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Medicare options postIf you did not know it’s open enrollment time for Medicare, the barrage of advertisements would give you a major clue.

While I have not hit the Medicare-eligible age yet, it is knocking loudly on my door.

My 91-year-old mother’s coverage decided to shove the door open with a resounding bang.

Although Mom is far more knowledgeable than the average 90-something, I involved myself in this latest twist.

I figured over 30 years in the health care/insurance industry should be of some help.

  • One would think
  • But maybe not

Medicare Good News/Bad News

Dad’s former employer is ending its retiree health coverage my mom has had since Dad retired and since he passed.

That’s the bad news.

The good news is the company is subsidizing the coverage. A Medicare “navigation” company has taken over administration.

Medicare Education

I admit I have not kept up with all the details of Medicare options. And trust me. There are plenty of details.

Until I ventured into the world of sole proprietor, my insurance experience was almost exclusively group plans sponsored by employers. As the trend has been for more and more companies to drop retiree health coverage, my exposure to Medicare has been limited.

As someone who likes all things simple, I needed to understand the basic options – and quickly. We had a call scheduled for my mom with one of the administrator’s consultants in a few days.

Medicare Parts

Below is a very basic overview of Medicare options.

  • Part A – hospital insurance
  • Part B – medical insurance – e.g., doctor visits, lab and x-rays, outpatient
  • Part C – private insurance offering Medicare benefits – called Medicare Advantage
  • Part D – prescription drug insurance – also offered through private insurance

Eligible individuals can choose between what is called Original Medicare (very original) and Part C private insurance offerings called Medicare Advantage.

The image below illustrates those options.

Medicare Options

 

My mom had the original Medicare with my dad’s retiree plan as secondary coverage.

Senior Hoops

As I said, my mom is not the typical senior when it comes to health insurance. I used to say she would make a great claims processor. Due to my dad’s health challenges, Mom got very good at claims.

Even with my 30 years in the business, plus Mom’s experience, we had a difficult time overcoming the numerous hoops.

  • The administrator’s online site was not accepting passwords provided by the company
  • The company did not distribute any summary of plan options
  • That information-sharing was left to the new administrator

I am a visual person. That’s why I tried to access the site for available plans.

Our call with the consultant consisted of her reading various plan details over the phone.

  • Deductibles – no deductibles
  • Coinsurance, copays – no coinsurance, copays
  • Out-of-pocket limits, no out-of-pocket limits

It quickly became an exercise in futility.  There were 5 Medicare Advantage plans and 28 Medicare Supplement plans. And that was before we got to the dental coverage.

The consultant was gracious – and patient. But reading off benefit summaries with a million moving parts is not very clear.

Also, she neglected to ask my mom a very BIG question.

Who are your doctors and would you be willing to switch?

Doctor, Doctor

Finally, my 30-plus years in the business served some good.

I knew plans like those found in Medicare Advantage have networks. Not all doctors are in those networks.

Depending on the plan, seeing your doctor could result in one of the following.

  • The visit is covered as an in-network provider (meaning the highest benefit level)
  • The visit is covered as a non-network provider (typically with higher out-of-pocket costs)
  • The visit is not covered as your doctor does not participate in the network

How many seniors do you know who do not want to keep their doctors?

After I advised the consultant that my mom wouldn’t even consider a plan without her doctor in the network, the consultant checked his status for the first time.

From a glass half-full perspective, at least it eliminated a lot of plans.

When I was able to get access online, I found the following −

NONE of the Medicare Advantage plans had my mom’s doctor in its network.

Exceptions Need Not Apply

I also did separate research on eHealth for Medicare plans.

  • eHealth had additional Medicare plans approved for our state
  • If we went outside the plans offered by the “navigation” company, we were on our own
  • AND – my dad’s company would not contribute to the plans selected outside the company

Throughout this process, I wondered how the average senior deals with this UN-simple process.

  • Would the average senior know to ask if their doctors were in the plan?
  • Or would the senior just assume their doctor was in the plan?

How many of my dad’s fellow retirees have seen an ad for a meeting with an insurance company they know? They are everywhere.

  • On TV
  • On the radio
  • In the newspaper
  • On signs plastered around the city

I doubt many of them would know what happened if they signed up with that carrier instead of one offered by the navigation administrator.

My dad’s company could have done a better job of communication (in my humble opinion).

  • Why didn’t the company let their retirees and their families know the consequences of going outside the navigation company plans?
  • Why didn’t retirees have access to their choices prior to the call with the consultant (either online or in print)?

As I help Mom assess her options, one fact is clear.

There is nothing simple about Medicare options − but the communication could be.

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Helping you Keep it simple, clear & uniquely yours – contact me for help with your business writing needs. Visit my business blog, Simply stated business.

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Notice of Disclaimer –Cathy Miller is not an attorney or health care provider and cannot provide legal or health care advice. The information provided is for your general background only, and is not intended to constitute legal or health care advice as to your specific circumstances. We recommend you review legislation with legal counsel and visit your physician for health care issues.

BigStock Photo Credits

 

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