The Doctor Dilemma We Boomers Pass On To Our Children and Grandchildren Part II: Treatment, Insurance and Medicare

As I reflected in Part I, regarding the doctor dilemma we Boomers pass on to our children and grandchildren, it took this Grandma one year to get an appointment with a well-regarded ophthalmologist who specializes in cataract surgery at Bascom Palmer Eye Institute, a world-renowned ophthalmic care, research, and education center affiliated with the University of Miami. It is consistently ranked as one of the best eye hospitals and vision research centers in the nation. I was told cataract surgery is a given as you age. I was advised to make the appointment before I needed the surgery so that I would not be a new patient when I needed the surgery.  Then, I would be able to get in for the surgery with this specific specialist when I needed it. 

When I explained this to my daughters, the generation below me, I said, I guess I really should explain the doctor dilemma that is facing us Boomers that has several facets, so you aware of what is coming as you age.  Part I of the Doctor Dilemma We Boomers Pass on to Our Children and Grandchildren addresses the state of medicine, doctor issues, and prevention.  Part II of the Doctor Dilemma We Boomers Pass on to Our Children and Grandchildren addresses treatment, insurance, and Medicare.

We love and have confidence in our doctors, more than other professionals, and they are changing!   Women make up the majority of students in medical schools. Here is a link to 2024-5 statistics about medical schools and enrollment from the AAMC (Association of American Medical Colleges).My daughters, please expect that your specialist in the future is more likely to be a woman!

BE YOUR OWN ADVOCATE AND CASE MANAGER OR HIRE ONE. I will begin this blog post where I left off the last: the lack of coordination of various specialists one Boomer has, the treatment by each, and the impact of that treatment on the overall health and welfare of the Boomer. Yes, I know that you, my daughters, are not Boomers, but when I was your age, I did not expect age would creep up on me as fast as it did.

As we age, we see more doctors in different medical specialties. In retirement, I try to keep one day each week set aside as my appointment day, near the beginning of the week as some doctors do not work certain days, so that is the day I must also be the scribe to summarize the appointments.  Also, it allows more organization in my life and activities, and you know I am organized.

Yes, as we get older, we see that many doctors in different medical specialties.  As I said in Part I, the roster is never ending: dermatologist, gastroenterologist, cardiologist, endocrinologist, rheumatologist, ENT, orthopedist, urologist, gynecologist, urogynocologist, retina specialist, ophthalmologist and one who specializes in cataracts, optometrist, podiatrist, acupuncturist, physical therapist, massage therapist, hand therapist, and a new one several of my retired friends have added, wound specialist.  Remember, at some point there is going to be a caregiver, and the caregiver must be part of the team. See,  “When Do Paid Caregivers Support the Health of Older Adults? Geriatrician Perspectives.”

One must be one’s own advocate, or may also become the caregiver whose job to be the advocate, or hire a health care advocate. It is useful and time saving to keep an updated medical file with each doctor and specialist, vaccinations, pharmacy information, medications (note start date, changes, side effects, drug interactions) section under each doctor (name, address, telephone, and fax number) with dates of appointments (summaries of concerns, diagnoses, and treatments), surgeries, and family history. This file is your medical bible and goes with you to each appointment, and can be kept digitally. I have all this information in one place accessible when I need it.  You can make notes on your IPhone confidential.  Check how.

Several specialists may order blood testing for selected treatments.  Several specialists may order other kinds of testing. Try to coordinate blood testing for several specialists together, to save your time and effort.  Have the specialist fax the results of all testing to each specialist and the internist/geriontologist.  That is why you definitely list the fax numbers as you may need to do the faxing. You are the coordinator to make sure that each specialist knows who the other specialists are and the testing they are ordering and the results.

DRUG INTERACTIONS. I have found that drug interactions, from medications, prescribed by different specialists, can cause serious issues and declining health, so pay attention to drug interactions as you get older and have various specialists prescribing medications. Make and keep a drug interaction chart in your medical file.  As each medication is prescribed, list the side effects.  You may find, for example, that several medications cause low blood pressure.  Once you see that, the combination must be addressed as the consequences may be dizziness and fatigue, that is not the cause of the conditions but the cause of the drug interactions. 

Please reread Part I regarding Prevention. And, of course, never let a medical issue fester. 

TWO WEEK RULE. This is the two week rule our family has followed: if you are still ill or in pain for two weeks, follow up medically, get necessary tests and treatment. If it is something serious, find an expert state and nationally or internationally recognized teaching hospital on the issue; consult about any serious condition (not just cancer, as she is so knowledgeable in so much medical) with our wonderful helpful cancer advocate Jaye Seidlin (telephone number 212-748-9053 jayeseidlin@gmail.com).  The rule added years to your Father’s life.

By the way, one of my favorite doctor specialists says her family added a week to the rule, and they have a three week rule.  Choose whichever you feel more comfortable with.

Until you are sixty-five, and qualify for Medicare, pay close attention to your insurance coverage.  More and more younger people are being diagnosed with cancer.  Young people can’t think this will happen to them.  Cancer in people fifty and under is becoming epidemic, according to Jaye. 

It’s vital when choosing a health plan, and reviewing the health plan you have annually, as rules change, that both the best cancer hospital in your state and nationally recognized cancer hospitals take your insurance, especially those that specialize in any cancer of any  members of your family who have had cancer. Each has a website with a phone number. Telephone and check what insurance they take; if yours is not included, you have an opportunity to change insurance to one they take.  I would do this proactively before you need to think about it so you have access to the best medical care if there is a cancer diagnosis.  It’s not much more costly to switch to a plan where the best state and nationally recognized cancer hospitals are covered.

CHERISH MEDICARE. I am leaving the most important tip for last. Cherish your Medicare. Do not get a Medicare advantage plan. Do not go to an HMO. Just when you need options the most, those plans limit access and put obstacles, like preauthorization in front of you. See the explanation of the differences in “The Effect of Extending the Window to Disenroll From Medicare Advantage Among Post-Acute Users.”

“Medicare beneficiaries must choose whether to receive their benefits under traditional Medicare (TM) or through a Medicare Advantage (MA) plan. The MA program has grown in popularity over time, with 51% of beneficiaries participating in MA private plans in 2023 (Ochieng et al., 2023). Beneficiaries enrolled in MA face trade-offs about how important services like post-acute care are covered. MA plans receive risk-adjusted capitated payment rates and have discretion to implement varied benefit designs, narrow networks, and utilization management tools to control costs. To ensure their care is covered, enrollees must remain in their plan’s network, potentially limiting their choice of post-acute provider. Plans also have financial incentives to steer patients toward lower acuity settings, limit their stay in a skilled nursing facility (SNF) (Gadbois et al., 2018), or refuse prior authorization for this care (Skopec et al., 2020). In exchange for these limitations, enrollees receive lower premiums, an out-of-pocket maximum, and supplemental benefits not included under TM coverage.”

SUPPLEMENTAL COVERAGE. Please do not scrimp on access to quality medical care of your choosing before you qualify for Medicare. Yes, when on Medicare, get a supplemental private plan to your Medicare. Please, under no circumstances, give up your rights that Medicare gives you to select your doctors, and allow your doctors to give you the care that you need without limitation, and provide access to the best hospitals.  Remember what happened to your grandfather, who was on an HMO, and could not access the care he needed.

Dear daughters, I hope you have learned at least one new thing from this blog post. I think it is unfortunate that I have to give you the heads up, especially because as you get older, you both shall be or are considering being in Florida for at least part of the year.  I cannot talk about the rest of the country, but somehow I do not think that the problems that we of the Boomer generation are struggling with, this doctor dilemma, are finding it only in Florida.  

Please keep researching on your own.  Please pay attention to the status of treatment, insurance, and Medicare.  Remember PubMed as an outstanding resource for medical studies and information.

Please pass this along to our other family members, and especially my beloved grandchildren. Pass this along to those you care about.

What is most important is that all of the above impacts our health as we age.  It is detrimental to my and Boomers’ goal, of staying forever young, as well as healthy with

Joy, 

Mema