POZ Community Forums
Meds, Mind, Body & Benefits => Insurance, Benefits Programs & HIV => Topic started by: Oceanbeach on May 06, 2013, 12:26:35 pm
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Hey Forum Friends,
I just love being a 50's TV housewife. June Cleaver with AIDS and has Medicare, Medi-Cal and ADAP assistance. Mr. Ward Cleaver does not have HIV, is self employed and has private insurance. The Cleavers are not legally married.
Mr. Ward Cleavers BCBS policy has a $1400.00 per month premium which was increased by 100% this year, 50% last year, is "grandfathered in" so Obamacare rules re: any rate increase over 10% do not apply. BCBS has the right to charge any rate increase they choose. Mr. Ward Cleaver has to pay $7500.00 out of pocket, share of cost, each year before receiving any benefits from this policy.
Mrs. Ward Cleaver has been living with AIDS for 17 years, goes to the same medical facility and the same pharmacy as Mr. Ward Cleaver but gets better care which is paid for by Medicare Parts A, B, & D. The annual costs for Medical and Pharmacy are over $100,000.00 per year w/ no share of cost. Mrs. Cleaver's meds cost $3600.00 per month and beginning in 2014 there will be a share of cost which escalates each year until 2020 when Medicare Part D is eliminated from the Medicare roster of services.
I am thinking... If Ward and June cancel his private policy with BCBS policy in October 2013 and open a new policy with a different insurer, so this policy will not be "grandfathered in" and the insurer will be required to get govt approval for rate increases greater than 10%. This will be a big savings.
The pre-existing conditions clause goes into effect in October 2013 as does the Pharmacy policy offers and pricing for 2014. October 2013 is the time to shop.
Mrs. Cleavers medical costs, paid by Medicare Parts A & B is greater than Mr. Cleaver's annual out of pocket, share of cost. My question is: If Mr. & Mrs. Cleaver were on a joint policy with Mrs. Cleaver getting Medicare and Medi-Cal and using Mr. Cleavers policy as a supplement, would Mrs. Cleavers Medicare and Medi-Cal paid medical costs apply to Mr. Cleavers share of cost? If there is enough savings, I can justify pharmacy insurance for both of the Cleavers. 8) Have the best day
Michael
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Hello Oceanbeach,
You would have to look at Ward's policy to see how they apply their pharmacy share of costs. If they combine costs from different beneficiaries (if June and Ward aren't the same beneficiary), and if they allow SOC to be met by payments made on behalf of a secondary beneficiary (aka June), then maybe.
But in practical terms, I doubt it.
MediCal specifically, and Medicare in practice, consider themselves to be the payer of last resort. That means if you have other insurance (if June is put on Ward's policy), Medi/Medi may expect that carrier to pick up the bulk of the payments, if not all. So June would have to get her meds through Ward's pharmacy carrier, with Medi/Medi picking up the slack.
IOW, tread lightly June ol' gal!
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Yikes June!
Just wondered how old Ward is these days.
Has he shopped around?
$17,000. per year with a $7500. deductible!!!
I thought my costs were high at $13,000. per year, no deductible, but I do have copays for almost everything which will add another $3,000. or so this year.
(I am self employed and also have BCBS)
Also, this is the second time I've heard about Medicare Part D fading away by 2020.
I hope to be on disability by this time next year (ALJ hearing) and know it will take a couple more years to get on Medicare.
What are June and I expected to do about our high cost of meds???
Does the current government drug coverage (I forget what it's called) for the elderly also apply to the disabled or will ADAP have to cover the full price of our meds?
I hope June and Ward (and I) are able to find a solution other than bankruptcy.
It wouldn't take long.
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Of all the TV moms, most people would see June Cleaver as a twit of a housewife who flounces around in a billowy apron while Ward Cleaver makes all the family decisions. June called the insurance provider United Healthcare, the company has stated they and the other pharmacy providers will know in October, what they will charge during 2014. There is nothing that can be done re: pharmacy until then.
Ward Cleaver doesn't shop... His BCBS policy predates Aristotle and he bought online, has a printout. June has shopped online but did not want the phone number of an agent in L.A.. A live independent agent, sitting at a desk in San Francisco who can be reached with a double latte. That which JR said about MediMedi being the payer of last resort makes a lot of sense. As I said earlier June Cleavers medical and pharmacy bills exceed $100,000.00 every year and June is never charged any share of cost. Since her disability is AIDS, she will never be expected to work again, will always get SSDI and Medicare
Mitch, I have no idea why Wards BCBS policy is priced so much higher than yours. He is in his mid fiftys, is a health single male living in San Francisco, never meets his deductible. BCBS did increase his premium amount by 100% this year and 50% last year, because they can. I read in another thread where Cigna was saddling their policy holders with unfair premium increases. I am looking at AARP affiliated brokerage firms and will find something for Ward.
This leaves us all back at square 1, Who is going to pay the pharmacy when Medicare Part D is eliminated from the roster in 2020? I speak with the Pharmacy Manager every month, they say they will call if there is a problem with any of the insurers while, the Pharmacy Provider won't know anything until October. We are living with HIV, are we expected to live in blind trust the government will take care of it? June Cleaver will probably ask Ward Cleaver to pay for pharmacy insurance 8) Have the best day
Michael
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Is June eligible for ADAP?
Wouldn't it solve the pharmacy dilemma ?
Sounds like Ward needs to get out more and learn the art of shopping.
My BCBS had a huge (30%) increase this year so I called the agent to find out what other plans were available.
We switched to a different BCBS plan with higher copays.
I think we will be saving a little but not much.
The insurance companies have us by our balls and the pain is turning me blue.
Guess I will check in October what is available at what cost.
You have a nice day too. :)
m.
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June served a term on the Commission-On-AIDS and for 3 years sat between a Chief of the Sacramento ADAP Section and on the other side the Director of the local office handling all Medi-Cal in Sonoma County.
June has always had Medi-Medi and ADAP which in Northern California provides excellent healthcare for people with HIV. June moved from Sonoma County almost 3 years ago to marry Ward Cleaver What happens on January 1, 2020? A wise man once said there are no entitlements any funded program can end. June very much wants to make sure... if the times comes, she can get a policy.
June lives in an amazing city with a population of nearly 3/4 million people who live within the city limits and an additional 1 million (est) visitors every day of the year. There is a pharmacy on Market St and O'Farrell with 1 pharmacy manager and 3 pharmacy techs. June only goes once a month but from month 2, they all say, "Hello Mrs. Cleaver". Today, June picked up the months supply of meds w/no co pay. June received meds last month during the ADAP cut that was like $5 Million and also during the sequester, her meds were delivered. The Pharmacy Manager will call June immediately if there are any insurance issues.
On her way to the pharmacy, June had the top down,(a little trick learned from Shirley Partridge). Anyway, June passed the Lamborghini dealership on Van Ness Ave. June remembers a story told of Grace Slick who ordered a pink Lamborghini after the release of Surrealistic Pillow and laments... We built this city on rock and roll. Oh to have been a singer instead of a TV mom.
June went online last night to search for a San Francisco based, independent insurance broker who maintains an office and staff and clicked on one in the Financial District and had a window with a link to get a quote. I gave them my throw away email address, a San Francisco area code with a Sonoma prefix, wards name, age and Zip code. June got an email addressed to Beaver for his dad, offering a conversation by phone but my problem is worse than this... Wally and Beaver are not born yet and one will be born a girl. Wally will most likely be the girl child. They feel it would be inappropriate to name their daughter, The Beaver.
The rep left an out of state phone number but June will have until October to find one. Before AIDS, June was in a top management in a company which designed safety programs for the workplace so she worked with a lot of commercial line insurance brokers. June knew every candidate for State Insurance Commission for 3 election terms from business. In her google search, she found several interesting and low cost insurance policies for a single male, living in the Castro who is 55 years old. BCBS had several policies costing a couple hundred to 3 thousand bucks. If they were as savvy as they hope to be, they and apparently Cigna too have been increasing premiums of their long term insured, people like you and Mr. Cleaver. It will be an aggressive campaign to grab each others client base. So anyway, the insurances of the Cleavers are being negotiated by Mrs. Cleaver- THIS HAS NEVER BEEN DONE IN 50's TELEVISION... The TV mom in the 50's does not do that stuff! They (BCBS) should entice their existing client base to stay by offering fair rates for a quality service, some refunds because in this economy, the insurance company with the most clients wins. June is searching for a broker who gets a commission and puts his diligence in his or her work so, there is nothing to do until October on this. 8) Have the best day
Michael
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June selected an insurance broker out of the newspaper who will represent the Cleaver family insurance needs. She has a convenient office, we like her and she handles many personal line insurance products. I like being a 50's Retro TV wife. 8) Have the best day
Michael
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June seems to be a savvy lady and has things under control. :)
(http://i49.photobucket.com/albums/f277/nadine202/JuneCleaver.jpg) (http://media.photobucket.com/user/nadine202/media/JuneCleaver.jpg.html)
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June is savvy and in an email from the Human Rights Campaign saying "Marriage Equality Returns in California. Since June 28th it has been legal for 1950's TV characters to marry each other in California and those marriages are recognized by the federal government. The Cleavers may now marry and share the best of healthcare resources and raise their family like any other married couple. If they choose!
June knows if married to Ward, she will retain her SSDI income because her diagnosis is AIDS and her Medicare coverage is for life but would lose Medi-Cal and ADAP support. Looks like a little insurance will cover that and fortunately... June found their Broker whose office is blocks away. June does a lot more than flounce around in her fluffy white apron and high heels... 8) Have the best day
Michael
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So June, when is the wedding? Now that it is legal there should be no more excuses for the two of you to continue living in sin. :)
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The other TV moms, Harriet Nelson, Shirley Partridge, Mortisha Addams and Roseanne Connor, they all knew from the first time they ever wore a pillow case for a vail that they were going to be married. They have had their whole lives to plan their weddings but June, formerly known as Jim was packing a chainsaw with his Paw to learn how to fall timber in the Coastal Range.
June has had 2 weeks for the knowledge that marriage equality has returned to California and is contemplating everything that might mean and the Cleavers have had a long, traditional courtship so first, there will be a romantic proposal. Being an old fashioned girl, June wishes Ward will propose but knows he will have to do so himself. June is thinking about hiring a singer with guitar accompaniment to serenade outside the window at bed time (or) building a huge fire on the beach during a full moon, leading with a Buddhist chant which gives the user unstoppable happiness, then calling upon the guardians of the Watchtowers and the Spirit Elements for contact with the Gods and Goddess for their blessing in the Wiccan Tradition (or) Using a case of white 7 day candles to signify a campfire in the Redwoods, June and Ward could be walking hand in hand when they happen upon a welcoming campfire, they stop and from the trees behind 4 singers step from behind different Redwood trees, sing a traditional Native American song promising a long happy life and blessing the marriage. This is just the proposal... 8) Have the best day
Michael
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Well, given the fact that June has had only two short weeks to think about her nuptials, I would say her mind has been quite active along this front.
All of the proposals sound lovely.
Another option would throw a few hints Ward's way. Subtle enough to make it seem like his idea. June is a clever Cleaver.
However it happens, I'm sure it will be a joyful event!
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I'm romantic / pragmatic ... I would use a lawyer with a pen and prenup playing a ukulele .
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Yes, June is the Clever Cleaver and she knows a good lawyer with a ukulele is not enough in a situation like this... June remembers Lori Partridge played piano and was practicing law in L.A. when the Partridge Family broke up. There are hopes Lori Partridge will play, "You Can't Always Get what You Want" on the organ, leading to The Bridal March with the USC Trojans Marching Band! 8) Have the best day
Michael
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There have been laws blocking the marriage of TV show characters since before TV was invented, while everyone knew a TV Mom was one hell of a tax deduction and pretty good with the credit cards.
When June was a teen and out of high school, she joined the AIR FORCE during the Vietnam War era. For serving her country, she was given an honorable discharge and the life long right to a Veterans Administration home loan. This loan was denied once because June's disability income was to small to cover any mortgage payment.
The other day, June ran into a real estate broker on the street and asked about using her VA loan if married to another TV Show Character. The broker was also a TV Show Character who legally married his TV Show character, the last time TV Show Characters were allowed to marry. He did not know but referred June to a local lender who specializes in VA home loans.
The home loan lender said he would need a marriage license to prove the couple is married and the DD 214 to show one of the couple is a veteran and guaranteed them a home loan. He quoted interest rates a full percentage point under conventional loans for a 30 year fixed rate. The Cleavers were encouraged to apply and verbally pre qualified for a stately riverfront home for entertaining other TV Show Characters. Without the marriage license neither Ward nor June are qualified to use this loan.... The VA home loan is federal and is being offered to same sex married partners just like they do the opposite sex marriages.