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Thread: Head up if you're on Medicare & get physical/occupational therapy

  1. #1
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    Default Head up if you're on Medicare & get physical/occupational therapy

    Sad to say but apparently those of us on Medicare may very well be seeing cuts already. Apparently congress can't be bothered to renew the override on caps for physical or occupational therapy. I thought I'd post this for anyone in this situation who may not know and could potentially get a big surprise when they reach the very low maximum. I came across this in the Daily Kos newsletter...

    "For two decades, Medicare has capped how much it will pay for physical, speech and occupational therapy. But ever since the limits were imposed, Congress has passed an automatic exception that allows Medicare to pay for care beyond the caps when the treatments are deemed medically necessary.
    The latest exception expired Dec. 31, which means the caps of $2,010 for physical and speech language therapy and $2,010 for occupational therapy are now being enforced. These services fall under Medicare Part B, which covers doctor visits and other outpatient services. When the exceptions were in place, Medicare beneficiaries paid only the 20 percent coinsurance that Part B requires.
    So people recovering from strokes, or hip fractures from a fall, or who need ongoing therapy for chronic conditions are soon going to be forced to figure out how to pay, or go without the care they need. As of January 25, Medicare started processing claims as patients hit the cap.

  2. #2
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    yellnhollar is just really niceyellnhollar is just really niceyellnhollar is just really niceyellnhollar is just really niceyellnhollar is just really niceyellnhollar is just really niceyellnhollar is just really niceyellnhollar is just really niceyellnhollar is just really niceyellnhollar is just really nice

    I’ve gone without my remaining therapy because I can’t afford it. Medicare kind of sucks. I can’t get state help because I make $200 too much a month.
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    @yellnholler...I’ve been very satisfied with a Medicare although I do pay a hefty price for a supplemental plan that covers all deductibles and copays. I actually like Medicare better than the private plan from work because with Medicare I don’t have to get any pre approvals and they cover everything my Cadillac work plan used to cover...just without the BS.
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  4. #4
    @Bawston
    This stuff is all going to get worse, before it has any chance of getting better. I don’t want to bring in politics, but we spend Trillions on crap, but we come second. I seriously want to throw up, thinking that people that seriously need PT, or OP, will have to get gouged, if they can afford it, or never fully recover, if they can’t. This country is really going off the rails.
    Helpful El Grandote Rated helpful
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    I hate to advocate drugs, alcohol, violence, or insanity to anyone, but they've always worked for me - Hunter S. Thompson

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    Bawston has a reputation beyond repute
    @M77...couldn’t agree MORE! An example for me was when my migraines got so bad that I couldn’t schedule any kind of commitment that I couldn’t easily bow out of because of the unpredictability. My migraines are stay in bed except for crawling to the bathroom to vomit every 45 minutes (sorry, too much info) so I felt I had to try something, anything and decided on just paying for Botox injections out of pocket. So every 3 months I paid $1,200. Funny thing is Medicare actually started paying for it but I was not on Medicare at that time. After Medicare started covering it my “Cadillac” insurance then did too but I had to get pre approved every year and my doctor had to justify continuing it.

    Under Medicare if you get an injection by a licensed med professional in their office the cost of the Botox is covered under Part B (medical). But pre Medicare my doctor’s office decided my private insurance didn’t give them enough for the vial of Botox and they started this deal where I had to put the Botox under my prescription plan. Some doctors actually made me order it from the pharmacy & carry it in a cooler to my appointment. Of course under my prescription plan I had a deductible and copay so what had been free was suddenly $125 after my $500 deductible. So at least with Medicare, the doctor has to follow the Medicare rules which are...in a doctors office, by a doctor it’s under your medical plan = covered.

    I kept thinking if private insurance companies (which are often different from the prescription providers) continue this idea of putting every med under your prescription plan, where does it stop? You go for surgery and have to bring your own anesthesia and oxygen? Maybe your own supples like a staple gun and staples? If they can push the cost off onto someone else they will.
    Helpful M77, cookiegirl Rated helpful
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  6. #6
    Quote Originally Posted by Bawston View Post
    @yellnholler...I’ve been very satisfied with a Medicare although I do pay a hefty price for a supplemental plan that covers all deductibles and copays. I actually like Medicare better than the private plan from work because with Medicare I don’t have to get any pre approvals and they cover everything my Cadillac work plan used to cover...just without the BS.
    I couldn’t agree more! At least in my state Medicare rocks. It pays absolutely everything and my injections. I have normal insurance I buy about 8 months a year as I contract and then I claim loss of job for 4 months and during those 4 months is when I get every injection i can. Otherwise the plan I have costs $500 a month on top of about $2,250 each injection. I would actually work 10 months a year but doing the math if I get all my medical in those 3-4 month window I wouldn’t be making all that much as I’d still be in a higher tax bracket eating 30% plus all the medical expenses and insurance.

    Love my Medicaid months. I’m surprised what I do is legal but it is. Trust me I had to hire to sort everything out with Medicaid before so it’s all in my paperwork now what I do. Unfortunately I lose my Medicaid soon... really makes me sad.

  7. I'm frightened because my medicare insurance now has started to deny one of my migraine medications. Dr. is appealing it, my gosh it's a very inexpensive med. I'll have to use goodrx.com or one of the discount cards to pay out of pocket for my prescription at my neighborhood pharmacy worse comes to worse. I've always had good insurance, now all of a sudden they won't pay for a common medicine? It's not Botox which I know is quite pricey. Makes me wonder what they'll cut next. My goodness, I can't stop the migraines nor prevent them. :-(
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    Bawston has a reputation beyond repute
    Quote Originally Posted by cookiegirl View Post
    I'm frightened because my medicare insurance now has started to deny one of my migraine medications. Dr. is appealing it, my gosh it's a very inexpensive med. I'll have to use goodrx.com or one of the discount cards to pay out of pocket for my prescription at my neighborhood pharmacy worse comes to worse. I've always had good insurance, now all of a sudden they won't pay for a common medicine? It's not Botox which I know is quite pricey. Makes me wonder what they'll cut next. My goodness, I can't stop the migraines nor prevent them. :-(
    @cookiegirl...I’m assuming you’re referring to Medicare Part D, prescription plan which was the biggest boondoggle to the private insurance company ever and also the most expensive social safety net program ever implemented. The biggest problem with it was that it specifically does NOT ALLOW the federal government to negotiate prescription prices. Think about that for one minute - why would a program that was meant to reduce seniors’ prescription costs ever agree to bow down to the insurance companies and not negotiate? Sure it was better than having to pay 100% out of pocket but now we’re seeing prices increase and many of my prescriptions aren’t even covered at all! (As you’re finding out).

    Also, why do we have to sit down every year and research who is the best plan to go with? Why isn’t there ONE government plan rather than private price gouging insurance companies?

    The Botox is covered because any med injected in a doctor’s office is under a Medicare part B medical.
    Helpful cookiegirl Rated helpful
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    I don't get migraines (Thank the Stars!) but I know several who do, including my sister. Out of pure curiosity and only if you wish to reveal, what's the average cost for injection(s)?

    Many thanks and wishing those afflicted better days!
    magchik
    "Rules are for the guidance of wise men and the obedience of fools."

  10. I found a better insurance plan and enrolled a couple of weeks ago, it'll start next month and all of my regular tests & medications are covered. I dumped the other health care coverage, I simply could no longer trust them. So till then I have to wait for coverage on the scripts I take that aren't covered. I don't intend on going to the Dr. during this time at all, staying out of Dr. offices till this is over, God willing soon. You made very good points Bawston, thank you.

    - - - Updated - - -

    I don't get the injections for my migraines, I take Imitrex my neuro prescribes for me. I just can't stand the thought of that stuff in me (Botox), where does it go and how long it stays in your body? Creepy, plus I hate shots of any kind.
    Likes calgal99 liked this post

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