26 March 2011

Moving on down the road

My 65th birthday is imminent and with that event in America, one gets the dreaded junk mail and government mail storm of Medicare paperwork. One does not simply get older, there are decisions to make.

I am a skilled business systems analyst. I have about 20 years of insurance company work experience in my resume, most of it in management. Leave it to the USA, I had a time understanding the choices and forms. God in heaven help a person who does not have a bachelors in business or years of background!

First there is the question of "supplemental insurance." Medicare is divided into parts. Each is labeled alphabetically but to keep things confusing, some parts are not parts. So there is part A, basic health care; part B, hospitalization; part C, oh wait there is no part C and part D drug coverage, except some drugs are over in parts A or B! I am not making this up.

Part D involves private carriers selling something other than the "supplemental insurance" namely,"supplemental prescription coverage."

It gets better, there is an entire option for HMO coverage which takes all of this off the table and substitutes its own rules.

Under Parts A & B there are plans (not parts pay attention!) ranging from plan A to plan K except not all plans are available at all and not all are available from all carriers.

To actually decide what a person is doing, you have to make some priority decisions. Not all doctors participate in all options. Most for instance are not "in plan" for the HMO. If you want to stay with a primary care doctor, odds on bet is you cannot take the HMO route.

Not all doctors are "in plan" for all supplemental care plans, some are not for any! So a chat with the doctor or his office manager is in order, before you let agents anywhere near you.

For drug coverage, each of several dozen carriers has a "formulary" which in defines what it covers under which category. This is so hard to figure out that major pharmacies like Walgreens, OSCO and CVS will take a list of your prescriptions, submit them to a central computer and print a small book of possible listings with comparative coverages and costs.

I constructed a spreadsheet in the Google Cloud to compare various supplemental plans. I am good at doing that sort of thing -- it took several hours. It turns our that the premiums are not level across the country. Depending where you live, there is substantial variance in how doctors and hospitals price services. In some areas, they take Medicare's "usual and customary" fee as full payment at least most of the time. In other areas they bill more. The carriers deal with this by pricing by zipcode. In my zipcode, the difference between having "excess" coverage or not is $12 a year. In other parts of the country it is really a big deal. Heaven help you if you re-locate.

So, after a couple hours in the cloud, five hours of paperwork study, two hours on the phone and an hour executing and signing forms, I have "free healthcare" which costs $230 a month and covers 12 months of doctor' visits, 12 months of hospital coverage and slightly less than 7 months of drugs per year: this year. Next year as the premiums rise sharply for one segment, the coverage goes to about $300 a month but I still have five months without drug coverage. But wait, there is more.

My insured drugs will still cost a couple hundred a month in "co-pays." Next year I can cut that down a little because the 'co-pays' will be lower with the higher cost drug coverage, and both numbers can be finessed slightly with 90 day prescriptions from either 'mail order pharmacies' or those retailers who match the costs (Osco and Walgreen's that I know of, probably there are others.)

So all of that "free stuff" will consume between 1/4 and 1/3 of my social security income. This is what the government "gives" us. Or at least after a lot of reading and listening I think it is. Dying is cheaper. But I am not gonna do that anytime soon. So in October when "open enrollment" comes along, I get to do all this over again because the carriers and the government change the rules every year!


1 comment:

Christal said...

This Medicare system is sooooo messed up. I think you need a sedative just before beginning the process of filling out the paperwork.

St Laika's

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