>>Aren't medical expenses in the US heavily concentrated on measures to stave off inevitable death? >> I've read several articles (must have been either AARP, NYTimes or WSJournal) that say that 80% of Medicare's budget is spent on 20% of insureds - the very frail and dying. But we should remember, this is true the world over. It's merely a question of who pays for it and for how long. Nobody anywhere wants to be the one who says to the family, "the plug has to be pulled because we're not going to pay for it any longer." Now, the ridiculous claim of "Medicare Death Panels" has been thoroughly debunked already, so no need to go over that ground again. Factually, ALL insurance companies globally have a Chief Medical Examiner whose job it is to approve or disallow payment for expensive treatments. That's what they do - balancing medical guidelines, doctor preferences, patient coverage, and company profit (no, company profit is not always paramount; but is an important factor in overall portfolio risk management). In the absence of clear, specific legal forms by the patient as to how end-of-life treatment is handled, the medical profession by its nature will do everything to save you from dying. Palliative care and pain management is only beginning to make an impact on their thinking, but again - without clear legal guidelines as to what the patient wants, ESPECIALLY if those instructions are contrary to what the family expresses - the doctors will do everything possible. And these days, "everything possible" is usually expensive with little regards to the quality of life. That's why it's absolutely critical to talk about what you want with not only your spouse, but your doctor and your family. Then put it in writing! BTW, I should amend my posting about the 'wellness' exam of the Healthcare Reform Bill. The NYTimes did an absolutely wonderful, comprehensive piece on this subject - what is covered, what is not, and why some consumers are surprised when they receive a bill they didn't expect. We have to remember, a physical exam for a 16-yr-old is going to be different than that of a 50-yr-old, which is again different than the exam for a 70-yr-old with severe medical issues. As it stands now, with the government gradually clarifying what is paid for and what is not, the two key things to note are: most of these don't begin until next year, and in areas where it's still 'gray' without legal definition, the insurers are allowed to make their own decisions about what is covered and what is not. (Access to the NYTimes is limited to 20 free articles/mo.) Preventing Sickness, With Plenty of Red Tape NY TImes September 19, 2011 (Excerpt) "Prevention has never been the cornerstone of American medicine. In this country, we tend to go to the doctor only when something is wrong, a habit long bemoaned by researchers and medical groups. The federal government aims to change that, and soon. Starting this year, insurers will be required under the Affordable Care Act to completely cover such services as annual physicals, childhood vaccinations and dozens of screening tests for everything from high blood pressure to abdominal aortic aneurysms. Just last month, the Department of Health and Human Services released additional guidelines specifying fully covered preventive services for women. Mammograms, cervical cancer screening and other services already had been mandated; the new recommendations expand that list to include screenings for human papillomavirus (which causes cervical cancer) and domestic abuse, and reimbursement and counseling for contraceptives. These services are to be fully covered by most insurance plans beginning in August 2012. Despite these new regulations, there's still a lot of ambiguity - and not just among consumers - about what qualifies as preventive care and what insurers are obligated to pay for. "I've seen so much confusion among patients and doctors alike trying to figure out what's paid for and what isn't," said Dr. John Santa, director of the Consumer Reports Health Ratings Center and a primary care doctor. " Here is a link that might be useful: Full Article: Preventing Sickness

I'm finding that Part D plans don't change the base problem: The uncontrolled cost of prescription drugs. A low-premium Part D plan sounds good when it offers you an initial copay that is a small percentage of the retail cost of your medicatiion. But inflated retail on drugs means more people reach the 'donut hole' sooner. (That's $2930 total retail cost for 2012.) Then the individual will pay at least 50% of that inflated retail. Few will go beyond the 'hole' to the 'Catastrophic Stage', where they pay only 5%. (That kicks in only after a person has OUT OF POCKET costs of $4700.) Dadoes, I'm glad your grandmother doesn't need any expensive meds. Part D premiums plus our prescription drugs cost my DH and me over $4000/year. When I add the cost of Medicare Part B and a supplementary medical policy, the total is more than I budget for groceries. I've been taking Advair for about ten years. Their lawyers have a stranglehold on the product; I doubt I will live to see this go generic. In January of this year Walgreens quoted Advair retail at $516.79 for a 90-day supply, a big jump from the prior year. In March Walgreens quoted the same 90-day supply at $823.59 retail. This month it went to $849.19. Zap! I'm in the donut hole on this medication alone! I'm investigating Part D plans from two different companies. THEY are quoting retail of $684 for a 90-day supply of Advair in 2012. It's hard to believe they are right when Walgreens has been much higher for *this* year. IF the retail price quoted by a plan is accurate, I pay $110 copay for four 90-day supplies of Advair and I DON'T go into the 'donut hole' in 2012. (My drug's total retail won't top $2930.) However, if the retail is actually higher, I DO go into the 'donut hole', and I'd be paying 50% of retail (plus dispensing fees) before the end of 2012. In the second plan I looked at there is no flat dollar-amount co-pay; it's a percentage of the *whatever* retail from the start of the year, going to the same 50% of retail in the 'hole'. The unforseeable retail sways me towards the plan with a dollar amount copay. I can count on that exact amount for at least most of the year. If I avoid the 'hole', I'd be paying $440 for my Advair + $410 for the plan premium. Wow, 'only' $850 for one medication for one year. DH has TWO expensive meds. He goes into the 'hole' at the end of May -- or sooner if Walgreens is right on retail and the plan prediction is short. The least he will pay for these two meds and premium is over $3000.

patti43, after much research we decided on UHC Plan J as our supplement plan and the AARP Rx plan also through UHC. And you're right...if you don't sign up for a Rx plan now then if you sigh up later the premiums will be higher. At this point in time I'm not on any medications, but that will likely change in the future. So, caught between a rock and a hard spot, I signed up for a Rx plan. mcmann, all insurance reimbursements to Doctors are based on the allowable amounts designated by Medicare. Other insurance companies only pay a % of what Medicare would pay and the balance is simply a non-collectible write-off. This is a shame because the elderly segment of our population is left out in the cold trying to find doctors that will accept them as new patients because their doctor has stopped accepting Medicare or has retired. And I can't really blame them for not wanting to work long hours only to find that they've collected less than their expenses.

It is confusing, Mare...and that's what got me into trouble in the first place. Let me see if I can explain my particular issue to further clarify why I'm being charged a penalty. When my husband died a few years ago, all my benefits died with him due to an agreement he had made with the PBA long before he even knew me. His decision, unfortunately, was irreversible. Throughout our married life...all contact involving his benefits package had to be made by him even though I was covered under all his plans, therefor I was often left in the dark about what the plan included and who the carriers were. I was already enrolled in Medicare when he passed and knew that I would have to replace the supplemental policy he'd had for me with BC/BS. I did so immediately. What I didn't know was that I had to replace the Medicare D policy. I had never needed it and had no idea what it was let alone the fact that it existed as part of his benefits package. To make matters worse, the PBA didn't notify me that I had to replace this coverage with a policy of my own choosing. I went for almost 4 years without realizing that I was in default with Medicare. Fortunately, it was brought to my attention and I applied for a policy but in so doing, I learned that I was going to be penalized for the time that had lapsed between the loss of my husband's coverage for me and my "awakening". The penalty is based on a formula...1% of the policy monthly premium...times the number of months that one goes without coverage. It was a substantial amount to me and I had limited recourse. I contacted Medicare and filed a challenge. They agreed that I had a basis for my challenge. They reduced the penalty by 12 months...but said ignorance of the law was no excuse and I was left responsible for the remaining month's penalty. The penalty is NEVER removed. From now until the day I die...I will have that penalty added to whatever Medicare Part D plan I carry. My only hope to be relieved of this burden is that two US high courts agree with me...that the penalty, along with the Federal edict to force people to carry health insurance above and beyond Medicare...is illegal. If the Supreme Court agrees with the two lower courts, the entire forced insurance system will be reversed and my penalty will be dropped. Needless to say, I'm anxiously awaiting their decision. I hope this gives you a little more info. If you are already enrolled in Medicare, the booklet that they send out every year will give you more information. Or, you can call their office. I've found them to be very helpful...even thought I don't always agree with them. As long as you get Medicare Part D coverage as soon as you're eligible, you shouldn't have to worry about a penalty...unless somewhere along the line you decide to drop the coverage...and then pick it up again at some later date. You'd be penalized for the lapsed coverage time. HTH Anne