The Third Third

Medicare and Me

[Medicare][1] and Me.  It sounds like the booklet the government -- and at least a dozen or 50 different insurance companies -- mailed to me 90 days ago, *Medicare and You*.   Would that I had written the booklet.  Then I might have understood it.  Or at least the parts I did understand wouldn’t have seemed so depressing. I spent whole days -- *whole days* --  studying what are euphemistically called my options, and feeling dumber, older, frailer and more vulnerable by the hour.  I even asked my husband-the-lawyer to read the materials in case without a law degree they made no sense while with a legal education they did.  But they made no sense to him either. This I understand:  I am entitled, indeed, obliged to [sign up][2] for Medicare, Part A sometime during the month of my 65th birthday or in the three months before or the three months after that month. There is no charge; this is my due. If I am retired and/or not working at a “job job” (one that pays a reportable salary and benefits, for example), I am also obligated to sign up for Medicare Part B and, if I have not yet elected to receive my Social Security benefits from which the premium for Medicare, Part B, based on my income reported to the IRS two years ago would be deducted, to pay for it out of pocket. To summarize:  Medicare, Part A, is free and covers hospitalization; Medicare, Part B, for a sliding fee based on income, covers physician and other medical services.  But not all of them; 20 percent of all healthcare costs remain my responsibility, unless I purchase Medigap or Medicare Supplemental insurance.  In addition, neither Medicare A or B nor Medicare Supplemental insurance covers prescription drugs, so I must pay retail prices or also sign up for Medicare, Part D, a government-approved prescription drugs benefit package costing an additional premium and not available through the Social Security Administration, like Medicare Parts A and B, but through the same independent, non-governmental, private insurers who sell supplemental policies. This is where the arcane and the labyrinthian nature of the entire concept of Medicare begins to take over.  I’m thinking a more generous mental health benefit for folks “of a certain age” might prove both judicious and important. It might be simpler for me to stick with the insurance available through my husband’s business to which retired partners are still entitled --  even though it becomes “secondary” as soon as I sign up for Medicare, Parts A and B, which it requires, and even though it continues to cost just the same as if it were primary, which is about twice what that separate supplemental policy and a Part D (prescription drug) policy might cost.  Except that the cost savings I would realize by dropping my firm coverage and buying the two additional Medicare policies (supplemental and prescription drug) could be lost to Medicare’s so-called pharmacological  “donut hole,”  for which no Medicare insurer, public or private, is responsible. That is, each year until the donut hole “closes,” I will have to pay the cost of any prescription drugs over $2000-something until the costs reach $4,000-something -- or a good $2000-something annually.   You almost need an abacus or a logarithm to compute the relative benefit -- assuming you can afford any of it.  That’s not entirely true.  I’ve made the calculation, and even paying full price for some prescription drugs in the donut hole, I can save about $1600 a year by embracing all my Medicare options and leaving the law firm’s $7500 a year coverage behind. Which is not, I must add, the financial windfall I ignorantly thought Medicare might be. And then there’s this:  I know how what I refer to as “my” insurance works, and it works well.  I’m not so sure how well the insurance for that older person I am becoming this month works, and that uncertainty makes me nervous. What if the unthinkable happens? Am I truly adequately insured to avoid a financial meltdown in the event of a catastrophic illness (which is, after all, what I sign up for insurance for, albeit hoping I never have to use it)?  And finally, what about Obamacare (a term I eschewed when it sounded like a slur, but can now embrace as Obama does, I guess) -- what wholesale difference will it make to any of this? Clearly, I have figured out the costs, if not all the benefits.  I am still troubled, though, by the very *idea* of Medicare -- not politically, (though I grew up with a doctor who cursed it and love my sister, another doctor who curses it daily), but by the assumptions it makes about our lives at 65.  As I read through the benefits afforded me by virtue of this birthday, it was a sort of out-of-body experience: it couldn’t be *me* they’re talking about in that paragraph about walkers and oxygen tanks and post-broken hip rehabilitation facilities; that was my grandmother and, just last year, my dad. I’m not that old.  Or my 65 isn’t that old, or at least not so old as 65 was in 1965 when the federal government began administering Medicare.  What am I supposed to do with that thought?  Seems it comes down to this:  Stay healthy.  And feel fortunate.  Or feel old, very old.  



Some sources you may find helpful: -- the official site for all the basic (and sometimes confusing) information.  Here you can also compare prescription drug costs and coverage options. --

(Your state’s State Health Insurance Assistance Plan -- this is for Texas)  (the Social Security Administration website, where you sign up for Medicare, Parts A and B)  Just one source of Medigap and Part D policy information

[1]: [2]:
comments powered by Disqus