Saturday, June 13, 2015

US Seniors and the Medicare Maze

I continue to be astounded at the complexity of US Medicare.  This is the primary system for medical expense assistance to seniors in the US but it seems to require a sharp and organized mind, something many seniors lack due to their age.

A few examples of the complications of these systems:

  • If you don't apply when you reach the correct age of 65, you are locked out until the next enrollment period and may have to pay a penalty.  So you may have no medical insurance and the government penalizes you for saving them money?!
  • Your premiums depend on how many years you worked in your life, whether you applied on time, and your family income two years ago.  I am surprised they did not make you buy a scratch-off Medicare discount ticket as well..
  • Medicare is split into four bits that are helpfully called A, B, C, and D.  You can decide to only take A and not B but if you take C (Medicare Advantage), it usually covers A, B, and D but you normally take A, B, and D with Medicare supplement insurance.  Did you get that?
  • You can get two kinds of private insurance, Medicare supplement insurance or Medicare Advantage.  They are quite different and require different applications to different companies.
  • There are 31 different drug plans to choose from in Virginia.  The only way to know which is best for you is to go online, enter your drugs, enter your favorite pharmacy, and see what the tool spits out in terms of a premium and out of pocket costs.  You cannot understand the results, I have no idea why the $21 a month plan has lower out of pocket costs for 6 drugs than the $85 plan from the same company?  
  • There are options to call Medicare and they will run the drug plan choice tool this for you but the wait time is usually about 15 minutes minimum.  You could spend two hours on the phone spelling DIAZOPHENOLIDOVASTIONIPAM CHLORIZONE and all the other drugs to the operator.
  • Every year you get to pick a new drug plan if you want.  Be sure that you, the senior, still have Internet access so you can figure out which new plan is best.
  • You get bills for Medicare premiums that make make it a guessing game to understand what you are buying.  One monthly bill we received said that we had to pay a certain amount and "it may be for part A and/or part B".  We received another bill for 3 months that had no details on what it covered.  One bill could be paid by credit card, the other only by check, just to make it interesting.
  • You can nominate a person to do this for a senior, some kind of power of attorney.  What happens if you don't have a trustworthy, intelligent, and organized person to do this for you?
Pity the poor US senior who has to make this system work.

Photo credit: Flickr



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