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Corvallis, OR, United States
My personal obsession with prion diseases with smidges of music I like and rescue dog advocacy from a disabled Oregonian.


This Makes Me Ill(er)

I've been thinking about my health insurance premium lately. Higher premiums are in vogue this season so I pulled out the calculator to calculate the percent increase of my premium this year. The exact percentage is enough to trigger a stress migraine..a 47% increase from last year.

I could have picked a particular type of medicare Advantage plan called a special needs plan. This is a health plan for institutionalized patients or people with certain chronic illnesses. The premiums are zero. being the skeptic that I am I thought this sounds too good to be true and i did some research on my health insurer's web page. Being a thorough researcher I found a link to frequently asked questions way down on the right column. (Link) Who would have thought to look in such an obscure place for some very important information?

Can Samaritan Advantage Health Plan (HMO) end my membership and make me leave the plan?

Generally, we cannot ask you to leave the plan because of your health.

Unless you are a member of a Medicare Advantage Special Needs Plan (SNP) for chronic conditions, you cannot be asked to leave your health plan for any health-related reasons...


If you are a Samaritan Advantage Special Needs Plan (HMO) member and your Medicaid eligibility or benefits change. You will be disenrolled from the Samaritan Advantage Special Needs Plan (HMO) on the first day of the month after a 60-day grace period, which begins on the day your Medicaid eligibility changes. Samaritan Advantage Health Plan (HMO) will notify you in writing about your options.

So, if my health gets worse I can be asked to leave. Isn't that lovely?

After trying to read between the lines on these special needs plans and due to the fact that I might get other health problems I declined the zero premium and instead took the health plan with high premiums and also has vision and dental coverage. I wonder if I made the right decision frequently but I don't always have the energy and/or cognitive ability to understand the details of complicated health plans.

I did a little research on Medicare special needs plans and I can see that these plans have no quality assurance criteria and may lack the coordination of all my health care providers. As a consumer, I wasn't convinced that I would get good care being in a special needs plan. I also didnt like the dissemination of information on how I can be disenrolled. None of their letters sent to me explained how I could be disenrolled. It was only by chance that I found this information through in depth reading of their website.

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