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This article was first posted January 1, 2026. Big news for 2025 is that I had my right leg amputated above the knee in July after a failed popliteal artery bypass surgery. Apparently, I had a "decades old calcified aneurysm" in the leg that had finally pinch closed the artery. Spent 23 days in the hospital, the last 14 in an in-patient "fast rehab" program that would prepare me for life on one leg. Despite the rehab director's strong misgivings, I returned home to my 2nd floor condo with a 15-step flight of stairs. Managed to negotiate that on one leg, as well as drive my Tesla with my left foot. I didn't lose much in terms of mobility although it does take me a lot longer to do things from a wheelchair. Hospital sent a physical therapist twice a week for a couple of months. Said that he'd "never seen an above knee amputee go up and down a flight of stairs during the first home care visit." I was off to a good start. Medicare provided me with a microprocessor-controlled prosthetic leg that was delivered just after Christmas. I'm expected to resume my previous level of activity (walking 5 to 10 miles per day, up and down hills), though it may take 6 to 12 months for me to fully restore my sense of balance and walk "naturally" with the new leg. In the interim, I should be able to get all the exercise I like on a treadmill in my living room where I can use the handrails to maintain my balance. Oddly my 30+ year long career as a very early retiree seems to have prepared me for the challenge and left me in good humor. And also, I'd like to praise traditional Medicare for it's problem-free performance during this unexpected medical disaster. I never had any care delayed due to any of the "prior authorization" nonsense that comes with a Medicare Advantage plan. And also, Medicare approved what the doctor and prosthetist ordered (in this case an $89,000 microprocessor-controlled device that will reduce my fall risk and subseqent cost of emergency care.) Medicare Advantage operators often call these advanced prosthetic devices "experimental" and deny coverage. My Medigap high-deductible Plan G (with a premium of $48/month) flawlessly picked up my Medicare co-pays once I exceeded the roughly $3,000 annual deductible. Thus, about $400,000 in billings at the standard rate, and a Medicare reimbursement of around $150,000 for 2025, netted out to about $3,000 out-of-pocket for the year. Of course, not everyone is so lucky. The Government Accountability Office (GAO) says that only 30% of Medicare beneficiaries with a limb loss received a prosthetic device in 2016. And some need to take out loans to cover the 20% Part B copay (e.g., there was a $12,000 co-pay on the $60,000 Medicare reimbursement for my device.) Under current law, it's even possible for a lender to repossess a prosthetic device just like an automobile.  Consider your Medicare choices carefully. Happy New Year. Resources for additional information.Medicare website 2022 Trustees Report on Medicare Vox News: The subtle privatization of Medicare KFF: Health Insurers Limit Coverage of Prosthetic Limbs, Questioning Their Medical Necessity GAO HighlightsL LIMB LOSS Rehabilitation Services and Outcomes for Medicare
Beneficiaries Physicians for a National Health Program: Our Payments, Their Profits Senators press Medicare Advantage insurers over claims denials Another week, more Medicare dis-Advantages New Reporting on Insurance Claim Denials Highlights 'Scam' of For-Profit Healthcare I Set Out to Create a Simple Map for How to Appeal Your Insurance Denial. Instead, I Found a Mind-Boggling Labyrinth. Manchin Leads 63 Bipartisan Senators In Urging Support For Medicare Advantage Program Medicare Advantage spending, medical loss ratios, and related businesses ; An initial investigation A Medicare broker can help find the best coverage for you. Here’s what to know before you hire one Scripps Medicare Advantage cuts also kill out-of-network access Hospitals are dropping Medicare Advantage left and right True Cost of Health Care, by David Belk MD Medicare Advantage Wikipedia Profits, medical loss ratios, and the ownership structure of Medicare Advantage plans October – December 2020 Approved Medicare Supplement (Medigap) plan premiums (WA state) National Association of Insurance Commissioners -- 2018 Medicare Supplement Loss Ratios Comparing Medicare Supplement (Medigap) and Medicare Advantage plans State Averages for the 2020 Medicare Advantage Monthly Capitation Payments Medicare Advantage Plans Overbill Taxpayers By Billions Annually, Records Show Proportion of branded versus generic drug prescriptions dispensed in the United States from 2005 to 2019 |
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