AKF no longer paying my premium...

[angela515]

(Sorry, I don't have a clue as to where this topic should of went, so I put it here.)

The AKF was paying for my Medicare supplemental insurance premiums when I was on dialysis b/c I make a low-income. They continued to do so after my transplant, but they only do it for the first year... that is up in January. My social worker told me at clinic I need to call Blue Cross and Blue Shield and find out A) What plan I'm currently on. B) What my monthly premium is C) Do they have any programs for helping pay for the premium for low-income people and then go from there depending on the answers.

He gave me a print out of all the plans current premium amounts, and let me just say they range from $100.00-$450.00 monthly. I have no idea which plan I am on until I call or I could of just looked at that sheet to find out what my premium is and so I would know how much I would be needing to pay. The bad news is, if they don't have a program to help low-income people pay their premiums, I'm screwed because I can't even afford the $100.00/mo premium. So, I might lose my Medicare supplement... which means the 20% will be due by me.. and I can't afford that either!

I need to calm down until I call tomorrow and find out.. but just the thought of not having my supplement... scares the sh^t out of me!

 



EDITED:  Moved post to proper thread "General Discussion" - Goofynina/Admin.

[Ken Shelmerdine]

Jeez! it's enough to make you ill all over again worrying about all the shit you have to go though just for health care. Has there been or ever been any kind of campain in the USA for fully federal or state funded health care? Do any of your politicians campain for it? I just don't know how you cope with the seemingly chaotic system you have to put up with.

[Sluff]

Wisconsin just passed a bill so all children will have health insurance no matter the parents income. I wish they would come out with a program for adults .

[stauffenberg]

I think the maze of different people covered for different conditions in the U.S. (dependent children, veterans, single mothers, people on welfare, people with renal failure but not people with lupus, people who became incurably ill when minors yet who are now adults, employed, unemployed, etc.), plus the variety of health care plans (Medicare Part A, Part B), in addition to all the various co-payment rules, is part of a deliberate effort to discourage anyone to rely on any form of public assistance for disease.  The government really just hopes you will give up and die, thus making your required contribution to the supreme value of American society, which is keeping taxes low on rich people.

At the opposite extreme is Britain, where you only have to show up at a GP's office, register as a patient, and then, without even having a healthcare card of any sort, you are covered forever for everything that might happen to your health.

[paddbear0000]

At the opposite extreme is Britain, where you only have to show up at a GP's office, register as a patient, and then, without even having a healthcare card of any sort, you are covered forever for everything that might happen to your health.

I'm moving to Britain. 

[BigSky]

There is a federal program called QMB (qualified medical beneficiary) that is run by the States Medicaid office(Department of Human Services).   

I believe the income limit is 837 for a single person.  There is also an asset limit.

You apply for QMB though the Medicaid office and if your income is below that level you qualify for QMB.  They will pay your Medicare premiums and the 20% co payment on all approved Medicare charges.

If you income is above that limit I believe there is another program called SLMB (Specified Low Income Medicare Beneficiary) and QI  (Qualified Individual). 
However I believe they only help pay for your Medicare part B insurance  premiums.

[Ken Shelmerdine]

At the opposite extreme is Britain, where you only have to show up at a GP's office, register as a patient, and then, without even having a healthcare card of any sort, you are covered forever for everything that might happen to your health.

The British NHS does have it's faults but I thank my lucky stars that it is there for everone no matter what their place in society is. The main problem with our hospitals seems to be their cleanliness, there are lots of cases of MRSA infections and C- deficile the start of which seemed to be the governments decision to contract out to private cleaning companies some of whose employees couldn't care less about doing the job properly because they get paid buttons.

But on the whole I still think it is the best healthcare system in the world.

[Romona]

Angela, I know what you are saying about the cost. It is hard to scrape by as it is. Good Luck in finding some help out there. 



I think it would be great if we could combine the best of all the health care systems. They all have advantages and disadvatages.

[stauffenberg]

When you compare the various healthcare systems around the world, keep in mind that while the United States spends 15% of its gross national product to cover the healthcare costs of just 86% of its population, the highest per capita spender on the list of free, national healthcare systems is Canada, which spends only 10% of its gross national product to cover the costs of 100% of its population.  Britain is somewhere around 7% of GNP for its population.  So if you want the best of both systems, make sure you notionally boost the quality of healthcare in countries with socialized medicine by the greater funds available in the American private system to get a fair comparison.

[Ken Shelmerdine]

When you compare the various healthcare systems around the world, keep in mind that while the United States spends 15% of its gross national product to cover the healthcare costs of just 86% of its population, the highest per capita spender on the list of free, national healthcare systems is Canada, which spends only 10% of its gross national product to cover the costs of 100% of its population.  Britain is somewhere around 7% of GNP for its population.  So if you want the best of both systems, make sure you notionally boost the quality of healthcare in countries with socialized medicine by the greater funds available in the American private system to get a fair comparison.

I don't know the percentage figures but you have obviously researched this and I take your word for it but my gut instinct tells me that any kind of privatisation of health and social care where profits and shareholders are the priority is bound to compromise patient care. There are moves afoot to privatise parts of the NHS which is receiving much opposition and rightly so in my opinion. You mentioned Canada. My aunt and my cousins live in Ontario and the waiting list for a doctors appointment is on average two months. Here it is about 4 days.

[BigSteve]

Ken: Where did you get that only 4 day waiting period for a Dr?
I have Medicare and a secondary supplement so that I can go to
any Dr. I choose, but it still takes weeks to make an appointment
with my regular Drs. let alone a new one. Maybe if I am sick enough
to try some "urgent care" walk in clinic and take some newly graduated
M.D., but it takes time to get an appointment round here.

[angela515]

I found out today that my premium is $138.48. I called to ask about low-income help, but they took my name and number because they are backed-up on calls, i'm on the call back list for Monday. I'll hopefully find something out then. 

[Black]

Ken: Where did you get that only 4 day waiting period for a Dr?
I have Medicare and a secondary supplement so that I can go to
any Dr. I choose, but it still takes weeks to make an appointment
with my regular Drs. let alone a new one. Maybe if I am sick enough
to try some "urgent care" walk in clinic and take some newly graduated
M.D., but it takes time to get an appointment round here.

Where are you?

I'm in SC, USA.  If I have a problem - cold, flu, bronchitis, broken toe, etc.  I can get in to see the physician's assistant within a few hours.  For bloodwork, I get a script from the PA or my doc, and walk into the hospital outpatient, without an appointment, and get in and out in less than hour.  My visit to the podiatrist in June required an x-ray - I was in and out of the hospital radiology department, without an appointment, in less than hour.  My gallbladder surgery in Feb was done 12 days after my diagnosis.  Mike's neph, on the other hand, required appointments be made about a month in advance, but would see him the next day if he had a problem.  His GP would work him in the same day.  (I don't know if that has changed since he started dialysis and is now covered by Medicare instead of self pay.)

Because we did not have and cannot get any insurance, all of the hospital care, including x-rays, labs, etc., was provided at no charge.  We paid only the surgeon, radiologist, pathologist, etc., and some of them cut their bills by one half, and some to zero.

Mike is now on Medicare so our free medical care will expire in Jan.  I will not be eligible for Medicare for 3 1/2 years so in the meantime I will have to be very careful and very lucky to not need any expensive medical care before then.  

Such is the medical care in the US.

[Bajanne]

At the opposite extreme is Britain, where you only have to show up at a GP's office, register as a patient, and then, without even having a healthcare card of any sort, you are covered forever for everything that might happen to your health.

I'm moving to Britain. 

It's almost like that in my country Barbados, too.  Only you don't go to a GP, you go to a health clinic.  The difference is that it is a bit slower than going to a private doctor and you can't choose whom you see.  However, if you are under 16, over 65, or with a chronic disease (asthma, diabetes, hypertension, ESRD, etc.) all medication is free.

[2_DallasCowboys]

Angela,

I just wanted to say Good Luck in finding
your co pay coverage.  The darn healthcare
system needs to be reworked completely, it
is so out of control. 
Please try to have a nice weekend, will be
thinking of you
Anne

[Ken Shelmerdine]

Ken: Where did you get that only 4 day waiting period for a Dr?
I have Medicare and a secondary supplement so that I can go to
any Dr. I choose, but it still takes weeks to make an appointment
with my regular Drs. let alone a new one. Maybe if I am sick enough
to try some "urgent care" walk in clinic and take some newly graduated
M.D., but it takes time to get an appointment round here.

Steve, the 4 day period is in the UK to see the general practitioner (family docter) to whom you are registered.

[stauffenberg]

There is a general assumption that if you have socialized medicine, you also have to accept long waiting times for treatment, but that is not true in public healthcare countries such as France and Germany, where the waiting times for treatment are as short as they are in countries with privatized medicine.  In Canada, however, with its public healthcare system, the wait for an appointment with medical specialists can be lethally long, up to two years for some patients. The reason for the difference is that because Canadian doctors have no trouble switching to practice in the U.S. system, where the income for doctors is very high, they can also demand a very high salary from the public healthcare system in Canada which, since it is underfunded, has to meet those high salary demands by cutting down on the number of doctors hired and thus imposing deadly waiting times on the patients.  But in France and Germany, where the average doctor makes the same amount of money per year as the average high school teacher in the U.S., the public healthcare service has enough resources available to deliver fast and efficient care to all people. 

In short, what generates long waiting lists that kill many patients in need of much quicker access to specialist medical care in some socialized medical systems is the lunatic greed of doctors, demanding such a high salary that people wind up dying to support it.  Is that consistent with the Hippocratic Oath?

[okarol]

I found out today that my premium is $138.48. I called to ask about low-income help, but they took my name and number because they are backed-up on calls, i'm on the call back list for Monday. I'll hopefully find something out then. 

Hi Angela,
I worry about this too as Jenna will no longer be covered on our private health insurance policy soon as she is no longer considered to be disabled after the transplant. The Medicare benefits will continue for 3 years after your transplant so since it's been almost a year, you need to cover the next 2 years in monthly premiums. If it were me I would make an appointment to go in to the local office and ask for help. Jenna's premiums are deducted from her SSI check each month. Is that what they would do for you?
Are you eligible for your state run health care program? I think since you're unemployed you do, and this will also cover your medical costs.
I wish there was an easy answer - if you find one let me know!

[angela515]

I found out today that my premium is $138.48. I called to ask about low-income help, but they took my name and number because they are backed-up on calls, i'm on the call back list for Monday. I'll hopefully find something out then. 

Hi Angela,
I worry about this too as Jenna will no longer be covered on our private health insurance policy soon as she is no longer considered to be disabled after the transplant. The Medicare benefits will continue for 3 years after your transplant so since it's been almost a year, you need to cover the next 2 years in monthly premiums. If it were me I would make an appointment to go in to the local office and ask for help. Jenna's premiums are deducted from her SSI check each month. Is that what they would do for you?
Are you eligible for your state run health care program? I think since you're unemployed you do, and this will also cover your medical costs.
I wish there was an easy answer - if you find one let me know!

I don't have SSDI premiums, mine are paid for due to my low-income, and will remain that way until my 36 months is up. It's just the Medicare supplement that i'm gonna have to start paying the premium on, and I cannot afford it, so i'm trying to see if they have a program for people who don't make much. As for the Title 19 (Medicaid) I don't qualify, as they say SSDI pays me too much to qualify, so only my kids get that.

[angela515]

Well, they called me back today and said they do not have anything to help pay premiums... so dunno what I am going to do yet. I cannot afford the premium. My social worker said I should apply for MESP with my local DHS office, so I called and there sending me an application. My social worker said as long as someone is willing to put in writing that they are paying me to do something, then I should qualify. He said like my parents can say they pay me 20.00 to clean house on a weekly basis, or whatever... as long as it's 1.00 or more. So if I end up qualifying for it, then I will have Title 19 (Medicaid) to be my supplement for my Medicare and drop my BCBS. If I have a premium at all with it, it will be very small compared to what i'm supposed to pay on BCBS.

I'll keep you all updated.

[2_DallasCowboys]

Angela,

Just wanted to say goodluck with this, I
hope it will work out for you and get this
big worry off of your back.

Anne