CRAZY TOWN WAITING ROOM - TESTS coming up? All Stages Welcome.
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proud to spin- I got a call from UHC a week ago to go over my meds on plan D. They did not ask for any plan numbers. They proceeded to go over my list of meds....did not ask me for the names...they had a list. I got a follow up letter from them verifying our conversation. Today, I got an email cautioning me about the new Medicare cards that are being mailed out and phone calls from scammers trying to get information. You might want to call UHC to see if they initiated the call. It is getting so I no longer want to answer the phone. I get so many junk calls. I have enough trouble keeping up with medical issues I don't need scammers too
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Threec, gee never thought about that and i have heard that on news. Hmmm, had my normal confirming calls from the online company that confirms my shipment, that is normal
Maybe i will give uhc a call, thanks for reminding me
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Bob said to go ahead and fill my Dexilant script, even though it will kick me into the donut hole next week, because it makes it likely I'll be able to climb out before Jan. And by then, I'll start taking my 9-month Canadian supply of it. (In Canada, Ventolin inhalers---my other major drug expense--are much cheaper, so maybe we'll take a weekend trip to Windsor or Toronto, or convince him to use our HGV points in the Canadian Rockies, since I have no foreign trips planned till next April, when the CBA'S CLE trip is to Amsterdam & Jerusalem). My plan is to try and avoid falling into the hole at all next year--and it's supposed to close in 2020.
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Sandy, I wished we lived closer so I could take you out for a glass of wine or two in exchange for an explanation of Medicare. As I approach eligibility, I am finding it hard as whatever to understand their site or any explanatory sites as to what it will really cost, what I really need in the way of supplemental insurance, and all of that. And I have a post-graduate degree! If anyone has good sources of information to point me to, I'd appreciate it!
I find it interesting that social security was so much easier to navigate. But I shouldn't be surprised I guess....('who knew medical care could be this complicated'..sorry, couldn't resist)...
By the way, though I am open to looking at AARP materials, I am not a member. I've never forgiven them for caving (just my opinion) on the Part D Medicare donut hole (which apparently I understood a whole lot better back then than I do now: could it be chemo brain?). Perhaps it is time to forgive them?
Octogirl
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Everyone gets Part A (hospital care) automatically when you register for Medicare (coverage starts on the first of the month in which you turn 65). Part B is like major-medical, for outpatient visits & treatments, with deductibles & co-pays (both of which are less than regular insurance). But if you don't sign up for it right away, you can be assessed a penalty that increases for every year you delay. (Some people take that chance because their or their spouse's insurance might give you the option to stay on their plan as long as the policyholder remains employed &/or the employer continues offering it). If you can at all afford it, get a Part B & D supplement (or if you don't mind being limited to an HMO or PPO, an Advantage plan that combines the two). Medicare supplements have low or no deductibles and pick up the Part B co-pays. I didn't go with the AARP supplements because they're United Health Care (my former pre-Medicare) carrier--and in Bob's experience, BCBS has better customer service, faster approvals (especially for equipment) and pays providers faster. Because I didn't want to be limited to an HMO or closed-panel PPO, I went for the highest premium fee-for-service "Plan F" supplement rather than an Advantage plan. Because of that, I had to get a separate Part D plan. The way I did that was to sit down with our agent, list the drugs I was taking and would be likeliest to take, and see which carrier had the largest formulary likely to cover them. I went with Humana Enhanced.
OTOH, I'm torn about Social Security. I became eligible at 62, and am of the age-group in which full-benefits start at 66 (I'm 67). Bob is 68, and hasn't filed yet either. I suspect that if I wait till 72 (benefits increase for each year you delay from 66-72) I will collect more per month but may have left too much "on the table." And with bc, longevity is always an open question. Bob has a longer and more lucrative work-eligibility history, so his benefits are three times as much as mine. Rather than take the "spousal share" (half his) right away--which remains steady as long as he or I live, I think I'll start collecting mine now and switch to widow's benefits (full amt. of his) if & when the time comes. If I die first, he would collect his own benefits rather than the lower widower's benefits. He says both spouses in a married couple can't collect their own individual benefits during their lifetimes, but I think that's baloney. It's not like joint tax returns.
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octo, when i was nearing the age to go on medicare, i started asking for i fo on all the companies and when i started getting all the materials then i wna s torturing the reps with questions like difference between supplimental and medigap........they are the same! I have ended up with good plans i think, the pharmacist and financial sloan even told me i had good plan, course i did just hit the donat hole but i will likely come out of it before end of year. Guess my insurance from my work was so bad......this feels good.
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Octogirl- I did tons of research and ended up with AARP United Healthcare for Plan F (supplemental) and a Part D Drug Plan. I was a teacher and signed up for a UHC Drug plan through a statewide retired educators group. I have no annual deduction nor do I ever go into the donut hole. I pay a high monthly premium for the drug Plan but it covered the majority of my RX's. My husband got a Part D drug plan through Humana for 10% of the cost of my plan, but he only takes a couple of low cost prescriptions. Every company has different plans in different states. For example: BCBS of North Carolina is a non-profit business, where BCBS of Florida is'nt. I had an employer sponsored plan through BCBS last year when I started on the Breast Cancer Train. Every appointment cost me a $40 co-pay. It was a "threshold charge". If I went to have labs, (40$),then the MO (40$)then a scan (40$) for $120 that day. Then I would get the bill later for my out-of-pocket. When I went on my Medicare plans I have paid Zero so far, except for my premiums and RX. I too find Medicare a nightmarish program to figure out. It is definitely not user friendly
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thanks for the input Sandy and Iris...
Sandy, on Social Security you can indeed collect yours and your spouse his...what you can't do is collect both yours and your spouses at the same time once he or she dies..(I think). When my sister's husband (who was older than she) died, social security advised her to take his widower's benefits until she reached full retirement age, then to switch to her own, which by that point would have exceeded the amount of his...
Part of what is throwing me on Medicare is that I did ask for a quote and got $55 a month from the PPO version (AARP) for Medicare Advantage. That is a tenth of what I thought it would cost! So I keep trying to figure out what I am missing: is it really that cheap? It costs more than that for hubby to cover me on his employer plan. Also, I am currently retired, but if I go back to work, what happens if I have filed for Medicare? I guess it is time to start doing what you did Iris, and bug the reps for more info (I become Medicare eligible in February of next year).
Octogirl
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Rainny - I'm so sorry to hear about your mom. Thinking of you.
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Yes--Medicare Part B supplement plans are also referred to as "Medigap." An Advantage plan (sometimes referred to as Part C) combines Medigap with Part D, but even Advantage PPOs have much narrower networks than regular insurance's PPOs. Before I went on Medicare, I had United Choice Plus PPO, which has a wider network than its cheaper plans, but there were still a very few providers that were out-of-network for me--and whenever you have a surgery you need to check to see whether any doctors who attend to you are out-of-network. You can't always tell in advance--even if you check with your insurer and with the provider, doctors can leave or switch networks at any time; and you often have no choice as to who will be your anesthesiologist, radiologist, or emergency room physician. (ERs at an in-network hospital often contract with emergency medicine groups which are out-of-network, so only the residents who see you are in-network while the attendings may not be; if you need an ER or emergency surgery you don't have the luxury of time to ask the hospital whether attending ER physicians & specialty groups are in-network--you have no leverage). The Plan F class has no networks--Medicare IS the network, and any doctors who take Medicare are in it and may not "balance-bill" you. They must accept whatever Plan B and any supplement pays. Not everyone takes Medicare, however--the CTCA chain is a notorious example.
Advantage plans, even the PPOs, are cheaper for that reason. They have narrower networks, smaller drug formularies, and restrict you to certain pharmacies (usually Walmart & Walgreens) for your prescriptions. If you're okay with that, they are a good fit--especially since they have no donut hole into which you'd otherwise fall were you on standalone Medigap and Part D plans.
I wouldn't have fallen into the donut hole had my GERD been mild enough for me to use over-the-counter acid-blockers (Zantac, Pepcid) or PPIs (like Prevacid, Prilosec or Nexium or their store-brand generic versions). OTC drugs are not covered (nor are those bought "outside the insurance system" such as with GoodRx, cash-only such as Costco's member discount, or foreign-purchased), but often cheaper than your Part D co-pay on Rx-only ones. Unfortunately, Dexilant's 2-stage time release formulation is the only drug that works for me--it doesn't come off-patent till 2020, and my co-pay is $409 for 90 days' worth (as is Humana's share of the price). What sucks about Part D is that the threshhold for the donut hole (aka Stage 2) is how much you and your insurer, combined, have paid for your drugs--but the threshhold for climbing out is only how much you alone have paid out of pocket for the year to date. This year that is $5K--but it includes your amount of co-pay that kicked you into the hole in the first place.
My example is that the threshhold for going into the donut hole is $3750--even though I may only have forked over less than half of that ($1750). But that $1750 counts toward the $5000 needed to climb back out. What I plan to do is refill this 90 ($409) and the next 90 days of Dexilant, which will jump to $900, plus three more $94 refills of Ventolin inhalers. That and my relatively cheaper generic maintenance meds (none of which exceed $27 for 90 days on Stage 1 nor $54 while in the hole) would pull me back out into Stage 3, or "catastrophic coverage." Right now, before refilling this batch of Dexilant, I had a month-and-a-half on hand. This refill gives me a 4-1/2 month supply, which takes me to mid-Sept. The next 90 days would get me to mid-Dec., when I'd be climbing out of the hole, at which time 90 days' worth plunges to <$150. Meanwhie, 9 mos. worth of Canadian Dexilant, at $1K, is en route to me. I will use that plus whatever remains from the Dec. 90-day refill starting 1/1/19--which would definitely keep me out of the hole all of next year (barring an expensive outpatient cancer med or a Shkreli-esque price hike on my generics), especially since I will buy as many foreign-purchased Ventolin inhalers as I can fit into my luggage on my next foreign trip in April (Amsterdam & Israel, the latter of which has a much cheaper and a wider OTC availablilty of US Rx-only drugs than even EU countries). By 2020, unless Congress screws us over, the donut hole will be gone.
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Rainny - Deepest sympathies on the loss or your mother.
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yeah, give yourself as much time as possible to review all the plans. Even with my preplanning, i initially chose a part d that did not cover my meds, but found out within the first 30 days and was able to switch to the plan i have. I have not paid anything to docs and all my chemo stuff has been covered
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(((((rainney)))) sweetie I am so sorry for the loss of your dear mother. My prayers are with you.
Hi everyone, popping in to say hi. Wyatt's hanging in there but sleeps most of the day. I officially have stage 1 LE. Finally saw a LE PT. I will do twice weekly therapy for about 4-6 weeks once I get authorization. I also need to be fitted with sleeve and glove. She's going to help work on breaking down the tightness from rads on my left breast as well. She walked me through MLD and I've been watching videos. I will get the hang of it. Anyway spending most of my time baking bread to keep my mind off everything.
Big hug and love to you all.
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Good to hear from you Molly, thanks for the check-in. I am glad to hear Wyatt is hanging in there, and I fully endorse bread-baking therapy!! Hugs and Love back at you!
Octogirl
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Well now i know why weather reports were slightly wiggy.....pouring rain today after lovely day yesterday. Hit the gym yesterday and did more than other times, did feel good. Also was gifted with a package of indian sprouted beans, as in prepared by one of my indian pals. She gave me sprouted ones and also seasoned sprouted ones! Love my gym pals. Also saw the woman who runs the spa there and who i used to do massages with, she was asking about me. I am going to check with my therapist if ok for me to do massages again.
Clearly my gym is my home away from home. Hope everyone has the same, and home all get at least one sunny day
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(( Molly )) ...Sending love and prayers ...I can smell your bread cooking from here :-)
Iris ...Our table tennis group is definitely our home away from home ..We play 3 times a week ..and they are 3 hour sessions ..I love the game and the wonderful group of people that go ..Hope you can start your massages again !!!
Hugs to all
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(gently, supportively) I cannot replace the list creator--I haven't her skills with a spreadsheet--but having settled much of my own crazy, I would like to reach out into the crazy/rabbit hole of the boards and help whomever needs it. (shyly) Where do I go? Is there someone who can help?
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queen... iit would be wonderful if you took over list management of the group, i could give you some help on the spreadsheet but only as assistant
Well gonna hit the gym for a bit, it is only open half day today but my back was not happy this morning ,, it was calling for a nice warm shower
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Proud: I'll see what I can come up with this week.
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Queen ..great idea ! Glad Iris has offered to help you , because I wouldn't have a CLUE what to do !!!
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Lucy: (laughs) keep in mind, I haven't a fraction of Beppy's sociability. But I'll try. Because this list helped me when I needed help, and I hope that we can help others who've fallen down the rabbit hole.
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queen, we can do it! Used to do a lisr with some pals of survivors on weight watchers
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OK, where do we start? I can do spreadsheets, sort of; I know Beppy relied on them.
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Queen ...I guess try to get list of everyone's upcoming tests and dates ....also maybe other fun things , like birthdays , anniversaries etc ..how many grandkids etc....??? Hobbies ..??? Ducky will probably arrive ...she can sure out-do the rest of us when it comes to how her family is growing !!!!🤗
Beppy always had the magic touch to make everyone feel so special ...We all miss her so much ...I'm sure she'd be happy to see you are trying to keep her Crazytown going !!!
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Lucy: I will try to step up/
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On furlough from CrazyTown Inn:
If I thought my wrist pain was bad enough, I just returned from my wrist MRI--which was the longest half-hour of my life. (Yes, worse than active back labor). 30 minutes of my life I can never get back...nor would I want to. I had thought, "pfft, it's just my wrist, seat me on a chair and stick my arm in the MRI tube, and I can sit still for half an hour." Hahaha...first uh-oh was that I had to lie on my stomach (which I haven't done since I was pregnant 34 years ago). They propped me up with pillows, but my boobs got squashed and my face smushed into the pillow anyway. Then they extended my L arm all the way 180 degrees from my shoulder, propped my hand palm down in the "cradle" and taped it in place so I wouldn't twitch or tremble.
I didn't mind the noise--been there, done that, since I've had five prior MRIs and one each nuclear heart and full-body bone scan. (No, not the DEXA). They gave me headphones and I chose "classic rock," thinking I would get the usual mixtape I had for other MRIs. Nope--they had to use YouTube (!) because the hospital would have had to pay ASCAP & BMI to play a freakin' tape or CD even if they owned it outright (and a streaming service or satellite radio--both of which have the royalties built-in--would have cost them a subscription fee). That meant $%^&*() commercials (one in Spanish, for pity's sake) in between songs...six songs I will never ever again be able to listen to without breaking out into tremors and cold sweat.
You see--after one minute, my L shoulder began to hurt... then hurt worse & worse, like I was being suspended from the ceiling by my arm, which was being pulled out of its socket. "So this is what 'enhanced interrogation' feels like," I thought. The only things that got me through the experience without screaming or moving was singing along in my mind's ear with the lyrics of the songs I recognized...and thoughts of rewarding myself afterward with the most delicious and worst-for-me treat I could possibly find (hopefully, reaallly gooood chocolate cream pie).
When it was over, I could not turn over and get up by myself. They sat me up. I wasn't dizzy but I couldn't move my arm at all! The techs had to walk me back to the locker room...where the combination I'd picked didn't work (thank heaven they had an emergency unlock code). I picked up my bra, expecting my L wrist to hurt--as always--when fastening it. But I had so little strength and ROM in that arm that I had to call for the nurse to scoop "Thelma & Louise" into their respective cups and fasten the bra (on the loosest hooks). Only half an hour with an ice pack and then slow "wall-walking" with my fingers enabled me to finish dressing and get to the coffee shop--where there was no pie but there was a big handcrafted yeast-raised Oreo-crumb-glazed donut with my name on it.
My doc will get the report tomorrow or Monday, and he will let me know what's up (my guess is just soft tissue inflammation & OA) and what's next. I will make my PT/OT appointments right away--same PTs who took care of my LE--because that might give me enough grip strength to play without messing up too badly. And if something is so really, really wrong that therapy &/or playing might further injure my wrist until after surgery, we'll jump off that bridge when we come to it.
Y'know, if I weren't a guitarist, if I hadn't signed contracts for these gigs and I didn't have a singing partner depending on the fees...I could live with the slooooow healing.
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sandy, wow and a half! I am not a fan of mris but have had way too many, none left me weak like yours, hope you feel better today and hope therapy gets things moving easy again
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Yup Sandy - don't dare move or they start over again! - It was the worst experience in my life. Every muscle in my back cramped up! All to find out I have osteoarthritis in my wrist - I could have told them that ;-)
Hope you feel better!
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Sandy ..gosh ..what an awful experience...hope you are feeling better !
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i was contacted from an ad i saw on line if i would participate in a blind study of my current chemo and taxol. I said i was interested, it would be done in coordination with my current hospital, sloan kettering. I was interested and said i would listen to their proposal and of course talk to my onc for her opinion
Then it dawned on me, taxol means hair loss just as my hair has come in again. And i would also end up suffering through the nasty side effects of my current chemo, xeloda which does a number on my hands and feet.
I am feeling negative now, anybody bo anyy blind studies?
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