Sunday, December 11, 2011

Managing the Medicare Maze (Part IV)

Now that I’ve detailed our experiences arranging the various pieces of our retirement insurance coverage, it’s time for me to wrap up this series with a few comments about the situation.


On the positive side is the fact that Medicare exists at all. Too many conservative politicians want to abolish it completely so they can toss senior citizens and people with disabilities back into that shark tank infested with insurance companies that care more about amassing profits than providing access to affordable medical care. Details in this article apply to the current situation, not the right-wing “wet dream” that, should it ever come true, would be a hideous nightmare for the neediest people in the country.

Currently, Medicare Part A, which covers a large percentage of the cost of hospital care, is available at no charge to qualified U.S. residents when they turn 65 and younger people who’ve received Social Security Disability insurance for two years. The program is supported by payroll taxes from people who are currently employed. A qualified person just has to notify Social Security within two months of the date eligibility begins. Part B covers a percentage of doctors’ visits and outpatient tests and treatments, but the insured person must pay a premium for this part of the coverage.

Many people purchase a Supplemental policy to cover medical costs not paid by Parts A and B, or an Advantage plan, or Part C, which is a comprehensive package that covers Parts A and B as well as co-pays. Most Advantage plans also include drug coverage, which is called Part D when purchased separately with Parts A and B.

Part D is the newest piece of the puzzle and it has numerous flaws, especially the cost to people who need the more expensive drugs. Many of these costs will go down as the government plan, commonly called “Obamacare” by critics, comes into effect in stages over the next few years. That fact should be viewed as an argument to support the new health care law. But to conservatives, whose empty claims to compassion disappeared as soon as they took power in 2001, it’s a reason to attack the program.

One way to lower drug costs even more is to use mail order to purchase drugs taken regularly over an extended period of time. In spite of the fact that many drug providers have featured this service for many years, some people are still reluctant to depend on mail for their medications.

Having used mail order through several different insurers over the last couple of decades, I can say that overall, the service is no better or worse than using a local pharmacy. It’s up to the consumer--that’s you and me--to keep good records and alert the provider when there is a problem. Some companies are harder to deal with than others, but that can also be true with many local stores.

One last positive thing I can say about dealing with Medicare is the fact that the website is extremely helpful and the customer service staff are both friendly and supportive. There are some excellent online charts to help users choose Supplemental and Part D plans, but it did take me several tries over a few days to figure everything out. I finally called and a really nice lady patiently talked me through the necessary steps. Besides that, I signed up for regular email updates from Medicare.


As useful as Medicare, with all its parts, is proving to us, especially with our complicated medical issues, we still don’t like the way it’s designed. First, it took a lot of work, especially on my part since I’m the family “office manager,” to research and set up all the pieces of the puzzle. That’s a lot of time and energy that I could have focused toward other pursuits. In addition, this task is generally being performed by people in physically and/or mentally weakened conditions, so it takes more energy from us than it would from young healthy people who are generally more tech savvy.

In addition, there is the fact that plans differ according to services offered by different providers. We had to choose from a range of Supplemental plans and drug providers based on our current medical needs. Since Jim and I both have complicated medical conditions, albeit somewhat different from each other, we ended up with the same Supplemental plan through the same insurance company. But because we each take a completely different number and range of medications, we each had to sign with a different Part D provider.

The problem with this is we’re stuck with these plans for a full year, until the end of 2012. If either of our medical situations changes and our current plans don’t fit our needs, that’s just tough cookies. We can’t make changes until the next annual enrollment period, which begins on October 15 and ends on December 7, and those changes won’t go into effect until January 1, 2013.

There is a provision for people with certain qualifications to switch to certain Advantage plans, and another situation in which a person must be disenrolled from their previous plan. But this is all just a testament to the fact that when government services are controlled by politicians and for-profit companies, the rules are even more complicated than when the government is the only service provider.


As I explained in the first article in this series, as much as Advantage providers tempt people with low overall prices, the hidden costs are a time bomb just waiting to explode in the faces of clients who live far away from in-network providers. And drug co-pays which are low for insured working people skyrocket for retired people who live on a fixed income. All in all, these are just more ways that the for-profit medical industry squeezes every last penny they can out of the most vulnerable people in the country.

Then there’s the insidious “credible coverage” requirement for previous insurance. This one makes perfect sense to the profiteers, but it amounts to financial punishment imposed on sick and disabled people. Here’s how the plan works:

Many younger people with medical problems are being denied coverage by insurance companies because of their conditions. Then when they finally qualify for Medicare, they’re charged a penalty on top of premiums specifically because of the fact that they weren’t able to obtain insurance before that. These extra costs are just one more way that the for-profit medical system in this country torments people who commit the “mortal sin” of being imperfect.


Lest anyone think any of these issues are an argument against government managed health care, I vehemently disagree. The complications arise from the involvement of for-profit companies and the meddling of lobby-supported politicians.

If health care were supplied to everyone in a straightforward manner according to each person’s need, with no costs added to boost corporate profits and executive compensation, the service would be much cheaper and far more successful than it is now. And I’m not opposed to charging penalties to people who want coverage or care when they’ve previously refused to participate in a universal system.

We just need to actually have such a system that doesn’t discriminate against sick and disabled people, as the current for-profit system does. The only way to care for everyone who needs it in an efficient manner would be establish a truly universal health care system which requires everyone to pay what they can afford for coverage.

And now that I’ve come this far down that circuitous path to Medicare, I’d like to say I’ve earned a black belt. But since politicians are always tinkering with the system, I’ll just claim a brown belt now and steel myself for the battles that I know must surely be lurking farther down the road.

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

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