This is Week #3 of describing the Medicare Machine. It is also March 31st, 2011.
Today, from 2:00 to 4:00, a few of us will be lurking about Life Care Center of Port Townsend (aka Kah Tai) to talk about whatever you want to talk about, and eat cookies.
Tomorrow is April 1st, which is April Fool’s Day – Symbolism is where you find it.
OK, the Medicare Machine: I am not going to regurgitate the last two weeks’ columns, because that would place all of us squarely into the Department of Redundancy Department, so if you’re just walking into the middle of this, good luck.
Remember the part about how you could delay enrolling in Part B because you were still employed? Well, if you retire, become unemployed or, for whatever reason lose your employment-related health insurance, you will have an 8-month “Special Enrollment Period” (SEP) to get into Part B, which starts the month AFTER your other insurance ends, and it the effective date of your Part B coverage will be the first day of the month following enrollment.
If you have prescription drug coverage through employment (or whomever/wherever) and it goes away, you will have a 63-day SEP to get into a Part D plan without incurring the dreaded Penalty.
Now, you may or may not recall that, last week, I vaulted over Part C, which most of us refer to, affectionately or ruefully, as “Advantage Plans.” Here’s the deal:
Basically, there are two ways to get Medicare: (1) “Original” Medicare, which means everything that we’ve been immersed in for the last three weeks, or (2) through a Medicare Advantage Plan. Advantage Plans are Medicare’s version of “managed care,” so the classic example would be a HMO (“health maintenance organization”). Most HMO’s in the world are places you go to and receive virtually all of your healthcare – Same place, same folks, same billing procedures, all your records in one place, same coffee, same magazines, etc – Many people who use HMO’s love them.
We do not have any HMO’s on the Peninsula, so there are various permutations of Advantage Plans, like “preferred provider organizations” and “private fee-for-service” plans, and others. Historically, some folks have really liked them because they tend to be cheap and, sometimes, offer benefits that “original” Medicare doesn’t offer, like some vision, hearing and/or preventive stuff. The down side has been that not all healthcare providers have accepted all Advantage Plans, so it was always a crap-shoot about who-accepted-what this year and, sometimes, there were some other funny little things like “facility charges” or whatnot – The litany was: READ THE CONTRACT.
Last year (which means THIS year – 2011), a lot of Advantage Plans went away. There are several reasons for this, some or all of which are “wonderful” or the “end of the world,” depending upon your socio-political views of the good ‘ole U.S. of A, and none of which matter if you’re just trying to understand the Medicare Machine, because “gone” is…Gone.
There are a few Advantage Plans around. If you become Medicare-eligible this year and want to learn more, go to www.medicare.gov and read it slowly and carefully, or call any of the numbers at the end of the column and ask for help, where decent people will help you, for free.
In as few words and as few weeks as possible, that’s what the Medicare Machine looks like, so reassure yourself about your attention span, and reward yourself with a cookie (or some celery, depending upon your socio-political views) and breathe, but beware of lulling yourself into a false sense of security or knowledge, and here’s why: Once you enter The Machine, you’ll begin to encounter unanticipated (although, often, GOOD) variations-on-themes, like the “Low Income Subsidy,” which can help pay for Part D-related stuff, or the “Medicare Savings Programs,” which help pay for Part B-related stuff, and on and on and…On.
Medicare does not pay for long-term care, long-term. It will pay for up to 100 days in a “skilled nursing facility” (read, “nursing home”) IF you need it and IF you meet certain eligibility requirements. It doesn’t usually pay for things like hearing aids or dental care or foot care – Note the use of the term, “usually.”
See? This isn’t easy stuff, but don’t panic: Most of us seem to be able to figure out most of this, most of the time, and usually with help – Help is allowed – So, you CAN do this, but understand that it will go BEST if you take your time, pay attention and think of it as your “job,” not just a quick, little “something” that you’ll get done between batches of cookies…
…because you won’t.
I know what you’re thinking: “There has GOT to be a way to beat this game!” You’re right, there is: Use it as little as possible, which means use “healthcare” as little as possible, which means stay as healthy as possible – And you don’t need me to tell you how to do that; besides, I probably wouldn’t listen to you on that subject, either.
Take the politics and the emotion out of all this, and remember that, if you’re old enough to care about this stuff, then you’ve been smart enough, for 60+ years, to survive in America, so you can do it – You just don’t want to.
I don’t blame you - Neither do I – So, I’m going to have a bumper sticker made:
“Medicare happens.”
No comments:
Post a Comment