Beware maddening complexity of our current Medicare system
Dr. Elisabeth Rosenthal described nearly perfectly the ever-expanding and mind-numbing complexity of health insurance options (“Choosing a plan from the impossible health care maze,” Opinion, Dec. 2). Obtaining Medicare coverage is just as daunting. We should put enthusiasm for “Medicare for All” on pause. A single-payer system? Yes, but not the current, cumbersome Medicare system.
I note that the enthusiasts for Medicare for All do not rely on it; the politicians, even the geriatric ones, are covered by private programs. The various health care titans recently interviewed likewise are covered by what I am sure are platinum private plans.
There are many Medicares — A for hospitalizations, B for outpatient services of most types, D for drug plans. Standard (often called “original”) Medicare B does not provide full coverage, leaving copays and coinsurance costs. To insure against these costs, there are two alternatives: Medigap plus drug plans or Advantage plans. These are private plans. Medicare.gov found 10 Medigap (B) plans and 25 Part D plans available in this area. Advantage plans (Medicare C) merge the B and D coverage realms. Medicare.gov found 30 Advantage plans available in this area.
No one, let alone the elderly, has sufficient working memory to keep all explored options in mind. Medicare.gov offers tools allowing you to compare options. If you are not comfortable with endless website digressions, do not venture in. Insanity lurks.
Weigh what can be afforded with your personal goal: control recurrent costs (premiums, deductibles, copays, medications), or traditional insurance (protection against catastrophic costs), or both. Then recruit help from family or friend. If your town provides a Serving Health Insurance Needs of Elders program, a SHINE counselor can help manage the decision with you.
The country needs a single-payer system that can coexist with options for private insurance. Medicare as currently constructed should not be allowed to be that system. It is a mess.
I am a recently retired physician who has just survived enrolling in Medicare B and D.
Dr. Michael P. Alexander
Newton Upper Falls
A click on the Mass. Connector site, and then the calls flooded in
In preparation for a sabbatical, I investigated health care plans through the Massachusetts Health Connector. I put in my contact information on the website to get started and was directed to a page of agents. Almost immediately my phone started ringing and getting texts. I was getting calls every five minutes from phones around the country.
Thinking this was part of the process, I replied to one, and had a nice conversation with an agent who found me a good plan at a great price. Then she wanted my credit card number. I declined, saying that I wanted to see details in writing first. She insisted, and brought on her supervisor. I felt like I had somehow entered a high-pressure sales pitch for a time share.
I hung up and called my office’s benefits agent, who told me that the plan the agent was proposing wasn’t a plan at all, but rather a network of doctors. So it looked legitimate online but wasn’t an actual insurance plan. Totally confused, I took the easy route and signed up with my company’s COBRA option.
My questions: Are these “agents” who are calling me just scam artists? How many people are falling prey to these schemes? How does someone navigate this maze to get to legitimate Massachusetts Connector plans? Did I somehow miss the legitimate path? After having deleted about 100 voice mails from my phone, I don’t want to go near the process again.
The writer is a pediatric neuropsychologist.
The Connector connects, with a fair share of disconnect
I’m currently contracting for a tech company. The company’s insurance was expensive, so I went to the Massachusetts Health Connector to shop for a better deal. My partner needed a hip replacement, and we wanted to be sure his primary care physician, his surgeon, and the hospital were all on the new plan.
Trying to find a plan that was affordable and accepted by our doctors was so confusing. Even the broker I was using and the doctor’s office itself were confused about which plans they accepted. The process was horrible.
I finally found a plan that worked, but the steps it took to get there were so convoluted and confusing.
An unpleasant surprise, even after she checked the price
In September my podiatrist wrote an order for me to get a short air-cast boot. He recommended that I go to a specific place to pick it up, maybe because it was the closest in our area. Prior to going to the facility, I searched online for a similar item to get an idea of the price, which was in the $69-$99 range. I figured that even if my insurance didn’t cover the boot, I could pay for it myself.
I went to the supplier of orthopedic products, gave them the doctor’s request, and they handed me a boot off the rack. At the time, I didn’t ask them how much the charge would be, since I assumed it would be similar to the online pricing.
A month later I received a bill for $350, of which my health insurer allowed $24, and I paid the balance of $326. According to my insurance company, it allows the orthopedics supplier to charge that much.
This is an example of unreasonable charges that drive up the cost of health care for us all.