Wednesday, November 30, 2011

Managing the Medicare Maze (Part III)

In the first two parts of this series, I discussed the basics of Medicare plans and the one issue that arose within the Medicare system because of a communication snag. But these only involved the plans covering hospital and doctor services, not prescription drugs. That’s the Part D piece of the puzzle.


Now that we’re well into our senior years Jim and I are both dealing with complicated medical issues. Jim first began to face reality--or, to be more precise, his mortality--when he was diagnosed with diabetes in the early 1990s, but I’ve had to deal with various health problems my entire life.

Since I haven’t had a support system during most of that time, I’ve had to become the expert in my own medical case. That’s why I’m much better educated than most people about the pros and cons of treating every little thing with pills, as too many people are wont to do. And that’s why I’ve developed the philosophy that when it comes to medications, less really can be more. Over the years, that approach has saved me a lot of pain and tons of money that I could have wasted on useless, and often dangerous, drugs.

Another factor we have to deal with now is the way medical insurance is managed for retired people. While Jim was working, his employee insurance covered both of us under his identification data. Now we’re treated as individuals, so our policies and ID numbers are generally different. The only thing that’s the same is when we use our AARP (aka, Geezers United!) membership--which considers Jim the primary member and includes me as his spouse--for our Medicare supplemental insurance policies

On the other hand, our Part D choices are much more complicated than they are for supplemental insurance, especially because we each have different needs. Up to this point, we were well prepared for the steps we had to take:

  • First, we had to decide whether to get an Advantage plan or go with the multi-part package that includes Medicare Parts A and B and a supplemental policy.
  • Having decided against Advantage, for reasons I explained in Part I of this series, we chose an insurance company we’d had positive experiences with during the years we were covered by various employee policies.
  • When we called that company to set things up, they asked us for enough details about our medical conditions so they could help us choose which type of supplemental plan we each needed.

From this point, our choices became much more complicated, but I’ll get into more detail about the downside of that in the next, and last, part of this series when I wrap up my opinions on the overall situation. For now, I’ll just say that because of our different conditions and needs, we had to find separate providers for our Part D policies.

Though we aren’t thrilled with that fact, we have discovered some good things about choosing and setting up our Part D policies:

  • We each had a wide range of choices about what companies we could get the prescription drug service from.
  • The most positive aspect of this part of the experience is that Medicare’s website features a fantastic chart to help us compare all the choices available to each of us. It took me several turns at the pages in this section over a couple of weeks, as well as a desperate call to Medicare for help at one point, before I got everything straight for each of us. But without that chart, we’d still be fumbling around, trying to get all that information together in a coherent and understandable form.
  • If we waited too long after his old insurance was terminated, we’d have to pay a monthly penalty over our regular monthly premiums. Fortunately, the maximum waiting period is 62 days, and with the helpful tools available from Medicare, we were able to make our choices and get things all set up for both of us well within that period of time.

One more good thing was that, except for one of my prescriptions, we happened to have a good supply of all our medications on hand to carry us through that waiting period, so the delay didn’t do us any harm, medically speaking. Since my missing prescription is a generic drug, I was able to buy it at a local pharmacy for a reasonable price for a couple of months until my Part D service kicked in.

So, now that our Part D policies are in place, we have only another 24 hours to wait, as I finish writing this article, to begin taking advantage of the Part D prescription service. Of course, things could be better, but at least we do have this. Just a few years ago, Medicare patients had no help at all with their drug costs. Yes, things have moved forward, but certainly not far enough ahead. Come back here in a few more days and you’ll be able to read a lot more about that in the final article in this series!

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

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