"Wellness"
(and Medicare)
(last worked on: January 8th, 2018)
(You're at: http://craigeroochi.neocities.org/wellness.htm)

* For those concerned about Medicare, "Advantage", "Part D", and supplemental ("Medigap") insurance, my wife and I are (together) shelling out  $623.80/month for Medicare-B plus our medigap coverage (Plan C and Plan F respectively), so I looked around for alternatives. (Short version: didn't find any.)

The State of Oregon is making an outstanding effort to extend health care to the poor, does its own Part-D (prescription coverage) insurance which is open to everyone, and publishes an excellent guide book to help sort out the many insurance offerings which overwhelm us through the Senior Health Insurance Benefits Assistance (SHIBA) department. For those living in other states, I caution that costs/rates vary widely, even within Oregon.

You can download the current version of the SHIBA guide as a PDF from:

> www.oregonshiba.org

--but even with that resource, choosing the right coverage reminds me of the Monty Python movie in which a poor schmuck keeps trying to make a better deal with the Devil.

* The Medicare Part B gap amounts to 20% of your outpatient billings and has no out-of-pocket upper limit. That, along with the cost of medications, can easily bankrupt an old person of modest means. While full coverage (standardized plans "C" or "F", say) via a medigap supplemental insurance policy is expensive (perhaps $200 for an 80 year-old), if it's within your monthly budget, at least you won't end up a charity case.

* The alternative of a (privately administered) "Medicare Advantage" plan is (in my opinion) fraught with perils and "gotchas" in the form of co-pays, "co-insurance", deductibles, and "we won't pay because you forgot to get prior authorization" --and that often applies even to "in-network" care providers (read the fine print!).

Oh sure: you're hurting, sick, your primary care provider hooks you up with a specialist --and then you're going to think to call a halt while trying to get through to your insurance carrier --remembering to get all the medical details, tests, procedures and clinic/physician identities right --maybe to be put on hold, maybe to hear: "we'll get back to you". No! With good medigap coverage (if you can afford it), simply show them the card and get on with the help you need.

* Try to pick a good medigap company at 65 years --one that doesn't up your rates with age, and stay with it.

* Perhaps what us common folks need is an affordable "B grade" system of medicine --which avails you of whatever your doctor (or nurse practitioner) can fit into a satchel and his/her medical office.

When I was a boy, our family GP took care of anything short of internal surgery. He set fractures and applied casts, had his own X-ray contraption, an all-purpose nurse, and was located up a narrow flight of stairs from our pharmacy (and soda fountain!) --one stop shopping. He had no problem attending to my several childhood disorders (allergic rash, vacuous, lost to the world day dreaming in school, fall-to-the-ground shakes). Dr. Travis diagnosed ("iron deficiency anemia") and treated most everything.

* Oregon's guide book contained a revelation for me: Medicare explicitly does not provide for an annual physical examination^. Presumably, you have to come in (or be hauled in) with a pending medical problem. In looking at the benefits of the Pacific Source "Medicare Advantage" alternative, I again see no mention of an included nuts and bolts physical examination.

No doubt many of us walk around with diagnosable medical problems that we can jolly well live with, so perhaps our insurers would rather not encourage Docs to engage in fishing expeditions. My inference is that, on the average, early discovery and treatment --costs more than just letting stuff play out --until a condition becomes manifest.

I remember an old study showing that there was no morbidity/mortality rate difference between people given annual exams and those not. Perhaps that's largely still the case --at least for the run-of-the-mill health care I can afford.

Apparently, and in lieu of physicals, Medicare subscribers are entitled to an annual "Wellness Visit". I at first had a hard copy of the 2014 Oregon guide book which stated in bold print that, during the Wellness Visit, your physician may "not" touch you^ or give you any kind of tests --nor should you or your doctor talk about any current medical problems or medications that you might be taking --!!

Out of this "visit", Medicare proposes that your doctor should then be able to come up with a "personalized plan to keep you healthy" ---arghhhh!

So aside from the financial exposure of only having Medicare, it would seem that you need to pay something out of pocket for an actual physical examination  --either directly or through some other insurance.

From everything I've read, not even top drawer "C" or "F" grade medigap insurance helps to get you a physical examination^, and the medigap terms are very explicit in that they cover only your portions of what Medicare normally covers --no "extras". (I'm not an expert, so verify all information I offer here.) The various (Medicare replacement) "Advantage" plans have their own holes and pitfalls, but I've read that some of them do include an annual physical exam (as distinct from a hands-off "wellness" interview).

^ However: I have experienced occasional hands-on examination, perhaps in exploration of specific symptoms. My wife and I are given blood panels several months apart, perhaps due to tracking specific conditions. Everything's been covered by our current Medicare + medigap coverage.
 

Craig