Mets Day 791 - Welcome to Medicare

A couple of days ago I received an envelope welcoming me to Medicare. I looked at the envelope with the same jaundiced eye that I use whenever I receive an AARP mailing. Eventually I peered into the envelope and thumbed through the contents.

A bit of back story: As I explained in a previous post, the federal government classifies all persons with metastatic BC as totally disabled, regardless of how they are otherwise able to physically function. This is because the long-term survival odds are so low for those with mets BC. Thus, in September 2013, the Social Security Administration concluded that I was 100% disabled as of May 2012. After the required 5 month waiting period from the onset of the disability, SSA concluded that I was eligible to receive SSDI benefits as of October 2012. I continue to receive a monthly SSDI payment, and Garrett also gets a monthly payment as a minor.

Another SSA rule says that, if someone under age 65 is found to be totally disabled and eligible for SSDI benefits, then two years after the SSDI benefit eligibility date, that person is eligible to receive Medicare benefits. Thus, the letter stated that I qualify for Medicare effective October 1, 2014, because that is two years and five months after my bladder cancer was confirmed to have metastasized outside of my bladder and into my lymphatic system. (May 2012 + 5 months + 2 years = October 2014.) I don't pretend to understand or agree with the policies behind these time periods, but am just relating how the rules apply to me.

I thumbed through the enclosed Medicare pamphlet and looked at the online handbook, and learned about Medicare Part A, Part B, Part C, and Part D. Part A is "free" (no extra cost to me personally); but there are costs associated with the rest of the coverage. Fighting to keep my eyes from glazing over, I read various warnings about penalties if I didn't properly enroll. I looked into the exceptions, and learned that as long as I have private insurance provided by an employer, I probably didn't have to pay for parts B-D. That continues to be the case with me: as a partner at my law firm, I still receive comprehensive health insurance for me and my family. As an equity partner, I am considered a co-owner, so there is no employer contribution towards my health insurance. In other words, I get to pay 100% of the actual cost of my health insurance for me and my family, which is over $22,000 per year.

I've confirmed with the benefits coordinator at my law firm that my ongoing participation with my law firm's health insurance means that I do not need to pay for Parts B or D of Medicare.  If I was to leave my firm's private insurance plan, and go on Medicare, I'd still need to pay for Parts B and D, or join a private insurance company under Part C, in order to have the same type of coverage that I currently have through my law firm.  I also confirmed that, if and when I leave my law firm's health insurance, I would not be subjected to a Medicare penalty, as long as I promptly enroll in Medicare Parts B and D, or join a Part C plan. 

The problem is, if I was to go on Medicare, I would have to find insurance for the rest of my family, probably through Obamacare. It becomes a cost/benefit analysis: How much would it cost to put together Medicare coverage for me, and alternative health insurance for my family? I assume that it would be possible to stitch together coverage for me and my family, but for now I'm not going to worry about that. Maybe I'll run the numbers at the end of the year and work through the pros and cons, but for now I am grateful that I can continue with the existing United Health Care health insurance that so far has been very good about paying for my care.

I am keenly aware that bladder cancer is the single most expensive cancer to treat on a cost-per-patient average. BCAN's press guide says, "Bladder cancer has a recurrence rate of 50-80 percent and because it requires life-long surveillance, it is the most expensive cancer to treat on a per patient basis." A 2010 article from the Canadian Urology Association Journal confirms: "As measured on the basis of cumulative per patient cost from diagnosis until death, bladder cancer is the most expensive to treat." Just yesterday I received a comment on my prior blog post stating how, for that person, "bladder cancer has been a financial disaster". The cost of my treatment for bladder cancer so far has been over $200,000; not counting the cost of my health insurance premiums, my out-of pocket cost for deductibles and co-pays has been around $2,500. 

I feel fortunate for the fact that my private health insurance has covered my treatments. I am grateful for the ongoing support of my law firm. I'm also fortunate that I listened to my insurance agent more than a decade ago and purchased disability insurance with an income replacement.  I eventually layered my disability coverage with four different policies. The premiums cost several hundred dollars a month, and are now paying out at 100%. Since I paid the premiums with my own post-tax dollars, the benefits are tax free, which is nice. Those payments greatly alleviate what would otherwise be a highly stressful tension of trying to push myself to work to provide for my family, while at the same time trying to prolong my life through different therapies.  I am grateful that I can spend more time with my family during what is likely to be a much shorter life span than I had been anticipating before cancer.