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>>That's why I have the tank of helium in the closet if I detect any early warning signs.

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Helium? Won't you just be talking like a duck and still be demented?<<

----------------

That would be daffy.

---------------------

LOL. It's hard to get a laugh out of this board sometimes. Retirement Investing is serious business for the serious minded.




Oh well, I tried.

https://en.wikipedia.org/wiki/Daffy_Duck#/media/File:Daffy_D...
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Yeah...but....

The article only tells half the story. My Medicare premium will also increase by about the same amount. What the government giveth, they taketh away. :(
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No. of Recommendations: 18
"The article only tells half the story. My Medicare premium will also increase by about the same amount. What the government giveth, they taketh away. :("

True, but also not the full story. Medicare B premiums are going up about 6% - from $148.50 to $158.50 per month. And SS payments are going up about 6%, from an average of about $1543/month to about $1650/month. So, on average, an increase of about $10/month for Medicare Part B, and an increase of about $110/month for SS, on average.

As usual, the people at the bottom, earning less than the average in SS, get hit the hardest - proportionally and in terms of needing the money the most.
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Per US Today -

"The part B premium is set to rise by $10 and prescription drug plan premiums are likely to increase an average of about 5%, says Mary Johnson, a policy analyst for the Senior Citizen League."
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prescription drug plan premiums are likely to increase an average of about 5%,...

I'm dumping Medicare Part D on October 15th. Why buy an insurance policy that forces you to pay 2X to 4X times GoodRx prices for your meds? You can always sign up later if you have to take a really expensive name-brand prescription.

intercst
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I thought that once you leave you are required to pay a penalty to re-sign. Is that no longer true?
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You can always sign up later, as long as it's during an open enrollment period, and you are willing to pay a permanent surcharged for having a lapse in coverage, if you have to take a really expensive name-brand presription. There, fixed that for you.

Hopefully, you don't find out that you need that name-brand drug in January, just after your coverage lapsed, so you have to pay for it for a full year before getting your prrmanently more expensive coverage again.

It's insurance. You pay for coverage you hope you won't need, but are really glad to have if you do need it.

AJ
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JimKredux asks,

I thought that once you leave you are required to pay a penalty to re-sign. Is that no longer true?

</snip>


The penalty is still there. You have to compare the current premium on a drug plan you don't use to the future penalty if and when you sign up for drug coverage.

It would be fine if insurance companies were using their market power to get you the best price on the drugs you use, but they're not. A lot of them now own the Pharmacy Benefit Manager they force you to use. The more they jack prices, the more they make. It's a complete conflict of interest, and just one of the reasons the whole Part D program is a scam.

intercst
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aj485 writes,


Hopefully, you don't find out that you need that name-brand drug in January, just after your coverage lapsed, so you have to pay for it for a full year before getting your prrmanently more expensive coverage again.

</snip>


Sure. It's a risk you take. If my doctor prescribed a name brand drug, the first question I'd ask is "What did they use for this disease before this new drug came out?" There are very few really "new" drugs. Most just offer a marginal improvement at an astronomical cost.

intercst
(30 year investor in Pharma)
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aj485 analyzes,

It's insurance. You pay for coverage you hope you won't need, but are really glad to have if you do need it.

</snip>


It's also a complicated financial product sold to people that don't understand the arithmetic. There's a reason I've made a fortune in Pharma stocks over the past 30 years, and it's not because they were developing a lot of cures for disease. <LOL>

intercst
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No. of Recommendations: 9
I'm dumping Medicare Part D on October 15th. Why buy an insurance policy that forces you to pay 2X to 4X times GoodRx prices for your meds? You can always sign up later if you have to take a really expensive name-brand prescription.


Aren't you the one always harping on the need for "cheap insurance" in case you run into a string of bad luck?

You can always sign up later if you have to take a really expensive name-brand prescription.

I'm not sure that is the case. Do you have to wait until an open enrollment period?
Aaah, found this:
"If you decide not to get it when you’re first eligible, you’ll likely pay a late enrollment penalty if you join a plan later. Generally, you’ll pay this penalty for as long as you have Medicare drug coverage. To get Medicare drug coverage, you must join a Medicare-approved plan that offers drug coverage."

So offhand it sounds like you can't "sign up later" without having to wait for open enrollment to switch to a new plan, plus you will have to pay an extra penalty forever.

Anyway, you can have both. Both GoodRX and Part D. We find that most of the time our Part D Rx is cheaper, but occasionally GoodRX is cheaper.
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Anyway, you can have both. Both GoodRX and Part D. We find that most of the time our Part D Rx is cheaper, but occasionally GoodRX is cheaper.

I'm just starting to look at Medicare options as DH will be 65 next year, and have wondered about GoodRX. How does that work exactly? Do you pay for that similar to insurance?

I've found the least expensive plan for him given what he takes for meds is the $13/month plan (there's also a $7.40/month plan, but that's more costly given what they do and do not cover). For him it looks like there will be no co-pay for the drugs he uses, and so the annual expense is just the premiums for a total of $156 per year. I can't imagine there's anything less expensive, but I'd love to also learn about GoodRX.
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Rayvt writes,

Anyway, you can have both. Both GoodRX and Part D. We find that most of the time our Part D Rx is cheaper, but occasionally GoodRX is cheaper.

</snip>


Sure. That's what I did this past year. I paid $72 in Part D premiums and got 2 of the 3 drugs I take at "zero copay". They would have cost me about $60 out of pocket, so the Part D insurance was about $12/yr, net.

For 2022, the copay for the two drugs is more than the Goodrx price and the third drug I take is 5X the Goodrx price, so it now makes sense to dump Part D.

Insurance isn't patriotism. I know that it's sold as "responsible people have insurance", but that's just a marketing pitch. You need to evaluate if "risk retention" and forgoing the expense of the insurance premium is the better deal. Minimizing "the skim" is the key to early retirement.

I'll reevaluate it for 2023.

intercst
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2gifts asks,

I've found the least expensive plan for him given what he takes for meds is the $13/month plan (there's also a $7.40/month plan, but that's more costly given what they do and do not cover). For him it looks like there will be no co-pay for the drugs he uses, and so the annual expense is just the premiums for a total of $156 per year. I can't imagine there's anything less expensive, but I'd love to also learn about GoodRX.

</snip>


I wrote an REHP article on this in January.

If you can find a Part D plan that's covering most of your drugs with no co-pay and the annual insurance premium is roughly equal to the Goodrx price on the drugs you take, it may be a reasonable deal. Otherwise Part D is a shell game, until you get prescribed a really expensive drug, which most people don't. (And the wife of a college buddy of mine has a $600,000/yr drug bill (cancer), so I do know it happens.)

Navigating the Medicare Part D Drug Plan cesspool
https://retireearlyhomepage.com/medicare_partD_2021.html

</snip>


intercst
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I was told a while back that insurance is gambling. I'm not a gambler, so I don't know all the terminology. But the short version is that you're betting something will happen to you, they are betting it won't, with odds that they determine. And there is something called "laying off the bet" which apparently insurance companies do also (though I don't know what that is...again, not a gambler).

We have a few years to think about Part D. Hopefully they improve it, but I don't see that as likely given the current (and likely future) state of Congress.
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And the wife of a college buddy of mine has a $600,000/yr drug bill (cancer), so I do know it happens.

What happens if you cancel Part D and then get diagnosed with a cancer where the best treatment is one of the really expensive drugs in January or February, 2022? Cancer doesn't always have warning signs for months ahead of time.

AJ
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I'm dumping Medicare Part D on October 15th. Why buy an insurance policy that forces you to pay 2X to 4X times GoodRx prices for your meds? You can always sign up later if you have to take a really expensive name-brand prescription.

intercst


I have occasionally asked my MD to give me a scrip instead of turning it over to the insurance company. GoodRx seems to have an amazing clout to get the prices they do.

CNC
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Dad did not have Part D coverage when I took over his finances when he could no longer manage his affairs. It was a wash until his dementia somehow devolved into delusions requiring psychotropic drugs costing $1,000 or more per month. The good news was that I was able to purchase coverage D and the penalty was not that much. Here is the present formula, I think:

https://www.medicare.gov/drug-coverage-part-d/costs-for-medi...

The bad news was that there were no exceptions to the rule. It did not matter that he had dementia and that he had no clue Coverage D existed. He was late. He owed the penalty. I don't recall there being an 'open enrollment requirement' for Part D at that time, but I guess the laws have changed.
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1poormom I don't believe has Part D. But she has prescription coverage through her Medi-Gap plan. I've heard such horrible things about Part D that I would want to look at that option (if it's still an option).
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Many of the drug companies have foundations that provide the drug for nothing to low-income individuals - - AGI somewhere around $45,000/yr.

Even though we had drug coverage through our Advantage plan, the drug my spouse was prescribed was $4000/month on the open market (our co-pay was $1500/month). I contacted the company's foundation and we got 18 months at no charge. We only had to submit the previous year's tax return and the doctor had to confirm it was prescribed.

I was not aware of this program until a friend (who is a PA) told us about it.
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aj485 asks,

<<And the wife of a college buddy of mine has a $600,000/yr drug bill (cancer), so I do know it happens.>>

What happens if you cancel Part D and then get diagnosed with a cancer where the best treatment is one of the really expensive drugs in January or February, 2022? Cancer doesn't always have warning signs for months ahead of time.

</snip>


Actual cancer usually does have warning signs. The odds against you of showing up in the emergency room and needing a $600,000 out-patient prescription drug are astronomical. It would probably be a better bet to purchase "asteroid insurance". <LOL>

intercst
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No. of Recommendations: 2
CountNoCount writes,

<<I'm dumping Medicare Part D on October 15th. Why buy an insurance policy that forces you to pay 2X to 4X times GoodRx prices for your meds? You can always sign up later if you have to take a really expensive name-brand prescription.

intercst>>

I have occasionally asked my MD to give me a scrip instead of turning it over to the insurance company. GoodRx seems to have an amazing clout to get the prices they do.

</snip>


Exactly!

GoodRx is purchasing it's drugs from the same supply chains as your insurer, and they collected about $500 million in commissions and kickbacks in 2020.

How much is your for-profit Part D insurer skimming from you when he's charging 2x to 4x the Goodrx price? Thus, my conclusion that Part D is a complete scam.

And also, you need to remember that the meds you buy through GoodRx don't count towards your Part D deductible. You have to use the insurance company's captive PBM and pay the much higher prices to get credit towards your annual deductible.

intercst
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1poorguy writes,

1poormom I don't believe has Part D. But she has prescription coverage through her Medi-Gap plan. I've heard such horrible things about Part D that I would want to look at that option (if it's still an option).

</snip>


I think you mean Medicare Advantage plan. Medi-gap plans don't cover out-patient prescription drugs.

Medicare Advantage is even more of a scam than Part D. <LOL> You're likely much better off with regular Medicare.

intercst
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nothingissimple writes,

Many of the drug companies have foundations that provide the drug for nothing to low-income individuals - - AGI somewhere around $45,000/yr.

Even though we had drug coverage through our Advantage plan, the drug my spouse was prescribed was $4000/month on the open market (our co-pay was $1500/month). I contacted the company's foundation and we got 18 months at no charge. We only had to submit the previous year's tax return and the doctor had to confirm it was prescribed.

I was not aware of this program until a friend (who is a PA) told us about it.

</snip>


It's great that you were able to benefit from a drug company foundation. These foundations are a major driver of prescription drug price gouging since they allow the drug companies to argue that "we're still taking care of the truly needy", even through we're screwing everyone else.

I'm surprised that they only look at "tax returns and AGI" and not assets. This may be another avenue for the savvy retiree to mine if and when the time comes. <LOL>

intercst
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intercst:"Actual cancer usually does have warning signs. The odds against you of showing up in the emergency room and needing a $600,000 out-patient prescription drug are astronomical. It would probably be a better bet to purchase "asteroid insurance". <LOL>"

Don't get pancreatic cancer then. It's usually only diagnosed when it's at Stage 3 and then you have at best a year to live. 5% live longer. When that happens, you'll suddenly be facing the decision to do lots of invasive surgery, take a gazillion drugs (not cheap) to stay alive, or simply giving up and waiting out your six or 8 months till you spend the last few weeks in Hospice as they hold your hand as you quickly tick toward 'was alive'.

BIL got diagnosed at age 69. Gone in 10 months. No symptoms other than 'tired' before that.

Alex Trebec (of Jeopardy fame) managed more than a year, but his gazillions of dollars didn't do squat to keep him alive. Extended it more than your 'average person'. He, too, was late diagnosed with pancreatic cancer.

Just for intercst:

https://www.cbc.ca/news/canada/british-columbia/meteorite-cr...

"Ruth Hamilton says space rock came through the ceiling, landing on her pillow at her Golden, B.C., home"

Of course, that space rock will sell for hundreds per gram - likely a $50,000 'space rock' that came zipping down, through her roof, landing on her pillow.







t.
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"GoodRx is purchasing it's drugs from the same supply chains as your insurer, and they collected about $500 million in commissions and kickbacks in 2020.

How much is your for-profit Part D insurer skimming from you when he's charging 2x to 4x the Goodrx price? Thus, my conclusion that Part D is a complete scam.

And also, you need to remember that the meds you buy through GoodRx don't count towards your Part D deductible. You have to use the insurance company's captive PBM and pay the much higher prices to get credit towards your annual deductible.

intercst"

**************************************************************************************

Always depends upon what drugs a person is prescribed. Generics of some drugs are zero
co-pay in several Medicare-D providers (DW and I use different providers and the prices
differ mainly in the higher "tier" drugs).

Howie52
Hard to get the price below zero.
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Actual cancer usually does have warning signs.

Not in my experience. My Mom's cancer was found because she was having a pre-surgical MRI for back surgery, and the radiologist noticed enlarged lymph nodes. A month later she was on very expensive chemo drugs for her Stage 4 cancer.

For a guy who rails on about how SS provides longevity insurance, and how ACA can be gamed, you seem to be completely oblivious to true medical risk.

AJ
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Actual cancer usually does have warning signs. The odds against you of showing up in the emergency room and needing a $600,000 out-patient prescription drug are astronomical.


Depends on the cancer. And the person. My best friend was just diagnosed with stage 3 ovarian cancer. She went to the doc for typical menopause symptoms.
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For a guy who rails on about how SS provides longevity insurance, and how ACA can be gamed, you seem to be completely oblivious to true medical risk.

That's because he believes what he believes, and makes observations that confirm what he already believes. If the way he thinks about similar things contradict one another, that doesn't matter.
Selective blindness and confirmation bias.
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aj485 analyzes,

For a guy who rails on about how SS provides longevity insurance, and how ACA can be gamed, you seem to be completely oblivious to true medical risk.

</snip>


And yet, I survived a golf ball-sized brain tumor cut out of my left side head at age 32 and a smaller one sliced out of the right side two years later. (Second one I found myself a week after the head & neck surgeon said there was nothing there -- a benign, slow growing tumor. She missed it. It wasn't something that had popped up in the intervening week.)

Then at age 44 after I'd been retired for 5 or 6 years, I got diagnosed with lupus nephritis -- an autoimmune disease where my immune system was producing antibodies that were trying to kill off my kidneys. No symptoms other than than microscopic blood and protein in the urinalysis from my annual medical exam.

Doctor sits back in his chair and says, "We got to figure out how to treat this".

I ask, "How do you usually treat it?"

Doctor says, "Kidney preservation therapy, but a lot of people can't tolerate that. Then we move on to kidney replacement therapy.

I ask, "What's kidney replacement therapy."?

Doctor, "Dialysis or a transplant".

I ask, "Why would they give you a transplant? Wouldn't the lupus just burn up the new kidney?

Doctor, "Oh no. The anti-rejection drugs they give you after the transplant also prevent the lupus from damaging the new kidney."

Me, "Well, duh. Why wouldn't the anti-rejection drugs allow you to keep the original pair of kidneys?"

Doctor, "They might. But no one has done a study on that, so there's no basis for prescribing those meds. And they're very expensive -- your insurance probably won't cover it for anything short of a transplant."

So we do a monthly inter-venous steroid infusion for about six months that leaves me wide awake for about 48-hours after each infusion -- pumping me full of steroids is unlikely to be a long-term solution.

Then the doctor says, "There's a study from Hong Kong in 17 patients that says CellCept (the anti-rejection drug) improves lupus nephritis symptoms. I can prescribe it for you on the basis of that if you want to try it." I say fine, I had good insurance at the time that covered the drug with about a $50/month co-pay for a medication that cost $8k-$10k/yr.

Six months later, the kidney specialist I was seeing said that I had no evidence of any ongoing kidney disease and that I was wasting my time seeing her. As long as the CellCept kept everything in remission, I could have the Rheumatologist do the monitoring lab work and she could refer me back to the Nephrologist if any symptoms went South.

As my health insurance got crapified over the years along with everyone else, I increased my deductible to control costs and started buying the CellCept from Canada out-of-pocket (at less than 1/2 the US price.) I also started ordering my own lab work and paying cash, rather than let the insurance company price gouge me on it. So over the past 20 years, I've been able to manage a deadly, complex disease with about $1,500 in annual out-of-pocket cost despite a high deductible health plan. (Once the Cellcept went off-patent, a year's supply was $200 to $300 depending on my current dose.)

CellCept increases your risk of skin cancer -- more so for someone like me who spent 20 years in the Texas and California sun playing golf and tennis without sun screen. So I'm careful to monitor myself for any skin lesions.

Last year I noticed a few spots on my right leg that I self-diagnosed as a likely squamous cell cancer that's slow growing. I discerned that I could safely wait a year until age 65 to get it removed once I qualified for Medicare. I started Medicare of February 1st of this year and had the two spots removed on Feb 6th. The pathology report confirmed my diagnosis and Medicare charged me $120 out of pocket to remove the 2 lesions. With my high-deductible Obamacare plan, it easily would have cost $1,500 out-of-pocket to have a dermatologist do it any earlier.

The doctor I had been seeing only accepted Medicare Advantage (which I was unwilling to do) so I dropped him and found a new doctor once I turned 65.

New doctor wanted to reinvent the wheel and ordered a bunch of expensive immunological studies to baseline my condition. I would have objected if I was on Obamacare, but since Medicare covers all the lab work without any cost-sharing, why not?

The lab order had about 1/3 of the boxes on it checked and the doctor had handwritten another 8 or 10 non-standard, rarely ordered items. Three girls are standing around the computer like it's a seance trying to input it all and one of them turns to me and says "We've never done this many labs on one person before". They take more than a dozen tubes of blood from me. (The "normal" monitoring labs I'd been ordering myself for the past 20 years were just 2 tubes.)

I see the doctor two weeks later and he's astonished.

He says, "You're producing a ton of antibodies that are attacking your kidneys, but the CellCept is doing a remarkable job of protecting them. Kidney function declines with age even in healthy people. At 65, you have the kidney function of a 55-year old."

Then he asks me how often I get an infection. (Apparently most people on immunosupressant drugs are getting infected all the time and are typically wandering around with heavy doses of antibiotics.)

I tell him that I've never gotten an infection, "I know I'm immunosuppressed and avoid crowds. If I cut myself, I quickly wash it off and put some antibacterial ointment and a band-aid on it."

I saw the doctor again about 6 weeks ago and I showed him some guidance I'd found from the American College of Rheumatology on the COVID vaccine. They said you should discontinue the immunosupressant drugs for 7 days after the innoculation to increase the chance the vaccine will cause the desired antibody response. (I got no reaction to the first two doses of the Pfizer vaccine.)

I could see that he was rather surprised that a patient was providing him with specialty society guidance that he should probably know himself. But, I understand that he probably has 200 or 300 patients with 40 or 50 different diseases. He can't be on the cutting edge of the medical literature for each and every one of them. I regularly follow the medical literature on lupus nephritis, kind of like a hobby, and am probably more up to date on it than most doctors.

So in response to your observation that "you seem to be completely oblivious to true medical risk", I'm fairly confident based on 20 years of experience that I have a great handle on my medical risk as well as the ability to adroitly control the cost of my treatment.

Of course, like investment returns, your mileage may vary.

intercst
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CellCept increases your risk of skin cancer -- more so for someone like me who spent 20 years in the Texas and California sun playing golf and tennis without sun screen. So I'm careful to monitor myself for any skin lesions.

Last year I noticed a few spots on my right leg that I self-diagnosed as a likely squamous cell cancer that's slow growing. I discerned that I could safely wait a year until age 65 to get it removed once I qualified for Medicare. I started Medicare of February 1st of this year and had the two spots removed on Feb 6th. The pathology report confirmed my diagnosis and Medicare charged me $120 out of pocket to remove the 2 lesions. With my high-deductible Obamacare plan, it easily would have cost $1,500 out-of-pocket to have a dermatologist do it any earlier.


I was born and raised in Texas, and I spent a lot of time as a child running around with no shirt and often just shorts. Since moving to California I have mostly worn a shirt, but I have had a couple of squamous cell carcinomas and some basal cell carcinomas, all attributable (at least to me) to the Texas sun in my youth. These all developed after age 75.

You mentioned "The "normal" monitoring labs I'd been ordering myself for the past 20 years". How did you go about ordering your own labs? The medical establishment don't welcome the unlearned masses to the inner sanctum.

CNC
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CNC asks,

You mentioned "The "normal" monitoring labs I'd been ordering myself for the past 20 years". How did you go about ordering your own labs? The medical establishment don't welcome the unlearned masses to the inner sanctum.

</snip>


About 2 years into the lupus nephritis, I noticed that I was sometimes paying 10 times the Medicare reimbursement for lab work, which I felt was completely unreasonable. With some investigation on the Internet, I found that there were several companies that provided lab work online. The patient selects the labs they want to buy and the app fills out a lab order that is sent to a doctor they've hired somewhere to to actually sign the lab order. (It's a volume business, they're probably paying the doctor $2 or $3 per form, but he's signing hundreds of them so it's easy money.)

They also have some safeguards in the process. If you order an AIDS test or some kind of genetic cancer screening, they'll typically have someone call you with the results to make sure you don't commit suicide. For the plain vanilla stuff like I was ordering, they just send you an e-mail that the lab report is ready and you can download it from Quest Diagnostics just like the doctor's office would do. Also, you go to the local Quest office for the blood draw. You're using the same lab as the doctor uses. It's not some fly-by-night, cut-rate operation on the actual lab work side, they're just eliminating the price gouging.

Over the past 20 years I've had a couple of shops I've used shutdown by state authorities. Not out of any concern for patient safety, but probably to protect doctors' incomes since they typically mark up the price of any lab work they order for you. The place I've been using for the past few years before I got on Medicare is Ulta Labs.

https://www.ultalabtests.com

Once you're on Medicare, all the lab work is done at no cost to you. Medicare goes after the doctor if he's ordering anything hinky to pad his income, so I'm fine with letting them order whatever they like. With private insurance, they make you pay for the price gouging, so you have to be much more careful with what the doctor is doing. I kept everyone on a short leash, pre-Medicare.

intercst
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As my health insurance got crapified over the years along with everyone else, I increased my deductible to control costs and started buying the CellCept from Canada out-of-pocket (at less than 1/2 the US price.) I also started ordering my own lab work and paying cash, rather than let the insurance company price gouge me on it. So over the past 20 years, I've been able to manage a deadly, complex disease with about $1,500 in annual out-of-pocket cost despite a high deductible health plan. (Once the Cellcept went off-patent, a year's supply was $200 to $300 depending on my current dose.)

Nice job. I've also presented research to doctors and informed them of things they don't know, so it doesn't surprise me. You have to be your own advocate.

That said, there may come a time when you can't do all this leg work. My parents were lucky that Sis was a nurse and well schooled in how to do paperwork for the insurance industry and Medicare. Just handling their claims was an insane amount of work that stressed her out. I probably couldn't handle it now, never mind in 20-30 years.

IP
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IP writes,

<<As my health insurance got crapified over the years along with everyone else, I increased my deductible to control costs and started buying the CellCept from Canada out-of-pocket (at less than 1/2 the US price.) I also started ordering my own lab work and paying cash, rather than let the insurance company price gouge me on it. So over the past 20 years, I've been able to manage a deadly, complex disease with about $1,500 in annual out-of-pocket cost despite a high deductible health plan. (Once the Cellcept went off-patent, a year's supply was $200 to $300 depending on my current dose.)>>

Nice job. I've also presented research to doctors and informed them of things they don't know, so it doesn't surprise me. You have to be your own advocate.

That said, there may come a time when you can't do all this leg work.

</snip>


I only had to do "all that leg work" when I had private insurance. With Medicare, I can just let them do what they want without much financial consequence. I've found that most doctors are trying to the best they can with the information and tools available to them. It's only their Private Equity, MBA overlords that I have a beef with. If I stick with traditional Medicare, I can avoid that.

intercst
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With Medicare, I can just let them do what they want without much financial consequence.

Good luck with that. It was not my parents' experience.

IP
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inparadise writes,

<<With Medicare, I can just let them do what they want without much financial consequence.>>

Good luck with that. It was not my parents' experience.

</snip>


Haven't you said that your parents suffered from dementia? Obviously there's not much you can do with that.

No history of it in my family, but there's always the danger that you'll be the first. That's why I have the tank of helium in the closet if I detect any early warning signs.

intercst
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That's why I have the tank of helium in the closet if I detect any early warning signs.

intercst


----------------

Helium? Won't you just be talking like a duck and still be demented?
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No. of Recommendations: 1
Haven't you said that your parents suffered from dementia? Obviously there's not much you can do with that.

I also said that my sister, the nurse, was dealing with their medical claims. Their dementia did not impact her issues with insurance.

Claims were constantly being submitted by the medical facility with the wrong codes, or simply denied, even by medicare. It was a part time job for Sis to be dealing with it.

I also know a number of people who are dealing with dementia without a previous family history. Just because you've been able to do what you say you have done in the past, does not predict what you will be able to do in the future. Frankly I have no doubt I will change your mind, and this is really a warning to those considering following in your footsteps.

Just another data point to consider in the equation of deciding on insurance.

IP
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No. of Recommendations: 5
What happens if you cancel Part D and then get diagnosed with a cancer where the best treatment is one of the really expensive drugs in January or February, 2022? Cancer doesn't always have warning signs for months ahead of time.

This.

If often amazes me that people worth seven figures chose to skimp on things like insurance.


Hawkwin
Whose wife developed CML in her 30s, two years after having obtained a 20 yr $1 million term policy on her - for which she would not qualify today.
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Why is Medicare Advantage worse than regular Medicare?
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No. of Recommendations: 5
If often amazes me that people worth seven figures chose to skimp on things like insurance.

Especially considering that Medicare -- including all Parts -- is cheap for the customer, since they pay only about 20% of the premium while the poor sod working taxpayers pick up the other 80%.

I just looked up some prices. $148 Medicare premium, plus $49 for a Medicare Advantage plan that includes drugs. Drug deductible $195. Maximum out-of-pocket $7,000 per year. Round up, call it $200/mo. FWIW, some Humana plans include $75/quarter OTC benefit.

My employer retiree pre-65 plan was $1000/mo.

Even the very highest Medicare -- at income above $500,000 -- is only $505/mo.

There are some drug-only plans that came up, Cheapest was $7.30/mo with $445 deductible. Most expensive was $86/mo with $0.00 deductible.

Somebody brags continuously about working the system to get Omamacare for almost free, yet chokes about $49/mo for drug coverage. I don't get it.

I *also* don't get a person who claims to be on Obamacare and Medicare simultaneously. You can't. Once you are on Medicare you are not covered by Obamacare. But what do mere facts matter when there is a claim to be made?
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No. of Recommendations: 1
Why is Medicare Advantage worse than regular Medicare?

It isn't. Just different.

Some may argue that it is worse because it costs the government more (the government subsidizes Advantage plans considerably more than medicare plans).

But, that argument ignores the fact that Advantage plans often have many of the additional benefits (dental, vision, hearing), that Congress is currently trying to have applied to traditional Medicare plans. It is fair to assume that if those benefits are added to Medicare, that the costs for both programs will be much closer and it would not surprise me if Medicare actually becomes the more expensive program.
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No. of Recommendations: 8
thegreatdane asks,

Why is Medicare Advantage worse than regular Medicare?

</snip>


See this:

What I'm doing for Medicare insurance at age 65
https://retireearlyhomepage.com/medicare2020.html

Why are people so hot to sell me a Medicare Advantage plan? Who's being "advantaged" if I buy one? Let's look at the numbers.

The actuarial value of your Medicare benefit is somewhere around $12,000/year. It varies a bit from state-to-state and county-to-county. Surprisingly, the lowest Medicare spending is in Hawaii with a value of $883/month or $10,596/year. Unsurprisingly Alaska has the highest average costs of a bit over $14,000/year.

If you choose Medicare Advantage, the Centers for Medicare & Medicaid Services (CMS), transfers that average $12,000/year benefit to the private health insurer you select. In turn, the insurer is allowed to skim off up to 15% of that $12,000 in admin expenses (i.e., $1,800/yr) though in many urban areas competition may limit that skim rate to 12% or so. That 15% figure relates to the so-called Medical Loss Ratio or MLR. Medicare demands that Medicare Advantage insurers spend at least 85% of your benefit on actual medical services and no more than 15% on overhead & profit. For Obamacare, insurers were allowed as much as 20% overhead & profit and an MLR of 80%.

<snip>

Meanwhile for 2019, traditional Medicare had program costs of $796.2 Billion and spent $785.6 Billion on actual medical services for its 61 million beneficiaries, leaving $10.6 Billion for administrative expenses. That's an admin cost of 1.3%. (See page 10 of the Trustee's Report.) And the Gov't bureaucrat running the Centers for Medicare & Medicaid Services (CMS) makes $165,000/yr and flies commercial. Who's likely providing you with the better deal?

<snip>


So with Medicare Advantage, you're buying less actual doctor and hospital services in exchange for more private insurance company bureaucracy and much higher executive compensation. I don't see how any of that is going to improve my health care, so I chose traditional Medicare.

intercst
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Ralph Nader harps on Medicare Advantage on his podcast all the time. He calls it "Medicare Disadvantage". People should avoid it as it just puts you a private plan where you get screwed if something happens. Which, at retirement age, chances are good.
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Hawkwin writes,

If often amazes me that people worth seven figures chose to skimp on things like insurance.

Hawkwin
Whose wife developed CML in her 30s, two years after having obtained a 20 yr $1 million term policy on her - for which she would not qualify today.

</snip>


Even before I was "worth seven figures", I was very attentive to insurance costs.

My younger brother is a Fellow in the Casualty Actuarial Society specializing in auto insurance. (He set the rates for the AARP's nationwide auto insurance program at The Hartford before he got fed up with corporate bureaucracy and retired in his early 30's to play golf.)

I learned from him that even the most efficient insurers are going to charge you the actuarial risk for whatever you're trying to insure against, plus an extra 20% to manage "the pool." So if you're wealthy enough say to replace a new car that is damaged or stolen, it's always going to be cheaper in the long run to retain that risk yourself and replace the vehicle out of cash flow or savings rather than buying insurance.

However, I do carry liability insurance on my vehicle (as required by law) and I have a $5 million umbrella liability policy as well. I can't control someone suing me for good or bad reason, so I'm willing to buy insurance to cover that, but not insurance to replace the vehicle.

I think it makes sense to buy term life insurance if you have a young family to protect, and I'm glad it paid off for you. But unless "CML" is an illness that presages a much shorter lifespan and the term policy is more of a winning lottery ticket at this point, I'd probably let it lapse once I'd accumulated enough savings and investments to provide for my family.

intercst
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The one place where Medicare Advantage appears to be, well, advantageous is when someone is also on Medicaid. My entire dataset, though, here is one—my mom.

She is in a nursing home and on Medicaid (and Medicare). Medicare and Medicaid do not provide dental coverage or eyeglasses, etc. At least in Tennessee, you have to buy a separate policy for teeth and eyes, which then alters the patient contribution amount. In other words, because we had to pay this extra premium for another stupid policy (and I forget the amount, but I thought it was really expensive), the amount paid to the nursing home was less. So financially it was a wash as to how much my mom paid (basically signing over her social security check), but it was another level of administrative stuff for ME to deal with every month.

Without talking to me, last year during open enrollment she signed up for an Advantage plan, which include that coverage. So it was worth it in my opinion not to have to deal with another bill every month. (Although it screwed up everything with the nursing home for about three months).

Either way, though, I think the state is getting tripped off.

Just another (limited) perspective.
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Social Security benefits to jump 5.9% in 2022...

Considering inflation is almost matching that, it is a wash at best.

JLC
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Actual cancer usually does have warning signs.

Not in my experience.


Tried to go back and find the writer of this to respond directly but I can take a good guess.

"Actual cancer", whatever that is, frequently has little to no signs until it is in advanced stages. And often those signs are easily mistaken and overlooked for everyday benign events. Because of this, that is why we have developed "screening tests" at prescribed ages. Catch things early BEFORE signs and symptoms occur.

I could give you many examples I have seen during my career but here are a few personal examples.

A friend's mother diagnosed with stage 4 ovarian cancer in the ER with what she thought was appendicitis. No other complaints prior.

A friend died of pancreatic cancer, initial diagnosis stage 4. Which is often the case with this cancer because of the anatomy of the pancreas.

A friend recently received a bone marrow transplant for multiple myeloma. Her cancer was diagnosed as part of a "long COVID" symptom workup. She was/is a hero nurse that contracted COVID while taking care of patients before the vaccine was available.

JLC
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MEK writes,

The one place where Medicare Advantage appears to be, well, advantageous is when someone is also on Medicaid. My entire dataset, though, here is one—my mom.

She is in a nursing home and on Medicaid (and Medicare). Medicare and Medicaid do not provide dental coverage or eyeglasses, etc. At least in Tennessee, you have to buy a separate policy for teeth and eyes, ...

</snip>


Wendell Potter, the ex-Cigna executive turned industry whistleblower has on on-point observation about his mother in a Tennessee nursing home while on Medicare Advantage.

Medicare vs. Medicare Advantage: Ill Health Often Leads to Plan Switch
https://www.kiplinger.com/article/retirement/t039-c000-s004-...

When Wendell Potter’s mother broke her hip and needed rehabilitation in 2011, her Advantage plan’s network included only one nursing home in her home area of eastern Tennessee. In the facility, she made little progress and developed bedsores that didn’t heal, Potter says. And within a few weeks, the Advantage plan’s utilization management nurse told Potter that his mother was unlikely to recover and that she wouldn’t be eligible for further skilled nursing care.

Potter, a former insurance company executive turned industry whistleblower, had originally encouraged his parents to enroll in Medicare Advantage—but as his mother faced the coverage cutoff, he helped her switch to original Medicare and move to a new facility. There, “the care they gave her was lifesaving,” he says. Although she suffers from dementia, she’s still relatively healthy at 93, Potter says, and “she has lived some additional years that I’m certain she wouldn’t have” were it not for the switch.

</snip>


Of course if you're in a nursing home, you're unlikely to survive the medical underwriting when you apply for a Medi-gap policy to go along with regular Medicare. You need to be wealthy enough to cover the out-of-pocket expense on your own.

The husband of a cousin of mine in New York was in a rehabilitation faculty for a few months after an injury. She worked for the City of New York and the husband was on her policy, so they were fine. But she noticed a lot of folks with Medicare Advantage were complaining that the insurance company was hot to throw them out of the facility while their loved one was still improving from the rehabilitation regime. Regular Medicare didn't do that.

intercst
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No. of Recommendations: 6
"Considering inflation is almost matching that, it is a wash at best."

That makes sense since the purpose of the COLA is to ensure that SS and SSI are not eroded by inflation. From their informational site:

"The purpose of the COLA is to ensure that the purchasing power of Social Security and Supplemental Security Income (SSI) benefits is not eroded by inflation. It is based on the percentage increase in the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W) from the third quarter of the last year a COLA was determined to the third quarter of the current year. If there is no increase, there can be no COLA."

This year's COLA is also interesting to me because it is based on a set of facts that are used to determine real inflation as applied to wage earners and because this is the highest COLA adjustment since 1982. There may be a fight over whether it will be transitory or enduring, but I am beginning to take inflation warnings seriously even though our personal inflation is not yet obvious.
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No, cancer (early stage...you know, when it may be treatable) has few, if any, warning signs. By the time you know you're sick, it's often too late.

1poorlady had stage 2 cancer. Didn't feel a thing. Her mom now has kidney cancer. Doesn't feel a thing (we only found it because it turned out she has stones in her bile duct, and while imaging that they noticed the kidney mass).

Just two examples I know about. We're not atypical. That's why people should get regular screenings.
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She does not have Medicare Advantage. She has straight Medicare with a gap policy (plan F, which is no longer available to new recipients) from GCU, plus Silver Scripts for meds. Set up by her insurance agent long ago. I had assumed Silver Scripts was part of GCU. She doesn't pay any extra premium for that, just for the gap policy.
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Selective blindness and confirmation bias.

There’s a lot of that around.

An awful lot.

Tons and tons, and perhaps tonnes as well.

I find it mostly on one side of the political divide, but then I’m on the other side so perhaps there are a few pounds over here, too.
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No, cancer (early stage...you know, when it may be treatable) has few, if any, warning signs. By the time you know you're sick, it's often too late.

Dad had cancer twice. Both times it was caught super early. Prostate cancer picked up via annual check up and esophageal he went in when vomiting blood. Surgery both times, stage 1A, no chemo or radiation. For the esophageal cancer he was writing himself off before knowing what stage cancer it was. He was ready to throw in the towel. I talked him into at least going to get the analysis of the stage of the cancer so that he could make an informed decision, and if he still decided to throw in the towel when he knew what stage the cancer was, that would be a valid decision.

Then again, that 10 hour esophageal replacement surgery really messed him up. Fun times getting old.

IP
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No. of Recommendations: 5
Social Security benefits to jump 5.9% in 2022...

Considering inflation is almost matching that, it is a wash at best.


And those who delayed taking SS until FRA or age 70 are getting the 5.9% on a larger amount.
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CuriousQ writes,

And those who delayed taking SS until FRA or age 70 are getting the 5.9% on a larger amount.

</snip>


Absolutely!

Waiting until age 70 to take SS is going to be a bigger windfall for me than the much-hated "free Obamacare." <LOL>

intercst
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And those who delayed taking SS until FRA or age 70 are getting the 5.9% on a larger amount.

It doesn't work that way.

ALL SS benefit amounts are moved up by the same percentage. Doesn't matter if you are taking SS or deferring it.

There's one gotcha.
If you are getting SS and you have the Medicare premium deducted from the SS benefit, then when/if the Medicare boost is more than the SS boost, then your net benefit will not be decreased. Your Medicare premium will be capped. That's the "hold harmless".

But if you are not collecting SS and are paying your Medicare premium directly, you'll get hit with the entire Medicare boost. It is not capped.

This already happened once, a few years ago.
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Rayvt explains,


There's one gotcha.
If you are getting SS and you have the Medicare premium deducted from the SS benefit, then when/if the Medicare boost is more than the SS boost, then your net benefit will not be decreased. Your Medicare premium will be capped. That's the "hold harmless".

But if you are not collecting SS and are paying your Medicare premium directly, you'll get hit with the entire Medicare boost. It is not capped.

This already happened once, a few years ago.

</snip>


Correct. The other "gotcha" is that the "hold harmless" provisions don't apply to the top 5% of SS beneficiaries who are dinged by IRMAA (i.e., the extra Medicare premiums for folks with incomes above $88,000/yr.) Presumably that applies to a lot of folks posting here.

intercst
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Medi-gap plans don't cover out-patient prescription drugs.

My husband's state of SC retiree insurance plan does, and I suspect other employer retiree plans do as well. But that doesn't apply to most people.
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"Medi-gap plans don't cover out-patient prescription drugs.

My husband's state of SC retiree insurance plan does, and I suspect other employer retiree plans do as well. But that doesn't apply to most people."

**********************************************************

Medicare Part D plans are what is designed to cover prescription drugs. Takes time to go through
the formularies for various suppliers - but the effort seems worth-while.

Howie52
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No. of Recommendations: 7
That's why I have the tank of helium in the closet if I detect any early warning signs.


----------------

Helium? Won't you just be talking like a duck and still be demented?


----------------

That would be daffy.
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>>That's why I have the tank of helium in the closet if I detect any early warning signs.

----------------

Helium? Won't you just be talking like a duck and still be demented?<<

----------------

That would be daffy. - hk2


---------------------

LOL. It's hard to get a laugh out of this board sometimes. Retirement Investing is serious business for the serious minded.
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No. of Recommendations: 4
Why use helium?

Assisted suicide by oxygen deprivation with helium at a Swiss right-to-die organisation
https://pubmed.ncbi.nlm.nih.gov/20211999/

Conclusions: The dying process of oxygen deprivation with helium is potentially quick and appears painless. It also bypasses the prescribing role of physicians, effectively demedicalising assisted suicide. Oxygen deprivation with a face mask is not acceptable because leaks are difficult to control and it may not eliminate rebreathing. These factors will extend time to unconsciousness and time to death. A hood method could reduce the problem of mask fit. With a hood, a flow rate of helium sufficient to provide continuous washout of expired gases would remedy problems observed with the mask.

</snip>


Science and arithmetic people.

intercst
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No. of Recommendations: 16
So interesting how these threads can twist and turn...

My Dad used helium - the quote from Intercst is accurate.

Dad talked with me about it once, but many months before he actually took control. His wife of 53 years had died 6 months before. He knew his own health problems would make the next 2-3 years very miserable (heart, digestive, lungs, eyesight, skin cancer - all incurable). He was incredibly depressed.

I get that there are many POVs on this. However, only those who have walked the path at the end-of-life can possibly understand....
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Remember this sensationalized story from 2006?
https://www.wistv.com/story/4986147/two-college-students-fou...

The students apparently pulled down the eight-foot-round balloon and crawled inside it.

The mother of one victim says they thought they were doing "a fun thing," apparently trying to inhale some helium.


Rent a big helium balloon for your exit party?

And there was the Cleveland Balloonfest disaster of 1986.
https://ultimateclassicrock.com/cleveland-balloonfest-86/

🤔
ralph
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No. of Recommendations: 3
>>That's why I have the tank of helium in the closet if I detect any early warning signs.

----------------

Helium? Won't you just be talking like a duck and still be demented?<<

----------------

That would be daffy.

---------------------

LOL. It's hard to get a laugh out of this board sometimes. Retirement Investing is serious business for the serious minded.




Oh well, I tried.

https://en.wikipedia.org/wiki/Daffy_Duck#/media/File:Daffy_D...
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>LOL. It's hard to get a laugh out of this board sometimes. Retirement Investing is serious business for the serious minded.


Two old guys, Fred and Sam went to the movies. A few minutes after it started, Fred heard Sam rustling around and he seemed to be searching on the floor under his seat. "What are you doing?" asked Fred. Sam, a little grumpy by this time, replied "I had a caramel in my mouth and it dropped out. I can't find it." Fred told him to forget it because it would be too dirty by now. "But I've got to", said Sam, "my teeth are in it!"
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Conclusions: The dying process of oxygen deprivation with helium is potentially quick and appears painless. It also bypasses the prescribing role of physicians, effectively demedicalising assisted suicide. Oxygen deprivation with a face mask is not acceptable because leaks are difficult to control and it may not eliminate rebreathing. These factors will extend time to unconsciousness and time to death. A hood method could reduce the problem of mask fit. With a hood, a flow rate of helium sufficient to provide continuous washout of expired gases would remedy problems observed with the mask.

I wouldn't know where to get helium, or nitrogen for that matter. But before I would die a painful cancer death I would find out.

CNC
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I wouldn't know where to get helium....

</snip>


You can buy a tank at those "balloon stores" that sell materials for children's birthday parties.

intercst
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but aren't those tanks now 'watered down' by allowing for more oxygen in the stream in order to eliminate what we're discussing?
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Boy, this turned morbid. It has been a number of years, but back in the day I needed to buy compressed gasses of various forms. Any welding supply shop--of which there are a surprising number near you--has whatever compressed gasses you want in whatever purity you want. If you want 100% pure nitrogen they will fix you right up. I never had to buy helium, but I'm guessing it is the same.
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Smurfdogg asks,

but aren't those tanks now 'watered down' by allowing for more oxygen in the stream in order to eliminate what we're discussing?

</snip>


I don't know. There has to be a high enough concentration of helium to allow the balloons to float. And you're supposed to put a plastic bag over your head per the peer-reviewed article. The helium rises to the top of the bag and starts to displace the heavier nitrogen and oxygen.

If the stream is "watered down", maybe you need to run it for 15 or 20 minutes without your head in it to give it time to purge the nitrogen and oxygen?

intercst
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No. of Recommendations: 11
And those who delayed taking SS until FRA or age 70 are getting the 5.9% on a larger amount.

It doesn't work that way.

ALL SS benefit amounts are moved up by the same percentage. Doesn't matter if you are taking SS or deferring it.



Right. People who deferred are getting the 5.9% on the larger amount they received thanks to waiting, and those who took SS early are getting 5.9% on the smaller amount. So, just what I said, I think.
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Right. People who deferred are getting the 5.9% on the larger amount they received thanks to waiting, and those who took SS early are getting 5.9% on the smaller amount. So, just what I said, I think.

I read it the way you stated, too. Mostly since that's what makes sense?

Pete
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I wouldn't know where to get helium....

Walmart.

Probably Amazon, too. Look for "party balloon" kits.
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I wouldn't know where to get helium, or nitrogen for that matter. But before I would die a painful cancer death I would find out.
-----------------------------
If you were a cancer patient with a terminal diagnosis, you would probably have enough prescription painkillers to do the job. Heck, a week's worth of blood pressure pills could probably do it for me.

Bill
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