But let's begin at the beginning. In preparation for the Big 6-5 (and also to free myself from the $1,104 per month I had been paying for COBRA coverage since I retired), I studied the Medicare web site -- which is really good, considering it's put together by socialists. To assure that Medicare coverage begins on your 65th birthday, which is the earliest it can begin unless you're disabled, you need to start the official process 90 days before. But even before that you need to know what you want, and you have to have a passing knowledge of the lingo: Part A, Part B, Part D, MAGI (modified adjusted gross income), MedAdvantage (with or without Rx). You get the idea.
Medicare used to be pretty simple after it was passed in 1965. You turned 65 and you automatically got Part A (hospitalization coverage) free of charge, courtesy of the taxpayers of the United States. Fortunately, Part A hasn't been fiddled with too much, and it's still free for everybody. Part B (doctor visits, labs, outpatient procedures, etc.) was added a bit later and required you to pay a premium, but everybody paid the same amount. About a decade ago, Congress decided to means-test the Part B premium ("means-test" is code for "pay more). As a result, the IRS sends your MAGI to the SSA (Social Security Administration), which sends you a letter saying you made too much money two years ago and therefore must pay more than the Part B premium you thought you'd be paying when first started thinking about Medicare. Because I was a corporate fat cat two years ago (as opposed to the senior citizen on a fixed income I am now), I will pay the maximum until my lower MAGI on my tax return catches up in a couple years.
Part B only covers some things, therefore leaving you in jeopardy of getting gigantic bills you didn't expect. So, to alleviate that stress on us oldsters, the government permitted private insurance companies to offer Medicare supplement policies to cover things Part B doesn't cover. So-called MedAdvantage policies go a step further by relieving the government of the burden of paying my Part B bills by covering everything HMO-style. The government then rewards MedAdvantage carriers by paying them a stipend for taking my bookkeeping off its hands -- a situation that has come under considerable, and in my mind justifiable, scrutiny and criticism in the current health reform debate.
Part D (prescription coverage) was added in 2005; I have no idea why they skipped the letter "C" in adding a new Part -- another of those Don't Ask, Don't Tell government things, I suppose. Since Part D is handled entirely by private insurance companies (thus eliminating the socialists from the process), you have to spend an inordinate amount of time figuring out which carrier to use for prescriptions, which to use for Part B supplements or which to trust with both Part B and Part D. It's enough to give to you rheumatism or at least stigmatism.
Here's what I learned in the process: you have to be observant as an owl and opportunistic as an eagle to make the system work for you. The Medicare web site lets you compare Part B and Part D private plans in your area. It's a good system, but it doesn't protect you from the downside risks. Part B and Part D plans only guarantee your premium rate for one year. But what's particularly worrisome is that they may eliminate services they cover at any time, provided they send you a notice well in advance. Prescription drug plans use a formulary to decide which drugs they will pay for and how much your co-pay will be. They are free to raise the co-pay of any drug or to drop it altogether from their formularies at any time, once they give you advance warning.
Of course, you are free to change plans once a year during open enrollment. But what this means for most seniors is that they must engage in a guessing game each year: How sick do I expect to be? (If not very, go with the plan with the lowest premium.) How many prescription drugs -- especially the expensive brand-name types -- do I think I'll need? (If more than a few, it pays to check the formularies in advance of enrollment and pay a higher premium to get a lower co-pay.) And, after the first year on a plan, you're likely to get a hefty premium increase from just about any private carrier. No matter how much research you do in advance, registering for Medicare is a crap shoot.
I must say that the socialists have made the basic registration process pretty easy. I called a toll-free number; waited on hold for about three minutes; got transferred to a Social Security agent in Chicago; and completed the initial registration by phone in about 20 minutes. (The socialists have done an interesting thing: calls from the toll-free line are routed to any available Social Security agent anywhere in the country. I was so very, very happy not to be talking with a person at a call center in India. And I was pleased that no American jobs were sent overseas to achieve efficiency in Medicare.) At the end of the registration process, I was told I'd receive my official confirmation my mail and that my benefit would begin the first day of the month in which I turn 65 (November 1, 2009). And I was told I should sign up for a Part B supplement and a Part D prescription plan as soon as possible to make sure they are in effect when my basic Medicare benefit begins.
So, here I am today. Turning 65. A Medicare and supplemental plan beneficiary, and also a survivor of the registration process. To protect our free-enterprise system and prevent encroachment of socialism we have made the process more complicated than it needs to be. It's full of tricks and traps. I wonder how my dear mother, of fond memory, would have dealt with this process in her frail mental state. My guess is she wouldn't have. Just ignore it until you're broke.
