Dual Elligible/Medicare Advantage Getting The Shaft By Politicians

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Regular Member

Date Joined Dec 2008
Total Posts : 110
   Posted 5/20/2011 12:20 AM (GMT -6)   
I'm trying to understand what's happening to Medicare Advantage HMO plans as a result of the various health care bills/laws that have been passed, or are being considered. Does anyone have a grasp of the situation? After President Obama's health care law, I'm pretty sure that medicare advantage plans were negatively affected. Now the republicans have proposed their budget that screws with Medicare & Medicaid and from what I'm reading, once again those dual elligible/medicare advantage plans are taking it on the chin even worse! All I know is about a year and a half ago I was doing just fine on my medicare advantage HMO Bravo. My doctors were covered as well as my prescriptions and everything was fine. Then they notified me they were dropping me from coverage. So I searched the medicare.gov website and found Cigna, another medicare advantage HMO plan. My doctors were covered and my prescriptions as well. Then Cigna notified me that again I was being dropped and would have to find another company. However, when I went back to the medicare.gov website, there were hardly any plans available to me...and none of the plans would cover both of my doctors (Primary physician & Pain Doctor). Apparently my pain doctor had decided to stop participating in any medicare/medicaid plans. So I had 2 choices...1) Pick a plan and lose my pain doctor and my lifeline of pain meds...Not really a choice...or 2) Switch to straight Medicare which the doctors have to accept and pay 20% of all bills. That's what I did and so far so good, because 20% of the doctor's bills was similar to the co-pay I had to pay previously. However, that brings me to my current problem. I used to have a good knee (Right) and a bad knee (Left knee...11 operations and void of muscle strength). However, somehow my "good" knee started hurting real bad and was getting worse over the several months I tried to ignore it. The MRI shows I have torn meniscus in my "good" knee and I need to see an orthopedic surgeon for a probable surgery. There's no way I can afford to pay 20% of an operation (Surgeon, hospital, anesthesia, etc). So I'm suffering with progressively worsening pain in my right knee, to go along with the already painful left knee (Bad knee). This is on top of my daily, constant debilitating nerve pain throughout my back, legs, feet, groin, arms, hands, etc. And I have NO idea what to do about it...I feel totally stuck with no good options other than worsening and never-ending pain. Does anyone out there have any more information about what's happening with dual elligible/medicare advanytage HMOs?
Herniated Lumbar Disks L5 S1, L2 L3
Herniated Cervical Disks C6 C7
Spinal Stenosis
Degenerative Arthritis Left Knee
Pes Planus Both Feet
Multiple Neuropathies
Brachial Plexus/Thoracic Outlet Syndrome
Nerve Pain in Arms, Hands, Back, Legs, Feet, Groin, Testicles

Veteran Member

Date Joined Jul 2009
Total Posts : 2042
   Posted 5/20/2011 1:48 AM (GMT -6)   
Sorry pal, but I have this feeling that by the time the government get done screwing around with the health care in this country it is going to make health care in Uganda seem like country wide Mayo Clinic.

I don't know what your income situation is but I suggest you talk to which ever hospital that you would be having surgery at, if you have it, and find out if you would qualify for some kind of financial assistance.

While the income guidelines vary from community to community I have found that those limits are quite "generous" to get at least half the bill written off, if not the entire thing.

We have a family of 3 and we made close to $30,000 last year all told and we still qualify to have 100% of our medical bills written off at the hospital which includes any doctor employed there. If it was only me and my wife we would still have qualified to have 75% forgiven.
2 confirmed herniated lumbar discs. Spinal Arthritis. Spinal Stenosis, diabetic peripheral nueropathy.

Regular Member

Date Joined Feb 2008
Total Posts : 314
   Posted 5/21/2011 6:37 AM (GMT -6)   
Doctors have to tkae medicare? I know mutliple doctors that will not accpet any form of medicare or medicaid especially primary care.
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