Column: Madness and migraines? Side effects of trying to negotiate the Medicare maze
More than half a century ago, while working as a teenage playground aide, I made my first payroll-deducted contributions to Social Security and Medicare.
Recently the federal government sent me a letter informing me that I’m about to begin collecting on my investment. That’s good news, but in a perfect world, there’d be less paperwork and bureaucracy as you get older, and fewer hard choices and confusing options.
With Social Security, you’ve got to decide whether to begin collecting at lower monthly amounts in your early to mid-60s or wait for the maximum payout at 70. It’s a roll of the dice either way. I went with the latter, which meant leaving money on the table while worrying that I’ll drop dead 10 minutes after getting my first check this October, when I turn 70.
Medicare is a more complicated consideration. It’s been a while since I looked inside a can of alphabet soup, but that’s what we’re talking about in the big bowl of Medicare options. You have to get familiar with Parts A and B, and also Parts C and D. And then you’ve got the Medigap Plans, which supplement A and B and go all the way up through Plan N.
For clarification, I visited a Medicare website that offered comparisons of Plans A, B, C, D, F, G, K, L, M and N, along with this helpful tip: “The Medigap policy will only pay your coinsurance after you’ve paid the deductible (unless the Medigap policy also covers your deductible).”
I dont' speak gibberish, but it doesn't sound good. And I'm struck by what you don’t get with basic Medicare coverage, known as Parts A and B.
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“I'm glad it covers the catastrophic,” said Bob Yates, a Pacific Palisades resident who shares his thoughts with me on the joys of aging. “But what kind of ‘healthcare’ plan doesn't cover teeth, ears, eyes and prostates?”
Exactly, and just when all those parts begin to fail. The basic plan doesn’t cover prescriptions, either, just as you realize you need a small village of plastic pill compartments.
But fear not, because coverage for vision, hearing, dental and prescription is available in one of the many Medicare Advantage plans, which are also known as Part C, and please don’t ask me why.
I’m not lying when I tell you that on Wednesday afternoon, while trying to wade through all of this, I began seeing waves of bright light roll across my computer screen. I assumed my head was exploding, for which Part A would probably cover hospitalization, but you’d need Part B for an aspirin.
I reached a doctor who asked me to describe the symptoms.
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“Do you have a headache?” he asked.
Yes, I said.
He told me I’d had a visual aura migraine.
No doubt, and with good reason.
“Beneficiaries are confused, and they’re overwhelmed by the choices,” said Jeannie Fuglesten Biniek, a Medicare expert for KFF, a healthcare policy nonprofit. “They’re also overwhelmed by the ads on TV.”
In fact, the Biden administration launched a crackdown this year on inaccurate marketing pitches for Medicare Advantage plans, which cover roughly half of all beneficiaries. And some of the biggest Advantage insurers have been accused of raking in billions by exploiting Medicare.
In a just world, those profiteers would be ordered to cover the millions of people — including children — now at risk of losing Medicaid because pandemic extensions have ended. But there is no just world, and no perfect healthcare system, including Medicare. The good news, said Fuglesten Biniek, is that “the vast majority” of beneficiaries are satisfied with Medicare, whatever their plan.
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But which one is right for me? As someone with titanium knees and a pacemaker, I’d like to make sure I’ve got a fighting chance to keep cashing the Social Security checks. And I'll probably need them, because no Medicare plan covers the biggest medical bill many of us will ever have — long-term care in nursing homes and private residences.
When I got my Social Security payment notice, the same envelope contained an updated Medicare card. I’ve had Part A (hospitalization coverage) since turning 65, and now Part B (basic medical) has been added, effective in 2024.
I reached out to Tatiana Fassieux, a training specialist with California Health Advocates, a Medicare advocacy nonprofit, and learned two things.
First, I will have to pay for Medicare when Part B kicks in next year, and the cost ($164.90) will be deducted monthly from my Social Security checks.
Second, I don't need Part B as long as I’m still working and covered by employer-sponsored healthcare.
Don’t laugh, but I didn’t know you had to pay for basic Medicare coverage. And I don’t know how I ended up with Part B if I don’t need it. Did I make a mistake when I filed my Social Security application?
“Maybe there was a box you checked,” said Fassieux, who advised me to call Social Security immediately.
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Before I cancel Part B, I need to line up my company plan against a Medicare plan and compare premiums, caps, out-of-pocket expenses and what’s covered and not. Speaking of which, it was a bit unnerving to hear Fassieux — a Medicare expert — tell me she was worn out trying to unravel a coverage dispute involving her mother, who had taken a fall and was in recovery.
If you’re frazzled by coverage options, Fassieux said, you can call 1-800-434-0222 and speak to a counselor at the state-sponsored Health Insurance Counseling and Advocacy Program. Or you can call a private Medicare insurance broker, or several, and do some comparison shopping. I called Judy Flowers, with Williams Insurance in Fullerton, and told her I had just entered the Medicare maze.
“When people call me feeling the same way you’re feeling now,” Flowers said, “my job is to keep them calm and walk them through it.”
She gave me two sample options.
A Medicare Supplement Gx plan, along with an additional prescription plan, would cost roughly $400 a month. It would include vision, dental and hearing, and allow me to see doctors of my choosing.
The second, a Medicare Advantage Plan HMO, would cost less than half as much and cover the basics plus vision, dental, hearing and prescriptions, but limit me to a prescribed network of doctors.
It’s a lot to consider, with loads of fine print on caps, co-pays and whatnot, and there are more than 40 Advantage plans to choose from.
I hope at least one of them covers visual aura migraines, but for my health, I’m trying to remain calm.
steve.lopez@latimes.com
This story originally appeared in Los Angeles Times.
