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.

THE GOOD

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.

THE BAD

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.

THE REALLY UGLY

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.

AND IN CONCLUSION

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)

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, August 5, 2011
4:30 p.m. to 5:30 p.m.
The Courthouse, 125 Market St.

Ray Nakley (330-506-1999) and Ron Dull (330-518-9881) will hold their weekly Peace Vigil this Friday, August 5, from 4:30 p.m. to 5:30 p.m., at the Courthouse, 125 Market 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:

This week we begin the next-to-last month of Jim’s employment at the Gila River Indian Community. He’ll retire in October and we’ll enter the next phase of our lives. We have several things to do to prepare. Meanwhile, we breathed a temporary sigh of relief at the “compromise” that was reached in Washington that allowed Social Security and Medicare to continue--for now. But that doesn’t mean retirees and disabled people can relax and be assured they can depend on the current system. That’s why a big part of our work will continue to be my writing about the need to elect candidates to Congress that care about the needs of real people, not just corporations and millionaires.

As I wrote in my previous article, “Rewarding the wealthy at the expense of the poor and middle class: Bad economics, bad citizenship,” believing that our economy depends on making rich people richer while ignoring the needs of people in the lower classes is an upside-down approach to running a successful economy. That’s why the economy is in such bad shape now. And those who try to blame everything on the current administration are completely ignoring the fact that conservative Republicans have stood in the way of every positive step that Democrats and President Obama have tried to take in the past year and a half. Jim and I plan to do our best to encourage the election of people who care about the needs of everyone, not just the rich.

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!

Finding money: Social Security and the Economic Crisis

When people require extra money, both the reasons for the need and the method used to fill the coffers depends on the economic status of the individual.

Many in the middle classes live paycheck-to-paycheck. A missed payday, medical emergency, or car repair triggers a scramble for cash. People at this level might look for extra work, either overtime at their regular job or part-time at a second job. Many use credit cards, accumulating debt they might not be able to pay later.

In the depths of poverty, life is hand-to-mouth. People barely survive the negative gap between income and outgo and often lack money for food or rent. A few might find extra work, but many seek help from government agencies or charities.

In the rarefied air of the upper classes, need disappears and greed is the norm. Unusual expenses arise when Buffy demands a soiree to outshine the party hosted by her private-school rival, Missy, or Dexter IV expects a luxury vehicle when he attends Dexter III’s alma mater instead of the sports car he used during his prep-school years.

A few hundred thousands to cover these expenses is no problem. Dexter III just convinces his board of directors to boost his annual bonus. Then he gifts his trophy wife with a private Caribbean retreat for those long winter vacations.

When government finds itself short of ready cash for such essentials as military pay and seniors’ retirement, where does Congress look? To the Dexters who can spare a luxury or two and help the rest of us? Or to people at the middle and lower levels, where any unexpected expense could push them onto the road to ruin?

Most conservatives propose the latter. They make frequent reference to the sacrifices people must make, but they balk at any suggestion that the super-blessed be affected by any imagined “hardship.” Instead of raising taxes on the super-rich, they propose raising Social Security taxes and cutting retirement and medical benefits to the lower classes.

Social Security is a tax on the poor and middle class. The wealthy pay nothing more into that fund on earnings above $106,800.00, a pittance for people in the highest brackets. Social Security is a lifeline for the poor, but since benefits are based on previous earnings, the lifelong poor rarely enjoy a decent existence in retirement.

Since Social Security is paid by and most useful to people in the lower classes, the only people who should decide how to design and administer the service should be people who make less than $110,00.00 per year. The same goes for Medicare and Medicaid, which are vital to poor people and irrelevant to the wealthy.

Conservatives argue that concentrating wealth with the few ensures a strong economy, but this philosophy is upside-down. History shows that every era in which hard-working lower classes generate great wealth for the privileged leads to a period in which members of the poor and middle classes lose the benefits and capital they struggled to amass during boom times.

When wealth flows upward, people below suffer, and squeezing the common people eventually destroys the economy. That’s because companies depend less on investment than on income from the goods and services they produce. Without customers, a company will eventually fail and be forced to close its doors. Those customers are the millions of lower-class members who spend most of the money they earn or receive in various benefits to purchase products and services from the companies many of them also work for.

And that labor is another vital piece of the economic puzzle. Nobody generates a million dollars or more through their efforts alone. It takes the hard work of dozens of people just to provide the labor required to support the payment of a million dollars to anyone. If one million goes out to one person, then all the others in the equation must also receive a few thousand for their efforts. The highest earner directs the operation of lower-paid team members, many of whom could likely do their jobs without much direction in the first place.

The conclusion must be that we should worry less about the rich and begin to bolster the status of people in the lower and middle classes. Only then will we start to solve the serious economic problems now threatening the world economy.