Letter from America – Medicare part 2

You’ve probably heard about ‘Obamacare’, but maybe not Medicare. They aren’t the same thing. I don’t know much about Obamacare except that it protects my insurance for pre-existing conditions: it is my only legal protection. There are so many provisions to it, but basically it is a resource to help people find some kind of insurance. There were many problems with it at the beginning, but things seem to have smoothed out a little bit and now I think most Americans are in favour of it, especially if you call it ‘the affordable care act’; the moronic right doesn’t want anything to do with Obamacare…even though they are the exact same thing.

And why would anyone want to dismantle it? Well first of all, Trump’s goal is to destroy everything with Obama’s name on it – and he has done quite well at that. Secondly, Obamacare helps keep the corporate wolves at bay – at least to some extent – so it’s a bit more difficult for private enterprise to make money from healthcare. That’s not popular in Republican circles.

And Medicare, which I have: how does it work?  Short answer, it pretty much beats the hell out of me. But I will try my best to give you a brief description, again as I understand it. And it is only available to the 65+ crowd, except under very special circumstances.

Last week I received my annual Medicare Book for 2021. This 150-page tome is my guidebook for Medicare for the coming year. It comes just before the open enrolment period from October 15 until December 7 (any significance to the fact that that is Pearl Harbor Day?). Open enrolment is when you’re allowed to change your Medicare plan, as well as your supplemental plan, and you can also change your level of drug coverage. Whatever changes you make will start on January 1, and after that you’re not allowed to make any changes until next year’s open enrolment.

So basically there are two kinds of Medicare: Original, and Medicare Advantage. I have the Original, which is taken care of by the government. Medicare Advantage plans are run through private insurance companies, and may provide additional benefits, but you are limited to approved health care providers. There is a handy (?) 20-some page chart contained in the Medicare handbook to help you find out which plans you are eligible to subscribe to, and what the various benefits, drawbacks, co-pays, drug coverage, and premiums are for each plan. I counted 14 different corporate insurance companies which list plans in this chart. Aetna alone offers 42 different plans to choose from, again depending on what county you live in. And I have absolutely no idea whatsoever why that is a factor, but it is a big one. Oh, and there are four different parts to each type of Medicare plan: A for hospitals, B for doctors , C (nobody seems to know what part C is, and if it is in the handbook, I couldn’t find it. But I do know it’s there. Somewhere.) and D for drugs. Everybody gets parts A and B, and D is optional – you may also choose drug coverage through your supplemental plan. Oh, and did I mention that there are several different types of Medicare Advantage plans? Such as health maintenance organizations, medical savings accounts, preferred provider organization, private fee for services, special-needs plans… Easy, yes?

Just a quick note on what Medicare does not cover (although some Medicare Advantage plans might): most dental care, eye exams for glasses, dentures, cosmetic surgery, massage therapy, routine physical exams, hearing aids and exams for fitting them, and long-term-care. Concierge care… and I have no idea what that is… is also not covered, nor is anything from a doctor or hospital that does not participate in Medicare. So above all, you must make sure that you are dealing with a Medicare participant, or you will be expected to pay the full boat.

Everybody still with me???  Because if you are, your head is probably spinning like mine is. I am not the least-educated person on the planet, and it would take me years to sit down and figure this all out!  God help the poor sod with little education, let alone those who are illiterate. Now, I will say the handbook does explain things quite well, but there is so much information in there that you hardly know where to begin or how to process it all.

If you don’t have health insurance, you’re on your own. If your income is low enough, you may qualify for Medicaid, but the biggest problem with Medicaid is that it is administered by the individual states, and if you happen to live in a red (Republican) state, you’re screwed. Never mind that it’s money from the blue (Democratic) states flowing into the red states that gives them any funding whatsoever for most everything. My impression is you just go crawl in a corner somewhere and wait to die. Some hospitals will provide essential emergency treatment, but there is a very well-known story from years ago of a terrible burns victim who had to be transported to three different hospitals before somebody would treat him.

Well I think that is enough for one day. Just talking about this has given me a throbbing headache. Next time I will attempt to discuss the costs of Medicare, as well as what supplemental insurance is, and the costs for it. Wish me luck.