THIS IS WEEK No. 3 of describing the Medicare Machine.
I am not going to regurgitate the past few weeks’ columns, because that would place all of us squarely into the Department of Redundancy Department, so if you’re just walking into the middle of this, good luck.
Remember the part about how you could delay enrolling in Part B because you were still employed?
Well, if you retire, become unemployed or for whatever reason lose your employment-related health insurance, you will have an eight-month “Special Enrollment Period” (SEP) to get into Part B, which starts the month after your other insurance ends, and the effective date of your Part B coverage will be the first day of the month following enrollment.
If you have prescription drug coverage through employment (or whomever/wherever) and it goes away, you will have a 63-day SEP to get into a Part D plan without incurring the dreaded Penalty.
Now, you might or might not recall that last week, I vaulted over Part C, which most of us refer to, affectionately or ruefully, as “Advantage Plans.”
Here’s the deal:
Basically, there are two ways to get Medicare: 1) “Original” Medicare, which means everything that we’ve been immersed in for the past three weeks, or 2) through a Medicare Advantage Plan.
Advantage Plans are Medicare’s version of “managed care,” so the classic example would be an HMO (“health maintenance organization”).
Most HMOs in the world are places you go to and receive virtually all of your health care — same place, same folks, same billing procedures, all your records in one place, same coffee, same magazines, etc.
Many people who use HMOs love them.
Where HMOs aren’t, there are various permutations of Advantage Plans, such as “preferred provider organizations” and “private fee-for-service” plans, and others.
Historically, some folks have really liked them because they tend to be cheap and sometimes offer benefits that “original” Medicare doesn’t offer, such as some vision, hearing and/or preventive stuff.
The downside has been that not all health care providers have accepted all Advantage Plans, so it was always a crapshoot about who accepted what this year, and sometimes, there were some other funny little things such as “facility charges” or whatnot.
The litany was: Read the contract.
A few years ago, a lot of Advantage Plans went away.
There were several reasons for that, some or all of which were “wonderful” or the “end of the world,” depending upon your socio-political views of the good ol’ U.S. of A., and none of which matters if you’re just trying to understand the Medicare Machine, because “gone” is … gone.
There are no Advantage Plans in our neck of the woods.
Why? Well, because health insurance companies decided that they weren’t making enough money, so they pulled out.
They can do that.
So, why am I going on about them?
Well, they might come back or you might move or any other number of possibilities.
If you become Medicare-eligible this year and want to learn more, go to www.medicare.gov and read it slowly and carefully, or call any of the numbers at the end of the column and ask for help, where decent people will help you for free.
In as few words and as few weeks as possible, that’s what the Medicare Machine looks like, so reassure yourself about your attention span and reward yourself with a cookie (or some celery, depending upon your socio-political views) and breathe, but beware of lulling yourself into a false sense of security or knowledge.
Here’s why: Once you enter The Machine, you’ll begin to encounter unanticipated (although often good) variations on themes, such as the “Low Income Subsidy,” which can help pay for Part D-related stuff, or the “Medicare Savings Programs,” which helps pay for Part B-related stuff, and on and on.
Medicare does not pay for long-term care long term. It will pay for up to 100 days in a “skilled nursing facility” (read “nursing home”) if you need it and if you meet certain eligibility requirements.
It doesn’t usually pay for things such as hearing aids, dental care or foot care — note the use of the term, “usually.”
See? This isn’t easy stuff, but don’t panic: Most of us seem to be able to figure out most of this most of the time, and usually with help. Help is allowed.
So, you can do this, but understand that it will go best if you take your time, pay attention and think of it as your “job,” not just a quick, little “something” that you’ll get done between batches of cookies …
Because you won’t.
I know what you’re thinking: “There has got to be a way to beat this game.”
You’re right, there is: Use it as little as possible, which means use health care as little as possible, which means stay as healthy as possible.
And you don’t need me to tell you how to do that. Besides, I probably wouldn’t listen to you on that subject, either.
Take the politics and the emotion out of all this, and remember that if you’re old enough to care about this stuff, then you’ve been smart enough, for 60-plus years, to survive in America, so you can do it.
You just don’t want to.
I don’t blame you — neither do I — so I’m going to have a bumper sticker made:
“Medicare happens.”
________
Mark Harvey is director of Clallam/Jefferson Senior Information &Assistance, which operates through the Olympic Area Agency on Aging. He is also a member of the Community Advocates for Rural Elders partnership. He can be reached at 360-452-3221 (Port Angeles-Sequim), 360-385-2552 (Jefferson County) or 360-374-9496 (West End), or by emailing harvemb@dshs.wa.gov.
