So Stop Dithering, Already!

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.

Medicare for Dummies

OK, I need to buckle down and do this. After two years of scrambling to patch together some kind of health care coverage that we can more-or-less afford, in December I finally become eligible for Medicare. Apparently there are decisions to be made. I'm a little apprehensive about this.

Fortunately, the Centers for Medicare & Medicaid Services provide a little (147-page) booklet:

Medicare and You 

This is the official US government Medicare handbook

Yes! Documentation! A user manual! As one of the infinitesimally small number of people on this planet who actually read these things, I find this very reassuring. It's filled with pictures of such happy people. If they've done this Medicare thing and they're still so cheerful, how bad can it be? Aside from the gray hair, most of them don't even look all that old. In fact, they look about my age. What's up with that? The print is comfortably large, I guess so they don't have to produce a separate large print version – accessibility and all that. Well, maybe not. On the back cover, it says it's "also available in Spanish, Braille, Audio CD, and Large Print (English and Spanish)." I wonder how large the print is in the large print version?

So I start reading. They put the index in the front, which seems odd. I don't know if I like the idea or not. On page 58, I find:

Things to Consider When Choosing Your Medicare Coverage

Excellent. This sounds like exactly what I'm looking for. They followed this with a bunch of questions:

Are the services you need covered?
Are you eligible for other types of health or prescription drug coverage?
How much are your premiums, deductibles, copayments, coinsurance, and other costs?
How much do you pay for services like hospital stays or doctor visits?
Is there a yearly limit on what you pay out-of-pocket?
Do your doctors and other health care providers accept the coverage?
Are the doctors you want to see accepting new patients?
Do you have to choose your hospital and health care providers from a network?
Do you need to get referrals?
Do you need to join a Medicare drug plan? 
Do you already have creditable prescription drug coverage?
Will you pay a penalty if you join a drug plan later?
What will your prescription drugs cost under each plan?
Are your drugs covered under the plan’s formulary?
Are there any coverage rules that apply to your prescriptions?
Where are the doctors’ offices?
What are their hours?
Which pharmacies can you use?
Can you get your prescriptions by mail?
Do the doctors use electronic health records or prescribe electronically?
Will the plan cover you in another state or outside the U.S.?
Are you satisfied with your medical care?

Seriously.

The Socratic method is just not working for me here. How the f#@k should I know? Isn't that what I'm trying to find out? If this is an FAQ, I've got the Qs. What I need are the As. And the $$. I need to know about the $.

Aside from the gray hair, I do not resemble the smiling, happy people in this booklet. Maybe I shouldn't have started in on it when I was already cranky about MetLife terminating my group life insurance because they aren't sure I'm still disabled. I wasn't really feeling open-minded and positive and cheerful.

Seriously.

If I put off dealing with this until I'm feeling open-minded and positive and cheerful, it'll never happen. That's just a fact. Aside from the gray hair, I never look anything like the smiling, happy people in this booklet. Maybe I'm going to need to grit my teeth and slog through this stuff anyway.

Maybe tomorrow. Maybe I'll do it tomorrow.

Seriously.

Stray Parsley

I'm not usually one to badmouth written instructions. I spent most of my working life writing technical documentation, and apologizing for it. I know how hard it is to explain something in a way that will provide all the information anyone would need, and be totally clear to everyone who might read it.

Maybe the problem is that I expected this to be confusing, so I'm making it harder than it really needs to be.

Or maybe I just assume that anything having to do with the healthcare delivery system is going to be a pain in the butt. You start with healthcare, then throw in insurance and the government, and it's got to be bad. Wouldn't you think?

Maybe I just don't want to be doing this. Well, that part's true, for sure.

But I've got to tell you, trying to figure out what I need to do about my upcoming eligibility for Medicare, and how it may or may not coordinate with the insurance I'm buying through Scarecrow's employer, is giving me a new perspective on what it must be like to live with a learning disability. I can still read the words. I can still understand each of them individually. At least I think I can. I'm just having trouble extracting information that might be encrypted in those words, arranged in that order. I read them slowly. I read them multiple times. It's like reading a webpage that Google has translated. Each of the words is right, but they're just… not… coming… together.

I was recently reading a page that was originally written in Russian. I don't know any Russian, so I don't know how good or bad the translation might have been, but I thought I was kind of getting the gist. Then I came across this:

"But as in all of Russia, the big crisis came to Bobruisk, in connection with the attitude of the Jewish population to the Russian school in the 70's. This crisis was, as is known, connected with the executing of the law of general military service in Russia (1874), which gave great privileges to people with Russian education and origin--shorter military service. It was a stray parsley! Even in extremely religious circles the "fence-breakers" multiplied."

It was a stray parsley!