Medicare Is Not Free Insurance

During the 2016 presidential campaign, we heard “Medicare for all” as the solution to insure all Americans.  We are hearing it again now in 2019.  Currently, Medicare is not 100 percent coverage at no cost to the insured.  If politicians in D.C. can’t make it available without costs to those with Medicare now, how are they going to make it a reality to all Americans?

I am guilty of thinking that after paying into Medicare for more over 40 years, that once I reached 65, I would have healthcare insurance for free.  I was mistaken.

Medicare has four (4) parts.  The parts are explained in a handbook.  As I write this, next to me is “The Official U.S. Government Medicare Handbook”.   The subtitle is “Medicare and You, 2019.”

Medicare Part A is “premium free” and only covers hospital admissions, skilled nursing facilities, hospice care, and home health care.  I found at this link that Medicare Part A has a $1,364 deductible for each benefit period.  Benefit periods begin with admission to a hospital through the date of discharge.  After 90 days of hospitalization, the insured is responsible for all hospital costs.

Medicare Part B covers doctor services.  If an insured is admitted to a hospital without Medicare Part B, they are responsible for the cost of doctor services.  There is a $185 deductible per year for Medicare Part B. After your deductible is met, Medicare Part B covers 80 percent of doctor services.

The current cost for Medicare Part B is $135.50 per month.  That amount might be higher depending on annual income.   Currently, most providers do not accept Medicare for vision and dental because what they pay for is limited.

How do people avoid all the confusion and prevent surprises to their pocketbook and bank accounts in the event of illness?  Enroll in Medicare Part C.  Medicare Part C is the Medicare Advantage Plan.  It is coverage through a private insurance company.  The cost is generally what Medicare Part B costs.  If receiving social security benefits, it is deducted from monthly benefits and paid directly to the private insurance company.

Some private insurance companies offer benefits that raise the price.  That price is tagged onto the Medicare Part B premium and automatically deducted from social security benefits.  For example, I paid an additional $19 per month for Medicare Part D coverage.

Medicare Part D covers prescription drugs.  However, based on the Handbook it is confusing as to whether you can get Part D unless you’re enrolled with a Medicare Advantage Plan.   The monthly fee for Part D is in addition to the amount paid for Part B.

I have a Medicare Advantage Plan, and the condition for chemo drugs is the same as under Medicare Part D.  It’s 20 percent.  Logically, they cannot set a co-pay for chemo drugs because there are different drugs depending on the type of cancer, and chemo drugs vary in price.  My out-of-pocket cost for a year is $4,500.  One of my chemo treatments is $37,000, so my annual 20 percent co-pay is covered after one treatment.  The time of year when treatment begins should be considered.  For example, I began treatment in October.  January started a new year and therefore, another $4,500 out-of-pocket cost.  That’s a $9,000 bill in 4 months.

My advice?  If you have a Medicare Advantage Plan, don’t become seriously ill towards or at the end of a year.

If you look at the last page number of the Handbook, it is 123 pages.  However, that is rather deceptive.  For example, Section 11 starts with page 113 and is titled “Compare health & prescription drug plans in your area”.   After page 116, it is numbered pages 116a through page 116p.  Thus, there are 17 pages of insurance companies listed, what counties they cover or “service area” along with other columns, an important one titled “Annual out-of-pocket maximum”.

I would love to see a plan where all Americans are covered with healthcare.  I do believe that healthcare is a right.  However, unless a major overhaul is done, Medicare is not the plan. Bernie Sanders has a plan that requires a tax increase and he promotes that it will be balanced by taxpayers no longer paying insurance premiums, deductibles and co-pays for healthcare, which Sanders wants to eliminate.  A possible issue under that scenario is that social security benefits are exempt from taxes for many retirees.  It will be the working class that bears the tax burden.

Maybe the plan should be to eliminate Medicare deductibles and copays for senior citizens and the disabled first and see how it works without Medicare Advantage Plans.

The government bids out contracts for goods and services, and maybe a bidding system by private insurance companies should be considered.