No. of Recommendations: 2
One of my golf partners in Houston is going to be very upset.

Medicare Part B Premiums Rise 7% In 2020, With Premiums For Highest Income Couples Nearing $12,000 A Year
https://www.forbes.com/sites/ashleaebeling/2019/11/09/medica...

By comparison, the wealthiest retirees – singles with $500,000 of income or more and couples with $750,000 of income or more – will face total premiums of $491.60 a month per person, including a $347 surcharge, in 2020. (That comes to $11,798.40 a year f0r a couple.) The 2019 numbers are here.

</snip>


Seems like a "high-class" problem to have.

intercst
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Yes it is a first world problem, and while I’m very happy to have a good income and Medicare, I’ve got to admit that really deep down the IRMMA irks me a bit. Probably because when I was doing retirement planning in the 80’s and 90’s there was no IRMMA to plan for. The .09% extra Medicare tax on my income above $250,000 doesn’t bother me as much, but the IRMMA gives me an involuntary flinch. Irrational, glad to be in this situation, but it’s something I didn’t plan for.

tsimi
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"Seems like a "high-class" problem to have.

intercst "

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

The 7% increase is reported to be across the board - but is overall less than the
increase in Social Security. So seems to be pretty much OK for all.

Howie52
Doctors in this area continue to be treating Medicare patients - although more
doctors and hospitals seem to include a form stating that a patient is responsible
for "full" charges. I think the issue is that if Medicare rejects the charge - the
provider of services will still be paid from someone - but my reading of the form
kinda indicates some interpretations could push the envelop farther.
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Doctors in this area continue to be treating Medicare patients - although more
doctors and hospitals seem to include a form stating that a patient is responsible
for "full" charges.


Are you talking about "balance billing" if so, I think it's illegal under Medicare.

https://www.aarp.org/content/dam/aarp/ppi/2017-01/medicare-l...
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I still got some time before Medicare applies to me, but I'm seeing more doctors going to the "concierge" style of practice where you have to pay them $1000+ per year on top of normal payments to visit them in order to get better service.

Before I moved west, I was talking to a family practitioner (internal medicine) in a bar who did that and I think charged $1500 and went from 600+ patients down to ~300 patients. He much preferred that. Of course that means ~$350K extra income. Whether it goes to his pocket or helps pay staff a bit more.

Right now there is a shortage of quality doctors from what I see.

I'll be "fortunate" since I will have my federal government health insurance along with Medicare. Hopefully that works out well. I'm guessing things may change a lot in the next5-10 years.

Rich
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JonathanRoth writes,

<<Howie: Doctors in this area continue to be treating Medicare patients - although more
doctors and hospitals seem to include a form stating that a patient is responsible
for "full" charges.>>

Are you talking about "balance billing" if so, I think it's illegal under Medicare.

</snip>


It depends on the knowledge and sophistication of the patient. If an ethically-challenged health care provider can screw the patient and get away with it, they'll do it.

How One Employer Stuck a New Mom With a $898,984 Bill for Her Premature Baby
https://www.propublica.org/article/how-one-employer-stuck-a-...

The benefits representatives told her information about the 31-day rule was in the documents she received when she was hired. It didn’t matter that it was six years earlier, long before she dreamed of having Sadie, she said. The representative also told her it wasn’t just Dignity’s decision, the Internal Revenue Service wouldn’t allow them to add the baby to the plan.

<snip>

But the federal regulator of Dignity’s plan said such plans can, in fact, make exceptions. An official with the federal Labor Department, which regulates self-funded health benefits, told ProPublica that plans can make concessions as long as they apply them equally to participants. Plus, federal law allows plans to treat people with “adverse health factors” more favorably, the official said.

</snip>


And of course, there's absolutely no penalty for a health insurer that lies to you when you ask a question on health benefits.

intercst
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richinaz writes,

I'll be "fortunate" since I will have my federal government health insurance along with Medicare.

</snip>


I'll pretty sure that your Federal Gov't health insurance is going to be reimbursing your doctor at the Medicare rate.

intercst
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Rich Right now there is a shortage of quality doctors from what I see.


Gee, maybe that's why I have to wait two months for Mohs surgery on a basal cell carcinoma on my left cheek. By time I see the surgeon, it may cover half my face.

CNC
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Gee, maybe that's why I have to wait two months for Mohs surgery...

Do we have the same doc? I guess this wait **is** typical. My cell cluster (also on the cheek) was very small and very slow growing so the wait ended up not mattering too much, but there is some psychological toll with the wait...

Pete
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Ask your doc?

Is it possible to treat it with Fluorouracil?
https://www.webmd.com/drugs/2/drug-16269/fluorouracil-topica...

I've used Fluorouracil a couple times.

I particularly thought it very effective for a "spot" treatment on my hand. Takes about 1 month of daily application.

🙂
ralph
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Y'all must live in Canada.
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"Rich Right now there is a shortage of quality doctors from what I see.


Gee, maybe that's why I have to wait two months for Mohs surgery on a basal cell carcinoma on my left cheek. By time I see the surgeon, it may cover half my face.

CNC "

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

Have you considered "Acme Corporation Home Surgery Products"?

Howie52
Doctor quality does tend to become important when scheduling surgery.
I might tend to worry if surgery were scheduled the day after New Years say.

Good luck with yours and may patience turn out to be worth the wait for the virtuous patient.
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Mohs is very specialized—not every dermatologist is trained—and skin cancers are up—something like 70% over a 20 year period, I think. I had a squamous cancer on my face removed pretty quickly via Mohs, but it was growing rapidly. (My doc in Dallas was very good, but man—assembly line! She did the removal one day and the plastic surgery the next day—for everyone. But my scar is barely visible). My friend with melanoma got in to see her doc in about two days. Depends on the severity of the cancer and the number of patients.
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I've had two Mohs surgeries on my nose (both by the same docs in Denton, TX) and was lucky that they got all of it on the first go-through. Very efficient. My mom (92) has had several, but more serious, meaning she needed plastic surgery taking a patch from her shoulder to fix.

The fact that in Mohs they look at the margins after each incision means that they really will get all of it . . . a very good thing.

Just retired and moved to the Olympic Peninsula in WA state, so need to find a new dermatologist.
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<<Rich: Right now there is a shortage of quality doctors from what I see.>>

Gee, maybe that's why I have to wait two months for Mohs surgery...

</snip>


You could see any specialist you liked if you weren't in that crap Medicare Advantage plan and had traditional fee-for-service Medicare instead.

intercst
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Gee, maybe that's why I have to wait two months ...

I've found having a two month wait is hard on the nerves and good for the health. Getting told it will take 4 days to get lab tests back then the doctor personally calls you at 8 am the next day is never good news.

Hope all goes well with you.
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"You could see any specialist you liked if you weren't in that crap Medicare Advantage plan and had traditional fee-for-service Medicare instead."

Got regular Medicare.....had a weird skin lesion/rash and set up appointment with dermatologist that my regular doc recommended....took six weeks to get appointment. Follow up was made at that time and was right on schedule month later. Was nothing serious. Has not re-occurred.....

I suppose if it were really bad, would have got in sooner.

t.
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Have you considered "Acme Corporation Home Surgery Products"?

Howie52
Doctor quality does tend to become important when scheduling surgery.
I might tend to worry if surgery were scheduled the day after New Years say.

I wound up waiting two months to have a squamous cell carcinoma removed from the back of my right hand, and it doubled and quadrupled in size while I waited.

CNC
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For those with some interest in Mohs technique. Fred Mohs was at the University of Wisconsin

https://skincancer.org/treatment-resources/mohs-surgery/hist...

This link has a schematic explaining a bit more about the technique.

https://www.mohscollege.org/about/about-mohs-surgery

tsimi
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DS: Just retired and moved to the Olympic Peninsula in WA state, so need to find a new dermatologist.

That's quite a move! Any culture shock? Rainy side or sunny side?

CNC
... lots of salmon!
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I wound up waiting two months to have a squamous cell carcinoma removed from the back of my right hand, and it doubled and quadrupled in size while I waited.


I’m just curious where you guys live that you’re having so much trouble getting appointments. I’ve never had to wait that long—anywhere close—and I do appointments for my mom who’s on Medicare, and she’s never had these issues, either. I live in Memphis, which is a good sized city, and we have a medical school here and several major hospitals.
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MEK: I’m just curious where you guys live that you’re having so much trouble getting appointments.

We live in Ellay. Not like we're in Podunk with only one doctor. I blame the insurance company (Health Net). Their "In network" stable of practitioners may limit them. I plan to change to another company, but I am loathe to do this so close to the end of the year, as a new insurance company won't pick up where the old one was. Any follow-on work will certainly go into 2020.

CNC
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Just retired and moved to the Olympic Peninsula in WA state, so need to find a new dermatologist.

Good luck with that. You'll probably have a long wait, at least if you're in the North Olympic Peninsula area, based on what I've seen in Clallam County. My docs are still all in the Seattle area, and even then, it can be hard to find a new doc. Out in the boonies, the wait lists are pretty long.

AJ
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... lots of salmon!

Not enough for the orcas. 😢

AJ
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AJ,
Are you anywhere near Port Angeles? I visit friends in PA often. 4-hour drive from Portland, OR.
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I'm sure problems with getting appointments depends on anything from where you live, your insurance, the type of doctor, etc.

As a pure guess I'd imagine retirement locations such as Florida and Arizona are bad due to the large number of older people living and needing medical attention. I'm currently in AZ (moved back a few months ago) and will see how it compares to the east coast. I'm not on medicare so that issue doesn't apply.

One of the worst parts of moving (and there are plenty of them) is finding new doctors. And as you get older you need more than just a primary care doctor, dentist and eye doctor, which just makes it more of an "adventure".

At least I do have health insurance through my employer which is more than many people have.


Rich
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You could see any specialist you liked if you weren't in that crap Medicare Advantage plan and had traditional fee-for-service Medicare instead.
============================================
We've got Medicare Advantage, with a PPO feature, through Aetna, and have the same doctors as before my wife retired. (We were on her health insurance through work, previously.)

We did change pharmacies, and pay practically nothing out of pocket for our regular prescriptions. And we now have access to a group of orthopedic doctors that we really liked, that we went to years ago, before her job change.

As long as we stay reasonably healthy, the copays aren't too bad. And our Medicare C & D premiums are $26/month, each.

Bill
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