I recently had to have a biopsy for results gleaned from my mammogram from the state breast and cervical health program. I asked the nurse what would happen if the biopsy was cancerous, would the state program pay for surgery? She said she didn't know. She went on to say that the doctors and nurses intentionally stay ignorant of the programs, and who is covered and who is not, so that the exact same care is provided to people who are covered by insurance, and people who have no coverage at all. She said "people get all nervous about whether they have health insurance or not, but it doesn't matter to us." My insurance is by Anthem, catastrophic care only, many restrictions, and I also have a Health savings account. People think I'm nuts, but I actually like an arrangement that encourages me to be more active in my health and health care decisions. With apologies to Robert Frost, a hospital is a place where, if you have to go there, they have to take you in.

Late husband worked for a health insurance company, and that was the last time we had a health insurance benefit. When he left that job, we got catastrophic care insurance, with a huge deductible. We eventually opened HSAs as well. Over the last ten years, each of us has had jobs that offered health insurance plans. We looked at the cost (to the employee) of those company plans, and the benefits, and restrictions imposed. We compared them to the cost of our current plans and benefits, (when you pay yourself, you chose who you want with no restrictions). The HSA balance creeps up over time, allowing more payments, (dental, doctor's office visits, optometrist exams,) on a schedule we controlled, instead of what the company plans would allow. Employers have been hit hard the last few years, too. The workplace plans we were offered had higher premiums than our individual accounts with Unnamed Health Insurance Company, and were not of more value to us. In spite of being a "catastrophic care" policy with a high deductible, It seems to be paying for things, or making partial payments for things, every time i turn around. Tick removed from back at walk-in facility: Paid half the bill. Prophylactic medication in case I was exposed to Lyme disease: I was stunned to have the couple bucks and change it cost. I asked the pharmacist "Isn't there a minimum dispensing fee?" Yes, she said, but the insurance covers it. If I hadn't had that policy, it would have been twenty dollars or so, for two pills. As it was, I paid less than three dollars out of pocket. I'm actually quite happy with the situation I'm in: the fewer people sticking there noses into my health care (policy wonks in DC or that lady in personnel) the better I like it. And it had no bearing on Poor Late Husband's demise: He had lung cancer, quite likely from his thirty eight years of smoking two packs a day. There were unusual circumstances that contributed to his sudden death only five weeks after diagnosis. No amount of chemo, surgery etc., would have saved him. I had a cancer scare myself, actually less than three months after his passing. I asked a nurse what would happen if I had cancer, and my insurance didn't cover treatment. She said she didn't know how that worked, and she said the doctors and nurses take precautions to not know anything about the finances of patients. That way, she said, those with or without insurance are treated the same way while in the hospital. I think it's stupid to go without insurance to have more money for lattes and cell phones, but I defend others' rights to spend the money they earn in a way that they find valuable. As for people who "End up in the emergency room because they couldn't afford a doctor" I've personally known, lived near, worked with some of those people...and they abused the emergency room option so they wouldn't have to pay. I've heard them rationalize taking a child with an earache to the emergency room to avoid a $20 co-pay at the doctor's office, and the hassle of scheduling an appointment. Then in the next breath they griped that they had to wait so long to be seen.

Regardless of age and health issues she is paying entirely too much. Go to an insurance agent that sells Medicare Supplements and Medicare Part D (prescription drugs). The Insurance company cannot refuse to enroll her the first time for any reason. Also, check with an agent for dental coverage. I am 69 and pay about $30 per month with Aetna for dental and $120 (Plan G) for the Medicare Supplement that pays the balance after Conventional Medicare Part A and B (80%). Depending on age the Medicare Supplement, Plan F that pays all claim amounts (if Medicare pays for the procedure) with no copay or deductible should cost about $100 per month. Likely, you will find that aetna currently has the lowest price. Regardless of the company, all providers in her state must offer identical coverage with the premium being the only variable. Plan G will even be a lower price than Plan F with the only difference being she will pay an annual Medicare deductible for 2013 of $147. Medicare part D pricing will vary but Medicare has an excellent website where you can enter the drugs taken and you will find the out of pocket pricing. I now pay about $30 per month with First Health and pay nothing for Tier 1 generic drugs. I have changed providers now 3 times due to lower prices offered by another provider. I shop every year! The Part D prescription various amounts depending on the provider and plan chosen. In general, it covers about 40% of drug costs unless it is a tier 1 generic drug. Be careful that you do the research because one can be screwed. So, with the Medicare Supplement, Medicare Part D and dental insurance, the monthly cost should be about $160. Keep in mind that she can pay much more if she falls in love with an insurance company as she already has. She is likely paying a 3% administrative fee to her past employer for Cobra. Cobra should only be a temporary alternative until one is 65 and qualifies for Medicare.

dedtired -- There are 'advantage' plans that are PPO's. DH's former employer offered us one from Aetna for 2012 and I seriously considered it because our expensive meds were much, much less for us under that plan. However...it left us open to 20% copays. (This one was basically Medicare benefits plus a drug plan.) Our MD and hospitals did accept this 'advantage' PPO. It paid the same for in- and out-of-network doctors. Look at what you will get just from Medicare. It covers a lot of 'normal' stuff, like an annual 'wellness visit' (mini-physical), mammograms, colonoscopy, flu shots, other 'preventive' services. You may not need enough more to warrant buying a supplementary policy, depending on your health. At 70 and 73, we decided to continue with the Aetna 'medigap' supplement we had for 2011. It's $744/year for both of us and pays the 20% Medicare doesn't pay. Example: The doctor bills $300 for a service, but he accepts Medicare assignment. The Medicare-approved cost of his service is $100. Medicare pays $80. Our Medigap policy pays $20. He can't bill for his 'missing' $200 because he's agreed to take Medicare assignment. Our medigap policy will also pay a bit more for the MD who 'balance bills'. This MD can bill 15% more than the Medicare-approved fee, and our supplementary policy will pay it. In 2011 we had zero doctor, lab or diagnostic bills. Medicare and our supplement paid everything. I think our 20% copays on our bills might not have totaled as much as we paid for the policy in 2011, but I don't want to gamble about 2012. (And, the premium actually DEcreased.) If you don't anticipate needing expensive prescriptions, take the cheapest-premium Part D plan. It you DO have expensive prescriptions, tally the premium and what your drugs will cost under a plan. As long as the insurance and pharmacutical companies own Congress, this is the way we have to live.