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Signing up for Medicare

August 27, 2012

I have been helping my husband get signed up for a Medicare plan.  This process is incredibly, ridiculously complicated.  There is a specific window of time in which you must sign up, 3 months before and after the month in which you become eligible to join, a total of 7 months.  My husband will be eligible this fall, so I’ve been looking over the plans available in my area.

Medicare consists of part A (Hospital care), part B (other stuff like doctor visits, lab work, etc.), part C (Medicare Advantage plans), and part D (drug coverage).  I assume the reason for all these separate parts is because this is a clunky system that is difficult to modify as times change.  As expenses for different aspects of health care become unmanageable for the average person, another part is added on, such as the addition of part D when it had become painfully clear that nobody can afford to pay for medicine themselves. The bizarre regulations within each part, such as the “donut hole” of part D must result from the contentious negotiation that goes into developing these programs.

In my husband’s case, the first step was receiving his Medicare card in the mail when his SSDI claim was approved.  One is eligible for Medicare 2 years after the date Social Security begins paying disability benefits, 2 years and 5 months after the date you actually are determined to be disabled.  For example, you get sick and stop working February 1, 2012.  That would be the date you became disabled.  You would be eligible for payments from Social Security Disability Insurance five months later, July 1, 2012.  You would be eligible for Medicare July 1, 2014.  Certain exceptions exist, such as immediate Medicare coverage for those with end stage renal disease.

Next, it is time to review the Medicare plans available in your area.  For this, go to Medicare.gov.  Click on the button that says “Find Health and Drug Plans.”  This takes you the the Medicare Plan Finder.  The Plan Finder has you enter your zip code to find the plans available in your geographical area.  You will have the option to enter the prescription drugs you take in order to get estimates of actual costs for each plan.  Yes, there are different plans all over the United States.  In my area, there were plans offered by big companies like Humana and Scott and White, then there were no name companies you never heard of with plan names like “Any, Any, Any Gold.”  I am not commenting on the value of the Any Any Any plan, but come on.  How can you possibly take that seriously and depend on it for your health care?

I am still figuring out the in’s and out’s of this business, even after committing my husband to a year of a Medicare Advantage plan.  I figured out after I signed up that you can only get a Medigap (medicare supplement) insurance plan if you use original Medicare.  You are not allowed to buy supplement coverage with a Medicare Advantage plan.  The advantage of using a Medicare Advantage plan is there might be more doctors available to you.  Some doctors, particularly primary care, have stopped taking Medicare because of the bureaucratic burden and/or poor reimbursement.  Most of those doctors still take private insurance.  That is the case with our primary care doctor.  She stopped taking Medicare a couple years ago, but takes insurance like Humana, United Healthcare, etc.  Signing up for a Humana PPO plan allows my husband to continue seeing her.

It all comes down to doing the number crunching.  Figuring out whether the cost is less using original Medicare A and B with a Part D prescription drug plan and a Medicare supplement OR a Medicare Advantage plan.  In our case it may still have been cheaper to use the Medicare Advantage, but I didn’t get to compare properly before choosing because I didn’t realize you could only use a supplement with original Medicare.  See this site for an explanation of Medigap policies.

Doing the final price comparisons was easier for me on the actual insurance company website.  I looked at what was available in my area on the Medicare website, decided which company I probably preferred to deal with (in my case Humana since I have had coverage with them several times in the past and had no real trouble dealing with them), and then found the Humana Medicare website.  The big companies seem to have a separate site for their Medicare policies.  For example, Humana has their primary website and a site dedicated to their Medicare plans.  Once on their website, I was able to enter my husband’s prescription drugs and get estimates of our out of pocket costs for different plans.  Yes, Human has something like 10 different Medicare plans in my area.  On their site you could also enter all your doctors, so the plan details would show whether they were in network or not.  Nowhere could I find an actual list of the doctors on their panels.  It was trial and error, entering doctor names and then seeing if they were in network on various plans.  I gave up trying to find any primary care doctors on their HMO.  I prefer PPO’s anyway despite increased costs.  It’s worth a few more dollars to me not to have to get PCP referrals every time I need to see a specialist.

The layers of bureaucracy and complexity in the Medicare system are ridiculous.  It’s extremely difficult to navigate, though works ok once you have everything set up.  Signing up actually isn’t hard, but understanding your options is.  If you find it overwhelming, get help from an insurance professional or a friend with knowledge of the system.  It’s hard to figure out the best deal, but if it doesn’t work out as well as you like this year there’s always next year.  You get to change plans every year during open enrollment!

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