Does Your Medical Insurance Really Matter?

I have had some different types of insurance since 1963, so I am going to say yes medical insurance does matter. I think it does when we factor in that there are many individuals on Medicare now more than ever who are not 65 years of age. We typically think of Medicare for those over 65. This is no longer the case.

Insurance impacting treatment choices

I find it very mind-boggling that two people can have the exact same illness, but one can be treated with the creme la creme medication while the one who is receiving Medicare gets another treatment or medication. I spoke with someone who went into extensive details about her medications and treatments. She suffers from chronic psoriatic arthritis pain. She has repeatedly asked the doctors to treat her with a medication that would be more effective. She even went as far as telling them about a medication that she knew would be of benefit to her. However, because Medicare will only cover certain medications, this medication was not an option, and neither was her going into her wallet to pay for the medication. Why, because the medication was very costly, and you had to have a certain insurance to even to think about getting it.

Fair or not fair

When we look at the big picture, is this okay? My personal opinion is no. Why is it that because of the type of insurance you have that this determines what drug you can use? It determines whether you have a surgery that may be necessary for you. I take it personally when this hits home.

My sister has been on Medicare for several years and she does not meet the age requirements, but because of her medical conditions, she found herself disabled in her 40s. Has it been a ride where she's had the best choice of medicine? No, it hasn’t. She met a lady that had the same problems that she did. This lady suggested she speak with her doctor in reference to a medication that is one pill a day for relief. When she approached her doctor, they knew Medicare would not cover this medication. She had to continue on the medication that really wasn’t 100% effective. Why is it because we have an unfortunate disability that we must suffer?

Who calls the shots?

When it comes to high-cost medication and who pays the price? I can tell you who pays; the one who may be in their 40s walking around with the red white and blue card being told by the insurance company what treatments these people can have due to being on disability. This must be revamped and we must realize that everyone whether disabled or not should have access to the best medicine, best treatments, and best quality care. Are we being partial to those with certain insurance carriers?  Have we somehow gotten so greedy that it just doesn’t matter, or have we just overlooked a high-risk population that depends on Medicare every day?

Understanding the fine print

Medicare recipients who have arthritis, cancer or other complex conditions may find they have to pay thousands of dollars a year for their medications, even if their insurance plan covers most prescriptions.¹ There are a lot of us baby boomers coming of age. If we take a medication that has been excluded from our plan our costs could be off the roof. So many of us are on biologics and the out of pocket costs could be over $10k a year if you’re not covered. You might not realize that if you exceed your limit that you are responsible for these expenses. I would suggest that when the time comes to shop around for a Medicare plan that covers the drugs you are taking; many plans vary in their charges so shop around.