The Medical Insurance Coverage Game

Happy New Year to all my fellow zebras. It's a time of starting anew, getting in shape and, of course, your medical deductibles! Not only do most of us have to figure out how we are going to pay for these deductibles, but we also have to play the insurance game. Here is how I am handling things this year. I hope your deductible time is going better than mine.

First of all, I am on social security disability. That means that I have Medicare. Medicare is great, except that they only cover about eighty percent, (80%) of my medical expenses. That leaves me with having to cover the cost of the other twenty percent, (20%). On average, I have about five thousand dollars ($5,000.00) in medical expenses each month; sometimes it can be a lot higher. That leaves me paying about one thousand dollars ($1000) a month that I need to find insurance or other programs to cover the costs of.

Being poor as I am, I also qualify for MediCal, the California low income medical insurance coverage. This is great, with the exception that the doctor for my asthma, allergies and immune deficiency does not accept this insurance. (Please note that there is not another immuniologist in my area that I can go to.)

In addition to the above medical insurances, I also pay for a Medicare Supplimental Plan. I enrolled in a high deductible F program because this program actual covers the most and costs less than other programs with doctor copays and such. This supplemental plan will cover

​the twenty percent, (20%) that Medicare does not pay- AFTER the decutible is paid in full. My deductible for this plan is two thousand one hundred dollars, ($2,100).

This leaves me needing to find a path to get all my medical expenses covered through the various medical insurances that I have.

To begin, all my medical apointments at locations that accept all three medical insurances will be covered completely. The reason is that Medicare will pay thier eighty percent (80%) first. Then my supplemental plan will look at the remaining twenty percent for the bill and not pay untill the deductible is met. The remaining balance, (the deductible portion), will then go to my Medi-Cal insurance who will then pick it up and cover the remaining twenty percent (20%) of costs. Therefore, with these doctor and medical appointments, the costs will be covered completely and I will have to pay nothing out of pocket.

However, that still leaves my specialist that does not accept Medi-Cal and my deductible for my supplemental is not met yet. So now what will happen? In this case Medicare will cover thier eighty percent, (80%). That leaves me owing the remaining twenty percent because neither my supplemental plan (deductible not met) nor Medi-Cal (doctor does not accept this insurance) will pay for it. This isn't a simple doctor's apointment either. During these apointments I get injections that are very expensive- about five hundred dollars ($500) each. So I really need help to cover the cost of these appoinments.

The next step is to try and get patient assistance. Patient assistance are funding programs from the drug manufacturer and other organizations that help patients be able to afford the medications that they need. To find out about what patient assistance programs you can ask your doctor, the drug manufacturer and search online. Needymeds is a great resource for patients who need assistance affording their medications.

Today I called six different companies. Currently I am waiting to see if I can get funding through one foundation. If they can not help me, then I have another number to call for a differenct organization. In the meantime, I have had to cancell my appoinment for my injections. Hopefully I can get funding to cover the cost before me next apointment for these injections. In the meantime, I will continue to search for other patient asstance programs.

​Here is a very short list of patient assistance that may be helpful for you. If you need assistance- keep calling and filling in forms. This may be tedious, but the rewards are so worth it. You deserve peace of mind from medical bills.

needymeds.org

Patient Assistance Foundation

Healthwell Foundation

Good Days

and don't forget the drug's manufacturer.