Column: If you do cough up a lung, is one healthcare plan better than another?

Not that I’m seeking your sympathy, but I felt washed out on Sunday, had a throat full of knives on Monday, and became convinced on Tuesday that coughing up a lung is a medical possibility.

I lost my voice and had to postpone a reporting trip to the Bay Area, but didn’t want the week to be a total loss. So I began reading a book called "The Measure of Our Age," which is about the challenge of aging well thanks to ageism, holes in the system and the crippling cost of care. And I dived back into the Medicare maze I wrote about earlier this month, facing a deadline on choosing a healthcare plan.

As if this weren’t enough to keep a sick man occupied, I was in the midst of a blood pressure scare, but let me back up first.

I agreed recently to participate in a study on the impact of air quality on the cardiovascular health of people with heart conditions, and this involved the placement of two air purifiers in my home. As part of the deal, I have to take my blood pressure every day on a device that transmits the results to a lab, and my numbers were consistently high.

So I emailed my cardiologist, who sent in a prescription order to Express Scripts and told me to supplement the hypertension medication I was already taking. I then got a text from Express Scripts, on Aug. 20, saying my Rx would be delivered by Aug. 29.

This company is located in Arizona, which, as I recall, is next door to California. But I’ve run into this before, where I’m told it could take a week or more for medicine to travel 400 miles, and yet the company insists on calling itself Express Scripts. Maybe the name is short for Pony Express Scripts, but even at that, a three-legged mule could make the trip in half the time.

I went to the drug company’s website to see if I could speed things along, and first I needed to enter my user name, which I don’t remember, followed by my password, which I don’t know, and I decided to tempt death rather than comply with the rules of staying alive. So I’m putting my faith in the horse.

As for Medicare, a big thanks to all the readers who sent me stories and advice on navigating the system, with its alphabet soup options, some of which don’t include the coverage you’re most likely to need as you age — prescriptions, vision, hearing and dental care.

Mark Schubb said he’s college-educated but felt like Medicare was “designed to torture and gaslight senior citizens… . And NEVER ask anyone to explain the RX coverage DONUT HOLE because your brain might overheat.”

“I retired after working as an attorney in a largish firm for over 30 years and consider myself of moderate intelligence and ability,” said Michelle Oullette. “But it took many hours on the internet, reading a book on the subject and talking to two insurance brokers to sort of understand. What's a person without a legal background to do?"

(One answer is to call 1-800-434-0222 and speak for free to a counselor at the state-sponsored Health Insurance Counseling and Advocacy Program.)

I heard from readers with only the basic Part B coverage that costs $164.90 a month. And I heard from readers paying as much as $750 monthly for various add-ons. Some touted Medicare Advantage plans; others scorned them.

“Medicare Advantage is terrible,” said Laurie Brenner. “It requires you to negotiate, search and manage limited options under the worst possible circumstances, when you are ill and frightened.”

Gwendolyn Poindexter said that thanks to IRMAA, she was “shocked to find out that I am paying more for my healthcare in retirement, and on a fixed income, mind you, than when I was working.”

IRMAA is the Income-Related Monthly Adjustment Amount that is tacked on to Part B Medicare’s current base rate of $164.90 for individuals and couples with higher incomes, based on a rising scale. And Poindexter was one of several readers who gave me a heads up.

“A lot of seniors are paying $578.30 for just Part B, not $164.90,” wrote a frustrated retired dentist. “And there is IRMAA for all Part D drug plans, adding $77.90 to the cost of any plan.”

None of this is confusing to John Tickner, a retired insurance man and Thousand Oaks resident who says he helped write the first supplemental policy in the 1960s and thinks of Medicare as largely successful and cost-effective. He helps residents of his retirement community figure things out, he said, “and I can assure you that the vast majority of people on Medicare love it.”

As I had written earlier this month, I was notified that I’ve been enrolled in Medicare Part B and will be charged for it beginning in February. That was due to a mistake by me or the government in my filing for Social Security checks, and I still haven’t solved that mystery.

But as someone with an employer healthcare plan, I was advised to cancel Part B before I start getting charged for it. So I called Medicare and was on hold for several minutes before an agent told me I needed to instead call Social Security.

At a certain point, do you find yourself face to face with the Mad Hatter?

“Thank you for holding, someone will assist you shortly,” said one recording, while another reminded me that 50 million other Social Security beneficiaries might be tying up the lines.

While waiting, I came upon this passage in “The Measure of Our Age,” by M.T. Connolly, founding head of the U.S. Justice Department’s Elder Justice Initiative: “Many Americans are surprised to learn two things about long-term care. The first is that Medicare does not cover it, making it the biggest financial risk most Americans face.”

So unless they’ve got long-term care insurance, says Connolly, which is expensive, they have to rely on family or friends, or intentionally dump assets to be poor enough to qualify for Medicaid. And the second surprise about long-term care?

“You can be asked to leave” a long-term care facility for any number of reasons, Connolly writes, including the possibility that it doesn’t accept Medicaid.

Getting older is hard enough without all of this to negotiate, and by the way, I’ll be talking to Connolly about her book on Sept. 6, at Chevalier’s in Larchmont Village.

After 45 minutes on hold, a Social Security rep told me I’ll be mailed a form to un-enroll myself from Medicare Part B. Meanwhile, my voice was coming back and an early surprise arrived from Arizona. I did not see a horse, but the package was left at the door.

One small victory on the long and winding road.

steve.lopez@latimes.com

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This story originally appeared in Los Angeles Times.