A Cautionary Tale About Getting Good Medicare Coverage (medical, plan, hospital)

[Robyn55]

There are all kinds of threads here about Medicare and what you need when you go on Medicare. Some people say "I'm healthy - so I can afford to skimp". Or perhaps it's a family member who's saying this.

So I have a story to tell. My father and his siblings (3 of 5 are still living in their late 90's) are about as remarkable as they come. My father - 97 - has no chronic medical conditions and takes (believe it or not) no meds. He lives independently (although he has recently hired a home aide). He always grumbled about paying for his Medigap policy. And it was like pulling teeth to get him to change his ancient non-standardized Medigap plan to Medigap plan F last year (took us a couple of years to do that).

In any event - all good things must come to an end. My father got a severe case of jaundice last month. And was diagnosed in < 2 days with pancreatic cancer (at the Mayo Clinic - he's in the concierge practice there - my husband and I are too - and it's great). In a period of 4 days - he had a huge number of tests - and a 3 hour out patient procedure to insert a stent in his bile duct (the cancer had closed up the duct and the stent opened up the duct). And the jaundice disappeared. Bought him some time and avoided some miserable complications of a clogged bile duct.

Total cost - at Medicare rates - about $30,000. His out-of-pocket - maybe $100 for a bunch of blood tests that Medicare doesn't cover 100%.

Now - at age 97 - my father isn't planning to do anything heroic. Like surgery that would probably kill him. Just palliative care that will make his last months/years easier. But any of us could get a Dx like this when we are decades younger. Out of nowhere - out of the blue. And we might want to do more. Even if we didn't want to do more - even the basics cost a bunch.

So I never want to hear anyone here saying that they're healthy - they don't need good insurance. Because everything can change in a heartbeat - for anyone. Robyn

[Flamingo13]

Thank you for the post, things can change in the blink of an eye. We know you're father, good for him and his health! - won't be around forever, but folks need to realize "better safe than sorry".

[newcomputer]

Respectfully, at 97, with your father's condition as described, I might choose hospice care which is covered by Medicare A

[Robyn55]

Palliative and hospice care are pretty much the same thing here (same organization) except for some minor administrative differences. And that's what we'll do if and when the time comes (in terms of pain management or similar). At home if at all possible.

OTOH - today- there's really nothing to do. Everything is back to "normal". My father is back home (like I said - his procedure was done on an "out-patient" basis and he was back home the day of the procedure). He lives in a 2 bedroom "independent living" villa in a senior facility. He needs a home aide now for about 16 hours a week (to help him with meals - laundry and similar). And he has some mobility issues. But he's got all his marbles and is back to his normal routine.

BTW - there was absolutely no issue about stenting the bile duct obstruction. Without the stent - the blockage would probably have caused complications that might well have led to a speedy and not pleasant death. No reason to inflict that on an otherwise pretty healthy person - regardless of age. OTOH - we took options like surgery (it's the only possible cure for pancreatic cancer but is very major surgery) off the table. Mostly because even if the surgery went well - it would probably incapacitate my father for the rest of his life and require that he move into a SNF for a minimum of months. Which he absolutely positively doesn't want to do. Radiation and chemotherapy are also possibilities when it comes to pancreatic cancer. But they have major side effects and aren't curative in the absence of surgery. And would also result in a temporary/permanent move to a SNF. So they are off the table too.

Now if someone was younger - like say 67 or 77 or perhaps even 87 (we had a consult with an oncologist so we would know what the options were and he has treated people in their 80's) - surgery/radiation/chemotherapy might all be options. And they would turn an expensive disease into a hugely expensive disease.

I guess my main point is you never know what's going to happen. Or when it might happen. And - when it happens - the last thing in the world you want to deal with is figuring out how you'll pay for it - what your co-pays might be - whether doctors (especially big deal specialists) or hospitals are in or out of network - getting pre-approval for tests/procedures - etc. - etc. I am *very* glad we didn't have to deal with any of that.

I realize that getting great coverage on Medicare these days is far from inexpensive. And that buying insurance is never fun. But it's a worthy expenditure IMO if one can possibly afford it.