medicare. What my goal here is, to tell you what I have learned as a recipient of Medicare in the time Russ and I have been subject to its intricacies. Maybe I missed it in Ricks blog, but I wondered about prescription drugs in Canada. Do you have to have an additional insurance policy for drugs and do you have to pay for drugs you use? Do you have dental and/or vision coverage? Is every province on a different plan and do you have to do anything special if you are not in your home province (but still in Canada)?
I certainly welcome any other views as I honestly and sincerely do not know what the answer is. I know that as the population ages, the problems we are already seeing will only escalate. I know that older Americans are running out of money to pay medical bills. I know the system is broken. the question is, how do you fix it?
Someone commented on Rick's post wondering if higher income taxes in Canada might be paying for part of the medical insurance coverage. Can they really be that much higher than here (just wondering)? I thought we were paying through the nose, but maybe it's not as bad as I thought!
We have seen what happens when our government touches anything. It seems to go from bad to worse.
My main concern about universal health care is that if the government is in charge, it can only get worse. With the donkeys we have in Washington running the show, what could possibly go right? Government interference in medical care is my greatest fear but I suppose with Medicare, we’re right there already. If Medicare is any example, then I don’t think I want anymore government run health programs…but read on please.And now a bit about our experience with USA health care. Before Russ was on Medicare, we had private insurance. We paid almost $1200 per month for medical and prescription coverage – no dental, no vision. Plus we still had co-pays. This was under his retirees benefit program from Weyerhaeuser. Can you believe it would have actually been higher if not for the retiree's program? When he turned 65, and when I was declared disabled, we were REQUIRED to go on Medicare.
We didn’t have too much problem with forms, under the private insurance, as the doctors billed the insurance directly. But if the billing code was incorrect, then there were all kinds of problems to resolve.
Now we are both on Medicare. In addition to the Medicare premium of over $100 each per month, we both have a Medicare supplement which picks up part of what Medicare doesn’t pay. We pay about $160 per month for the two of us on this. We also are REQUIRED by Medicare to carry a prescription policy (Part D). Between the two of us we pay about $60 per month for this coverage. My plan is $45. and Russ’s is $15 but I didn’t have a deductible. Are we all confused yet? Try reading the brochures and online resources and then picking the plan that is going to provide the best coverage. IMPOSSIBLE!
Talk about PAPERWORK. Russ is diabetic. He has been on Medicare since April 2011. Our Medicare supplement is with Mutual of Omaha and our RX plan is with Humana. Diabetes supplies (test strips, needles, alcohol swabs, etc.) are considered durable medical equipment rather than drugs
but we have to order them through our prescription plan. So we have to jump through all kinds of hoops and deal with all three insurance payers to get anything done. Multiple calls, letters, faxes, to and from the doctor and just last week Russ finally got some needles - at an outrageous cost. He is already in the "donut hole" so all expenses are out of our pocket. Do we get to quit paying insurance premiums while we are in the donut hole? - not a chance! So we pay for insurance that we cannot use plus pay all RX and durable medical costs out of pocket. Oh, by the way, he STILL has not received any test strips! While the insurance fights back and forth with the doctor, we go to Wal-Mart and buy what we need! His poor doctor must just be frazzled with all the calls to insurance just to get Russ test strips and needles.Russ has been getting his Insulin all along but no needles to inject it with and no strips to test his blood. The latest letter from the insurance (received yesterday) states that they cannot fill the order for test strips as he does not show a diagnosis of diabetes!!! HUH???? They send insulin and needles, receive an RX from the doctor for test strips and they say he doesn’t have a diagnosis of diabetes???? I think their game is to just deny us as long as they can, knowing we will go buy these supplies on our own. When we buy things on our own it does not count against the amount we need to spend to climb OUT of the donut hole!! Can I hear a big "GOTCHA"?
Oh, my prescriptions? I take three and can get a 90 day supply at Wal-Mart or Fred Meyers for just $10 each WITHOUT INSURANCE! But I can get them for FREE from Humana – I only need to pay the $45 per month premium! Let’s see 3 months at $45 = $135. Without the insurance I could get the same medications for $30 for all three for 90 days. Is there something wrong with this picture? Remember, Part D, prescription coverage is REQUIRED!
Part of my question about the Canadian plan was the wait for service. I can call any specialist and get an appointment in very short order. There is little waiting for elective surgery. (Why do they call it “elective” to have a hip or knee replaced? Like you really WANT to have that done?) But this runaround with the diabetes supplies has me wondering what the heck is going on. Talk about a wait for service!
I still don’t know what the answer is. I think a lot of RVers are in this same position or will be as soon as they turn 65. With elections coming up next year, we need to figure this out. I fear that the system is broken beyond all repair as I can see no equitable and sensible solution. Maybe I’ll just move to Canada LOL!! (really I LOVE the USA, I just don’t like our politicians all that much!)
Do YOU have an answer? What has been YOUR experience with Medicare? Maybe our experience is the exception rather than the rule???
Here’s another blog from RV Life is Good that I read and found interesting. Beware, this one is a bit more outspoken.
Just for clarification, when I said "donkeys" in Washington, I was not referring to any one political party. I distrust them all equally. "Donkeys" is just a nicer name than what I wanted to call them!!
ReplyDeleteMedicare combined with a supplement has been an absolute gift for us. Mike had an operation on Feb 9th which took an unexpected turn and he was not able to return home until April 1st. We have Medicare and a BC/BS supplemnt which is around $300 a month.
ReplyDeleteHis hospital bill alone for 10 days was over $238,000. I still have no idea how much the rehabilition came to. We though long and hard about paying the $300 for the Blue Cross/Blue Shield supplement last year...I always hope than insurance is one of the things that we are just throwing money away on..do not want it to pay for itself. I have yet to have the prescription plan pay out anything for me (and I am very grateful about that) but they pay a lot for Mike.
being from British Columbia, like Rick..we have medical/extended medical and dental through my place of employment.it is deemed a taxable benefit..about $35 a month for both of us...most things are covered..under the medical part/prescriptions you have to pay a deductible of $100 for the year and then after that Blue Cross pays a portion on the prescriptions and then we pay the balance/..vision?..we are allowed one pair of glasses each every two years..and get re-imbursed for up to $350 and that is for prescription sunglasses too..eye exams we pay for at 75$ per..
ReplyDeletedental ..100% on regular stuff and 60% on crowns bridges and orthodontics..we also are allowed physio and massage unlimited..we pay and send the reciepts in and get 80% back....chiropracter..$200 limit for a year..
now when I retire we will still have medical/dental coverage but it won't be as good..I think the dental goes down to 75%..hope this answers some of your questions?..I read Kenny's post..someone is none too pleased!!
We are not old enough for Medicare yet, and who knows what it will be like in a few years. Medicare, like social security, is one of those things that probably sounded good at one time, but has grown into a monster that our country just can't pay for. Don't get me started on Obamacare--let's just say that I'm not a fan of anything that will bankrupt our country even more. Come on, politicians, listen to real people and get these systems back under control. And let's not tax people even more, but let's DO revise the tax code into a more manageable system. I'll probably end up in the bottom of the bear pit, but I'll enjoy my time there if we can get a balanced budget, just like we have at home!
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ReplyDeleteCertainly a lively discussion! I'm not sure Carol was advocating for the abolition of Social Security - just stating that it is a mess that also needs cleaning up. Sure hope they don't do away with it or I'll be up a creek!!
ReplyDeleteBeen doing some additional research on this subject and it seems most opinions are pretty polarized - on both sides of the border. Too bad we can't just trade places for a period of time and live each other's experience. 'Twould be interesting to say the least.
I think in both systems you will find people who have had really good or really bad experiences. I think those are the extremes. Also, you will find politicians on both sides of the border who will take contrarian positions as it suits their agenda.
I hope everyone will bear in mind that I am not asking which system is BETTER, just what the differences are so that each person can weigh those differences and decide for themselves what they think is the preferred method of health care delivery. We likely will not solve all the world's problems in a blog but an exchange of ideas should always be a positive experience.
Study on!
"Donkeys" is a far mpre polite description than what I've been calling those elected officials in DC ... esp. lately. IMHO all politicians are the same ... the world over. We're not at Medicare age yet ... I seriously doubt it will be around by the time we are eligible ... at least not in its present form.
ReplyDeleteWe are not quite there yet, age-wise, for Medicare, but it is right around the corner. Currently, we are covered under TriCare -- because hubby is retired military. When we become of age, Medicare will be our primary and TriCare will be our secondary. We must have Medicare Part A&B to remain eligible for TriCare. We currently have a supplement to TriCare, but it hasn't paid squat since we took it out, so we will be rethinking that situation! So far, we have been very pleased and feel blessed to have TriCare -- as long as we stay within the network of providers. TriCare is a govt-run program, but they seem to have their act together -- for now anyway! I'm not sure who is responsible for its overall management. Good post -- thanks for your thots...hopefully, "they" will realize Russ NEEDS his diabetic meds & supplies. Hubby is pre-diabetic, on oral meds.
ReplyDeleteWhat a mess... I don't understand a lot of it. I am not on medicare but my husband just went on it. He got a supplement and I carry dental still for us still from my work that i retired from. It just isn't simple especially if you are a trveler.
ReplyDeleteHave fun & Travel safe
Donna
I am in the process of deciding which supplement and which Part D plan to go with. We have to leave our HMO at 65 because we live in the wrong county! But that's OK because I want to have a more flexible plan if we ever get to travel.
ReplyDeleteCraig went on Medicare and A supplemental policy last year, but he has only been to the docotor once for a physical so he could get his blood pressure medication.
He has a part D plan, but we haven't used it yet. His blood pressure medication is only $7.00 per month and he has a deductable so I haven't bothered to do the paperwork.
I think we have the coverage so that if anything does happen, and he need medications he will have coverage. I'm switching him to the Walmart plan in December.
The combined cost of the medicare premium and the supplemental premium is far less than what I pay for an HMO now.
For us, Medicare has been great. My husband has Medicare with Blue Cross supplement though his prior job; the Blue Cross also covers me (5 years to go to Medicare for me).
ReplyDeleteMy husband was diagnosed with prostate cancer 3 months after he went on Medicare. With Medicare and the BC supplement, his 2 1/2 months of radiation treatment was completely covered.
Four months ago, he got a partial knee replacement - again, completely covered by Medicare and BC. By the way, knee replacements (and other similar surgeries) are considered "elective" because the condition is not life threatening, so doesn't require immediate attention... he could have waited longer if he needed to, but neither Medicare nor BC required us to wait.
Both of my parents are 86, and both are on Medicare. They like their doctors. When my Dad had a stroke 2 years ago, and then again last year, he had treatment at a state-of-the-art hospital and rehab facility, covered by Medicare. For them (and my 88 year old aunt), the biggest (and essentially only) hassle is the annual revaluation of what changes are being made to their coverage. They are in an HMO - I don't know all the details.
We were very disappointed when single payer was "taken off the table" during the health care debate. Talking with our acquaintances and siblings, it seem to me that for-private private insurers are FAR MORE likely to deny/delay coverage than Medicare is. I'd far rather have a government bureaucrat signing off on my healthcare than a mid-level manager of a for profit insurance company whose bonus depends on how much of my premiums he or she holds on to.
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ReplyDelete"I'd far rather have a government bureaucrat signing off on my healthcare than a mid-level manager of a for profit insurance company whose bonus depends on how much of my premiums he or she holds on to."
ReplyDeleteThat's a good point Laurie, frankly one I hadn't thought of. Thanks for sharing your point of view.
For us older folks (73 and 68), Medicare has done a fine job, coupled with our AARP Supplement. We have paid absolutely NOTHING for any medical care since getting that combination. Yes, it's expensive, $337 a month, because Suzy needs the highest level of coverage, while I just have basic coverage. But that premium comes out of the existing budget, doesn't spike one month and go to nothing the following month.
ReplyDeleteWe chose the AARP supplement because we still travel the country, and their coverage is nationwide. When we sign up to see a doctor in some new area, they ask what insurance we have. We tell them, and they nearly always tell us that the AARP plan is the easiest for them to work with.
Our dental is also through AARP, and it's pretty much the same as all of them with a graduated payout structure.
Oh -- I was wrong: in 8 years, we have had to pay for one vaccination Suzy got -- a major one for $70. But not a penny for knee replacement, shoulder replacement, heart catheterization, etc. Can't complain too much.
please don't blame just the democrats for the stolen $2.5 TRILLION dollars,, It was a mix of all Republicans, Democrats and the Wealthy, thats who Stole Your Social Security Money,, Do you think we will ever get it back,, HA HA ,
ReplyDeleteI worked for Nortel a global telecommunications Company and a subsidiary of Bell Canada. Many of our high ranking executives were working in the US on Green Cards to escape the Canadian health care plans. I worked for one who eventually became a US citizen because he didn't want to subject himself or his family to the Canadian system. That should tell you something. I heard many, many horror stories during my time with Nortel.
ReplyDeleteI have been fortunate (knock wood) because the few times I've had to use Medicare, I had no problems at all. I had cataract surgery and I could choose my provider and have the surgery performed by my choice of surgeon and time of surgery.
I kept my policy from Nortel for coverage for my husband and I. (Nortel has since gone bankrupt) When I turned 65 and went on Medicare, I converted to a retirement supplementary policy. It's expensive. 315 per month (the very talk of Obamanocare sent the premium way up) for an indemnity plan, and through it any drug I need I get for $7 no matter where I travel. I don't have to go to a primary doctor--I can choose a specialist of my choice and go directly to them. I don't even know about Plan B, D, etc.
Like one of the other posters stated, I'd far rather throw money away month after month for insurance than need to use it.
I think if I were traveling outside of the country I would take out a US policy for the length of time I was going to be gone.
At this point Michelle Bachman has my vote because she swears (who knows) that she will take down Obamacare. The whole thing is a farce. I know people who have no health insurance not because they can't afford it, but because they'd rather have a 2nd new car in their driveway.
The hospital my daughter works in is going broke because they do major surgeries including heart transplants for indigents. Patients don't have to be citizens and they are not allowed to turn them away.
Sometimes I wonder if we need insurance, at all, in the United States since we can get emergency medical care anywhere in the country.
I can't speak for what my children or grandchildren will face, but let's hope it's better than Obama's socialistic idiocy.
Okay, I'm off the soapbox--not totally finished with my points of view, but I think you get the jist.
Thank you for the forum to present my opinion.
@John...Thank you for your comment. Just wanted to laet you know that I absolutely DO NOT blame only the Dems for the mess we are in. That's why I inserted the little disclaimer as my own comment. After calling them all "donkeys" I just wanted to clarify that I wasn't referring to the democrats but to all the politicians that have put this country in the position it is now in. What I really wanted to call them was jacka$$es!!
ReplyDeleteOne reason SS is going bust is because when it was implemented people retired at 65, the expected average lifetime was 67 and people died of things that are easily cured, today; therefore, extending lifetimes and the number of years that people can collect.
ReplyDeleteThe problem is that these facts were known by many administrations which did nothing to fix it--same as the oil shortage, and who knows how many other things.
My husband put in all his life and never lived to collect a dime as he died before he was eligible for SS.
I wouldn't blame either party for the problem, but I blame both for not fixing it.
Guess I may be a bit late here, but since I am catching up, this was a good topic to catch up on! I am with Laurie actually, I would have liked to see a single payer system. Most folks I know who are on Medicare get far better health care than my kids who have no insurance and are struggling constantly. My son has diabetes and can't get medication. My daughter now has health insurance but didn't a few years ago when she had to have an emergency appendectomy, she still owes $35,000 and is paying monthly. She and her husband work hard but health care costs them a lot. It seems to me that in a country full of all the wealth and wonder that we have, it is tremendously selfish to deny health care to our citizens, or force them into bankruptcy if they are struck down by illness. I willingly pay my taxes to fund infrastructure and caring for our people. Just sayin' All opinions are my own by the way, I don't speak for Mo who feels exactly opposite of the way I do, which makes for some interesting conversations!
ReplyDeleteI am not an RV'er, but I am Donna's sister and a recipient of Medicare. Before my husband retired I needed spinal surgery. Our private insurance held it up for one year, during which time I developed permanent nerve damage in my foot. While on Medicare I needed abdominal surgery, which was approved immediately, and was paid for at 100%, between Medicare and our supplement. (same as Donna and Russ)
ReplyDeleteWhat Humana is doing to Russ is beyond ridiculous, but the only problem we've ever had with them is their annoying phone calls wanting to re-fill your RX's...even when you just had them re-filled. No complaints other than that.
I agree with what Laurie said about who is signing off on what you get. I think my stories of surgeries illustrate that point!
What to do? I don't have a clue. I, for one, would not want to trade our system for Canada's. I think both of the systems suck!! Wish I had some answers, but I don't! I just like this debate and wanted to add my two cents worth.
Happy trails to all you nice RV'ers!