Dan Demystifies the Colonoscopy Experience   Part 2 of 4

Recap of Part I – Five days before my colonoscopy exam, my Medicare insurance coverage has been denied.  I fortunately find an alternative gastroenterologist up the road in Kennebunk, Maine, but he needs my files faxed to them before he can operate.  Click here for Part 1.

The very next day after the denial of coverage (Friday).  I get a call from Southern Maine Health Care Gastroenterology (SMHCG) saying that my colonoscopy files have been faxed to their offices already!  What could have taken five days, takes one!  I’d be scum if I don’t call Kelly at Atlantic Digestive Specialists to thank her for expediting the delivery of my files.  Today, I am not scum.

Donna at SMHCG sets me up for a colonoscopy appointment for the very next Friday, in just seven days, only three days later than my original appointment!  I have been psyching up for nearly two months for one of the most preventable-of-cancer screenings – the colonoscopy.  Truth to be told, I am looking to get the damn thing over.  Sometimes you win, and sometimes you win unexpectedly.

Six days before the newly scheduled appointment (a Saturday) With this reset, I have time to think about the Aetna Medicare Advantage health insurance Hannah and I have.

colon aetna medicare

We have had two separate Medicare plans since we turned 65.  From 2013-2015 we had a high end AARP Medicare supplemental plan.  To save money because we have been quite healthy, we opted in 2016 for the Aetna Medicare Advantage plan, which we currently have.

Fact is, there are some sweet benefits to Medicare Advantage insurance.  We pay no monthly premium.  None.  We get a dental and optometry stipend for yearly check-ups.  We pay $5 for a doctor’s visit and $35 for a specialist within network.  Sounds pretty good, n’est-ce pas?

colon how medicare works

With this Aetna plan, Hannah paid $150 out of $4500 in bills from the ER at the Santa Barbara Cottage Hospital after her fall off the San Ysidro Trail one year ago.  I paid something like $175 of my $14,000 bill from my overnight at York Hospital and subsequent myriad of tests after my recent episode of Transient Global Amnesia.

We cannot pay more than $6000 each for health care in any one calendar year.  And, let me remind you, we pay zero per month to Aetna.

colon social security

Let’s be clear, our Medicare is not free.  Everyone, no matter whether they have a supplemental plan or an advantage plan, pays the federal government something like $140 per month.  If you are on Social Security, as we are, that money is taken directly out of your monthly Social Security check.

There are limitations to a Medicare Advantage plan.  Though our primary care physicians at Kittery Family Practice and the local York Hospital are in-network, we have found that not all local specialists are in-network.  Two and a half years ago with Aetna Medicare Advantage, I found that the dermatologist I had previously used under a regular Medicare supplemental plan would not take my Aetna coverage.  Fortunately, another physician in her office at Northeast Dermatology did and successfully removed a small growth on my cheek.

colon SMHCG

Two days ago, I was informed that my preferred gastroenterologist did not take my Aetna Medicare coverage.  I found an in-network replacement here locally at Southern Maine Health Care Gastroenterology.  Is SMHCG as good as the doctor I wanted and that had been recommended by a trusted friend?

There is a more expensive alternative to Aetna Medicare Advantage – a Medicare supplemental plan.  This year the AARP Universal Healthcare Supplemental plan would cost us each $225 per month.  That’s more than $5400 for Hannah and me per year whereas Aetna Advantage is zero per month.

colon medicare supplemental

With a top end Medicare Supplemental plan like we had from 2013-2015, we did not need referrals from our primary care physician for specialists.  Basically, every health care provider loved seeing us coming.  I don’t remember a co-pay.  Our Plan F for supplemental insurance was the gold standard.  My previous colonoscopy with a doctor of my choosing was covered without a second thought or additional expense in 2013.

But here’s the bigger question as Hannah and I turn 70, how good would our coverage with Aetna Medicare Advantage be if we had something really serious – say a heart attack, cancer, something we don’t even know that might be going on in our bodies?  Would we be denied top medical providers that are available to others with a Medicare supplemental plan?

A young friend of ours had a breast cancer diagnosis.  She had the choice of Mass General or Dana Farber Cancer Institute, both world class hospitals in Boston, from which to choose for her cancer treatment.  Would I have such an option if I had a similar serious diagnosis?

Calling our Aetna customer service representative, I learn we would not have the choice of either of those hospitals.  Local is not worse, but why would I limit my options when elite hospitals are sixty miles away in Boston?

colon mass general

So, Hannah and I must decide, while we are currently quite healthy, if the extra expense of a Medicare supplemental plan is worth the additional $5400 cost per year.  If necessary, I would want the choice between Mass General and Dana Farber.  Wouldn’t you, if you could afford it?

Part 3 details my mindset and preparation as the colonoscopy draws nigh.