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.

PART D PRESCRIPTION DRUG COVERAGE

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)

Managing the Medicare Maze (Part II)

In Part I, I shared the basic details of Medicare, including the reason we chose to go with Parts A and B and a Supplemental Medicare policy instead of relying on one of those much-touted comprehensive Advantage plans. Now I’ll share some of the wrinkles we had to iron out as we tried to get things set up and began to use the insurance plans with our medical providers.

THE PATH BECOMES ROCKY

The first issues we faced were a result of Medicare red tape. Social Security couldn’t complete the paperwork until they received notice from Jim’s employer confirming his retirement date. Trouble was, the people at Human Resources didn’t finish their paperwork until the middle of his last month on the job, barely two weeks before D-Day--or to be more precise, R-Day. Once that was done, Jim had to take the Medicare form to HR and get it filled out and signed, then mail it back to Medicare.

Because of that delay, we didn’t get our Part B cards until well over a week after it was to go into effect, and we’d already scheduled an appointment with one of our doctors during that first week. Fortunately, the office manager, who happens to be the doctor’s wife, was completely understanding and took our information for an emergency form she uses in such cases. Then she sent it to their billing service, and we hoped everything would work out fine.

But within the next few weeks, we had a couple of other medical appointments, and soon we began to receive calls from them because Medicare was denying our coverage. I called Medicare and found out the problem was that they hadn’t registered the fact that his employee insurance had ended on the last day of his employment.

While he was still working, the employee insurance was his primary provider, while Medicare would be the secondary provider, to be billed only for deductibles and co-pays. Now, of course, Medicare is supposed to be our primary insurance provider and the Supplemental plan we’d purchased from a private company is our secondary provider. But that’s not what our records said at Medicare.

We were told that Jim would need a letter documenting the fact that he was no longer covered by employee insurance. It took almost a full day and involved people at his old employer’s HR Department and the old insurance company calling and faxing back and forth. Finally we had copies of those letters, one for Jim and one for me, in our hot little hands. Then we called Medicare again and learned that as long as we can produce the letter, they were satisfied and nothing else needed to be done. They didn’t even need us to fax the letters to them.

I then had to call people at all the medical service providers or their billing departments to advise them that we’d corrected the problem and things should go smoothly from then on. Ah, but not so fast. This is the one time when the government agency didn’t work as it was supposed to.

Turns out the main Medicare Department is not the agency that takes care of all that. It’s handled by a separate government agency called Centers for Medicare & Medicaid Services that handles all billing and payment matters. Only after the second denial of a particular payment a week after we obtained those letters did I learn that little tidbit. So, naturally I had to call CMS and get them to straighten out the problem.

When I explained the situation to the very nice young man at CMS, he made sure to keep me on the line while he went through all the steps necessary to update our accounts. Again, we didn’t need to show them the letters documenting the old insurance coverage and termination dates. We just have to make sure we have all that information and can prove it if we ever need to. That’s where good record-keeping comes in handy.

In fact, those good records proved to be a blessing with later issues that came up. But I’m getting ahead of myself here. In the next article in this series, I’ll explain how those records are helping us with our Part D coverage. Watch for it!


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

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.

MEDICARE BASICS

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)

Friday Peace Vigil, Youngstown, OH, and surrounding area:

PEACE VIGIL
YOUNGSTOWN, OH
Friday, November 18, 2011
4:30 p.m. to 5:30 p.m.
Broadway St. & 5th Ave.

Ray Nakley (330-506-1999) and Ron Dull (330-518-9881) will hold their weekly Peace Vigil this Friday, November 18, from 4:30 p.m. to 5:30 p.m., at the corner of Broadway St. & 5th Ave., Youngstown, OH. They invite anyone who is interested in showing their support for ending conflict in the world to join them. Hold out positive thoughts for that!

This week:

Whoa! Just when we think we’ve got our medical insurance crazy quilt all sewed up, another strip of red tape rears its ugly head. How’s that for a totally mixed-up metaphor?!

I’d hoped to finish and post my blog article on the Medicare maze this week--until we got some letters showing two more problems, not with the government aspect of the puzzle but with one of the corporate players in the game. In fact, when I do put the finishing touches on that article, I plan to emphasize the fact that the insurance and drug company lobbies are keeping the process so messy that as much as the government agency tries to keep up with it, even they can’t be aware of all the problems we’ll have to face. That’s not only shameful, it’s a complete waste of time, money, and energy, both physical and psychological. So, as soon as we iron out this latest wrinkle, I do plan to tidy up that article and post it for everyone right here and on my Facebook and Twitter accounts. Watch for it!

Meanwhile, let’s all send out our most positive thoughts and, for those who are believers, prayers to support and benefit all those suffering in so many parts of the world!

The Trouble with Electric Shopping Carts (Part IV)

In the first three parts of this article, I detailed the steady deterioration of electric shopping cart services at stores in Casa Grande. Now it’s time to wrap up this series by explaining what happened when I tried to get help with this and other problems related to my disabilities from the Casa Grande Mayor’s Committee on Disability Issues.

When I first wrote the two-part article about electric shopping carts for my column in the Arizona City Independent/Edition, I also called and sent a letter trying to get the attention of someone on the Committee regarding the problem. We lived in Arizona City at the time but did all our shopping in Casa Grande, 15 miles north of our home.

I’ll give Committee members the benefit of the doubt and just say the reason they might not have responded to my original complaints might have had something to do with the fact that we weren’t residents of the city. Still, that logic doesn’t compute when you consider most subsequent developments in relation to the issue.

In 2007 we moved to Casa Grande, and a few months later I volunteered to serve on the Committee. At that time I explained that since my original complaint regarding the lack of enough working carts, stores had begun to replace their old carts with new ones without arms, making it difficult, or even impossible, for people with certain types of disabilities to use the carts and, thus, shop in those stores.

Finally, a Committee member called several large grocery and discount stores in town to survey them regarding the replacement of their old electric shopping carts with armless carts. When I attended my first Committee meeting as a member, they presented me with the survey report. After that, there was no more talk of armless electric shopping carts--or any other issues connected with hidden disabilities.

Conversations at meetings were mostly about visible disabilities, such as mobility, sight, or hearing problems. I heard little or no discussion of other disability issues, such as those affecting people with seizure disorder, mental or developmental disabilities, AIDS, or those confined to nursing homes or rehabilitation facilities.

The same problem existed with outside activities sponsored by the Committee. For instance, the annual Disability Awareness Day was focused on difficulties faced by people confined to wheelchairs or those with visual impairment. The one time I was able to attend a Disability Awareness Day luncheon, I told a couple of people attending who held management positions at the local Wal-Mart that I hadn’t shopped at their store for a couple of years because of the problem with armless shopping carts. They said they’d check into it, but they never got back to me and didn’t even answer the followup email I sent after that meeting.

Besides that, I could never attend the Committee’s annual Halloween party because my nervous system can’t tolerate vibrations from loud music and I’m deathly allergic to dyes in all the refreshments served at the event. In fact, in 2009 after taking a colored pill I’d previously been able to pass in a few days with minor symptoms, I ended up in the ICU for two and a half days. That means that for the rest of my life, I have to avoid all those chemical dyes that make food and drugs so pretty to look at. One more exposure could propel me past the ICU all the way to a slab in one of those little refrigerated compartments in that windowless room in the hospital basement. No thanks!

Meanwhile, two more of my problems continued to worsen, but whenever I mentioned anything I was going through to anyone on the Committee, they showed absolutely no interest. First, even more stores are replacing their older electric shopping carts with newer armless ones. That means it’s getting to be impossible for me to shop comfortably in just about all the larger stores in town. I am fortunate enough to have a manual wheelchair, but anyone who’s confined to a chair knows that sitting low to the ground limits their view of most store shelves and makes it difficult to chat with people standing up near them.

Meanwhile, my physical symptoms are deteriorating, as they have slowly but surely pretty much all my life. I no longer have the stamina to manage most normal activities. When I need to go out to see a doctor or shop at a local store, we have to plan the logistics carefully. My husband does all the driving now, and since I lack the upper-body strength to push my own wheelchair, he has to push me wherever I want to go.

Of course, it would be great if I could use my own electric cart. Unfortunately, our house isn’t accessible and has no garage. We can’t just roll the cart in or out of the house, and if we had a hoist installed on his truck, it would be vulnerable to theft or vandalism. That means I’m stuck with the inconvenience of my wheelchair. At least I do have that.

And since my disabilities are of no interest to anyone on the Casa Grande Mayor’s Committee on Disability Issues, I’ve chosen to focus my limited energies to more important and more effective activities, such as writing about a world in which the needs of every single person are respected, even those people who have to deal with hidden disabilities.

Part I: Going the Distance (Part I)
Part II: Going the Distance (Part II)
Part III: Disarming the Carts

Friday Peace Vigil, Youngstown, OH, and surrounding area:

PEACE VIGIL
YOUNGSTOWN, OH
Friday, November 11, 2011
4:30 p.m. to 5:30 p.m.
Belmont Ave. & E. Liberty St.

Ray Nakley (330-506-1999) and Ron Dull (330-518-9881) will hold their weekly Peace Vigil this Friday, November 11, from 4:30 p.m. to 5:30 p.m., at the Belmont Ave. & E. Liberty St., Youngstown, OH. They invite anyone who is interested in showing their support for ending conflict in the world to join them. Hold out positive thoughts for that!

This week:

Whew! Jim and I were finally able to put the last piece of the senior medical insurance puzzle into place. Now we’re trying to catch up with all those other things, large and small, that we hoped to take care of during his first weeks of retirement. I hope to regain my focus soon so I can finally begin to write about all the tricks and traps we had to go through and around in order to get things set up so we’ll get the care we need. Then there’s that last part of my report on the problems I’ve encountered with electric shopping carts. I hope to have these articles written and posted by this time next week. Hold onto positive thoughts for that miracle!

Meanwhile, let’s all send out our most positive thoughts and, for those who are believers, prayers to support and benefit all those suffering in so many parts of the world!