PUMPING IRONY: The Medicare Muddle

Along with pitches from local mortuaries and long-term-care “communities,” our mailbox here in Geezerville regularly attracts invitations to learn more about various Medicare Advantage plans. It’s not fair, I suppose, to call these health-insurance promos unpersuasive, since they’ve always landed in the recycling bin unread. Suddenly, however, My Lovely Wife and I find ourselves intensely interested in what they have to offer.

Part of our previous disinterest involved the fact that we’re both covered by my employer’s generous health plan, one that convinced me to enroll upon my 65th birthday only in Medicare’s basic hospitalization plan, also known as Part A. But with MLW nearing her own senior status, it seemed prudent to begin investigating our options. What we discovered was both slightly alarming and — if I understand it correctly — surprisingly gratifying.

Unlike her husband, MLW tends to approach major decisions by gathering sufficient information to thoughtfully weigh all options. In this case, she registered to attend a Zoom seminar hosted by a local Medicare expert. I suspected the session would veer irretrievably into an annoying product pitch, but she counseled patience, and on the appointed evening we gathered around her computer at the dining room table to take in the spiel.

Five minutes in, she was ready to abandon ship, but I suggested we linger through another slide or two. Soon, we were ushered into the murky world of Medicare and its mysterious web of mandates, guidelines, and exemptions. Who knew that enrolling in Parts A, B, and D was mandatory unless you’re covered by your employer’s plan? Or that failing to sign up triggers harsh financial penalties? Or that most Advantage plans cost nothing beyond your basic monthly Medicare premium and in many cases cover much more than a typical health plan?

We like to think of ourselves as fairly well-informed healthcare consumers, but our hourlong Zoom session left us wondering how we’d managed to stay in the dark about so much of the Medicare puzzle — especially since I’d enrolled five years ago. Turns out we’re far from alone.

More than 700,000 people paid late-enrollment penalties in 2017, according to the most recent data from the Centers for Medicare and Medicaid Services (CMS). And most of them probably responded to those penalties like Sarah Truman did. The 67-year-old retired teacher’s aide was covered by her husband’s COBRA plan, so she waited until a couple of weeks before that plan expired to enroll in Medicare Part B. But she “got the shock of my life,” she told the Wall Street Journal,when she learned she’d have to wait eight months before her coverage would kick in — and she’d be charged as much as 20 percent above the normal monthly premium for her delayed enrollment.

“I don’t feel like I did anything wrong,” she says. “I wasn’t cheating the system. I had insurance. It makes no sense to me that I am being punished.”

Then there’s Matilda Gavalis, with whom I can’t help but feel some camaraderie. She and her husband enrolled in Parts A and B at the appointed time, but they opted out of the prescription drug plan (Part D) because neither of them felt the need to take medications. When Gavalis attempted to sign up for Part D after her husband’s death a few years later, she learned her tardy enrollment would add $44 to the plan’s basic monthly premium — more than doubling the cost — for the rest of her life.

“No one said if you don’t sign up now you are going to pay a penalty and it’s going to go up every year,” she told the Associated Press. “I’m sure if [my husband] realized the consequences . . . he would have signed up even though we didn’t need it.”

MLW and I are similarly wary of pharmaceutical interventions, but we’re fortunate that my employer’s health plan offers coverage, so we should avoid Gavalis’s fate when we make the move to Medicare. Still, it’s just another example of how opaque the enrollment process can be. “People I talk to just didn’t understand and didn’t know they had to take affirmative steps to enroll,” says Leslie Fried at the National Council on Aging.

Like many of my geezer compatriots, I’d overlooked the fact that Medicare is really no different from any other insurance plan that requires a balanced risk pool — a blend of healthy and unhealthy people paying into the system. Hence the penalties assessed to those who fail to enroll. Allowing healthy seniors to put off signing up until they feel the need, Fried explains, would be like “allowing someone to buy fire insurance when their house is on fire.”

Writing in MarketWatch, Allyson Schwartz, CEO of the Better Medicare Alliance, describes the many ways Medicare has changed since its creation in 1965 while bemoaning the government’s inability to communicate those changes. “The lack of clear information on enrollment options and deadlines impacts not only costs for seniors, but access to the care and benefits they need,” she notes. “It doesn’t have to be this way.”

The bulk of Schwartz’s recommendations — a stronger role for the Department of Health and Human Services, multilingual information sources, a “CMS approved” seal for Medicare resources — falls a bit short of the mark. But I perked up when she suggested that CMS should begin reaching out to folks with enrollment information a year beforethey turn 65 while also encouraging employers to convey its many nuances to their employees.

And, having briefly logged on to CMS’s Medicare Plan Finder, I’d have to agree with Schwartz that the site doesn’t exactly mitigate the general sense of hopelessness among anyone hoping to weigh their best healthcare options.

What is clear is that, among the dozens of Medicare Advantage plans available in our neck of the woods, there seem to be several that offer benefits unavailable in Parts A, B, and D — with no copays or deductibles — for the same monthly premium charged for Part B. Those benefits include dental and vision services as well as hearing aids (which are of particular interest to this hearing-impaired geezer). The monthly costs would be slightly higher than what I’m currently paying for my employer’s coverage, but the overall coverage is far superior.

Or at least I think it is.

Toward the end of our Zoom session, when the presenter encouraged attendees to schedule an appointment with one of his colleagues to explain all the options and complete the enrollment process, MLW and I rolled our eyes. Here’s the scam, I thought.

“How much does the consultation cost?” someone inquired.

“There’s no charge to you,” he replied, explaining that the company is paid by the Medicare provider you choose.

I’ve always been of the opinion that when something seems too good to be true, it probably is. I guess we’re about to find out.

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