Medicare & Me

If there’s anyone out there still thinking your information is private, I’m here to tell you it’s not. The health insurance companies started filling my mailbox with information on Medicare at least six months before my 65th birthday. They have apparently been watching and anticipating my big 6-5 along with the United States government. Despite the overload of information everything was as clear as the road before you on a foggy night.

Even the federally provided booklet Medicare & You didn’t clarify the subject. I consider myself a reasonably intelligent person. However much I thought I understood the government’s booklet, there was still a doubt, a HUGE doubt, that I had indeed grasped all the nuances. Convoluted doesn’t begin to describe it — Parts A, B, C, D, F, G and more.

Fortunately, the Osher Lifelong Learning Institute I attend at Furman University offered a course last fall in Understanding Medicare. I signed up. With each class dedicated to a lettered Part, the fog began to lift. The idea that it takes an hour and a half to explain Part A and so on is ludicrous. I wondered what people who don’t have access to a course do to understand and make an informed decision.

As my mailbox continued to hold offers from all kinds of insurance companies and agents, some of which I had never heard of, I piled their correspondence and applications on my desk. My strategy was to sift through them after finishing the class. However, our instructor recommended going with one of the five large, well-known carriers in the state. Since that made perfect sense to me, I eliminated all the rest. My pile shrunk by two-thirds, making the task less daunting.

If you are already receiving Social Security, you don’t need to apply for Medicare. You are automatically enrolled. Keep your eyes open for the government envelope carrying your Medicare card for Parts A and B. It does not look official! I almost threw mine out thinking it was from yet another unheard of insurance company. If you are not receiving social security, you have to apply for Medicare; you have 3 months before your 65th birthday and 3 months after to do so.

Since Part A is provided by the government, courtesy of your Medicare taxes while working, and Part B is provided by the government and paid for by a monthly premium from you, what you are really looking for from insurance companies is prescription drug coverage and supplemental insurance. Part A provides hospital coverage and Part B provides coverage for items such as doctor visits, flu shots and walkers. There are deductibles and co-pays, which is why you are getting supplemental insurance coverage also known as Medigap. You are not required to get supplemental insurance, but if you don’t, understand you will have to pay deductibles and co-pays from your pocket.

Some people opt for Part C known as the Advantage Plan, which means you have private insurance and do not use the federal government’s Parts A and B. The insurance company receives what the government pays for Part A as well as your Part B premium. Not all insurance companies have Part C plans. Most Part C plans have a co-pay for doctor’s visits. The real caveat is you have to use in-network providers including your primary physician. So Part C can be a problem if you travel, have a medical issue and your primary physician is not there and there is no in-network hospital. You will end up paying out-of-network rates and most likely have to pay the difference from your pocket. This is why I didn’t go with an Advantage Plan.

Note: If you travel to foreign countries be aware that Medicare does not cover you outside the United States. If you go with the Advantage Plan Part C ask for a copy of the policy before you apply and read it. In fact, read whatever policy you decide to buy. Knowledge is power!

Part D is prescription drug coverage. What company you choose for Part D will depend upon your prescriptions. Different companies have different tiers for drugs. Deductibles and co-pays vary from company to company along with which tier they put a drug into. Make sure you review what tier your drugs are in with each provider and what your out-of-pocket cost will be in addition to the cost of the coverage.

I went with Part F as my supplemental insurance. Part F covers deductibles and co-pays for both doctors and hospital stays. I can go to any doctor or hospital I want and don’t have to be concerned about “What if something happens while I’m traveling?” I do not have to be in-network. I also have 80% hospital coverage if I’m in a foreign country and have a medical issue.

The other letters such as G, L and N are simply other versions of supplemental insurance. You have to read about them in order to make the best choice for your individual situation. If you don’t have access to a course, I recommend calling AARP (800-272-2146) to speak to a United Healthcare agent as I found their agent to be the most knowledgeable, articulate and willing to spend the time reviewing the intricacies of Medicare. I receive nothing for making this recommendation to call AARP.  I did not go with United Healthcare as I chose to stay with the carrier I’ve had for the last 25 years even though they cost $3 a month more for my premium. This was one time I wasn’t leaving my comfort zone.

All of us in the United States will have to go through this process as we approach 65. I doubt it will become any less convoluted in the future. I hope this small explanation helps. For more information go to SSA.gov or medicare.gov. And good luck!

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THE DOCTOR IS IN

Recently, I’ve had the misfortune of having to see a few doctors to unravel the mystery of what was ailing me. Fortunately, I have health insurance and it’s turned out not to be anything serious. Over this same period of time, I also started seeing more than a few articles about how, as Baby Boomers age and the Affordable Care Act kicks into gear, there is going to be a shortage of good medical care as there will also be a shortage of doctors. I also read about doctors cutting their work hours and selling their practices to larger practices so they didn’t have to manage the business side of being a physician. All this, it seems, translates into worsening health care for we aging persons aka seniors, retirees. The bad news just seems to keep coming. I don’t know if the media has a shortage of negative news to report so they are conjuring up this stuff or there is really cause for concern but…enough already!

Baby Boomers have always been like this huge freight train coming down the track. When I think back over my life to when I first became aware of the numbers, I remember stories predicting doomsday scenarios for our lives even then. Stories like there won’t be enough jobs. Apparently, the authors of those stories didn’t figure on us being creative, inventive and entrepreneurial to the point where we created companies, invented products and made jobs for our generation. I guess they also didn’t think about how we’d spend, spend, spend, demanding more goods, houses and cars, which also created jobs. I remember the stories about our generation creating such a population explosion when we had our own kids there wouldn’t be enough food. Yet, with research and technology better methods of farming were developed so we have fed ourselves. One might even say we’ve overfed ourselves.

I don’t want to come across as Goody Two Shoes but I also can’t see, with the crop of doctors on my short list, where I won’t be receiving, not just good care, but, great care. For starters, the doctors I see are not just medical smart, they’re business smart. In the last 6 years I can honestly say my care has improved. And my overall experience with my doctors is better than it’s ever been. The longest I sat in a waiting room was thirty minutes the day after Martin Luther King Day this year. That’s the longest time ever in six years! Normally, I’m taken in by a nurse just about right on schedule. When my doctor opened the door to the examining room where I had sat for about another 5 minutes, the first thing out of her mouth was an apology for my having to wait so long. I’m here to tell you, folks, years ago I sat around in doctors’ waiting rooms for a good hour and then sat around in the exam room for another 30 or 40 minutes, if I was lucky. And, when Doctor “God” entered the room there was no apology for not being on time for my appointment. I was again lucky if I got a ‘Hello’.

That brings me to the new millennium doctor’s bedside manner. One of the doctors I saw recently was a first time visit. When this guy enters the room, he doesn’t say, “I’m Doctor Doe”. No-o-o-o. He says, “Hi, I’m John Doe” and shakes my hand. Then, he proceeds to actually engage in what ails me by attentively listening, asking questions, more listening. This is the same treatment I’ve received from my primary physician. She shows up with her laptop, pulls up all my records and actually has a conversation with me. Last time I saw her, after we put together my game plan, she said, “And, if this isn’t working for you, just call me and say, ‘Suzie, this isn’t working and we’ll go back to the drawing board’.” Really, that’s what she said.

Before this, my experience with doctors was they came in to examine you, told you what you were going to do, looked at you like you had two heads if you questioned anything and might not even answer you if you did have the nerve to question them. This new breed is working with you, the patient, in collaboration. It’s a partnership. Now, do you have to take some accountability for doing your part? You bet you do. I come armed with a list of things I want addressed and any questions.

So, I don’t see the future as being all that bleak on the medical care front. There may be fewer doctors working fewer hours. Or maybe supply and demand will prompt more people to become doctors or maybe some of the Baby Boomer docs will delay retirement. Yeah, that could happen. But, somehow, good old American know-how may find a way to fill the projected gap, maybe with more nurse practitioners or physician’s assistants in the same practice as doctors. I believe the efficiency I’m seeing in today’s medical field will only get better. For example, before going to see the doctor on the first time visit, I was able to download the new patient packet and fill it out prior to my visit. When I called on Good Friday and the office of my primary was closed down, I received a call within 5 minutes from the MD on call. She directed me to a hospital clinic where they were able to access all my records from my doctor’s office so I didn’t have to fill out a boat load of paper work. Everything was already to go meaning I could concentrate on why I was there and they could access everything needed to bring them up to speed in the shortest time possible. Yes, larger practices. Yes, a corporate health system. But, efficiency for the good of the patient!?! OK. You can call me Goody Two Shoes.