CHANGING MEDICAL PLANS – MASSADVANTAGE

I want to start by saying working with Blue Cross was great. They aren’t the cheapest service (or the most expensive), but they know how to run a medical plan. They approve requests for medication immediately and if you need to call them, a human answers and spends as much time as necessary dealing with your issues. They are patient, intelligent, and care about their clients.

Amherst Campus

So why change? Because MassAdvantage is new plan. It’s hooked to the hospital and doctors we already use. Since it’s new, it offers a lot of perks including a dental plan that gives you a couple of thousand dollars (minus a 20% deductible) with two free cleanings, x-rays, fluoride treatments. Their eye care isn’t much — a piddly amount compared to the cost of eyeglasses, but there’s one thing they have agreed to do that made them an instant winner.

I won the battle to have Garry’s hearing apparatus covered under prosthetic devices which means that though we’ll have a deductible, that can be arranged as small payments. We won’t have to worry that we’ll never be able to pay for new equipment.

I’ve said from the beginning that it was absurd to perform this surgery which REMOVES all the hearing parts in the ear and replaces them with an electronic device. This device is inside Garry’s head and his hearing machinery attaches to his skull with magnets. So this is not a standard hearing aid by any means and without it, Garry has no hearing at all.

Consultation and testing – hearing equipment
Nicole Seymour, audiologist on the job!

I said that to assume that elderly people living on fixed incomes could come up with a huge amount of money is unrealistic and wrong. Lack of hearing makes communications with the rest of the world impossible. Garry has no knowledge of Brail or sign language. Without being able to hear, he can’t respond. This matters. That I somehow managed to get the hospital to reclassify this equipment is probably my top achievement of the past five years. And I did it using logic and explanation of why I felt that the system was broken and should be fixed. In this world, that’s such a rarity I can hardly believe I did it.

This also means that everyone who needs to use such hearing machines will benefit from this decision. When I went to Blue Cross with this issue, they said “no” without any wiggle room.

More hearing tests

MassAdvantage said YES.

For us, this made a HUGE difference. They have other nice touches including free visits to ones primary care doctor, no monthly payments other than what you normally pay to Medicare for parts A, B and D (prescriptions). They have low prices for generic medications and even the more expensive tier medications are less costly than what I’ve been paying. Things like CATscans and MRIs are $200 — not $2000. And, of course, all our doctors, except one of mine, are part of the UMass medical system already. We aren’t going to have to change much of anything, not even prescriptions.

Cochlear implant hearing technology

How good a job will they do? I’m sure it will be bumpy at first. But the up side is they have excellent doctors and top quality facilities. If they can’t deal with a problem at one facility, they also have major hospitals in Boston, Amherst, Dartmouth, and Lowell. UMass Worcester is a hospital, but it is considered part of the UMass Medical School complex in Worcester. UMass is huge and occupies miles from downtown Worcester to the river. That’s miles of huge buildings for various things from hearts to eyes.

I did my homework. I realize it’s a new program. They have hired a specialized company to run it which might make it work out better. And they will enable Garry to get his hearing apparatus repaired and if he needs to replace something, we might be able to really do it!

Now, if only my teeth will hold up until we switch plans next January!



Categories: Anecdote, Health, healthcare, Hearing, Hospital, Medicare, UMass Memorial

Tags: , , , , , , , ,

16 replies

  1. I am working on it now. Part D is my concern since I am taking meds no one wants to cover, even advantage plans. My cheapest out-of-pocket if I need nothing new is about 12 grand for D alone, not to mention the supplement.

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    • Blue Cross’s advantage plant has significantly lowered their rates for that type of medication — really all meds that need to be taken regularly for diabetes, Hep C, Psoriatic arthritis, Aids, dementia (of all kinds). I know it’s different in each state, but it’s worth checking. They are still, in my opinion, the best provider. Even the value plan (it’s a PPO) we’ve got is very good.

      If THAT doesn’t work, get one of the supplement plans and go with straight Medicare + an supplement (I had Humana). They covered EVERYTHING including major surgery and I got a bill for ZERO dollars. It will cost you a couple of hundred dollars a month, but those supplement plans are made for people just like you. And for you and others like you, they are worth it. I waited to have my surgery until I had the plan.

      Liked by 1 person

  2. Well done Marilyn for arguing a good case over Garry’s hearing device. The new plan sounds like it will be much better for you if everything works as it should so a win for once.

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    • It was the first time I was able to win something using logic and persuasion. I think it may be a first!

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      • My hearing aids are far beyond their life exp. New ones will cost between 6 and 8K due to their being special and they come in pairs, so will not work as a single. I was waiting for congress to vote to help, but it looks like they think that we are not as important as the billionaires. A life of not hearing or seeing is not a nice way of living, and after all I paid into my social security insurance all those years while they borrowed the money. Also what others may not know is that if Social Security does not pay, secondary insurance uses that as an excuse not to pay as well.

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  3. Thank you from the bottom of my heart and you know why. Keep inspiring as always. If I say you guys were the reason that I couldn’t get away from the blogging community for long, I will not be exaggerating it all. Whatever good, bad, ugly happened during the pandemic and I had to take a long break but your soul connection held me there always. How I wish could’ve been as strong and determined as you, would have been grateful to Almighty. Any big small adversity in life I can deal with but when you get disappointment from close quarters it throws me off the track. I shouldn’t be like this but that’s the way I am. Hope I will come out stronger and practical this time.

    You take the best plan as per the doc’s advice and thumbs up to Garry for being there and holding the fort.

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    • I know what we’ve been promised. I just hope when the time comes that they honor the agreement. It’s a very big deal because those aids cost a LOT of money. I’m sure we are by no means alone in needing a better way to fund them.

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  4. Reading this is like entering another world. For all its faults the UK’s National Health Service is a wonderful institution! To read that you are pleased that you would ‘only’ have to pay $200 for a scan which we can get for free is amazing 🙄 Likewise Garry’s hearing equipment, which I am sure would be available on the NHS here if it were deemed the best option for him. You make me value our NHS even more than ever!

    Liked by 1 person

    • I was actually shocked that this equipment was NOT covered. How could they NOT cover it? It seemed absurd and wrong. I know most of the better off parts of the world get much better coverage than we do and it is infuriating.

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  5. I only know that the US are one of the most crucificating countries with regards to health and insurance questions. An uncle of HH (lived in the Chicago area) had to sell his house to cover the cost of his health requirements…. And he was for HH’s family always ‘the rich uncle from America’… Tells you a lot about that countries health providings (or lack of). So I’m glad you were able to get yourselves sorted. And pray that your teeth will oblige you – they are ‘very dear’ to us too in Switzerland. And I can’t probably ever visit my much beloved and appreciated French dentist any more with all those requirements and must-do’s/not do’s.

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  6. I am thrilled that you and Garry followed up on the link I sent you in a comment a while back that stated Medicare would definitely cover a prosthetic device for his hearing loss. Fantastic and life-changing choice. I have nothing against Blue Cross – I used to be a director at BCBS in downtown Boston – but your switch to a better plan was just what the doctor ordered. Congrats to Garry and you. Best, Babsje

    Like

    • I was surprised that BCBS would not consider it. I thought it was a reasonable request. Very reasonable and fortunately, UMass agreed. They should since they performed the surgery and that equipment is NOT any old hearing aid but ARE prosthetics which should be covered. I worked for BCBS in Boston for five years too, though I was a freelancer at the time. I wrote documents about their online system and how to use it. It was my favorite freelance gig because basically, I did nothing and got paid anyway. In those days, they ran a pretty loose ship.

      Liked by 1 person

      • I wonder if we were there at the same time? I was at 100 Summer, mid-90s? I think you were very smart to switch and am thrilled for you both. Now you can have those fascinating dinner table conversations together!

        Like

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