“Medicare and You”: A Review Essay

Disclaimer: I support government-provided health insurance and would vote for anyone committed to a single-payer system. I’ve always thought of Medicare as the doorway to a single-payer system for all.

Disillusionment: Medicare is not a “single-payer system” (and I am no longer in Kansas); it is a public/private hybrid of base and supplemental coverage premised on the participant’s ability to anticipate health needs and compare incomprehensible descriptions of private insurance plans.

Discovery: Medicare is decidedly more expensive than the health care coverage provided by the university to its employees, and navigating the costs and benefits of health care post-retirement it is unimaginably more complicated than my current insurance.

Despair: My years of training in research, critical analysis of data, deconstructing texts, and questioning arguments are woefully inadequate for the task of navigating Medicare. Sorting out health insurance options for retirement has reduced me to a level of wall-punching frustration usually reserved for reading the nth draft of a student paper (that has yet to incorporate the comments made on draft #1).

~~~

I am fortunate that my primary care doctor is also a “senior” because that’s how I learned about the need to sign up for Medicare when I turned 65. (Apparently – based on a sample [not random] of 2 friends who, if they had not been recipients of my Medicare rants, might have missed the date –this component of Medicare is not widely known.) Not signing up would have resulted in a “penalty” of higher payments. Since I have continued to work after age 65 in a job that offers employer-covered health insurance, I am only a member of/recipient of Medicare Part A. Just a toe in the insurance pool. I have not yet had to unravel the mysteries of parts B, C, and D. But, retirement looms in less than two years. So when the letter carrier dropped in my mailbox a fat booklet from medicare.gov with the promising title “Medicare and You” it seemed like a good idea to investigate my future relationship with government-supported health insurance for “seniors.” Oh, big mistake! Opening that book was like opening for the first time anything written by Foucault: Anticipation, excitement, insight, confusion, irritation, hostility, and the weighty realization that like Foucault’s influence on the historian, medicare.gov will not go away and will frame all future health care decisions. So, I will have to unpack its meanings and learn to use its framework to structure future relationships with illness and medicine.

“Original Medicare” offers participants like me some percentage of coverage (of many services) for which I will pay a monthly fee, that, I learn, will be deducted automatically from my monthly social security payment (and reduce my monthly retirement income by a bit more than $100). The fee covers Medicare’s “share” of the cost of health care (this connection is not drawn in the book…rather, “Medicare” pays a share and the Medicare-insured individual pays a share). Before Medicare pays its share, I will pay a “deductible” or set amount I pay only after which will Medicare kick in its share. Once the deductible is paid, the “sharing” begins. My share of the cost of medical care is my “coinsurance” – and for most services described in the book, the coinsurance is usually 20% of the fee Medicare has contracted to pay for the service (with a service provider who has agreed to provide services at the Medicare-determined rate). With me so far? I visit a physician; first I remit a “copay,” Medicare and You” says its usually $10 to $20/visit). The cost of the service is paid a) all by me if the “deductible” hasn’t been met; or b) 20% by me – my coinsurance share – if it has. But, good news. I don’t have to write the coinsurance check until Medicare has paid its share. This fee structure isn’t terribly different from the private health insurance plan offered through the university. The cost of any service is negotiated by Medicare, and presumably it is substantially lower than what I would be charged without insurance. This is Medicare part B – my interaction with the services provided by a physician or other medical personnel. (Part A, that’s for hospitalization and “Medicare and You” suggests I’m “fully covered” for these services.)

“Medicare and You” provides a long list of services “covered” by Medicare Part B, but in an aside (no big deal, right?) mentions that key body parts are either not covered or the “fix” isn’t covered. That would be the things likely to “go” as I age: teeth, eyes, and ears. Not part of the Medicare package: dental coverage; the hearing aid likely to be prescribed after the hearing exam; and eye exams for prescribing glasses (but one pair of glasses – per year or per lifetime? not states — seems to be partially covered? I put a question mark here because eye information is found on pages 54 and 71 and what exactly is an eye exam “for prescribing glasses”). Apparently I don’t need to chew, see, or hear well. But I can definitely get a colonoscopy, “depression screening,” and “obesity screening and counseling.” And if I “have a question or a complaint about the quality” of services covered? “Medicare and You” advises calling my “Beneficiary and Family Centered Care Quality Improvement Organization,” a number not provided in the booklet but one I can retrieve by “visiting” Medicare.gov.

But, you ask, what about all the drugs prescribed to keep the aging body going? That would be Medicare Part D; though it seems drugs are not really part of Medicare (with a very few exceptions). If I want Medicare’s level of prescription drug coverage, then, as the booklet states, I “ must join a Medicare Prescription Drug Plan.” Where do I get this plan? “Available only through private companies under contract with Medicare,” each of which has a “formulary,” with drugs divided into different pricing “tiers.” So I’m to understand that the state, representing all retirees, has contracted with private companies to make drug coverage ‘more affordable.” (And I’m urged, as with Medicare Part A, to join a Prescription Drug Plan as soon as I’m eligible, or risk a late enrollment penalty.) But this information is on page 83, and a quick glance tells me that later in the booklet I can read a  whole chapter on part D. Sigh….

I am now barely half-way through “Medicare and You,” and I’m floundering, but by now I’m convinced that unpredictable medical costs will drive my retirement budget. The teacher in me thinks…where’s the multiple choice exam that checks my understanding of “Original Medicare” before I tackle the rest of the booklet. Such an exam would likely be an assessment nightmare for the authors of “Medicare and You.” I suspect it would reveal high levels of confusion, misunderstanding, and definitely a failure to grasp the intricate balance between public and private medical insurance that is the cornerstone of Medicare. In lieu of an exam, readers are instructed to direct their confusion to medicare.gov or a Medicare expert at the end of Medicare helpline. Oh authors, surely you jest!

Since I do not have to make insurance decisions immediately, I am closing the booklet for the moment before tackling the authors’ discussion of Part D and Medicare Part C, the supplemental and simplified way to confront medical expenses post retirement. Since I’ve already learned from TV commercials that my Part C decision “all depends on what you need and what you want to pay,” surely there’s not much more to figure out!

“Medicare and You” promises to demystify the retiree’s health insurance structure. My review….it’s hard to imagine the authors could have written a less user-friendly guidebook. And I’m not convinced that my summary of the book’s information accurately expresses Medicare or the discussion provided by “Medicare and You.”

Should I invest in the 2015 edition of Medicare for Dummies? (Yes, Amazon.com offers this publication and several others that promise to clarify things.) Please, all of you out there who have tamed the Medicare demons and turned them into your servants, HELP! I need your reassurance that eventually the proverbial light bulb might shine, despair might pass, and Medicare, like Foucault, will become just another tool in the coping-with-retirement toolbox.

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4 thoughts on ““Medicare and You”: A Review Essay

  1. I’m a few months behind you. I find the language equally unfathomable so when I saw your post I thought, ah ha, at last someone will explain it all to me. I’ve also talked with our HR people. I remain utterly confused about all of it. I get daily mail with Medicare offers. I have so many many questions.

  2. What drives me to distraction…the notion that it is a “government-run” program that makes things so complicated, when it’s the effort to create this monstrous hybrid that undercuts a simple system with “competition” that offers “choice. HR here offers “are you psychologically ready” seminars but practical information like Medicare…nothing!

  3. Kathleen – I’ll be entering the Medicare nightmare in about 15 months. After reading your post, which I thank you for writing, I’m thinking it will take me that long to research and MAYBE understand all that Medicare entails. I’m an intelligent person but it looks like my IQ won’t be of any assistance in cracking this nut. No wonder Medicare is in such a mess.

    • thanks, Kathy. Health insurance must be one of the retiree’s worst nightmares, if not the worst. Part of my reluctance to retire stems, I think, from the prospect of navigating this program and its private partners. When the semester ends I’m going to investigate Medigap and Medicare Advantage — programs that seem even more opaque than Medicare. And leave me convinced that no matter what choices I make, I’m being ripped off by insurance companies.

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