Countdown to Medicare with Type 1 Diabetes:  5 Months / Anxiety

Laddie_Head SquareThere are frequent online discussions about addressing mental health issues along with physical concerns when living with diabetes. I am lucky to be mostly immune from things like diabetes burnout and depression. I don’t like diabetes but it doesn’t haunt or slow me down much. I come from a family with a history of depression but its dark clouds have never settled over me for very long. Still…

I have a tendency towards anxiety. The kind of worry that radiates in my chest and aches in my belly. It has never been so crippling that I have felt the need for professional help and I have been helped by progressive relaxation tools I learned from a book many years ago. Deep breathing and exercise also help.

I am very in tune with my anxiety. It surfaces when I need to make a decision or address a problem and I don’t feel in control. Sometimes the issues are trivial or at least very fixable, but my rational brain can’t convince my gut that I shouldn’t be stressed. I won’t call them silly, but my anxiety worries are not life-or-death. Maybe it is a leaky roof. Maybe it is a grandchild getting her feelings hurt. Maybe it is Christmas. Maybe it is thinking about what needs to be done to sell our house and we don’t even plan on selling the house.

Maybe it is Medicare.

I have been trying to get a handle on Medicare options for several months. I haven’t decided whether I know too much or not enough. I wake up many nights at 2:00AM and start thinking about Supplemental versus Cost* plans. I walk the dog and my stomach cramps thinking of Competitive Bidding. Part B insulin and test strip brands are a constant concern. This stuff is important, but not so important that I should be losing sleep.

But anxiety does not always make sense.

I finally have premium costs and plan information for 2017 and I am making worksheets to compare my options. I have only one decision that could have an impact beyond my first year on Medicare and that is the Supplemental versus Cost plan decision. Supplemental (Medigap) policies are only required to accept me (a person with pre-existing conditions)countdown-to-medicare-5-months during the first 6 months that I am on Medicare. After that I can be denied coverage or charged higher rates. At the same time there are guidelines about having guaranteed Medigap rights and some of those scenarios will grant me needed flexibility in the future.

The things that stress me are discrepancies like one plan agreeing that insulin for a pump will be covered under Part B and a similar plan saying it won’t. (That can be a big deal because Part B insulin does not go into donut hole calculations.) I think the plan saying no is wrong, but what do I do about it and do I dare risk signing up with that company? I need to consider that company because it happens to offer CGM coverage. Yes, I am lucky to have the option of CGM coverage with one plan! But I need to consider the whole package, not just one thing. More homework to do.

Another thing that is stressful is trying to figure out what pump and testing supplies cost. For the most part I have been using the negotiated prices from my current BCBS policy. But one friend shared his test strip cost info with me and it looks as though he is paying 20% of what I consider a high retail price compared to what a negotiated price should be. Am I right? Right or wrong it certainly makes me wonder what prices I should be using to figure out my anticipated costs.

Another thing that kicks me in the gut is competitive bidding. This is only relevant if I choose a Supplemental plan because Cost plans use their own suppliers. DPAC has published a couple of blogposts recently that scare the bejesus out of me. One post was written by a person with diabetes on Medicare and the other was written by someone who owns a durable medical equipment company. These are great articles to spur advocacy, but frightening for those of us anticipating Medicare.

One benefit of participating in the DOC is that I have support from other people affected by diabetes. A downside is that I read stories of people having nightmare experiences with Medicare. As a blogger, I get emails from readers sharing their stories and problems. At the same time I know many people with Type 1 who are doing fine on Medicare but those people don’t write much about their experiences. I mostly hear the bad stuff.

anxiety

I have anxiety. Some of it is unreasonable. I live in Minnesota and have several good (not perfect) options for Medicare. My husband still works and his income will provide a buffer from the shortcomings of Medicare. At the same time some anxiety might be reasonable because healthcare reimbursement at all levels in the United States is under siege and people with diabetes are getting hit particularly hard.

I expect that my next Countdown to Medicare post in December will outline some specifics of my choices. Obviously cost is a major concern, but so are things like drug formularies, test strip brands, and requirements for getting pump supplies. I have already eliminated choices that do not network my current doctors and I am looking at the plans of two different companies. It is likely that I will choose a plan that allows me to avoid competitive bidding because anyone with a tendency towards anxiety might not survive that disaster.

More to come. 😀

*

**Minnesota is one of very few states that offers Cost plans. These plans are hybrids that combine features of traditional Medicare and Advantage plans. Most people reading this post will not encounter Cost plans in their Medicare journey.

12 thoughts on “Countdown to Medicare with Type 1 Diabetes:  5 Months / Anxiety

  1. How appropriate that I read this blog now. I have gotten my denial for my first box of sensors for my CGM (big suprise). Speaking of anxiety, last night , after trying to work out a plan for the appeal, I took a Xanax and went to bed! You’re right about the lack of control, it scares me. Problem is, I dont know who to turn to for official help .Do people hire lawers, get a special advocate from somewhere? I will follow the Medicare process and also call the other insurance helpline provided by New Your State. I am planning to let my congressmen know each and every step I take. Tom Reed , my senator, is a sponsor of the bill before the house. I have recently learned that he has a 19y/o son with Type 1. Trying not to think I am not alone, but somedays thats how I feel.

  2. The most terrible things I have had on Medicare thus far are three. The sensors, (of course) the donut hole obviously and then the test strips. I can get all the test strips I need. But my pharmacy (local CVS) is not getting paid for them. Now for almost two years CVS has said no problem. But when I get those denials (CVS pays not me) my heart stops each time. I just can not get over the system being so out of whack. I figure each time they will say no more and then I will be looking for an alternative.

  3. By the way: This item has been referred to the TUDiabetes Blog page for the week of October 31, 2016

  4. For Rick,
    When I get denial letters, it is because the provider did not code it properly, or left off pertinent information. When they get the denial, the errors are corrected, and they then will get the payment due them. There was one instance, where the date had been entered incorrectly. It took a few weeks to straighten that one out, and I happened to be the one that realized the date was incorrect. Don’t let the denial letters worry you, as they do get corrected – sooner or later.

    For Laddie,
    It will go smoother than what you think it will. So try not to stress out over it. You will do just fine.

    Kathleen,
    Send for the paperwork. Answer all the questions, there are 10 of them, if I remember correctly. Make a copy for yourself, and with a cc to your doctor. I had to do one appeal, which was a few years before I hit Medicare age, so I am assuming that the appeal process would be the same or similar to it. Also, look at your Part B EOB that comes every month. There are instructions on the last couple of pages. One more thought, have your doctor do a Letter of Necessity, to include with your appeal paperwork.

    Hope this has helped somewhat for all three of you.

    Trisha (aka trisha01)

  5. Thank you for documenting this process for everyone. Insurance should NOT be this confusing! I remember navigating my Mom’s Medicare and secondary insurances. It wasn’t fun and she didn’t have a chronic illness! I’m currently in the process of deciding our health insurance future and I’m using spreadsheets. 🙂 Hugs. (and I look forward to seeing you this winter!!!)

  6. Laddie, thanks for sharing all of this. I hate that it has to be so confusing and overwhelming. Definitely not what we want when we’re already wrestling with diabetes, right? Sending positive vibes and wishes for a smooth transition.

  7. I know what you’re going thru’ with the anxiety of “what if’s” Laddie – even though I’m a Canadian living in the land of *free hospital / GP care* with my work life slowly coming to an end – I’m also having restless nights the past few years. 40 years as a working stiff – with most of the times – medical insurance for insulin and other diabetic supplies – that’s all disappearing next year. I’ll be paying out of pocket for all my ‘scripts/insulin/test strips/CGM – which I already pay out of pocket for now. I’ve made a move to a new province (state to you Americans) – that at least will allow me to not fork out for my next pump that I pay for out of pocket, so that’s a big help, but always in the back of my mind, is when are programs like this going to be stopped. So, as most of you reading this have probably already done, we’ve tried to put away monies over the years – hoping to at least fall back on those when we need them. I’m hoping the transition goes smoothly for you, that it’s affordable and less stressful.

  8. I can’t quite relate, but boy can I understand the anxiety over change. Until July 1, I was on a health plan with a rather high premium, but after that things were relatively smooth. I used the insulin, test strips, and pump that I wanted and didn’t have to worrry about the back room negotiations over pricing and preferences.

    Now that I’ve switched to a new and differently-structured plan (and yet another for 2017 which, I’m sure, has plenty to be uncovered) I can feel the nerves and anxiety over every site-change, BG test, and sensor replacement – challenging myself to stretch my current usage and my supply out as long as I can, because of the unknowns that come with needing more. Maybe the lower premium and constant fights for coverage will work out better, economically, in the end (I doubt it) — but there is a huge price for confidence and peace-of-mind that is unaccounted for in the current system.

  9. Hi Laddie
    Congratulations on your blog. You’re providing a valuable service to others trying to navigate the Medicare maze. FYI, I have spent my career in the non-profit health and human service field and for the past 7 years have been working as a certified Medicare Counselor in Rochester, NY.
    With this background, I’d like to share a few insights that you and others may find helpful:
    – if you’re 65 and your spouse is working for an employer with over 20 employers and offers health insurance to spouses, you can delay enrollment in Medicare Part B & D without a penalty. You need a standard form letter from the employer that their drug plan provides creditable coverage and notify/confirm with social security.
    – There are significant differences between Original Medicare, Medicare Supplemental (Medigap) plans, standalone Part D plans and Medicare Advantage plans. Every person needs to evaluate your medical and drug needs along with the plan full costs and restrictions. Many states permit individual to enroll in a Medigap plan after their initial enrollment period has ended. You can check that out with your state insurance department.
    -Durable Medical Equipment (DME) expenses have been a large source of abuse and fraud with vendors marketing directly to consumers along with poor vendor screening and monitoring by Medicare. As a result, Medicare has instituted a number of reforms and now your doctor needs to approve that the equipment is a “medical necessity”. Then, you need to select a Medicare approved vendor. You can find this info on Medicare.gov.
    If you have a Medicare Advantage plan, you need to contact their customer service and select a vendor that is included in their MA plan’s network. It could be different.
    -Medicare.gov contains a wealth of information that is specific to where you live.
    you can find out the MA, PDP and Medigap plans that are available to you and compare their costs and restrictions. By entering in your medications and pharmacies in their “Plan Finder”, you can also compare what is included, excluded, restricted and the costs.
    -For more info, check out my blog http://www.healthplanadvisor.org that covers how to avoid costly mistakes. It includes a number of helpful resources and links.
    Best wishes and keep up the great work.
    Jim Sorrentino

  10. Pingback: Countdown to Medicare with Type 1 Diabetes:  4 Months / No Decision | Test Guess and Go

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