The Medicare Labyrinth

Most Americans work for one or more employers for 54 years, from 16 to 65. When and if you retire, determined by health, finances and career, you need to navigate the labyrinth of Medicare choices for the best cost benefit. 

As my retirement plans were accelerated due to my diagnosis, I was forced to learn and quickly educate myself on the federally funded and administered health insurance options comprising Medicare. Here is a summary of what I learned.  

I learned that the companies contracted by the government to provide Medicare advice have negotiated deals with specific carriers to obtain a purchase price. These negotiated deals may or may not be in your best interest to purchase. 

I learned that when you turn 65, you should sign up for Part A Medicare, which is free. This must be performed within a specific window around your 65th birthday. All subsequent selections are also subject to specific windows for eligibility, and some have steep penalties for late registration.

Medicare is divided into 4 basic parts:

1. Part A = Hospital
2. Part B = Medical expenses
3. Part C = Medicare Advantage
4. Part D = Drug plans

The first decision is to determine whether you are a candidate for Medicare Advantage, Part C, or “original” Medicare, Parts A and B.

Medicare Advantage, like the commercials say, has some big benefits – it is usually cheaper than the Parts A and B it replaces and benefits will vary depending on where you live. Some states/counties offer dental and vision coverage, and all offer vaccinations, health screening and checkups with the caveat that your doctors are all in the Medicare Advantage network for your area. 

As I found out, If you see specific doctors out of their network, or specialists, you are not a candidate for Part C, Medicare Advantage.

This means that you will need to sign up and pay for Part B Medicare. The coverage is defined, and payment is on a sliding scale, based on your income. It does not cover everything, so you will need to purchase, if you are financially able to do so, a “Medigap” plan. These plans are also subject to defined payment schedules, but the costs can vary wildly. 

I found that selecting a Medigap policy required several calls to my state’s local department of insurance. The policies offered vary by location, so those consultations were invaluable. Be aware that insurance underwriting will lock you into a specific Medigap plan based on your health costs. You cannot easily switch plans if you have pre-existing conditions as insurance carriers can deny coverage or charge you more after that initial sign up. So, if you have pre-existing conditions, choose that Medigap policy very carefully.

My last choice was for a prescription drug plan, PDP, or Medicare Part D.  If you are taking any prescriptions, you can look those up on the Medicare.gov website, along with your preferred pharmacy and location to ensure the best costs and select a plan. 

I learned that having an account on both the SSO.gov (Social Security) and Medicare.gov website expedited the process and allowed me to track the progress, but a call, sometimes several, and a visit to my local Social Security office was also necessary, given my need for speed. I accomplished the entire ordeal in 3 weeks and I do not recommend it: this is the federal government, an entity still dependent on paper. The whole process would normally take 6-8 weeks with little recourse if paperwork was misplaced or faxed to the wrong location. 

The biggest surprise came from Social inSecurity – turns out my payment for Part B and Part D were increased due to IRMAA, or the income-related monthly adjustment which was attached to my monthly Medicare premiums due to the record of my salary prior to retirement. More money going out based on income previously coming in, and one that will need to be fought over the next few months. 

In all, I find it astounding that the average retiree can navigate this labyrinth, much less select options to their advantage to provide for their health care.