Medicare's Complexity Can Be Scary

Oct 8, 2014

As of Nov. 1, I will be on Medicare, which means I have to enroll this month. I should have plenty of company, since open enrollment for 2015 begins Oct. 15.

Credit .S. Department of Health and Human Services

As a reporter and editor on the health-care beat, I’ve been explaining Medicare to the public since 1976. So people assume that I understand it thoroughly.  

But writing about Medicare is one thing; living it is another. For advice, I called Barbara Katz, a former reporter and lawyer who recently moved to Longboat Key from another state.  She enrolled in Medicare and a supplemental plan six years ago.

“Oh my God, It was an absolutely awful process,” Katz said. “ I can read, I can understand, I can analyze,  and yet I found the Medicare explanations and choices almost impossible to figure out. I tried making charts, and I was getting nowhere."

“Did you get a booklet --it’s called “Medicare & You”? Absolutely I pored over it. Yes, I studied it as though I were going to have to take a test on it," she said. "I thought, you know, they’ve  laid it out in nice type and whatever, I should be able to figure this out. And guess what, I could not!”

She eventually turned to an insurance expert for help. So did I, sitting through four hours of Medicare 101 given by  a free state-sponsored information program for seniors called SHINE. Here is Polk County's SHINE coordinator, Jean Berken of Lakeland.

“The nice thing about our program is it’s made up of volunteers," Berken said. "Our services are free and confidential, and the best thing of all we don’t sell anything. We’re unbiased.”  

Carol Gentry

She offered lots of advice to me and about 30 other newbies to Medicare.

“Those of you who have been talking to all your friends now they know that you’re turning 65 – happy birthday, by the way –one size does not fit all, " Berken said.

New enrollees need to decide what’s most important. Which plans include your drugs? How important is keeping the same doctors? Is that flexibility worth the price?

To weigh the options, beneficiaries must understand Medicare’s alphabet soup: Part A for hospital bills, Part B  for doctors, and Part D for drugs.   (Part C is the official name for Medicare Advantage plans, but hardly anyone calls it that). 
         
The federal government charges a premium for Part B, just  over  $100 a month. Even then, Medicare Parts A and B cover just 80 percent of the bills. How to cover the other 20 percent?

One solution, says SHINE volunteer Bill Ferrari of St. Petersburg, is to buy a Medigap plan and a prescription drug plan.

Bill Ferrari, SHINE volunteer
Credit Marianne Ferrari

“That’s kind of the “Cadillac coverage” for people that might have issues about their health, concerns about their health," he said. "It provides the most coverage, the most flexibility in terms of seeing providers, and it’s something they should consider.”

That is, if they can afford it. A state Insurance Department website shows Medigap supplements range in price from about $2,000 to $6,000 a year (depending on how many services they cover, and the applicant’s age, county and whether they smoke).

It’s a lot of money, but some beneficiaries are willing to pay it just to avoid managed care.  

“For somebody new coming in, one of the first things I ask: How do you get your coverage now? Just to get a feel for what you’re comfortable with," Ferrari said.  "You’re in an HMO, so that definitely should be in the list of what we look at. Whereas other people say ‘I don’t trust HMOs, what else are my options?’”

Whatever the choice, SHINE volunteers say, it’s important for beneficiaries to check their options every year because they often change prices, drugs, and hospital or doctor networks.

But a lot of people don’t. That includes Barbara Katz.

“Well, I found the initial process so onerous, so unpleasant, that I have basically chosen not to look into it again ever since then,” she said.

With that cheery thought, I set out to look at my choices. I’ll report on how that works out later.

Meanwhile, those who are already enrolled in Medicare should keep in mind that open enrollment -- the opportunity to get better coverage or save money -- is set for Oct. 15 through Dec. 7.

Health and drug plans are listed by zip code at www.Medicare.gov.

Floridians can get free unbiased advice from SHINE (Serving Health Insurance Needs of Elders). A free program operated by the Florida Department of Elder Affairs and regional Agencies on Aging, SHINE volunteers offer unbiased advice on Medicare plan options, both in community meetings and one-on-one.

See a list of SHINE’s community events at its website, www.FloridaShine.org. For personal assistance, call 1-800-96-Elders, 1-800-963-5337,  Monday through Friday, 8 a.m. to 5 p.m., and leave a message.

Here are other resources:

-- Turning 65? 9 Tips for Signing up

--Beware of Shifting Options Within Medicare.

--Medicare Rights Center, especially the Medically Interactive section

--To Switch or Not to Switch?

-- National Council on Aging's MyMedicareMatters.

--Consumer Reports' "Managing Medicare"