AND SO IT BEGINS again—trying to figure out the mess that is Medicare.
A 132-page book from the Department of Health & Human Services arrived in the mail recently. “Medicare & You 2022” is four pages longer than the 2021 edition I received earlier this year, when I was turning age 65. I could barely bring myself to pore through the pages of that one, as I endeavored to understand the myriad choices facing me as I hit that magic milestone. Does this task really need to be so complicated and potentially expensive?
Last time around, I spent many hours on the subject and, even then, I was just barely comfortable making my Medicare choice. All of you who hit 65 this year will also know that the “official U.S. government Medicare handbook” is among a mountain of mail you received from insurers, many hoping to sell you a Medigap or prescription drug policy.
A volunteer from the nonprofit program SHINE (short for “serving health insurance needs of elders”) was of considerable help during the three sessions I attended. But just two months into the plan, I’m now questioning my choice. I selected a Humana HMO—a Medicare Advantage plan, instead of traditional fee-for-service Medicare—because all my doctors were in in the plan, and the copay for one of my major prescriptions was relatively low. The Humana plan also offers zero copays for all office visits, including specialists.
My first annoyance came right away: The plan chose a primary care physician (PCP) for me who wasn’t my doctor for the past eight years. I spent an absurd amount of time on the phone getting that corrected.
My current frustration is obtaining authorization from Humana for specialists I need to see. Others had warned me against Humana for this reason. Now I know why.
Why should health care for seniors—or really anyone—be this hard to understand? Why should there be so many pitfalls?
I could have chosen traditional Medicare. But experts recommend you add a Medigap policy. If you don’t, there’s no ceiling on what you might owe, and you will need a drug plan, too. That adds up. By contrast, the Medicare Advantage plan I chose has no premium, other than for Medicare Part B, and there’s an annual $3,400 out-of-pocket maximum.
I was exhausted today trying to determine whether my PCP, Humana and a specialist were communicating correctly. Through calls and online chats, I learned there’s a difference between a referral and authorization. But I’m unsure either of the doctors’ offices understands what’s needed and when, so I’m facing delays getting an appointment and the procedure that the specialist recommended. I didn’t expect this nonsense.
I have the option to change plans before Dec. 7, but that means more research and sessions with the SHINE volunteers. This is already my third health care plan in one year. After retiring at 64, I continued my employer’s plan under COBRA. I paid $800 a month for COBRA coverage for four months, and then switched to an Obamacare plan for $400 a month for another four months. Do I want to change again—and possibly not end up with something better?
I don’t care to use up brain cells figuring out all this. If it’s confusing for me at 65, what will it be like when I’m 85?
Ron Wayne spent 26 years working for newspapers in Pennsylvania and Georgia before becoming the editor in the University of Florida’s main news office. During his 10 years working there, he earned his master’s degree in mass communication and taught as an adjunct in the College of Journalism and Communications. Since retiring last fall, he’s enjoyed a simple life, including reflecting on his experiences on Medium.com. His previous article was Losing at Cards.