From the moment that envelope arrived, I knew it would be trouble. It lurked, sullen and threatening, on the far corner of my desk, until I finally acknowledged the inevitable, and set Scarecrow to work on it with a very pointy letter opener.
Back in June of 2009, when I officially retired from gainful employment, December of 2011 seemed unimaginably far in the future. I had no idea how I would patch together some kind of spiderweb of health insurance coverage that would last until I finally became eligible for Medicare. Somehow, between the COBRA subsidy, Tuffy being a university student, and Scarecrow losing one job and immediately finding another, we seem to have managed it. Now I'm simultaneously extremely relieved, and very apprehensive. I've spent the last couple of weeks, off and on, trying to figure out Medicare.
The following probably won't be of interest to anybody who's already on Medicare, because you already know all this. And it won't be of interest to anybody who's not on Medicare, because you don't need to know about it. It won't even be of interest to anybody currently sorting through their Medicare options, because you probably don't have the same choices I do. But blogs aren't about what you want to read; they're about what I want to write. And I need to sort this stuff out. Just so you know.
So, Medicare.
My first option, as I understand it, is to do nothing. Being a lazy slime weasel, this has a certain appeal. If I do nothing, I'm automatically enrolled in Medicare part A, the original major-medical-type Medicare, and Medicare part B, which covers outpatient-type stuff. There is a premium for Medicare part B, which is automatically withheld from my Social Security benefit. This option has the advantage of being easy, cheap, and I can go to any doctor who is willing to accept what Medicare is willing to pay them. The downside is that it leaves some significant gaps in coverage, not least of which is that there is no limit on out-of-pocket expenses, and no prescription drug coverage.
Another option, almost as easy, would be to supplement regular Medicare parts A and B with what they call Medicare part D. This is a policy sold by a private insurance company to cover prescription drugs. Different companies offer different policies, covering different drugs, with different premiums and different co-pays, so figuring out the best choice for the drugs you take today, and for the drugs you may be prescribed in the coming year, is no small undertaking. Still, once you do your homework, this has the advantages of unadorned Medicare, and it covers drugs. It also leaves Medicare's coverage gaps, including the lack of limit on out-of-pocket expenses.
There is something called a Medigap policy, which sounded like what I was looking for: Medicare, with some of the gaps filled in. Turns out this is something insurance companies only need to offer to you if you qualify for Medicare by turning 65. If you qualify for Medicare when you're younger than 65 – like because you're disabled – most states don't require insurance companies to offer you this kind of policy; Washington doesn't, and they don't. Next!
OK, now it gets complicated. Medicare part C, as I understand it, is a policy sold by a private insurance company. It replaces Medicare part A and Medicare part B, usually with some additional coverage, maybe including drug coverage but maybe not. Some policies limit you to providers in their network but some don't. They have different premiums and co-pays and coinsurance and drug formularies and a million other moving parts. The Medicare website offered to help me compare the 53 plans that are available in my area. It took a while, but I finally managed to narrow it down to two. The major difference between them is that one plan limits you to providers in their network – and it's a pretty small network. The other plan has a very large network of providers, including the family practitioner, neurologist, rehab specialist, physical therapist, and occupational therapist I've been seeing for the past couple of years, and is somewhat more flexible if you don't find anyone you like. It would also probably cost about $1500 more a year.
So after all that comparing, and what-iffing, and back-and-forthing, and endless dithering, it comes down to this:
You get what you pay for. And you pay for what you get.
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