Tuesday, July 9, 2013

I Apply for Medicare, Part II

     The other day I received an envelope in the mail from the Social Security Administration. I opened it up. I got my Medicare card!

     I feel like I've been accepted into an exclusive club. Better than AAA; better than AARP; better than my America the Beautiful senior pass to the National Parks.

     Now, if I only knew what Medicare covers. And what other medical coverage I should get.

     I went through one round of trying to figure out how Medicare works, apart from Parts A and B, as I recounted in I Apply for Medicare, Part I. I did learn some information; but not enough to make me think I could find an appropriate backup plan.

     So I phoned my sister. She's older than I am and has been on Medicare for a couple of years -- and I know she's used the system, so I thought I could ask her how it works.

     "You haven't gotten any information in the mail?" she said, incredulously. "I think I got several mailings. But to tell you the truth, I wasn't paying attention." She knew she was going on her husband's medical plan to supplement Medicare. It's a good plan and, as she said, "It's almost free," and so she didn't research other options. Some people are lucky. And she was happy getting whatever she would get.

     My ex-wife had mentioned that she'd gone to an insurance agent specializing in Medicare plans. The agent had assessed her situation, come up with several options for her and explained the details of both coverage and cost. I googled Medicare insurance agents in my town. The nearest one is a 40-minute drive. Maybe I'd go see him, I said to myself, but let me try to figure this out on my own. I really didn't want to have to drive that far, on speculation that the agent would know what he was talking about, and know what would be best for me.

     Of course, I'd neglected to ask my ex-wife what plan she'd decided on. So I called her back. She told me she's using a United Health Care plan she got through AARP. That was the one recommended to her by her agent; and so far it was working just fine.

     Meanwhile, I'd received two thick envelopes from my own insurance company. I opened them up; and the contents were both intimidating, and discouraging. Oh man, I really didn't want to read all that mumbo jumbo!

     Nevertheless, I gamely opened up the package and started to read through the material. There were several HMO plans. But I want to reserve the option to go to a doctor outside my network, in case I ever need a certain specialist. So I turned to the PPO plans.

     I tried to compare PPO I and PPO II and PPO III and PPO "High Option." I focused on PPO II and PPO III, figuring I didn't want either the cheapest or the most expensive plan. But it looked to me, as I inspected the columns of benefits, that PPO III is more expensive but offers fewer benefits. That couldn't possibly be right. So I threw up my hands and gave up. For the moment, anyway. I knew I'd have to go back to it.

     Then I thought, I should contact AARP. If it was good enough for my ex-wife, it would probably be good enough for me,

     I went to the AARP website. After searching through the site (the insurance plans are hard to find) I found a reference to several AARP Supplemental plans. And I also found a recommendation for Medicare Advantage plan. What's the difference between Medicare Supplement, and Medicare Advantage? I didn't know. I'd also seen reference to Medicare Gap plans. What are they?

     I decided to call the 800 number. I then spent about 45 minutes on the phone with a woman who explained all about the AARP Medicare Advantage plan that was available in my area. There are several advantages, she explained. It takes the place of Medicare Part C. It includes the Part D drug plan and some dental insurance and some other ancillary benefits.

     Then she finally allowed as how the Medicare Advantage plan is an HMO plan. "Oh," I said. "That means I have to stay in a network?"

     "Yes, that's right. But we have a lot of doctors in the network."

     "Wait a second," I said, as it finally dawned on me. "Are all Medicare Advantage plans HMO plans?"

     "Yes, that's right."

     "So how can I tell if my medical group accepts this AARP Medical Advantage plan?"

     "Oh, I can look it up for you."

     So she put me on hold for a minute. She came back on the line. It turns out my medical group accepts several other United Health Care options. But not this United Health Care Medical Advantage plan. So unless I changed to another doctor in their network, every time I went to the doctor it would be out of network, costing me a fortune.

     Were there any other options available to me? I wondered. What about that AARP Supplemental plan I saw on another page of the website?

     "Oh, I don't handle those plans," said the woman. "They're administered through someone else."

     So . . . 45 minutes down the drain. But at least I learned that a Medical Advantage plan is an HMO plan, requiring you to go to doctors in their network.

     I was drained. No more research today. I quit . . . knowing no more than I knew before -- which is that it is easy to sign up for Medicare, but hard to find out exactly what you're signing up for. But I will figure it out, for sure, for my third and final installment of how I applied for Medicare, coming up (hopefully) next week.



Linda Myers said...

I signed up for Medicare just yesterday! My decision was easy, though. We've had an excellent HMO for over 20 years, so I'm just moving between the one from my husband's former employer to Medicare. It did take some time, though, to review the other options.

Stephen Hayes said...

This is quite an education. I'm reading this and taking notes since I'm not that far away, age-wise.

Friko said...

Just join the NHS and be done with it.

Oh, I forgot, you can’t, you have a much better system acc. to some . . . . .

Kathleen McCoy said...

Oh, how I wish we had Friko's NHS!

My husband and I got a Medicare Supplement Plan from Mutual of Omaha. It offers very comprehensive coverage and is not an HMO. We have Plan F which covers a lot. We've been very thankful for it as Bob has had some neurological tests for his worsening epilepsy that cost up to $18,000 per test and with the coverage we have, we didn't have to pay a penny out of pocket. We DO pay a $304 premium to Mutual of Omaha every month, but it feels worth it, particularly given his medical issues.

DJan said...

I am currently on a Group Health HMO that is offered in Washington State. Last year I was on that AARP Medicare Advantage plan, and it was lovely. Last year it was no longer offered in this state. When I first got on Medicare, I paid $200/month for a supplemental plan, and I only went to the doctor once. It was way too expensive for me, although there were no other costs, no co-pays for anything. My current plan costs $43/month with co-pays, and the $106/month that is deducted from my Social Security for Medicare Part C. I've been very happy so far with Group Health, but I pay $20 to see my doctor and need a referral for a specialist, which costs $45/visit. Not cheap, but it's good coverage.

mxtodis123 said...

I got my card the other day. It takes effect on August 1st. I'm still working, retiring this Friday and my work plan will cover me up to the 31st of July. After that I am totally lost. I have blood pressure medications that I have to take for the rest of my life, thyroid meds, and gosh knows what they will find when they do my lung biopsy on July 22nd.

schmidleysscribblins.wordpress.com said...

As I suffer from migraine headaches, I try not to think about all these confusing medical insurance issues too much. I went through the whole shebang when I added Medicare to my existing insurance policy, but had to drop David's United Health Care Advantage plan because it confused everything else. Besides, the ACA removes the incentive for companies to offer the Advantage plan. I sure hope the ACA doesn't screw up everything. I am afraid it will. Dianne

Olga said...

I started Medicare last month. I just stayed with the same insurance company I had for the drug coverage and supplemental stuff. I have not had to use any of it yet so I can't say I made the right decision. Mike has the AARP insurance and it has worked okay for him except for that donut hole thing. I guess the key is to stay healthy and just let the insurance companies keep our money.

Janette said...

Once you figure it all out--- let me know!
We have been in socialized military medicine for 30+ years. My husband turns 65 in two years and he gets thrown to the wolves---lol. He will no longer be able to go to the military hospital. AGGGG!

June said...

Oh lord....
NHS sounds awfully good to me! Would it be too too dramatic to wish for death prior to Medicare age?

Tom Sightings said...

Mary ... lung biopsy? That's got to be scary. Best of luck with it; I'll be rooting for a good outcome. Olga, you're certainly right that the best medical plan is to stay healthy; unfortunately, a lot of that is out of our hands. I myself don't blame the insurance companies for keeping our money -- I think the doctors and the medical establishment get most of it. And June, take heart. I think in the end we'll find out that Medicare is a good program. It's just . . . why do they have to make everything so damn complicated?!?

Anonymous said...

The comment’s section doesn’t restricts the number of characters, so this a an abridged version of what I did to help a friend who had three sever strokes, and had to go on early retirement, disability and eventually Medicare. I’m not a insurance agent, or a solicitor but a just my experience helping my friend.
1) Research, the internet, read any good reference books, blogs. Cross check the info, do not believe everything you read on the internet. Medicare Official site is an excellent resource, though confusing and overwhelming initially
2) Register and enter the personal information on the Official Medicare site ( hold off the RX info to minimize the confusion). Compare the plans for your area and narrow the choices. I selected three PPOs which had existing doctors and Hospitals in network.
3) Now add the RX information and re-compare the selected plans
4) Prepare a spread sheet, and fill in as much information as you can, Max out of pocket, RX, procedures, cost for docs visit, PT, ambulance etc.
5) Go to the insurance web site for each plan to fill in the hole, or look for extra information and complete the spread sheet.
6) Write Pros and Cons of each plan
7) Call the your Primary docs nurse and ask her opinion (not recommendations).
8) My friend selected a PPO plan, includes the Rx , and basic dental ( two cleaning and ex ray) and one eye exam and one pair or glasses per year. Doc and specialist Co pay are very reasonable.
9) First try will take some time, but break it into small pieces and don’t get overwhelmed, work through one small piece every day.
10) Subsequent years, it’s much easier, as you update the existing spread sheet ( less than a couple of hours) with new info or a new plan and compare, if you didn’t like the existing plan, you can change it the next time during open enrollment.

My opinion, and YMMV, the Medicare Advantage Plan which my friend is on, is much cheaper, and superior than what I’ve at my employer ( which I consider to be an excellent plan)

Hope it helps.

Tom Sightings said...

Anon. -- Thanks for this good advice. But I repeat ... why do they have to make it so darned complicated?

Anonymous said...

You welcome and I hope it will be helpful. To answer to your question, why they make is so complicated. Our health system is very complicated, and if they made it any simpler, some of us we will be screaming “Socialism”, without understanding what’s at stake. First time it’s tedious, but after that it’s a lots less work.
Here is another mind boggling thing: My friend found out that, some of the generic Rx ordered through the Plan was being billed to Medicare for over $1000 per year after the copayment. Switching those Rx to another Reputable National Online Pharmacy, and filling these RX without any mention of Insurance coverage, the cost was same as the co-pay to insurance plan, but Medicare didn’t get billed for this extra $1000 a year. The reason is, according to my understanding, that congress has prohibited Medicare to negotiate the Rx prices with the pharmaceutical companies. Now imagine this, millions of Medicare recipients being pro active and saving Medicare a small amount on their Rx (getting the same medicine for the same copay from another pharmacy without insurance) can add up to billions of saving. After all it’s our Medicare and Our Government, and trying our part might help to prolong the health of the program. It’s important to realize that the Medicare Advantage Plan is jut managing the Plan D for Medicare, they are not implementing anything new. I’m well over a decade away from Medicare, but learned a lot by helping a friend in this process.

Bob Lowry said...

I think I'll wait until you figure all this out and in 10 months when I'm eligible I'll ask you how your decisions are working out.

I want a PPO, also. HMO's are just too restrictive.

christina neumann said...

I just was automatically signed up for Medicare since I will turn 65, but I had to sign a form to decline part B because I'm still covered by my husband's insurance. It was a little scary as I'm not sure what we're doing down the road. But for now this is the best plan till he fully retires at 70!
It's all very confusing and on top I have extraordinary expense drugs for myeloma( once I relapse) which I hoping is not for a while!
Keep us posted so we can learn from you!