Medicare will pay for whole $100,000 leg? Sign me up. Providence Advantage Plan pays for all but 20% of durable goods. And just got a letter Providence is no longer going to cover ANY out of network medical. I know your stance on the “skimmers”. Just considering my options. Who knows what the future will bring, as it stands I still have plenty of foot to stick in my mouth.
MS
No. I’m subject to the same 20% co-pay you are. But I bought a high deductible Plan G Medigap plan for $48/month when I turned age 65 that caps my annual Part A & B out-of-pocket at about $3,000 for 2025. The 23 days in the hospital put me over the $3,000 limit, but not by much. Now everything is covered 100% for the remainder of 2025. So I’m getting the $3,500 wheelchair and whatever the leg costs without a co-pay as long as it’s billed in 2025.
It’s also interesting that Medicare pays for the 3 to 5 year expense of maintaining the leg in an upfront lump sum which will be billed at the time of purchase (2025 hopefully). And prosthetic legs apparently have the maintenance requirements of an aircraft. I’ve been told that I should expect to be coming back about once a month for one adjustment or another. So Medicare might pay $100,000 for a $50,000 leg when you add in the maintenance contract. So I shouldn’t have any additional Robo-leg expenses during the service life of the leg.
As I noted over the years, someone in the Top 20% of the income/wealth pyramid should be able to easily fund the Medicare Part A & B copays without the involvement of an insurance company and the attendant 20% average “skim” on Medigap plans. I got the high deductibe Plan G Medigap because I was afraid the unlimited Part B co-pay might deter me from going to the ER if I had symptoms of a heart attack or stroke. I figured that if my out-of-pocket was capped at $3,000, I’d be more likely to just go to the ER, rather than doing a cost/benefit analysis with limited information – and the less than $600 in annual premiums only nets the insurance company about $120 in annual “skim”. i can live with that.
The standard plan G Medigap that covers everything 100% costs $264/month ($3168/yr) and nets the insurer over $600 in “skim”. No way I’m buying that since most years my annual Part B copays are only going to be a few hundred dollars.
WA State is probably the most consumer friendly insurance regulation in the country. If you hold a Medigap plan, there’s an annual, year round, open enrollment period where you can switch insurers at will. The minute United American is no longer the low cost Medigap insurer, I’ll switch to whoever is.
That’s not true in most states with a higher level of corruption.
intercst
The Physical Therapist already had me doing balance exercises about a month ago, which I’m continuing. I suspect that I’ll be using a Rollator to walk in the early months of using the artificial leg. I already bought one a few weeks ago and have been trying it out. (After the $3,500 wheelchair. Medicare likely wouldn’t fund the Rollator for me, so I bought one on TEMU for $92 – God knows what Medicare would have paid for one.) Note – my TEMU model is the exact duplicate of below. Go TEMU!
Anyway, I had my dog here last Wednesday for a visit and I decided I’d try the Rollator at the dog park. (The PT warned me that the Rollator isn’t designed for one-legged people. I should wait until I have the prosthetic before using it. But I’ve been using it to get around the condo complex for a few weeks without issue, so I thought I’d experiment with my 60 lb Boxer/Labrador mix-breed.)
When I was waiting about 10 feet to side of the entrance to the dog park to let a woman and her dog exit, my dog Bella moved towards the open gate, and jerked me off my center of balance and I fell over like a log onto the gravel surface along with the Rollator. I was uninjured save for a stubbed thumb which is now healed. But it was embarrassing to have about a half-dozen people rush to my aid and lift me to my feet. I’ll wait until I have the Robo-leg before the next dog park visit. {{ LOL }}
Note - wheelchairs don’t do well on gravel or grass surfaces, so I can’t use the wheelchair at the dog park – even a fancy $3,500 one.
intercst
Say, why not tie up Bella’s leg so she can be a 3-legged dog while you are a one-legged man? Then she won’t pull so much.
Just kidding! 
Wendy
AHA! You did get a Medigap plan after all! After all that poking fun at me for getting a Medigap plan because my grandmother told me to!
I don’t forget it when people insult my grandmother.
Wendy
But as I explained, I didn’t get the Medigap plan for the reason your grandmother recommended (i.e., people can’t afford the Part A & B copays) That was the important point. Lot’s of people are paying for 1st dollar Medigap plans they don’t need because they don’t understand what a fabulous deal traditional Medicare is.
intercst
No, my grandmother recommended Medigap to cover the potentially huge 20% that Medicare doesn’t cover. As you are seeing now.
Wendy
No. I’m not seeing it. I’m pretty sure you have a 1st dollar Medigap Plan rather than the high deductible plan, (or none at all) you’d have bought if you understood how Medicare billing works.
The only people who should buy a 1st dollar Medigap Plan are those with chronic illnesses generating a minimum annual Medicare Part B reimbursement of about $15,000/year. ($3,000 out of pocket). That’s a small percentage of retirees.
And as you learned from your own hospitalization, the fear of a large hospital bill under Medicare is completely unwarranted when a $1 million hospital bill is capped at $1,676 out-of-pocket for 2025.
intercst
Thank you. I am saving this thread.
Even with just 1 leg, you’re still kicking as$.
Good news and bad news.
Medicare approved the Robo-leg and Bladerunner Foot.
On Monday afternoon, I was taking my dog for a walk with the wheelchair and she managed to tip over the chair on it’s side – the right side where my stump is.
I remained in the chair, but I got a large bruise on my hip where it hit the armrest of the chair. I also cut the tip of my elbow, but I was wearing a nylon windbreaker so I didn’t get any road rash. The elbow was bleeding a bit, but I figured I’d attend to that when I got home (I was about a mile from home at this point.)
A young man who identified himself as a health care worker stopped his car and offered to help. He said we needed to call the paramedics. I said, "Absolutely not! I’m not paying a $2,000 ambulance bill if Medicare decides it’s not “medically necessary”.
Guy said, “Due to legal liability I can’t help you otherwise.”
I said, “That’s fine. I understand the issue. I’m able to right the wheelchair and get myself back into it on my own.” And then demonstrated the technique.
When I got home. I bandaged the elbow wound with some of the materials left over from the home care nurse who was taking care of the wounds on my stump in August and September. I checked it 2 hours later and it was still bleeding and I said “Oh crap, I think I’m going to have to go to the ER to get stitches to close the wound. Good thing I’ve already satisfied my Medigap deductible and it’s 100% covered.”
One of my neighbors offered to drive me to the ER (2 miles away, 10 minute drive.) I didn’t bother to take the wheelchair and just used the foldable aluminum walker. She dropped me off and I told her I’d take a taxi home.
Made my way through security and the check-in area and took a seat in the waiting room. About 20 minutes later an orderly opened the door to the exam area and called my name. I got up and grabbed the walker and started making my way towards her. She then got a look of panic and grabbed this bariatric transport chair and pushed it towards me. “You got to sit in this.” I said “OK”, but I don’t want to lose the walker. I need that to get home."
Then she said, "Would you mind if I asked you a question? How are you able to get around with one leg in an aluminum walker. I said, “i don’t know. In rehab they told me the walker was the one-legged device and to not use the crutches.” She said, “That’s rad”.
The nurse and physician assistant doing the triage said that the elbow wound was just a “skin tear” and they had a bandage that could take care of it, (Not true, it required 16 stitches to close) but they were more worried about the big bruise on my hip. They said at a minimum I needed an x-ray of the hip. I said OK.
X-ray showed no hip fracture, but while I sat for a couple of hours in the waiting room I noticed that the hip contusion was getting larger and I was starting to feel a little dizzy. (Though I hadn’t eaten in 12 hours and probably wasn’t drinking my standard water ration. It’s possible I was just hungry and dehydrated.)
I reported the symptoms to the nurse, and she said they’d likely need to check me for internal bleeding.
The first set of blood work was inconclusive and they said they wanted to repeat it in 2 hours. Second set of labs was worse and they ordered a CT scan to check for bleeding. The radiologist’s report didn’t arrive until about 6AM the next morning, but at least I got some sleep in the exam room while I was waiting.
CT scan showed no bleeding. Doctor said that they’d like to admit me “for observation” and I declined. Then she asked me to walk 100 feet in the walker to prove I was OK. Which I did and she said she said, "OK, but if you get light-headed at home, come back here immediately.’
A while later the nurse comes in and says we’re ready to discharge you and we have Medical Transport ready to take you home. I said, “What about my elbow? Aren’t you guys supposed to put some kind of magic bandage on that?”
They just had shift change, so the new nurse unwrapped the elbow and looked at it. “That’s a pretty deep laceration. I think it needs more than a bandage. Let me get your doctor back in here, I don’t think she’s left yet.”
Doctor apologized and said she shouldn’t have just accepted the triage diagnosis of a “skin tear” and examined the elbow herself. She then spent the next 40 minutes doing an especially careful job of stitching it up. Since this was after shift change, I hope she got overtime.
Other than the night sleeping in the ER, no real damage was done. The Medical Transport people were aghast at me going up the stairs on one leg, but I assured them that Physical Therapy had signed-off on my technique.
Only downside is that I’ll have to delay my next prosthetic visit by 2 weeks to let the swelling in my hip subside. Took the dog for a walk with the wheelchair this afternoon. It was uneventful.
intercst
Um, I think your dog may have it out for you, please be careful.
Glad to hear you continue to keep on L I V I N’!
I visited my Prosthetist yesterday for the 3rd fitting of the trial socket that will be attached to my stump to hold the artificial leg. Regrettably, this process has been delayed by 4-6 weeks due to the wheelchair mishap I had in October when my dog tipped over my wheelchair. The swelling at my hip resulted in the need to start fresh with a new mold. They still think they can deliver the leg before year end.
Anyway the prosthetist said that Medicare had asked for “a more fulsome rational” to support my need for a $90,000, high end prosthetic. He would need to write up an addendum to the initial application.
Given my talents as a legendary memo writer during my working years, I offered to give him a few paragraphs of prose describing my situation pre and post amputation. He said he’d never had a patient write up a Medicare claim before, but he was happy to get the help.
I got an email from him this morning saying that the write up was fantastic and he was sure that it would greatly bolster my case.
The trick is to document the high level of physical activity that you enjoyed prior to amputation, while still showing that you’ve maintained that level of fitness despite the 4 or 5 months of inactivity due to being in a wheelchair. Medicare is obviously hesitant to approve an expensive leg unless the patient is showing a high propensity to actually make use of it.
I came across a frightening statistic during my research on this.
The average Medicare beneficiary has a 4% chance of falling in a given month. For Medicare beneficiaries with artificial lower limbs, that fall risk increases to 65%.
Maybe Medicare should be encouraging amputees to remain in their wheelchairs? {{ LOL }}
Note: NMPK is non-microprocessor controlled. A simple hydraulic knee that can buckle if you don’t keep your center of mass within a tight range above the knee.
intercst
intercst, Thanks for the very very informative expositions on medicare and your leg and life. Please keep the updates coming as I am learning a lot that, if not useful to me, will almost certainly be useful to many of my aging very active friends.
And also!, your saga revivifies my own determination to battle both honorably and usefully against weakening into a pile of mush.
@intercst I’m glad you wrote this because I was going to touch base with you this morning.
What activities are you doing to maintain your fitness?
Wendy
Just my normal activities of daily living require a significant amount of exercise. I’m going up and down the 15 steps to my second floor condo 4 or 5 times a day walking my dog, going to the mailbox, and other errands. The Physical Therapist suggested that I remove the footrests from my wheelchair and use my good leg to propel the chair forward and keep it in good shape. I’m doing 2-3 miles per day in the wheelchair. (They also warned me to limit the amount of time I spend pushing the wheelchair with my arms and shoulders lest I get hunched over. Apparently the human body was not designed to push a wheelchair over the kinds of distances I typically traversed when upright.)
I’m also doing some stretching exercises to keep my stump muscles flexible and strong which will be required to control the prosthetic. The only problem I have is that I discontinued those exercises for about 3 weeks after the wheelchair mishap and hip contusion and lost my ability to flex my stump backward at an angle of 15 to 20 degrees, which is what’s required to walk properly. I restarted the stump exercises about 10 days ago and hope to be back to that 15 to 20 degree rearward flex by my next visit with the Prosthetist on Dec 16th.
During Monday’s visit, the Prosthetist hung a hydraulic knee and foot from the socket and had me walk on it for about 100 feet. I had trouble drawing the leg rearward to unlock the knee so that the lower leg kicks forward during a normal walking stride, but I was able to put my full body weight on the prosthetic without pain and having the second leg improved my balance. So those are both good signs.
The Prosthetist said that he could adjust the alignment of the leg to give me the ability to unlock the knee joint without the required 15 -20 degree rearward flex, but if I keep doing the exercises I’ll likely solve the problem on my own by the next visit.
intercst
I’m an old-timer to TMF (1997 or so as I recall), but new to the METAR board. I’ve noticed a lot of the names here are people I’ve missed since the board conversion, so I’ve stuck around trying to stay as up-to-date as I can given the tremendous volume of posting… 
Regardless, I just read through this thread, and the information you (John) have provided throughout could prove useful to anyone facing a major medical situation with Medicare coverage, so thanks for that.
Personal question - I missed what caused you to need an amputation in the first place. Sorry to hear about that, but would you care to share?
I apparently had a 20-25 year old calcified aneurysm in the popliteal artery of my right leg. My right leg has been problematic over the previous 25 years, but they attributed the swelling in my leg to the varicose veins I had in my right calf. They’ve done all kinds of tests on the leg over the years to diagnose the problem, just not a CT scan which was what’s required to see the aneurysm.
Here’s the thread where I describe what happened. I’ve had a medical expert review my chart and they tell me I have a $2-3 MM medical negligence lawsuit if I choose to pursue it. A 3 cm aneurysm is a near emergency and I should have been booked for an open leg bypass operation within a day or two of the initial consult with the vascular specialist. That they screwed around doing angiograms and a balloon angioplasty for 10 weeks was a “comedy of errors” that may have cost me the leg.
intercst
Cosigned. My “workouts” had been sort of vaguely doing something active. This board and these threads have inspired me to keep a training log with measurable goals of functional strength and mobility.
10 years ago, I used to see ads, and the air conditioned trailers, for a ‘life screen scan’ thing, where a Semi-trailer set up in a mall parking lot, would offer ‘scans’ of one’s body. Just show up, pay the fee (IIRC 200-500?).
It was a ‘pop up’ business. There for a couple weeks, then move on to the next parking lot.
These offers were roundly lampooned by TPTB. I’ve not seen one in a couple years, so TPTB might have succeeded in abolishing them?
Cardiac Artery Calcium scans, and Carotid Artery Calcium scans are now somewhat routine? But, you gotta have a Dr, and officially recognized facilities, in order to get such.
AI and advances in tech suggest (at least to me) that there’s a business opportunity.
Would access to ‘whole body’ CAT, just benchmarking the current situation, be useful in catching some ‘issues’ before they become ‘more expensive’?
I’ve heard many times over the years, about medical tourism, in which people go to some country (Mx, Thailand, Panama, etc) and get ‘work done’ that in the US would be prohibited by TPTB.
ralph