Tuesday, November 22, 2011

Managing the Medicare Maze (Part I)

From the moment Jim knew the date of his retirement, we began planning every step we had to take to transition from middle-age employment to full senior status. We knew the most important part of that process would be setting up full Medicare coverage to replace his employee insurance, which would end on the day he retired.

Over the years, we’ve kept up on Medicare issues, so we knew the basic steps we had to take to set things up. We hoped things would go smoothly, but we aren’t naive. We knew dealing with any organization takes time, effort, patience, and persistence, yet even we were surprised at all the hoops we had to jump through in order to get the job done.

We learned a lot along the way, and I’m going to share those things here. But as I relate the story, I must emphasize two points:

  • While our experience is individual, I doubt it’s unique. Not everyone will face the same issues, but it’s possible that my sharing these points could help people who do.
  • Some people will point to our experience as evidence that government-controlled health care is broken. On the contrary, Medicare works very well. Most of these problems were with for-profit insurance companies and the requirements that lobbyists and their Congressional lackeys insist on perpetuating as part of the American health care system.


First, here are some basic facts for Medicare newbies:

Medicare is the federal medical insurance program; Medicaid is the program managed by states for people with limited income and assets who don’t have employee insurance. Jim and I are fortunate enough to be concerned only with Medicare, not Medicaid, at least for now.

Medicare has several parts to it:

  • Part A: Hospital insurance;
  • Part B: Medical (outpatient) insurance;
  • Part C: Advantage (comprehensive) plans;
  • Part D: Prescription Drug plans.

Not included in the official Medicare list but an absolute necessity if we don’t have an Advantage plan is a Medicare Supplemental policy. For some people, Advantage plans work just fine, but most of those plans involve networks. That means you pay the least if you stay with providers in their network. But if you want to see a doctor or go to a clinic or hospital that’s not in their network, you could end up paying a lot more money than if you stuck with Parts A and B and a Supplemental plan.

Because Jim and I both have multiple health issues and we live in a county that’s considered rural, even though both neighboring counties include the two largest metropolitan areas of the state, we were pretty sure if we tried to deal with an Advantage network, we’d have to give up some of the doctors we’ve grown to trust over the last several years.

Turns out the truth is even worse than our suspicions: Even though the regional medical center a mile and a half from our house has recently been credited as one of the best in the state, it’s not in the network of the biggest Advantage plan serving Arizona residents. On the other hand, if we did stay in network to save possibly hundreds or more dollars with a hospital stay, we’d have to travel at least 50 miles one way to reach the nearest in-network hospital. In our conditions and at our ages, that’s not an option. So, we might have to pay a little more month-to-month, but at least we know we can get great care with providers we know and trust for little to nothing right here in our own area.

There are several groups of people who qualify for Medicare. Our eligibility began when we turned 65. We followed Step 1 of good Medicare planning by calling a couple of months before our 65th birthdays to set things up so coverage would begin in the months we turned 65.

Since Jim was still working and his employee insurance covered prescription drugs, we didn’t need Part D, so we opted out of that at first. But we were automatically charged for Part B for several months until we learned we didn’t need it while he had comparable employee insurance. That’s when we canceled Part B and saved a bunch of money. Then a couple of months before his retirement date, we went to the local Social Security office to renew Part B, beginning on the day his retirement was set to begin.

Now that I’ve introduced the basics of Medicare, in the Part II of this series, I’ll tell you about some of the bumps we encountered in our journey to set things up so that we should be prepared for any medical possibility--Good Lord willin’ and the crick don’t rise, as they say down south.

Managing the Medicare Maze (Part II)
Managing the Medicare Maze (Part III)
Managing the Medicare Maze (Part IV)

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