Friday, November 13, 2009

Medicare Scaring Us

You probably have your new "Medicare Options" package sent by your Part D provider. Starting Monday, we're supposed to be able to manage our decisions for the following year. What every senior and disabled person battles for this decision includes-
No Increase on Cost of Living For Social Security;
Increase by up to 28% of the Prescription Plans available;
No Sanctioned Increase of Insurance Premiums
Decrease in Available Medicaid Dollars
Increase in Co-payments (ie. Walgreens $4 prescription copay for generic will be $5 in 2010).

Addressing the obvious first. This year we have more Veterans returning from war than in any time in history since Viet Nam. During the early 1970's, the increase of those who went on permanent disability due to war related illness, PTSD, and other trauma was NOT picked up by the Veterans Benefits, and instead was placed into the general funds of Medicare. Service connected and Service Aggravated illnesses and trauma are not all covered by Veterans benefits. That saps quite a bit out of the funds for those who are in disability or are retiring seniors. Veterans care is increasing the amount we must pay for our prescriptions, and are charging for services at VA hospitals where before these were considered part of the benefits of service aggravated or connected illness.

The VA Healthcare System is being used as the model for Public Healthcare, a huge political battlezone at the moment. The system is very strict regarding the type of prescriptions, treatments, care, and surgeries are authorized per patient. I know, I'm a Veteran AND disabled. I've been on both systems for nine years now. The VA doesn't bill my medicare for anything, but instead, although my information is shared with both organizations and the cost could be spread between the two, I'm out of pocket thousands of dollars per year.

If I want prescriptions that are not in the VA system, I need to see and pay for a private doctor, then pay for the prescriptions, hoping they are covered by the Part D Medicare. There are very few pain meds that are covered by Part D. For those of us with Autoimmunity issues and joint disorders, the catch 22's seem innumerable. I can use a wheelchair but Medicare won't pay for it, but the VA will pay for one as long as it's a replacement of one I used for more than 10 years and was originally Medicare paid. Okay. I can have splints and braces on my hands, but I can't get them remeasured unless I pay for the second appointment, out of pocket, but I have to copay the braces up to 80%, unless Medicare copays, which they won't because they weren't the ones who authorized the braces. Got it? Yeah, me either.

Before the Part D split, I could apply for a wheelchair from Medicare or VA and they'd split the cost, and I'd have a small copay. Now I have to reapply for a chair with both, and if one approves first, the other form is revoked, so I end up paying not only my copay but the copay the other organization would have taken over. See how this gets confusing? See how this makes no sense?

For those on Medicaid- a state run version of Medicare, you have to meet financial limits. For most people on disability, full disability, I mean, you make about $300 to $1000 a year MORE than you should to qualify for Medicaid. So the money you make from Disability, which is borderline poverty level for most people on it, means you are too rich for assistance from your state, thus making more out of pocket costs a mandate. There are people who qualify for SSI, who cannot quallify for Medicaid. There are people who qualify for SSD who cannot get SSI, (such as married people like myself). If anyone thinks this government insurance system which we paid into is a hand-out- they're very wrong. They don't get that mose of us on disability had normal working lives, and had to work at least 20 years to qualify. We aren't sitting around eating bonbons.

Those of us on disability spend hours in physical therapy, sometimes psychological offices, oftentimes trying to find out how we will survive from one check to another. Homeless Veterans make up the largest number of people living on the streets, and without a permanent address, these heroes can't qualify for benefits. They aren't asking for a handout. They earned their place in society. Minimum wage doesn't prevent an adult from living in a hallway or a bus stop. And, being homeless doesn't mean being jobless.

Here comes the time of year when those of us who are trying to manage just being able to sit, stand, or speak in cohesive sentences are handed a book of options. The options are supposed to help us figure out how we want the government to best allocate our funds to pay for medications which may or may not be covered on the Part D of our insurance. I am on Morphine, an antidepressant, and a sleep assistant drug. Only the Morphine is covered, via the VA. I cannot get it through my private doctor. Only the sleep med are covered through the private doctor. Because both are "Controlled Substances" I sign a contract with each doctor and both pharmacies pull my records to ensure I don't double dose. If a doctor wanted me on a different medication, I may have to wait up to three months if it isn't on the approved list. Knowing all of this makes it very difficult to simply check a box and mail a form into Medicare.

I don't have Diabetes, high blood pressure, or a myriad illnesses that come with age. I will someday have some of these, as is the family history. Without the Medicare assistance, the cost of my health is upwards of $500 a month, because I have VA assistance. Without the VA, I would have a cost of about $1200 a month. My pay is nearly just that. I would be a homeless Vet if I wasn't married.

I don't know how you live your life, but it is my greatest honor to speak with senior citizens. I know the struggles they face. I face them too. It is my greatest honor to meet another person in a wheelchair. I don't know what they do to survive, but I'm doing it too. I know I'll try to elect the right choice that offers me the most of my medications and allows me the smallest of dignity.

Today's questions. Are you disabled and battling the big Medicare Question? Are you a senior and not sure what to do with the lack of COLA? How will you change your medical care this coming year?

And here is the rest of it.

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