Robert (not his real name) is a 66- year old patient who was an active, athletic businessman who suffered a stroke in September of 2020 leaving him with a severe aphasia (aphasia is a problem understanding or using language). A blood clot was removed from his brain by neurosurgery, and following an acute care hospitalization, he spent a week in a rehabilitation hospital. Since discharge home, he has received out-patient speech therapy. Because he is enrolled in a Medicare Advantage plan, he has a $35 co-payment for each therapy visit, and is now, also faced with numerous hospital bills for uncovered expenses. His wife sat crying in my office this week. Overwhelmed by her husband’s condition and by the unexpected medical expenses. “We were stupid, when we purchased health insurance,” she said, “we were healthy.”
Philip (not his real name) is a 70- year old with a diagnosis of Parkinson’s disease. He was recently seen for an out-patient evaluation with a subsequent diagnosis of a motor speech disorder (hypokinetic dysarthria) and dysphagia (swallowing disorder). Philip is enrolled in a Medicare Advantage plan HMO with a $40 co-pay per visit. He participated in 3 out-patient treatment visits, then self-discharged due to cost. Lack of therapy now, may very well result in a progression and worsening of speech and swallowing problems resulting in higher utilization and cost for health care services in the future.
Medicare Coverage and Pre-existing Conditions
The examples above are real patients, who represent the dilemma of purchasing health insurance, including Medicare. All were relatively healthy at the time they turned 65 and a Medicare Advantage plan with all the perks you hear in the TV advertisements, including low upfront costs, were appealing and seemed a reasonable option. None of these individuals imagined that within a few years of enrollment that they would suffer a stroke or be diagnosed with a chronic disease.
Few of us feel very savvy when it comes to purchasing insurance of any sort, and cost, which may be the only thing we clearly understand often guides decision making.
Original Medicare covers all pre-existing conditions. There are no pre-existing condition limitations or health questions when you enroll. You can also enroll in Medigap coverage (supplement plans), which depending on your plan covers remaining costs, which may include the annual Medicare deductible. During your open enrollment window which is a six month period after you turn 65, supplemental coverage will also cover pre-existing conditions. But, if you are enrolled in a Medicare Advantage plan and later want to switch to a Medigap supplement, private insurers can deny you coverage based on a pre-existing condition. Your Medicare Advantage plan will continue to cover pre-existing conditions, but you will contine to pay copays and coinsurance for services related to your health conditions as you go along.
The unexpected diagnosis of a neurodegenerative disease, head and neck cancer, or stroke are all life changing events. Coping with symptoms and treatments may go on for months or for the remainder of your life, and access to the best health care professionals and treatments will be a priority.
So, if you are turning 65 this year, and opting in for Medicare, choose your plan carefully. Consider your current state of health, your risk factors for chronic disease diagnosis and what you can manage with regards to un-anticipated out of pocket expenses. A qualified broker who specializes in Medicare will have experience to help you evaluate your choices.
What a year 2020 has been. I am so grateful for healthcare colleauges, especially those working in hospitals, who have willingly taken on the stresses and risks associated with caring for patients with COVID-19. I am grateful for the election of Joe Biden, a President elect who conducts himself with grace and maturity, and who, with the support of all Americans can bring some healing to our nation. I am grateful for my patients, who entrust me with their care.
“Darkness cannot drive out darkness: only light can do that. Hate cannot drive out hate: only love can do that.” – Martin Luther King Jr.
My MissionTo enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate and empower. Mary Spremulli, MA, CCC-SLP * FiTOUR® Group Exercise Instructor * Voice Aerobics® A Whole Body Approach to Voice Practice