You should pick a new plan for next year or Medicare will assign you to one. Do this before 12/7/2023.

Let me know if you need help. I will do what I can to accommodate.

We know from research that people can understand numbers — when they are clearly presented. Further, we know that people are confused by “verbal quantifiers,” such as “rarely” and “likely.” Unfortunately, experts often prefer such mumbling words, conveniently claiming that their audience is innumerate.

Read on . . . good information

https://www.statnews.com/2023/09/12/fda-prescription-information-one-pagers/

Mesa View, which is a little more than an hour’s drive east of Las Vegas, has a high percentage of patients enrolled in Medicare Advantage plans.

“Am I going to say I’m not going to take care of 40% of our patients at the hospital or the clinic?” Adams said, adding that it would be a “tough deal” to be forced to reject patients because they didn’t have traditional Medicare.

Mesa View has 21 Medicare Advantage contracts with multiple insurance companies. Adams said he has trouble getting the plans to pay for care the hospital has provided. They are either “slow pay or no pay,” he said.

In all, the plans owe Mesa View more than $800,000 for care already provided. Mesa View lost about $1.3 million taking care of patients, according to its most recent annual cost report.

https://kffhealthnews.org/news/article/medicare-advantage-rural-hospitals-financial-pinch/

ICYMI . . .

Good news for those with REALLY expensive medications . . .

Starting January 1, 2024, once your out-of-pocket spending reaches $8,000 (including certain payments made by other people or entities, including Medicare’s Extra Help program, on your behalf), you’ll automatically get “catastrophic coverage.” This means you won’t have to pay a copayment or coinsurance for covered Part D drugs for the rest of the calendar year.

https://www.medicare.gov/drug-coverage-part-d/costs-for-medicare-drug-coverage/catastrophic-coverage

ASSISTANCE FOR HEALTH CARE COSTS BY SPECIFIC DIAGNOSIS

There are many private- or government-funded organizations offering programs that help with costs associated with specific diagnoses. Some programs are national in scope, while others are limited to people in specific states. Most have some type of eligibility requirements, usually financial ones. Some cover one specific diagnosis, while others cover whole categories (such as all types of cancers) or even all chronic medical illnesses.

These diagnosis-based assistance programs may cover many types of expenses, including drugs, insurance co-pays, office visits, transportation, nutrition, medical supplies, child or respite care. https://www.needymeds.org/copay-branch

Same Patient, Same Drug, Same Insurer — Coverage Denied

Morales-Ferrer has focal segmental glomerulosclerosis, a rare kidney disease that results in scarring in the parts of the kidneys that filter blood. Even with treatment, many FSGS patients eventually progress to kidney failure and need dialysis or transplants. Recurrence is common after transplants.

Until a few weeks ago, things were looking even more dire. Morales-Ferrer’s insurance company was refusing to pay for the same infusion medication, Rituxan, that it had covered during her first bout of FSGS, one that her doctor credited with sending her disease into remission for years. She wrangled with them for weeks, facing down three separate denials, one of which forced her to cancel an important infusion. Her story offers a window into the confounding, seemingly irrational world of insurance coverage, one that’s given rise to a network of billing gurus dedicated to helping patients fight denials.

“The medication is right there,” she said. “My doctor is ready to offer it to me, but they’re blocking it. It’s mind-boggling.”

This is what can happen when you have a managed care PPO or HMO plan.

https://www.statnews.com/2023/03/02/bcbsma-rituximab-insurance-coverage-denial

In Closing . . .

The end of the year is coming up fast and I am praying that 2024 will be an improvement in many ways.

In other news, Christmas is canceled in Bethlehem (Israel, not PA.) for political reasons . . . “Google” it if you want to know more.

But here in Georgia it will be honored.

bob