Posts Tagged ‘Medicare’

Musings on Medicare

Posted: March 21, 2023 by chrisharper in Uncategorized
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By Christopher Harper

As the debate over the future of Medicare hits its stride during the upcoming presidential campaign, policymakers should look at the cost of Medicare Advantage plans as one way to save money.

Advantage plans are those run by private insurers rather than the government providing government payments for hospital care and physician costs. My plan also includes drugs, dental, and eye care.

Private plans have been an option in Medicare since the 1970s, but enrollment in private plans remained relatively low through the 1990s. Aside from changing the name of Medicare private plans from Medicare+Choice to Medicare Advantage (also referred to as Medicare Part C), the Medicare Modernization Act of 2003 made significant changes that propelled enrollment growth. The Affordable Care Act of 2010 also made many changes that enhanced plan enrollment. As a result, about half of all seniors have a Medicare Advantage plan, or 30 million people, up from 11.5 million in 2010.

Unlike the government plan for Medicare, which costs me $170 a month, whether in the program or an Advantage plan, the private insurer puts money in my pocket to join.

The coverage costs me nothing other than the fee for Medicare. But there’s a lot more. My Advantage plan gives me a $25 monthly reduction in my Medicare payment or $300 yearly. The plan pays my YMCA membership of $43.10 monthly or about $500 annually. The program gives me a $500 debit card to use mainly for dental work and eyeglasses, and I get a credit of $25 a month, or $300 a year, for over-the-counter drugs and items like throat lozenges. All told, that’s $1,600 a year for just signing up.

I’m not exactly willing to give up these perks, but it seems the government has been awfully generous to the private insurers if they can entice me with all these goodies.

The government pays private insurers about $12,000 a year for people who sign up for Advantage plans—a number that has risen significantly in recent years. That allowance is where I think the government should reassess whether that’s too much money.

Although I realize my health is better than many seniors, I cost my insurer about $1,200 last year. I’ll bet there are more people like me in my county, which is the geographical area upon which the government payouts are based.

According to the Institute for Health Metrics and Evaluation at the University of Washington, Lycoming County, where I live in central Pennsylvania, has seen better health since the 1980s. However, lung cancer and diabetes have increased somewhat.

I think various changes must be made to save Medicare, but I think a good hard look at Advantage programs and how they operate may be a good start without causing significant hardships to seniors.

The Medicare morass

Posted: June 21, 2022 by chrisharper in Uncategorized
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By Christopher Harper

As I head toward retirement at the end of the month, my wife and I have had to delve into the Medicare morass.

Simply put, Medicare is one of the most confusing bureaucracies I’ve ever dealt with. Since I used to report on government bureaucracies, I thought I would have some expertise in cutting through the weeds.

For the most part, I was wrong.

For those who have yet to head into the Medicare morass, I pity you. For those who have managed to get through the barriers already, I applaud you and also pity you.

Medicare, run by the Social Security Administration, is one of the most complex organizations in the country, providing some form of hospital, medical, and drug coverage for millions of Americans, most of whom are 65 and older.

Here’s my story of banging my head against the Medicare walls.

I wanted to sign up for Medicare coverage a few months before I retired, and that’s tricky. I was able to sign up for Medicare, but I couldn’t tailor our coverage until one month before I retired.

That’s when the voluminous number of letters and responses started with Medicare. It appears that the organization doesn’t know how to use email or other forms of electronic correspondence.

I had to file three separate letters to Medicare to convince the minions that I was retiring.

I then was told my Medicare costs would be significantly higher for my wife and me because I earned more than I should in 2020. I had to appeal that decision, convincing the authorities that my retirement in June would mean I wouldn’t make as much money. That took two appeals—another set of letters and responses—until I finally returned to the original Medicare cost.

Then I decided to obtain a Medicare Advantage program from a private insurance company to ensure my wife and I got decent coverage for health issues and drugs. It’s rather strange since we don’t have many health issues.

The number of Medicare Advantage programs is voluminous and complicated. I still don’t truly understand the drug formula, known as the “donut,”—which is supposed to make it less costly the more drugs you have to use.

Most of my doctors take Medicare, but my chiropractor doesn’t. He finds it too costly to get paid by the government.

Our dentist doesn’t take Medicare. In fact, only a handful of dentists in our area take Medicare, so we added an extra dental plan at $109 a month.

For the past decade, I have had a Health Savings Account, which allowed us to save about 25 percent in taxes on the money spent for copays and other approved procedures that insurance plans didn’t cover. That saved us about $600 a year in taxes.

Medicare doesn’t allow such accounts. Although Congress has tried to pass such measures, not much has happened.

During the 2020 campaign, most Democrats called for “Medicare for All,” meaning that everyone would be brought under the umbrella of the health program. Since it’s estimated that Medicare may go bankrupt in a few years on its present course, it seems evident to me that would be a bad idea.

I’ll report later whether Medicare works for my wife and me. But I’ve added a few more gray hairs and seen my blood pressure rise during my lengthy attempt just to get signed up for the program.