Medical costs during retirement

[docstudent]

I need to be a bit more educated on these serious matters per insurance and health care. For the most part, I live in a bubble as far as health care and expenses are concerned. The district that I'm employed in pays all health care related cost, plus offer lifetime health benefits upon retirement. To date, I plan to retire at 53 after 30 years of service. In essence, it means that I will fully covered with minimal co-pay cost. We are vested after 16 years of consecutive service, so i don't have to worry about health care. However, I know most jobs don't have such generous options, but from what I've been told the created a new system for new employees because the system is problematic and can't be fully funded if the options were not restructured. My family member was telling me that they had to pay $900 a month for insurance and I was astonished, and didn't know the gravity of the crisis that some Americans deal with on a daily basis. When I started working the veterans would say, I staying because of the benefits, now I fully understand what all the fuss was about....

[corn18]

I need to be a bit more educated on these serious matters per insurance and health care. For the most part, I live in a bubble as far as health care and expenses are concerned. The district that I'm employed in pays all health care related cost, plus offer lifetime health benefits upon retirement. To date, I plan to retire at 53 after 30 years of service. In essence, it means that I will fully covered with minimal co-pay cost. We are vested after 16 years of consecutive service, so i don't have to worry about health care. However, I know most jobs don't have such generous options, but from what I've been told the created a new system for new employees because the system is problematic and can't be fully funded if the options were not restructured. My family member was telling me that they had to pay $900 a month for insurance and I was astonished, and didn't know the gravity of the crisis that some Americans deal with on a daily basis. When I started working the veterans would say, I staying because of the benefits, now I fully understand what all the fuss was about....

If you work for Illinois, your pension and health care are at serious risk right now. Just an example of how a sure thing can go away.

[disneysteve]

Your state didn't have a high risk pool for individuals?

Just to add, I have no idea if there was such a thing in my state. I've never heard of it before you mentioning it and I've been a doctor for 24 years.

[Gailete]

I need to be a bit more educated on these serious matters per insurance and health care. For the most part, I live in a bubble as far as health care and expenses are concerned. The district that I'm employed in pays all health care related cost, plus offer lifetime health benefits upon retirement. To date, I plan to retire at 53 after 30 years of service. In essence, it means that I will fully covered with minimal co-pay cost. We are vested after 16 years of consecutive service, so i don't have to worry about health care. However, I know most jobs don't have such generous options, but from what I've been told the created a new system for new employees because the system is problematic and can't be fully funded if the options were not restructured. My family member was telling me that they had to pay $900 a month for insurance and I was astonished, and didn't know the gravity of the crisis that some Americans deal with on a daily basis. When I started working the veterans would say, I staying because of the benefits, now I fully understand what all the fuss was about....

This is something that affects ALL doctors and more than just personally. You HAVE to be aware of the cost of why your patients may be paying for insurance and why the may not be paying. It is why they may not be able to afford the drugs you prescribe or they take less than therapeutic doses. You have to LISTEN to your patients when they say they can't afford something as they usually aren't blowing smoke, especially for your senior patients as many are too embarassed to admit they can't afford something.

My husband has chronic pain and bad vision. He has had a corneal transplant since this happened, but still, the doctor said he had to have a drug screening. Okay that is part of the territory with taking a narcotic. BUT the cost of the lab work was written on the page that he had to sign. The lab worker handed him the paper, didn't read it to him or confirm in any way that he was willing to pay the price. I about had a heart attack when the bill came. Over $900! We managed to get the lab to discount it and then while were in the midst of trying to negotiate payments they sent it to collections which we paid until the bill was gone although the lab still has us showing as owing that money! However when I saw the doctor the next time I asked her if she had any idea how much that test was and she admitted that she didn't. When I told her what we had been billed she about went through the floor and then said that there were several drug screenings that she could order, one in the $50 range. Doctors have to know these things. She was a personal friend and knew our financial circumstances. She would never have ordered a $900 test if a $50 would have given her the info that she needed.

When a doctor hands me a new prescription AND a coupon, I know pretty much that I won't be getting it as something that is usually very expensive comes with a coupon and the Medicare D formulary's for most of the plans won't cover it. If yur patient absolutely HAS to have that med and you know that they are as poor as the proverbial church mouse, then go and get your samples for them and if it seems to be working try to have sample for them for each month or work with them to get a discount straight from the company that makes it. I had a doctor prescribe an ointment for me that when I took the script to the pharmacy I discovered it ran something ridiculous like $2000 and wasn't covered by my insurance. Of course I'm not going to fill it.

Doctors have to be aware of the costs of those prescriptions that they are writing so patient compliance will be greater. Same with medical tests and on and on. While a doctor obviously can't have all the various prices in their head, they can try to learn them little by little, especially anything new. I so appreciate that when my doctor wanted me on Humira she helped send for the info to get it on a discount. Humira company in their generosity said that I would be responsible for the entire $1600 (then) co-pay as I had Medicare D so I was already 'covered'. Considering my SSD check was way less than that I have no idea where I would come up with the money. So my doc tried something else and now I get Remicade, with zero co-pay as I get the IV at my doctor's IV clinic. That Remicade has changed my life!

Before I became disabled, I worked as an RN and was comfortable talking with doctors so for me it is easy to go in and discuss costs of things. For others they still tend to have that concept of doctors as God and would never question a doctor. So docs have to be the one at times to bring up costs.

[disneysteve]

when I saw the doctor the next time I asked her if she had any idea how much that test was and she admitted that she didn't.

Doctors have to be aware of the costs of those prescriptions that they are writing so patient compliance will be greater.

I agree with both of these points. The problem is that our system just doesn't work that way. When I prescribe a medication, there is absolutely no way for me to know how much it is going to cost you unless I physically call your pharmacy and have them process that prescription through your insurance plan. Even the pharmacy doesn't know how much it will be until they do that. The same medicine could be anywhere from free to $20 or $50 or $300 depending on the patient and their prescription plan. And those things are ever-changing. There is no possible way for me or the pharmacy to keep up and know in advance what something will cost.

[TexasHusker]

Whether or not there was a high risk pool and whether or not people could afford to buy into it are two very different things.

ACA for an individual in Texas is about double what the high risk pool was, and the deductibles and coinsurances for ACA are way higher.

If you are in New Jersey, you had a high risk pool. Whether you knew about it is really beside the point.

31 states had high risk pools with no pre-ex.

As for ACA, Obama's utopia lasted about 36 months before insurers realized that it was unsustainable. So your ACA patients are going to have to do something different, whether or not Obamacare is repealed. Left alone, it is repealing itself. Inconvenient truth. Insurers aren't playing ball any more. Apparently half or more Americans are too stupid to figure this out.

[snafu]

I'm not wanting to be political but this seems like a good time to write your Senator. They have huge variances but at least 36 countries have good programs for medical insurance. Surely these Senators who have no knowledge of how to develop a good, working, medical insurance program could review the best that have been operating successfully for a long time and adapt to English....
France, Italy, San Marino, Andorra, Malta, Singapore, Spain, Oman, Austria, Japan. Norway is also highly efficient and effective.

I know the human body is the same in all these countries, the only difference is the political desires and values used that are impacting people's lives.

[Gailete]

>>There is no possible way for me or the pharmacy to keep up and know in advance what something will cost.
<<

I realize that, but over the last ten years with lousy health, I found one of the biggest ways to tell if a script is going to be high dollar, is if the Medicare formulary doesn't cover it AND it has coupons to go with the samples that the drug reps hands out. I'm not talking $5 off, but $50-75 off if not more. While you may not know what it wil cost each individual patient, just the simple question about whether they were able to afford the medicine that you wrote a script for at their last visit, will tell you. Maybe someone with an income of $100K can afford $50 co-pay, but old ladies on $12K/year via SS is going to have entirely different answers. One kind of easy way for you to have a clue about costs is encouraging your patients with insurance to bring a copy of their formulary at each visit, so the med can be checked for 1. that their insurance will cover it and 2. how much it will cost and 3. does it need the Dr. to prove to the insurance company that the patient needs it and has tried other meds.

I have read that non-compliance with meds is at about 50% of all people with prescriptions that don't get filled. I wonder how many that would be if they could actually afford the medication? Would they be more compliant?

[disneysteve]

While you may not know what it wil cost each individual patient, just the simple question about whether they were able to afford the medicine that you wrote a script for at their last visit, will tell you.

A very valid point.

I can tell you from experience, however, that patients don't always tell the truth. Often out of embarrassment, I imagine, they fail to tell me that they have not been taking their medicine or couldn't afford the medicine. Sometimes t is only after a few visits of their BP not coming down that I finally call their pharmacy to check on their last refill and discover that they have not been taking it despite swearing to me that they take it every day. I've had numerous times when even after I did that and confirmed the non-compliance, the patient still insisted that they were taking it daily. Pride and denial are very powerful things.

Doctors need to ask and listen. Patients need to be open and honest. Without both of those things happening, nothing gets accomplished.

As for drugs that have coupons, you're right about that. Coupons are never good for government-sponsored insurances like Medicare and Medicaid. They're only good for commercial insurance and cash-paying patients, and they can be tremendously helpful in those cases, but not at all for Medicare patients.

[~bs]

I don't know, there really is no easy fix for the medical insurance problem. no matter what we do, someone will always be the loser.

The people that need the insurance the most are people 50+ in age. But those people are a net loss to the insurance companies, and no one wants to offer a policy unless the premiums are extremely high or the government forces them to. Making the younger generation carry insurance to offset the older generation's cost isn't fair either because it's unlikely any of these insurance acts or laws will be around in the same form (so they can take advantage when they get older). Forcing young people without full time jobs with medical benefits to pay for their own plans to subsidize people that aren't or can't work isn't really fair to them. The republicans are already busy trying to repeal current laws. And if you look at other government socialized programs like social security and medicare, they aren't exactly awe inspiring as to being able to pay out promised benefits 30 or 40 years down the road.

I think the only solution to the spiraling medical cost is basically some groundbreaking medical advancement that would be the equivalent of curing major diseases (such as cancer , diabetes, and heart disease) cheaply or being able to grow major organs for replacement cheaply. If not, you will always have a (relative) minority whos needs are so great, it will suck away disproportional resources from the majority at the expense of society as a whole. UNLESS (and this will sound heartless), a law is enacted where if you have certain stage of diseases, you will not receive treatment for them unless you can pay out of pocket for the treatments. The benefit (extremely low % survival rate) doesn't justify the cost incurred to try to treat the condition. It would be almost like the decision that people make with pets - Your dog is 15 years old, heart surgery has 50% chance to extend his life 6 more months, he may be suffering during that time. The surgery will cost $15k. What do you want to do?

[disneysteve]

UNLESS (and this will sound heartless), a law is enacted where if you have certain stage of diseases, you will not receive treatment for them unless you can pay out of pocket for the treatments.

Sorry but as a physician and just as a human being, I'm not okay with the answer to the high cost of care being "let them die". I am happy to pay more for my own insurance and/or higher taxes so that everyone can have the right to healthcare. I think it's a disgrace that this issue even exists in the US today.

[~bs]

Sorry but as a physician and just as a human being, I'm not okay with the answer to the high cost of care being "let them die". I am happy to pay more for my own insurance and/or higher taxes so that everyone can have the right to healthcare. I think it's a disgrace that this issue even exists in the US today.

AGREED, but I do think at some point, this issue will be taken up as a serious consideration at some point. Especially if the costs of medicine continues to rise. At some point, raising medical premiums/higher taxes is no longer feasible. Say you're paying $1000/month for insurance, which is reasonable cost for a family. But what if the costs of insurance spiraled up to the point where it was $10000/month or $100000/month? Then society needs to make hard choices.


I am still holding out for some medical advancement to help solve these problems. We've gotten good at treating the conditions of the major diseases, at great expense. But what we really need is a cheap effective cure.

[disneysteve]

I am still holding out for some medical advancement to help solve these problems. We've gotten good at treating the conditions of the major diseases, at great expense. But what we really need is a cheap effective cure.

A very high percentage of what I treat every day is SELF-INDUCED disease. We already have the "cure" for much of what is driving up healthcare costs. The problem is nobody wants to use that cure.

[Thrif-t]

I need to be a bit more educated on these serious matters per insurance and health care. For the most part, I live in a bubble as far as health care and expenses are concerned. The district that I'm employed in pays all health care related cost, plus offer lifetime health benefits upon retirement. To date, I plan to retire at 53 after 30 years of service. In essence, it means that I will fully covered with minimal co-pay cost. We are vested after 16 years of consecutive service, so i don't have to worry about health care. However, I know most jobs don't have such generous options, but from what I've been told the created a new system for new employees because the system is problematic and can't be fully funded if the options were not restructured. My family member was telling me that they had to pay $900 a month for insurance and I was astonished, and didn't know the gravity of the crisis that some Americans deal with on a daily basis. When I started working the veterans would say, I staying because of the benefits, now I fully understand what all the fuss was about....

Ya well things they tell you you are gonna have in retirement can change. My DH has been working for the courts for 26 years. He's always made less than the private sector but we were ok with that because of the great health care and retirement package.

His health care is still really good, but no longer great, we now pay co-pay's, co-insurance and deductibles where before everything was covered 100%. He also will no longer will have retiree healthcare benefits for spouse and family. We made a life decision for me to work part time to stay home and raise our kids. We didn't think we had to worry about benefits. Ya well now we do. When he retires he only gets healthcare for himself and only till age 65. Before he'd of stayed on the Courts benefits in retirement(along with me and any dependents) and medicare would've been his secondary.

Hope nothing changes for you and you get to keep your great benefits thru your career.

[Gailete]

The one sure thing in life is change.