Medicare, et al

 My wife and I are both working.  She happens to work for an organization that has good benefits in the health care area, so I have been riding on her insurance for several years, including years that I could have been on Medicare.  I did sign up for part A when it became available to me, but refused part b, drug coverage, and so on.

Now with her retirement coming in a year or so, I am working to get on full Medicare well before my benefits under her employment cease.  To that end, I’ve been talking with SHICK volunteers (SHICK is the Senior Health Insurance Counseling for Kansas program) I’ve been talking with them about how to enroll, the rules and regulations, what I can expect, etc.  By the way, SHICK volunteers in Kansas are knowledgeable, well-trained, easy to speak with, and best of all the service is no charge.

I’ve also done research with several different companies that offer supplemental health coverage including the newer Medicare Advantage plans that one hears so much about on TV at certain times of the year.

In the end, after a year of thought and consideration, I’ve decided to enroll in traditional Medicare part B along with drug coverage, a supplemental plan, and a dental plan.  That decision, however, and its implementation, was not without some angst and a little bureaucratic slowness.

I won’t get into the details, but when one signs up for old age insurance, one practically needs a crystal ball to be able to read the future.  Because, with few exceptions, once one has made a decision on the kind of coverage he or she will have, it cannot be changed, or at a minimum can be changed with financial penalties attached.  Will I need many hospitalizations?  Will I have to take a name-brand medication at some point in the future instead of generic?  Will I need skilled care?  Am I better off to have dental insurance or pay the dentist cash when I need something done?  Is the network I’m signing up for adequate for my needs?  Are my providers in-network for the insurance I am considering?  What happens if I have an emergency when I travel out of state or out of network?  And with these questions are a host of other questions along with multiple places to find answers.

And then there’s the bureaucracy.  Having to work with the Social Security office to sign up for part B, I had to do so the old fashioned way…with paper.  And with COVID, there was no in-person counseling by a Social Security worker.  And no on-line for Part B sign-up.  Sending the paperwork in by mail, I waited a couple weeks without comment from them.  I called.  My paperwork was incomplete, I was told, and they were waiting on the information needed.  Of course, it would have helped had they notified me that the information was missing in the first place.  Sending in the corrected form by FAX (yes, they still have those things), I waited another couple of weeks with no word.  Contacting them again, I was told that they hadn’t worked the FAX’es yet and to be patient.  The actual comment was, the person hadn’t picked up the faxes yet.  Say what?

Contacting them yet again a few weeks later, I was asked to hold the phone after a 20 minute wait to talk to a live person, to whom I explained my situation.  Twenty five minutes on hold after the initial conversation, that person came back on the line, told me he found the form in a stack of papers, walked it through the approval process for me, and I was all set.  Incredulous, I asked him what else I needed to do.  He said “nothing…you’re good to go.”  A few days later, I got the approval letter in the mail.  May that man who did that for me be forever blessed !!

Now that I have part B coverage, I was able to complete the process by signing up for the supplemental, the drug plan, and the dental plan.  I should be well-insured now.

 The one thing that stood out for me during this several month ordeal is, how do people successfully navigate this system who may not have the health care background I have, don’t know about the SHICK volunteers, or don’t have the boldness to call, check on, complain, and generally be a pest until things are done to one’s satisfaction?

How many people are taken in by shysters who hawk substandard insurance policies, sign people up for multiple unneeded policies, or take the money without giving anything in return?  How many know that the Kansas Insurance Commissioner is on their side and will advocate for them in the event of an issue with an insurance company?  How many people don’t understand that when they sign up for a particular plan, there are restrictions on what kind of changes they can make in the future?  How many understand that their medical provider may well NOT be in network for their particular plan and know that they need to check on that before they sign up for a plan that sounds too good to be true (like the one that says they pay you to sign up and send a check to you every month thereafter)?  The list goes on…

 I don’t know how they could make this process any more difficult and taxing.  I think they managed to hit all of the “buttons of difficulty” in this menagerie of rules, policies, paperwork, and decisions to be made.  Thank heaven for the Kansas SHICK volunteers, and thanks be to the man who shepherded my part B application away from the stack of paperwork and through the process of approval.  May you be so fortunate when it comes time for you to sign up.

 Blessings…