I spent the morning at the endodontist getting a root canal. To do it, the endodontist had to cut the crown which was on the tooth off in sections. I'm not whining. Well, yes I am whining, but more about the cost than the unpleasantness of the procedure. This is the first big procedure since I retired and am no longer on the company's dental insurance. The advice I was given was that it rarely pays to pick up your own dental insurance, that it is mostly just pre-paying for dental costs. I am going to have to rethink that, since I have notoriously bad teeth in spite of having taken care of them.
Of course there were the usual COVID precautions. There is no waiting in the waiting room. You call with your cell phone when you arrive, and they come out and wave you in when they are ready for you. Then temperature scan, questions about possible COVID symptoms, and signing consent forms. Previously when I made the appointment, I was told "Fourteen o three at the front desk when you leave." I said, "Excuse me, what is fourteen o three?" They said, "Oh, sorry. One thousand four hundred and three dollars. We take major credit cards." I was thinking, yikes. On top of that, there will be about $750 for my regular dentist to replace the crown. What really struck me was that I had had similar work done at this endodontist when I was still on dental insurance. That was less than three years ago. The adjusted cost, since they were on the preferred providers list, was around $800 dollars, of which I paid half, and insurance paid half. So approximately $600 dollars is knocked off for the insured patients, before you even get to the co-pay.
So my question is, why are teeth and eyes not included in medical insurance or Medicare? They are part of the body, and impact health. I guess you can get on a Medicare Advantage plan which includes them. But those are basically HMOs, and a lot of providers don't take them. And if you decide you want back in classic Medicare, it is pretty difficult and pre-existings apply. What do people do who have teeth problems and can't afford "fourteen o three"? Pretty sure they just have to let it go until the tooth has to be pulled. And most general dentists don't do extractions, they farm them out to an oral surgeon, which is also expensive.
I definitely hope the SCOTUS doesn't sink the Affordable Care Act. But we need to keep it, and improve it (and Medicare) to include things such as teeth and eyes, which are part of the body, and impact health.
Hearing aids aren’t covered by Medicare. A pair averages about $4000. I have spent more than $16000 out of pocket on hearing aids during the last 12 years because of my unusually fast rate of hearing decline and needing more advanced technology. Now. I buy accessories too, such as TV streamers, which add a few more hundred to the cost.
ReplyDeleteOh, yeah, I forgot to add hearing aids to my rant below. Costco has cheapos for sale, but cheap is relative. I think I'd just get one of those ear horns you see in the old timey pictures. I always watch TV with the subtitles on, anyway.
DeleteOr do like my dad does now. He is past the point of his hearing aids doing much good. He keeps a small whiteboard on the table and people write stuff if he can't understand them. Trouble is on the phone you can't do that. So a lot of times we are having two different conversations.
DeleteSounds like my dad's conversations with his uncle. Uncle Ward was only a few years older than Dad, and they were both deaf as posts. Dad would hang up and say, "Poor Uncle Ward can't hear a thing!" My cousin said that Uncle Ward said the same thing about Dad.
DeleteWe learned to gesture a lot with Dad. He could lip-read somewhat. Dad loved to tell stories and voice his opinions, so, really, all he needed to know was that I had mentioned the name of some relative or politician, and he was off on a monologue.
You're singing my song!
ReplyDeleteThe health of the elderly goes to pot if they can't keep their teeth up. And they fall down and break their hips when their eyes go bad. If they can't read or watch TV, they also start getting a little loopy.
Some of these individuals will unnecessarily end up in long-term care as a result, sucking megabucks out of Medicaid when Medicare is exhausted. A little bit of relatively cheap upfront care could have reduced their time in these expensive hell-holes.
Now that I am actually *on* Medicare, I laugh at all the "it's a death panel for grandma" rhetoric the Repubs like my friend Chuck Grassley quacked about during the Obamacare wrangles. When I called for a yearly physical with my GP at age 65, the receptionist said I couldn't get one because I didn't have Medicare supplemental that would pay for it. I asked how much it was and told her I was able to pay that out of pocket. Then I had a chitty-chat with the doctor to work out an affordable schedule for care.
Weirdly, Medicare pays 100 percent of my oncology visits and labs--but none of the chemo. Fortunately, the generic stuff works for me. The hot new stuff is $10,000 per month, list price. A drug supplement gets it down to $3,000 other patients tell me. (Oh, it can also cause acute lymphoma and severe depression in some patients, they're looking into that ...)
I keep looking at the dental plans AARP sends me, but there is a whole raft of stuff they don't pay for. So between the uncovered procedures and the co-pays for the covered procedures plus the monthly premium payment, I think you're probably saving about 29 cents.
I just keep my credit card balance low because I have a molar that will need attention as soon as the plague has passed.
I think Jack mentioned one time that he would be happy to have a good nurse and a physical therapist rather than all the "doctoring." I think it's a great idea, but I'd add a yearly teeth cleaning (every six months is idiotic for someone like me with iron-clad choppers) and screening for eye problems to that.
I'm still on Fed Blue Cross and don't know my Medicare but let me take a guess. If one has all one's teeth pulled and gets choppers, they'll pay for THAT. Once.
DeleteStanley, I don't know if they'll even pay for that. I know some seniors who have RVs who go down to this town across the border which caters to Gringos wanting cheap dental care. Seems risky to me.
DeleteJean, Medicare will pay for an annual "wellness check up". You have to tell them that's what it is when you make the appointment so they code it right.
I found out it's a bad sign if you have a horrible toothache that suddenly goes away. It means the tooth has basically died. And that won't be the last of it.
The "wellness" check isn't the same as a physical. They bring you in for 15 minutes every six months to check your vitals, feel your thyroid, address whatever your major maladjustment has been--constipation, tinnitus, dizzy spells, not knowing who's president (which would be a gift these days)--and review your meds. (Hint: Want a really good med review? Ask your local pharmacist. S/he is usually more informed about drug recalls, interactions, side effects, and alternatives than your doctor is.)
DeleteThe basic philosophy of Medicare is that they'll pay for what the docs already know is wrong with you--so I'm lucky that they caught the heart valve problem and the cancer before I was 65--but they don't want to go on any "fishing expeditions" unless there are some symptoms.
Basically all types of routine screening like pap smears, cholesterol tests, vitamin D levels, and other stuff they used to do every year are out. Medicare will pay for periodic mammograms, I'm guessing because the breast cancer industry and hospitals with expensive mammography equipment have lobbied to get more patients.
Medicare won't pay for dentures. Or dental services unless you have them in a hospital.
I don't want to gripe too much because Medicare is better than the days we had no health care insurance at all. And now that The Boy is grown up, it's all about quality of life. At least half of that is up to me--eating, exercise, attitude, finding meaning in my post-retirement life.
I guess we are lucky that somehow our doc has figured out how to get a blood panel paid for by Medicare with the wellness check. Maybe that's because we were both on a cholesterol med prior to going on Medicare.
DeleteI hear you about "quality of life". In fact I was kind of liking it during the quarantine when they weren't doing anything but COVID and emergencies and I couldn't go in for stuff like mammograms and teeth cleaning. But now I keep getting reminder postcards to make a mammogram appointment. I will. Eventually.
My primary considers the "wellness visits" a joke an usually has an assistant do them. This year he did it with me, and bellyached all the way through. He says they are required by Medicare. My wife, on the other hand, is on Medicare and has a primary and has never had a "wellness visit."
DeleteI don't think I've ever had a physical from my primary, but every time I see him he orders up a battery of tests, catScans and X rays because he sure loves to look at numbers. Last time he tried to find the hepatitis he says I am due for, but the tests failed him. He may be a MacArthur level genius. On the other hand, he is nuts. He once wrote me a prescription for a BMW. I doubt Medicare would have covered it.
But he hates Trump with a purple passion. His office manager warned me one time that he had thrown Trump tirades at two MAGA patients that morning and it would be better if I didn't encourage him any further.
DeleteKatherine, I had a dentist some years back who agrees with everything you say about dental care and the elderly. He said he has known of senior patients who almost died because of tooth infections which weren't treated.
ReplyDeleteI'm surprised there has been no mention in this discussion of David Bentley Hart's essay in Commonweal, "Three Cheers for Socialism". It was published in February and was on Commonweal's most-read-articles for months and months. It doesn't discuss Medicare and dental care in particular but the first half looks more generally at the deplorable state of American health care. He uses the price of insulin as an example of how cost and gaps in American health care provision kill patients.
https://www.commonwealmagazine.org/three-cheers-socialism
Jim, thanks for the link to the David Bentley Hart article. Somehow I missed it previously.
DeleteI think Medicare pays for cataract surgery? I wonder why that is deemed acceptable eye care but routine exams and eyeglasses presumably aren't? Well, it must be about the money.
ReplyDeleteJim, about cataracts, I think it is covered because it is considered a medical pathology. They cover anything such as conjunctivitis and macular degeneration. I think most older people eventually get cataracts. Especially people who worked outside a lot, such as farmers and ranchers. The surgery techniques have very much improved over the years. And saving someone's eyesight can mean the difference between them staying in their own home and having to go into a nursing home.
DeleteThank you, Katherine.
DeleteJim, Cataracts can cause a form of blindness in the sense that a person with extensive cataracts may have too much of their field of vision blocked to be able to drive safely. My husband found out he had cataracts when he failed the routine vision exam at the DMV. He was in his 70s. After surgery his vision was 20-20 again he could drive much more safely. He had a coupe of strange, fortunately small, incidents with the car which were caused by the reduced field of vision due to cataracts.