I went to the doctor, a podiatrist. It was my first visit to the clinic and I spent maybe a grand total of 6 minutes actually speaking with the doctor while she performed a very quick procedure. The cost for 6 minutes of her time? $193.07. Yes, I know, she has to pay rent, her staff, etc., but seriously, $193.07?! And, at the end of the procedure there was a sales pitch to buy a miracle cream for just $30; $40 if I bought the box set.
The Medicare Maze
Why do I bring this up? Because when one reaches a certain age, life presents all kinds of interesting scenarios. Enter… the Medicare Maze. No, I am not yet of an age to qualify for Medicare, but I did inadvertently fall into the maze while Abi – who celebrated his 65th year in August – did his utmost to navigate through the process of enrolling. The task is not for the faint of heart.
It all started when Abi signed on to collect his social security benefits. Fortunately, our local social security office is staffed with knowledgeable people who took the time to walk us through the process. Simultaneously, Abi took on the challenge of the Medicare Maze. It started with a visit to the Dept. of Aging. You know you’ve entered a new chapter in life when you set up a meeting at the Dept. of Aging.
Medicare Options
Luckily, we met with an exceptionally helpful woman who spent 1 1/2 hours with us detailing the abundance of Medicare options. Frankly, as much as it was helpful, it was equally overwhelming because it is not as simple as just signing on the dotted line and wham, bam, thank you mam, you’ve got a Medicare card. Oh no, no, no.
Parts A, B, C & D of the Medicare Maze
This is a mere glimpse into the Medicare Maze and the components of how one navigates the blind twists and turns:
- Everyone who has paid into the social security system qualifies for Medicare at the age of 65, unless you have special circumstances which might allow you to enroll before age 65. But it doesn’t mean you have to sign up if at the age of 65 you’re still working and have coverage through your employer.
Part A
- Part A is hospitalization coverage and Part B covers doctor visits, lab work, outpatient, etc. Each has its own set of deductibles that change from year to year based on the cost of living index. Part A is free, but Part B requires a monthly premium paid to Medicare based on your accumulated paid social security taxes. Neither Part A or B pays for 100% of incurred expenses. This means you can choose to enroll in supplemental coverage offered by private insurance companies. And, to make it even more fun, you have just six months to enroll in supplemental coverage. Otherwise you will incur a penalty should you choose to enroll at a later date.
Parts C & D
- Now let’s talk supplemental coverage Parts C & D, which are also offered by private insurance companies. Part C is referred to as Medicare Advantage Plan. It is generally a combination coverage of Parts A & B plus additional benefits such as prescription, vision, dental. Part C can be thought of as a good option for those who don’t want to think about taking on individual components. Think of it as a package. Part D covers prescription drugs. One has 63 days, from the first day you are approved for Medicare, to choose to participate in a prescription drug plan, otherwise you’ll get penalized should you decide to enroll in Part D after 63 days.
Major Medical
So how did I inadvertently fall in to the maze? As part of the process, Abi needed to cancel his health insurance. Two months later, much to our surprise and frustration, we learned my insurance had been cancelled as well. Without knowing it, I had been walking around without health insurance. Augh! There was a massive lack of communication. It boiled down to the insurance company cancelling my coverage because Abi was the primary on our account. What’s a girl to do? Start over.
Choices
There are, of course, a multitude of choices when it comes to heath insurance. I’m not even going to go down that road. I chose to stick with our previous company. Somewhat surprising, I know, having just gone 10 rounds with the company to get it all straightened out. But there you go. I now have individual health care coverage. But, because I rarely get sick and because I only have one prescription, I opted for major medical coverage. This translates to one hell of a deductible, which leads me back to the $193.07. The cost of an office visit now comes out my pocket. So, I’ve become keenly aware of how much I’m being gouged charged.
Medicare Maze
It’s a toss up, just like it is with the Medicare Maze. I could opt to pay big bucks to have more coverage. Abi could opt for supplemental coverage, but is it worth it? Oo pay money every month for insurance we may never use? Especially, when one is retired and living on a fixed income. It’s a crap shoot. It’s just one of the big “What If” questions everyone faces when they enter the Medicare Maze. Good luck!
To learn more about enrolling in Medicare:
Intentional Retirement. Joe offers several good articles.
The Official US Government site: Medicare.gov
Shocking prices, shocking pharmaceutical industry. I love how in so many countries in Asia one can get medications directly over the counter without a prescription. So you know you need antibiotics, you save the doctors fee and go directly to the pharmacist who gives you what you need. What a novel concept
Agreed with your thoughts on prescription meds. Thanks for stopping by!
Not something I look forward to and still have a few years for the rules to change again and again.
Gaelyn recently posted…Foto Friday Fun 181
I have a few years as well, and at least when I get there, we will have already navigated the maze and hopefully, it will be less challenging.
I’m a recovering Social Security disability lawyer. For 30 years, I represented claimants for Social Security disability benefits through appeals to Federal Court, if necessary. In law school, some of my classmates gave me the (affectionate?) nickname, “the Code Queen” because I seemed to be able to find my way through a thicket of regulations and statutes. For example, the definition of “disability” under the Social Security Act is only one sentence long, but then there are regulations, Rulings, case law and a Program Operations Manual interpreting every word and implementing a procedure for administering claims. I know that the Medicare system is just as complicated. I’m not looking forward to climbing down that rabbit hole when Mr. Excitement turns 65.
Suzanne Fluhr recently posted…Touring Iceland’s Golden Circle Route from Reykajvik
It’s not fun, Suzanne, definitely not fun. But, at least you have an edge in that you understand the social security system and how to navigate said system. That’s got to be a plus.
In the UK we are very lucky to have a good NHS, although it can sometimes take ages to get an appointment to see a GP or other health professionals. I work for the NHS and could also work privately, but have chosen not to do private work at the moment. My husband has private health insurance via his work and we tend to use that if we need a more urgent treatment, but if he retires next year we might need to think if it is worth continuing to pay for private health insurance? We probably just stick with the NHS and pay for a private consultation to get a fast diagnosis if needed. If only we could have a crystal ball to help us with these decisions?
Gilda Baxter recently posted…A Weekend in East Devon and Our First Airbnb Experience
You are very lucky indeed, Gilda. The US took a big step forward with the Affordable Care Act, but there are those who would love to knock it down. Just another political bone of contention, but it sure has helped millions of people get health care. I don’t know the cost factor in the UK, but private insurance in the US is expensive so Medicare is a big savings for those on fixed incomes.
We need single payer!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Would love to see this happen, Sandy, but it has become such a political hot button it’s seemingly unlikely – but we can hope!