Autumn in da’ Ville

They’re here.  The days when your breath floats on the air and the fading afternoon light glows gold.

Louisville-Autumn-950-5

This year isn’t as dramatically gorgeous as past; possibly it was too wet this summer? Most leaves are yellowing and falling, but the air is as crisp as high meadow and the rain raw with foreboding.

I’m acting like a squirrel acquiring stores. Yep, buying flannel pajamas, snuggly slippers, and snow boots. When I moved to San Miguel de Allende a year and a half ago I let most of my winter clothes go.  I came to regret it when San Miguel’s winter dropped down. Loo’vulle’s winter will not find me unprepared.

I like this time of year.  Far from feeling autumnal, Fall makes me feel bountiful. It summons the holidays, makes memories around a fire, transforms the earth in her cycles from summer matron to slender, wintry hunter.  I want to eat anything with pumpkin, ginger or nutmeg! So, tomorrow I’m making these soft Pumpkin Gingersnap cookies with – yum – unsulphered blackstrap molasses. Whee Ha!

pumpkin-gingersnaps1

Last week I revisited the senior low-income apartment on Richmond Drive to measure the rooms.

CIMG2337

Because the carpet installers came at the last minute I was foiled, but I can tell you, sans furniture those rooms look small. This will give me an opportunity to experiment with tiny dwellings. I won’t have a pink couch, but I like the idea of these shelves.

modern small aparment

While the name of the senior low-income apartment building is Highland Court Apartments, Peggy has taken to calling it “Happy Acres.” I am sure this is her image of living there; in fact, the manager in charge looks eerily like the standing woman in this Internet grab photo:

happy acres retirement homeMe, I just see the peonies and hope Highland Court will give them out to all us low income seniors come spring.

My time now is spent in spray painting old lamps and hopefully soon refurbishing an entertainment center into a contained office/t.v. space. Oh. And investigating Medicare Supplement Plans.

There are 22 Medicare Supplement plans in Kentucky. Each one must be explored singly and applied to individually. It’s a friggin’ full time job.

tearing-your-hair-out

So, I went with an anonymous agent from the anonymous Internet site EHealth.com and provided ALL of my personal information to get an app into Mutual of Omaha – at $120.00 a month the most reputable at the least expense. I found out that if you choose a supplement plan when you turn 65 and first get Medicare you can get a policy without being medically underwritten.  After that the jig is up and, trust me, companies are looking for any reason to turn you down. I should know if Mutual wants my money within the next day.

Arggggggggggg,

The nuts, the bolts, and the screws

social-security-checkNo one ever wants to talk about money, one of those curious taboos in America we tip-toe around. But if you’re following my Adventures in Social Services we need to be clear.

It turns out that the average Boomer’s social security check is around $1200 a month [and I am nothing if not average.] With no other income, 48% of the boomer demographic are 100% reliant on their social security.

So I looked into what the government calls the “Medicare Savings Program.” There are ceilings under which some retirees can have their $104.00 Part B premium, all co-pays, and all prescriptions paid for. At $1,216.90 per month (deduct the $104.00 monthly premium from that), I don’t qualify at the $937.00 per month cut-off for that program. But I do qualify to become what’s called a Ql-1 SM-1 Premium Buy-In Only, which means that as long as the sequester/debt ceiling doesn’t queer the deal, I can have my Part B premium paid for. As far as co-pays and prescriptions, I’m on my own.

Before you become dizzy with joy at the thought of the extra $104.00 a month I’ll have to travel the continents, let’s look at Medigap policies. These are licensed by the state, so every state is different, and there is no guarantee that anyone can buy one, at any price.  [Well, there’s guaranteed issue in New York, Connecticut and Massachusetts, but all the other states underwrite based on your pre-existing condition(s).]

Why seek a Medigap policy, known widely as Medicare Supplemental Plan F?

Medicare pays 80%. You pay the remaining 20%, a yawning chasm if you're hospitalized, eh?

Medicare pays 80%. You pay the remaining 20%, a yawning chasm if you’re hospitalized, eh?

It’s a no-brainer, but as of today – in Kentucky – you can’t know (a) if you’ll be accepted or (b) what it will cost, because it’s NOT OPEN ENROLLMENT, stupid.

Come October 15 we can begin to shop. I figure I ‘might’ be able to obtain a gap policy at $131.00. Deduct the $104.00 currently paid and I’ll only be an additional $27.00 a month out of pocket.

But no one can escape the do-nut hole.

evil do-nutWell, they can if they draw less than $937 social security a month.  For the rest of us lucky pensioners, even with a Medicare Supplemental Plan F, we’ll need to purchase a Plan D for prescriptions.

Ha, ha, ha!

While the Affordable Care Act has tinkered with the percentage of payments for prescriptions in the do-nut hole, climaxing in a projected year 2020 low, low twenty-five percent (wait, there’s more!), I just saw a hepatologist who recommended a treatment consisting of three drugs over the course of 12 weeks, one of which costs $4,000.00 a pop. I didn’t ask what the other two cost.

But o.k., let’s ration treatment and go for status as a Ql-1 SM-1 Premium Buy-In Only person. For this I have to have a caseworker who must have many documents to prove I am not cheating. Honestly, I have one of the nicest ladies I’ve ever met.

You know the movie.

You know this movie.

O.K., she’s a little scattered, but who wouldn’t be with the mass of poor, disabled, and/or old huddled at her door? If YOU ever have to manuever this system I advise that you do not mail or fax anything. Like me, be prepared to go in person, wait your mandatory 90 minutes or more until she/he is free, and hand-deliver the information. I suggest casual chit-chat until you see the person actually type in the desired data. After that, you’ve done your best.

Now for the bright side! Under my chosen method of Positive Poverty I qualify for $16.00 a month in food stamps! But wait, there’s more. I also qualify for elderly, low-income housing in which one’s rent can be no more than one-third of one’s income.  And for Section 8, though the waiting lists are so long I probably won’t live to see it. AND, much to my surprise, a free, life-line cell phone which a worker signed me up for yesterday.

Applying for housing is a separate process though, so I’m just beginning that. OF COURSE there’s no one-stop integrated social service.

Ya big silly.

Well, I’m off to hand deliver another piece of information to my caseworker.

I leave you with a photo of the August 1971 Womens March on Fifth Avenue for which I was an organizer and, at one point, exhorted the masses from the kick-off stage mic to knock over the wooden barricades halving the street and FILL Fifth Avenue with our demands.

Those demands included universal, single-payer healthcare paid for by taxes exactly as we pay for police, roads, the fire department and other Public Goods. A system in which there would be no Medicare Plans A,B,C,D,E,F, J or Affordable Care Act bronzes, golds, or platinums, or a myriad of Explainers to assist navigation through what is, in my opinion, a deliberately confusing system broken at nearly every level. And that’s if you’re not sick.

My, we were optimistic.

August 1971 march

 

 

 

 

 

 

 

 

Get on the bus

sweat on a stickThis pic isn’t Louisville, where the fair ended Sunday, but it’s a good ’nuff stand-in. On reflection, don’t you think it may be several decades old? It’s certainly no longer rare to have a stretch of mid-90s in late August almost anywhere in the U.S., so while the Dog Days of Summer used to be between July through mid-August, because they were tied to the appearance of the Dog Star Sirius, now everything is up for grabs. Today’s dew point in da’ Ville is destined for 62. Yes, just like San Miguel, I carry my parasol and a fan.

Unlike my previous whining self in Louisville though, this time I’m not crumbling under the heat. San Miguel’s sun hardened me.  You wanna feel hot?

Puleeze, people, this is just sultry.

stethoscope

It’s doctor week!

I now have a General Practitioner who promptly scheduled me to see four Specialists in, you guessed it, four widely separate locations. Oh, did I mention that Louisville is a car culture?

I investigated getting financed for a 50cc motor scooter, but my credit score is too low. Sigh. For the moment, as I scheme…

So, the city has a mediocre public transit system but at least the buses are air conditioned. I already have my elderly person’s card so I can ride at .80 cents, rather than the usual $1.75.

tarc busIf you aren’t old, disabled, or a student you have to pay the $1.75 which buys you a transfer good for four hours. If you don’t have exact change you’ll have to put two dollar bills into the machine. The city doesn’t give you your quarter back. I think we should give da’Ville props for robbing the citizenry outright rather than pussy-footing around, eh?

By luck of the draw my first specialist is a Dermatologist on Wednesday. I expect to be cauterized, frozen and/or perhaps sliced at some point,so I plan to take a valium an hour prior to the visit. The best thing is that I’ll be able to understand the doctor.

Friday it’s a Urologist.

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But how boring, eh? Perhaps more exciting is the fact that I now have a social services caseworker. Although I worked with a lot of clients who had caseworkers, I’ve never had one of my own and I’m curious to see the system from a personal perspective. After my induction interview by a tired, pleasant and overwhelmed woman at Kentucky’s Center for Family & Children, I’ve learned that I qualify for $16.00 a month in food stamps. THAT my friends is what growing old enough and broke enough will getcha if you play your cards right, and I must say it’s a welcome addition to the budget.

You may think this is small potatoes, but ta da!

Medicare Part B

I also qualify to get that $104.90 Medicare Part B premium paid by the feds. My social security is just * * much under the cut-off point of $1257. Whee! That’s $120.90 additional income which I think we can all agree won’t cover the cost of a Medigap policy, but could potentially chew it on the chin.

Today I have to catch the bus to the library so I can print off the proof that I have no hidden assets in the Caymans.

I AM the 99%!

bus stop

 

 

 

 

 

 

 

 

 

 

Healthcare for American expats in San Miguel de Allende

Can you live in San Miguel de Allende on $1200 USD a month?  Yes, if you’re 40 and frugal.  Probably not if your in your mid-60’s with chronic conditions that require specialists, or those ever-so-expensive “watch and wait” tests.

$1200 USD per month was the income requirement when I moved to San Miguel last June.  Let’s say you have that, but like me, precious little savings behind you.  [Mexico just changed its income requirement to $1900 a month.  After you read this, you’ll understand why that is a more realistic figure.]

Seguro PopularTo its credit, Mexico has a form of universal healthcare and expat residents can join. English speakers don’t really know what it covers since the booklet is published in Spanish and we’re not learning Spanish that fast, but the best that I can make out is that it’s geared towards infant & maternal health along with chronic conditions like diabetes and asthma.  As well it should be.

So what do most older American expats living here do when Seguro Popular isn’t enough?

premier bus MexicoFor anything complicated they either self-pay specialists, most of whom are in Celaya or Queretaro (not in San Miguel de Allende), or they bus or fly to the U.S. so they can use their Medicare.

But, those costs aren’t really in your $1200 a month budget, are they?

budget busterIt’s not to say that inexpensive healthcare isn’t readily available in San Miguel de Allende.  It is, for simple things like a bout of bronchitis, a round of [gasp!] amoebas, or a urinary tract infection. If what you need is antibiotics, you can see a doctor for less than $2.50 US.  You self-pay your prescription – probably around $25.00 US – and you’re on your way.  A specialist in any of the routine scenarios might cost you $30.00.  Waaay less expensive than seeing a doctor for routine care in the U.S.

And you’re good for an accident in Mexico too.  That’s where Seguro Popular comes in. Break your ankle and you’ll be treated. There will be some cost, but your budget will heal.

accident budget busterSo, what’s not to like?  You can self-pay for routine care, and you’re fairly well set for an accident.

healthcare spending by age

I don’t care whose chart you look at, unless you won genetic roulette, your healthcare costs are only going up and your ‘conditions’ are only going to get more complicated. While the trend in the U.S. is definitely to extort more and more money from everybody, your Medicare still pays 80%. But if you don’t have the means to return to the U.S. and use it, what good is it?

In Mexico, your self-pay portion is going to go up.  This nation doesn’t yet have the resources to provide quality care for its own citizens, much less a Grey Wave from NOB.  You want quality? It’s here, but you’re going to have to pay for it.

And that is why Mexico’s new immigration requirements of $1900 USD a month is a realistic figure.  With that amount of money you can afford to buy an expat insurance policy that will have you seeing world-class specialists in Mexico City.

[I’ve been advised that an excellent policy can be had in San Miguel de Allende for $325.00 a month, with a one-time deductible of $2,500.00 – not a yearly deductible like in the States.  No cancellation if you become horribly ill. This policy is beyond my reach, but might suit some readers.]

Factor in your travel costs and you’ve have $1500.00 to live on.  In San Miguel de Allende, it will be a frugal lifestyle, but that’s simply because San Miguel is the most expensive place to live in Mexico.]

I have no doubt that Americans with financial means have Zero interest in this blog.  What I’m trying to do is give readers who don’t have those resources a heads up while they ponder ‘the simple life’ south of the border.  While it is true that the 20% that Medicare doesn’t pay can (and for many of us probably will) drive us to bankruptcy, it’s also true that for many serious conditions you won’t be treated in Mexico unless you can first pay out of your own pocket.

“First” is the key word here. There’s no billing in Mexico.

“Old age is no place for sissies.”, attributed to Bette Davis.

“I don’t write ’em, I just report ’em.” jaxinmexico