I have been sick with a kidney infection for the past 3 days.  Having had many of them in my lifetime due to a genetic disease, I know exactly what they feel like and can pretty much self-diagnose them.  I always keep “pyridium” on hand – it’s an over-the-counter medication that helps to stop the bladder spasms and pain of urination.  I know to request Levaquin from my physician because it’s a good antibiotic for this type of infection.  It’s very expensive though….about $150.00 even with insurance (but then again, I have terrible insurance – more on that in a moment).

So it’s the 4th day of antibiotics and I still have pain in my kidney.  This means that I probably have a kidney stone (this is part of my genetic disorder – I’ve had hundreds of those too.)

Kidney stones require trips to the ER or at the very least an urgent care center that is located close to a facility with CT scan capabilities.  The LAST time I went in for a kidney stone (and was not even admitted to a hosoital room), it cost me over $3000.00.  The deductible on my CRAPPY insurance for which I pay $266.00 a month is $3000.00.

I don’t have $3000.00 to spare right now and because I know that chances are good that I’ll be admitted for lithotrypsy, (with a price tag of about 12K), I am continuing to hide out at home hoping the stone will stop moving and then I can ignore it for a few more months.

This could turn into a requiem for health care reform but that is not my pointing in writing this.  My point is that while we complain about the poor medical treatment received by senior citizens because of their medicare coverage, the fact is that Medicare provides pretty good coverage.

My father had 7 prescription medications that he took daily (some more than once a day).  With Medicare and Medicare Part B prescription coverage, most of these medications cost $4.00 per month. (The medication that I must take daily costs me $300.00/month).

When my father saw the doctor, his co-pays for visits were approximately $10.00 and this $10.00 was usually reimbursed due to the fact that he also carried a Medicare Part F supplemental plan which covers the 20% that Medicare does not cover for physician visits and other outpatient services (the Medicare Plan B was included in this plan and I believe that it cost less than $50.00 per month).

Visits to the ER, of which there were several during the last few months of his life, rarely set him back more than $50.00 per visit.  The largest expense by far was the 911 ambulance ride to the hospital – $150.00 each time.

At this particular moment, I am really wishing that I qualified for Medicare – oh well, another …..several years.

The part where Medicare fails the elder patient is in its long-term care coverage.  It covers a limited amount of nursing home/skilled nursing care facility days AND the elder patient MUST BE ADMITTED AS AN INPATIENT TO A HOSPITAL prior to an admission to either one of these facilities in order for Medicare to pay.  It does NOT cover assisted living facilities unless they provide certain services (skilled nursing, wound care, etc.)  Medicare does not pay for anything that would be custodial in nature or even diabetic testing in most cases.

Medicare also is deficient when it comes to paying for home health care.  Generally services such as bathing, help with dressing, companion care, etc, must come out of pocket.

Occupational and physical therapy visits to the home may be covered for a limited time and these visits are very worthwhile to both the elder and their caregivers.  Therapists will work with the senior on balance, proper ways to sit down and get out of a chair, will offer suggestions for safety equipment, show caregivers how best to mount grab bars in bathrooms, make suggestions for nutritional intake and can many other significant pieces of information.

As caregivers in the boomer era, there is not much we can do to change the type of coverage that our loved ones have available, but for ourselves, or for perhaps a younger aged parent, it is imperative to purchase long-term care insurance NOW while it is still affordable.  Hopefully it will better than my CRAPPY health insurance.  🙂