COCHLEAR IMPLANTS, MEDICARE, AND ADVANTAGE PLANS

We have had BlueCross’s Advantage plan now for the past five years and I really have no complaints about them. They are as good a medical carrier as I have ever had. As a Medicare advantage plan, they have been excellent — maybe better than excellent. Often really great. They cut costs whenever they can. They approve medications quickly. Pretty much every hospital and most doctors work with them.

This year, UMass came up with their own plan. I wrote about this earlier: CHANGING MEDICAL PLANS – MASSADVANTAGE. I chose MassAdvantage because they agreed to treat Garry’s hearing devices as prosthetic hardware which is like a wheelchair or an arm or leg. They pay 80%. We pay 20% in (hopefully) easy payments. Even split up, it is still a lot of money. We’re not talking hundreds of dollars. It’s thousands of dollars and the sky is the limit on pricing.

When I called Advanced Bionics and Garry’s audiologist about it, I was told that Garry’s hearing devices were not covered by Medicare. I pointed out to get the cochlear implants, they removed all the “hearing parts” of his ear. Without that device, Garry has zero hearing in his right ear and close to none in the other.

That the customer service reps didn’t understand what I was trying to explain is understandable, But Advanced Bionics is on BlueCross’s active provider list. They know it’s covered by insurance. It’s part of their business model.

I did my best to explain this and I’m a pretty good explainer. I got forty years of practice explaining complicated things. These are prosthetic devices that replace the normal functions ears. He can’t just go to the nearest hearing aid location and get a set of aids. These are specialized devices and would cost a fortune out of pocket.

The woman called me back and said no, they didn’t pay for them. At all. I had the same conversation with the MassAdvantage rep. But after she talked to her superiors she said not only would they cover them, but it’s in the Medicare directive that these devices are covered as prosthetic devices — which is logical because they are prosthetic devices. Thus they are covered 80% by insurance and the remainder is a slow payout which is presumably set up so we can manage it.

Today, when I called BlueCross to explain why I was leaving them — other than that MassAdvantage costs less — is they will cover his hearing devices. Moreover, Medicare says are covered. If Medicare covers them, Advantage plan insurers are legally obligated to cover them too. When I pointed this out to the BlueCross woman. She said that I must have been given the wrong information. That couldn’t be right. I agreed. That answer couldn’t be right. It felt wrong.

MassAdvantage agreed to cover them and when I heard that, I said: “You are the winner!” I signed up. Not much of a winner. We’re old. We need medical care.

Mind you, even with 80% insurance coverage, these device are a huge expense for people living on a tight budget. Our income has stayed the same for 20 years which is as long as Garry has been retired. Every month prices go up. I’m always amused by young people who think Medicare is “free insurance.” It’s not free. Not even close to free. And it’s missing a few pieces. What is more, we PAID for Medicare through all the years we worked. it was the biggest piece coming out of our paychecks.

The rest of the world may get raises (I hear the economy is improving), but we don’t. People surviving on Social Security get the same amount forever or until death do you part. I’d find this terrifying if I thought about it, but I try not to think about it. The past five years have been terrifying enough. I don’t need to make it worse.

I’m going to try to make sure everyone understands a cochlear implant is a surgical reconstruction of a individual’s hearing equipment. A necessary prosthetic is required and mandatory.

Not only is it time they start paying for Garry’s prosthetic hearing devices, but I’m waiting for them to begin covering the rest of us — like eyes, teeth, and insulin, AIDs medications and other expensive long-term medications that we need to keep on living. Meanwhile, they always remind us to have our eyes, hearing, and teeth checked but won’t pay to help us get them fixed. I don’t understand the point of telling us we get tests when the result is to leave us hanging in the wind if we need assistance.

I already feel like I have accomplished something if BlueCross recognizes this. Legally, they are required to recognize it. It would make a lot of people’s’ lives easier and better. Something to feel good about.



Categories: Anecdote, Cochlear implant, healthcare, Hearing, Medicare, senior citizens, UMass Memorial

Tags: , , , , , , , , ,

15 replies

  1. When we receive the first notice about reviewing and signing up for insurance in July, I dread it from then on. I think at this age everyone has certain ‘things’ they have to review plans for, and it takes a lot of research and heaven forbid that they provide for an actual human being to talk to. I picked up a prescription that is 90 days of tier 3 yesterday, and the woman said ‘do you know how much your copay is?’ Why, yes, I do, and I pay it every 90 days on two meds, and it almost makes me gag. I don’t think anything is going to be fixed in our lifetime, but I certainly do hope our grandkids do better.

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    • I’m afraid our grandkids will get nothing at all — and THEY are worried about it too. My son is worried, though at least he’s pretty sure Massachusetts is pretty good about shoring up people with disabilities. Compared, at least, to other states.

      I just got a MOUNTAIN of mail, from Blue Cross who we are leaving, MassAdvantage who we are joining, AARP, and some company that sells you anything you are willing to buy. I’m just hoping the new plan won’t be a total disaster. It’s run by the hospital we use anyway and to which all are doctors are using too. It’s just the billing and paying thing. UMass has a very wonky billing department. They never get anything right. I have an image of my on the damned phone every time they send another bill for something I’ve already paid for. I’m trying to stay calm.

      Liked by 1 person

  2. I agree with you! They were pricey and the D coverage didn’t help all that much with Rx drugs for me and I got tired of the gatekeepers – seems like some are deny deny deny as a matter of policy. They assume many people will just give up and won’t bother doing homework as thoroughly as you do! And you are so right about the ppwk!!

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    • That was what was really excellent about BCBS. They never did that. Not once in six years. They approved everything usually the same day. They weren’t available here in the beginning, but after a couple of years, when their plans became available and were actually LESS expensive than straight Medicare or any other plan, it was an easy choice. They have always been a really good company to work with. We also had a couple of plans (before BCBS) that were truly awful.

      Liked by 1 person

      • It’s wonderful that your experience was so positive. I can tell that were it not for their extreme recalcitrance around the prosthetic designation you could have been happy there for years to come.

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  3. Here’s a question I often wanted to put forward: How is Garry washing his hair and how can he have it cut with those wires and electronics ‘welded’ to his precious head?

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  4. Helpful post, Marilyn. One thing to consider is that people are not required to buy a Medicare supplemental plan like either the BCBS plan or your new one. I have straight Medicare and am not paying the additional supplemental fees monthly/quarterly/yearly. Garry could have had just Medicare pay for it when done by a doctor/hospital that accepts Medicare and you would not have had the safekeeping approval struggles with either plan. Medicare A and B are pretty sufficient for many people.

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    • argh autocorrect strikes again. That was gatekeeping not safekeeping. Why can’t we edit comments in WP? Sheesh

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      • I know. We were on straight Medicare for a long time. We only switched when there was additional coverage and often lower prices through the advantage plans. We DID have to pay the difference. One year I had a supplemental plan which was great. They paid everything, but they were also very expensive. I’m going to have to check again and see if we are eligible for discounts. The problem is that the “poverty” levels are set very low. In a state as expensive as Massachusetts, the amount they call “poor” is so absurdly low, we’d have to be living in a crate. But it’s possible they’ve changed the levels. They do that periodically. it’s just they always want pieces of paper i don’t have or can’t find. I get discouraged even looking at the requirements. Generally, I’m not easily discouraged but government paperwork has that effect on me. Garry won’t even look at this stuff, so it’s pretty much up to me.

        But you are right: straight Medicare can be a very good deal.

        Liked by 1 person

  5. So not only do you have to pay partial medical costs whereas we have our NHS (still wonderful despite issues caused by government underfunding), you also don’t have your Social Security pensions index-linked? Appalling! Here in the UK our pensions go up in line with the cost of living, more or less. And employment pensions too. My husband and I are both retired but after years working in the public sector (lower pay, higher pensions on the whole) and with me now qualifying for the State Pension too, we have a respectable income. We do have the advantage of having inherited my husband’s parents’ house which we rent out to supplement that income, but even without that we would be fairly comfortably off I think. I feel for you 🤗

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    • Garry’s pension was tiny when he got it. He only got half his pension because otherwise, I would not be included and if he predeceased me, I would be left with nothing. In theory our Social Security is linked, but sometimes they decide they can’t afford to link it so we get nothing for years in a row and when finally, we get something, it’s a pittance compared to the reality of the market.

      We had some money, but this house has gotten older and the repairs we’ve had to do — and there are so many more of them remaining — have emptied whatever we had saved. I’m still glad we have this house because otherwise, we’d be living in “senior living” — tiny little apartments we would really hate.

      I don’t understand why Americans put up with this. They really don’t have to but many people don’t understand how this works. Garry didn’t understand it until he was on the way out. He had no idea and at that point, I admit, I didn’t understand how it worked either. I never worked anywhere that even had a pension plan or any kind of savings for workers.

      We could have done better if we had realized how the system really worked. It never occurred to me that they would cut Garry’s none-too-generous pension in half so I would not be left with nothing. No one mentioned that. There were so many other things we didn’t know. I have learned the lesson the hard way and one of the things I keep trying to do is to warn people to find out EXACTLY what they are getting in the way of pensions (if any) and Social Security and Medicare. People don’t know nearly as much as they should. It’s awful to find out when it’s too late to fix it.

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  6. In Australia age pensions are linked to the CPI and raised twice a year usually although not by much. Other benefits like the one I am on, JobSeeker, are also linked to CPI but they are calculated differently so that JobSeeker is less than the age pension and never goes up by much more than a couple of dollars at a time. However, the PM is fond of saying that there may not be guaranteed pensions in the future which makes me very uneasy.

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    • I often realize how little people care about their elders. Supposedly we are entitled to a lot, but in the end, we get very little. As soon as we stop earning, we are a “burden.” All the taxes we paid for Medicare and pensions means nothing anymore. I suppose it beats being tossed to the wolves, but sometimes you have to wonder. I don’t know what I expected getting old to be, but this definitely wasn’t it.

      They have been trying to cut social security for years — as if it was something for which THEY are paying rather than something for which we paid every year of our working lives. We had a huge stash of money for it too, but the good old Republican party changed the rules when Regan was president. They “borrowed” the money — for what I still don’t know — and of course, once gone, it has stayed gone.

      Is there a moral to this? I’m not sure. It’s not like we can change things, even when we do know about them.

      Like

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