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Old 01-24-2010, 11:48 AM   #1
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When can I get Medicare?

Hi Folks;
I gather that most of you like most of the public aren't really in favor of the various health care reform efforts going on. Unfortunately or fortunately the public is just not given the information they need to form an opinion on these things. I happen to be one of those Americans who was unfortunate enough to actually use my health care at one point in my life. This put me into an "undesirable" category. Wasn't a real problem when I was in California and stayed with the insurance my former company had provided me all those years, but when I moved to Texas the nightmare started. Most people don't realize how easy it is to fall into the pool of unacceptable for insurance companies. In my case I recognized that in my stressful investment banking job with lots of stress I was drinking way too much. I used my insurance to get into a rehab..... began the most wonderful time of my life... 10 days inpatient and 90 days out patient, and AA meetings every day of my wonderful 9 years of sobriety to follow. I'm the happiest guy in the world
but now because of a "history" of alcohol abuse I can not get insurance from any company and am forced into the "high risk" pool in the State of Texas. They state on their form that they are allowed to charge "TWICE" the state average for a man my age. I am paying $1,850 per quarter for just me... little ole healthy me... who hasn't had a drink in 9 years....
So I thought with all the talk of a new bill that would eliminate the ability of an Insurance company to refuse coverage for pre-existing conditions I would simply apply now to CIGNA and see if they were already loosening their standards.... HAHAHA no such luck. And get this.... FELLOWS bet you don't know this... this time they turned me down not only because of the previously mentioned condition, this time they added "erectile disfunction"... YEP was having a lil problem and my buddy the doc gave me some pills that well shall we say made me even happier (not to mention a certain friend). SO take note.... all of you out there, if you are opposed to health care reform you better not be taking the viagra or cialis.
Anyway back to the reason I wrote this, seems now my only hope is to wait till i'm old enough for Medicare... so what age is that? and how much does it cost once you're there.
Thanks for listening and thanks in advance for any replies....
Ed
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Old 01-24-2010, 12:24 PM   #2
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Ed, sorry to hear about your dilemma. Try www.socialsecurity.gov for info. I am turning 65 the first of april, but not retiring, and have to sign up for Medicare Part A as does everyone. Must be within 3 months of your 65th birthday. Parts B and C&d differ. Good luck. John H...
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Old 01-24-2010, 02:36 PM   #3
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Ed,

The price you are currently paying is actually pretty good. I have insurance through the company I recently sold. We have to pay $1,597.00/month for myself and DW. She is 62 and I am 59. In that price, is our normal age group charge, 6% up-charge for small group and 8% up-charge for being unhealthy. Our normal rate for our age if healthy and in a large corporation would be approximately $2,120.00 per quarter each. When I turn 60, there is another 15% up-charge for a man 60 or more.

Now, know that it is a pretty good policy with universal acceptance, none of that HMO BS for us. Especially if you travel much, an HMO is cheap and you get what you pay for, it is not for the traveler. Again, insurance is like a car, the striped down models are cheap, get more options and the price goes north quickly.

My guess is your problem is more your age than condition or history. You are in the high risk pool in Texas and I assume that you were turned down for regular coverage outside of the pool. What many do not know, is that in the Texas High Risk Pool, the insurance companies are allowed to charge up to twice what they charge a similar age healthy person, but not for the entire State, but by the index for your county of residence. When my DW and I went into the high risk pool in Texas, we used Escapees as our official address. Their counties index is as much as 3 times more than other counties. The single largest factor for rates, high to low, in the Texas High Risk Pool, is the county you live in.

Currently Insurance Companies charge what they refer to as a 5 to 1 ratio based on age. That means that you pay 5 times more if you are 60 years of age or more than someone who is 20 years of age. Both the Senate and House versions of Healthcare Reform had provisions to improve this ratio to 3 to 1. That would have meant that the 20 year old would pay more and the 60 year old less than they currently pay. With the potential for some limited Bi-Partisan reform, similar changes are anticipated.
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Old 01-24-2010, 05:21 PM   #4
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Thanks Jim I appreciate the info. Problem is with me to get that "low" rate I have, I have to pay a $5,000 deductible. Again I am well aware of how I've been blessed in this life and I'm glad to pay my fair share, and fortunately for me I can afford to pay it. I just wish I didn't have to pay more than someone my age for substandard coverage just because of what I and my doctor consider to be "silly" preexisting condition. I would also be happy that if a health care reform bill is passed, it would include language that would get rid of the pre existing condition obstacle.
Thanks again Jim
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Old 01-24-2010, 06:34 PM   #5
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I never thought that I'd find someone with the same problem I have. I'm 62 and had insurance through my daughters retail business which she had to close due to the economy, November 1st. The insurance I had been paying $700 per month for did not offer cobra, not sure why.

I applied for health insurance thinking it was no big deal. I'm in the gym 5 days a week twice a day. I have no known health problems. I take no drugs. However, they turned me down because I had a perscription for Cialis! I never even filled the perscription!

I've paid for health insurance my entire life and now that I'm 3 years from Medicare I can't get insurance! I've contacted 6 brokers who specialize in health insurance and after I describe my situation they never call back. I've never had any health problems so I've paid far more in insurance premiums than I've ever used. Now that I might need that support it's gone!

Since this has happend I have two friends in their early 60's who are in the same situation but their health isn't as good as mine. They are scared to death they will have a major problem before Medicare!

We've placed all our assets into a family general partnership own by our family trust. That way if I do have a major medical problem my wife doesn't have to loose everything! If something major happens my best option appears to be India or Thialand. It's insane to think you have to leave your own country to get affordable health care!

I don't think our law makers have any idea how bad it is for those of us who are over 60 without insurance. It's obvious why insurance companies don't want us there is a bigger possibility that we'll have a problem as we get older. They would prefer to insure 20 year olds.

There was a proposal in one of the bills to allow people over 55 to buy Medicare before they are 65 however, it didn't last. Then again it appears reform is dead anyway. This is so volital I can't see either party doing anything about health care for year into the future.

I thought I was the only one who was ever turned down for getting a perscription for cialis. I'm glad I read your post and I hope that everything goes well for you in the coming years.

Michael

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Old 01-24-2010, 07:00 PM   #6
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Michael thank you so much... I know it doesn't really help but it does feel good to know that others are in the same situation..... I wish the public that is opposed to any kind of health care reform would educate themselves as to how easy it is to find themselves in our position. Not sure what your living circumstances are there in Vegas.. but if you're in a position to "declare" residency in Texas through "escapees" i think is their name... you can probably buy insurance in the Texas Risk Pool, it's underwritten by Blue Cross. Check it out.
Ed
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Old 01-25-2010, 10:12 AM   #7
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Hi Ted,

Thanks for the help, when I was searching for insurance I did find some policies that I could get if I didn't live in Nevada. I assumed Texas was one of those as from what I recall Texas does not require that companies have very much in the way of reserves.

It would be difficult for me to change residence as I have too many things going in Nevada. Anticipating that nothing would get done on this issue, this is my plan. Fortunately I'm in excellent health. I've hidden all my assests so that if I have to file bankruptsy or I face lawsuit no one can get at them. Since there are so many people without insurance these days my doctor was willing to work with me, $45 doctor visits and they will do the blood tests for less than I was paying under my old insurance policy as it was all considered deductable. So my costs for routine, check up, doctors visits have actually gone down. I was insured until November. It cost me about $9,000 a year for insurance. I've kept putting that money into a separate account. That way if something happens I'll have reserves to pay medical expenses, and it won't feel so bad. If I have an emergency I just have to go to the public hospital or quick care. Hospitals here don't have room for you if you don't have insurance. I'll have to work on them to see if they will accept what insurance companies pay them. If so I'll pay it. If it's too expensive them my only option would be bankruptsy. That's where hiding my assets comes in. If I need serious heath care my plan will be to go to Thialand or India. I understand they both have outstanding medical care for about 10% of what it cost here. If I need drugs in the future I'll get them in Mexico. I've been going to Mexico for denistry for years.

I don't know if you have experienced this or not but some people I have shared this experience with, get almost nasty about it! Telling me to go buy insurance! Like that was possible. Sometimes it feels like a battle between those who have insurance and those who don't. I've got insurance and I don't care if anyone else does. I've never been without insurance my entire life. They simply don't realize that nothing is available to many of us even catastrophic policies. Unfortunately nothing we do or say will solve the problem. We are just going to have to live with it until it's even more out of control and by that time I'll be on Medicare. Right now I'll just have to live with my plan.

The one thing I truly resent is the fact that I've paid thousands of dollars to insurance companies over my 62 years. I've never had any medical issues so I've contributed substantially to the profit of insurance companies. Now that I'm older and might cost them a few dollars, they have dumped! If they cover me they might have to cut those multi million dollar CEO bonuses!

I hope this doesn't offend anyone I didn't intend to bring it up but sometimes you feel like the only one with this problem. I'm still in shock that anyone could be turned down for a perscription for Cialis! If I had only known. You can buy it on line far cheaper without a perscription.
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Old 01-25-2010, 10:46 AM   #8
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Our health care system is in drastic need of reform!! If everyone agree's with that then there should be a program that can benefit ALL the people - but, alas and allack there's the rub: politics.
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Old 01-25-2010, 11:48 AM   #9
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I live in AZ, & I retired before I was 65, & had to pay high insurance rates before medicare kicked in -- In AZ. & if you live in Maricopa or Pima Counties, you have the option of either standard medicare, or a HMO -- Both my wife & I, chose the HMO with Cigna, & in 7 years, no complaints -- In fact the only way it could be better, is if the Dr. made house calls - I was in the hospital for 2 months last year, & the total cost to me was $250.00 co-pay -- I had the best of care, & was not rushed out of the hospital -- So, all bad things said about HMO`s are true -- Bill Willard
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Old 01-25-2010, 01:29 PM   #10
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I hope that my previous comments were not taken as a condemnation of HMOs in general. The problem with most HMOs is that an illness out of network is mostly on your dime. For someone who travels a lot, an HMO could represent short term savings and a catastrophic financial nightmare in the long run.

HMOs are usually far less costly for premiums, co-pays and maximum out-of-pocket, but if you have a major illness out of your HMO's network, it could result in a huge out-of-pocket expense that does not apply to your maximum. I had such an event when with an HMO and I had to pay the entire bill less my emergency room charge. The HMO did not consider my condition warranted out of network treatment and expected me to return 500 miles back to my network for treatment. The problem was, I could not drive!
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Old 01-25-2010, 03:01 PM   #11
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Ed, the thing with ED is, it's sometimes caused by an underlying medical condition. They don't care what the problem is they just want to make sure they're not on the hook.
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Old 01-25-2010, 08:47 PM   #12
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As cancer survivors, we paid a huge amount for health insurance ($1946/month). We had no choice. Insurance is all about sharing risk. We were both high risk and understood we had to pay more. If we had not and were "averaged in" then other people who had not had cancer would have been paying for our increased risk. This might seem good to us, but it isn't fair to the well folks. If I have a couple of wrecks every year, then I am going to pay more for my vechile insurance. Healthcare is the same concept. We can not expect others to pay for our risk. It just isn't fair. When we hear the politicians talk about the big bad insurance companies charging more for sick people, what they are saying is that they are going to charge everybody else more. We are in dire need of health reform, but not any healthcare reform is good. We need to cut out all of the special deals and just do some common sensee things. Defensive medicine and unnecessary tests costs about $65 billion a year, but nothing about these cracy lawsuits is included in the passed legislation. Lawyers give too much money to the politicians.
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Old 01-25-2010, 10:58 PM   #13
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When the people in Washington sign on the same plan they want for the rest of us then maybe will lissen,but a few small fixes would take care of a lot of you.This plan as is now would cause too many medical staff to do other things and we're short of staff now.The money there willing to give to get votes would go a long ways to help those like you.
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Old 01-26-2010, 08:38 AM   #14
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Lindsay;
I applaud you for having survived cancer. However, in my case I simply do not believe that I am a high risk for an insurance company just because I did the responsible thing 9 years ago and got help with a drinking problem. I have continued to do the responsible thing and stay sober. I simply wish an insurance company would give me the opportunity to take a physical exam and show that I am healthy. They will not do that. They simply can not think outside the box. And many people like me are being penalized because of it. In my mind, there is no fairness in that.
Ed
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