Getting Medicare: The Boring Details

I am covered by Medicare insurance as of today.   Last year, I quit my full-time position as a faculty member at Methodist University, and thereby lost my health insurance.  I could have continued with the Methodist U. plan using COBRA, (The Consolidated Omnibus Budget Reconciliation Act of 1985), a law which allows qualifying employees who lose employer-sponsored insurance to continue their insurance coverage for up to 18 months (more in case of disability, divorce, or widowhood).  COBRA is an especially appealing option for people who are uninsurable on the open market.  The downside is that it is often expensive to purchase the coverage.  For those who have lost much or all of their income at the same time that they lost employer-sponsored insurance, the cost can be prohibitive.

For me, the COBRA policy would have cost about $500 a month.  I had nine months between the lapse of employer coverage and eligibility for Medicare.  I could pay the $4500, go without insurance entirely, or try to purchase a less expensive policy for myself.  I wasn’t willing to forgo insurance, but thought that a low-cost, high-deductible policy might be a good alternative.  I contacted an agent and got some quotes.  For $154 a month, I could get a policy with a $7,500 deductible, a 20% copay, and a cap on out of pocket expenses.  I thought that if I scheduled doctors’ appointments before my employer’s policy lapsed, I might be able to almost entirely avoid medical expenses for the nine months.  I was taking two medications, but one was available as a generic and the other was Niaspan, a prescription version of Niacin, readily available over-the-counter.  The low-cost policy might save me $3,000 compared to the COBRA policy.  On the other hand, if I developed a serious medical condition, I would be paying several thousand more.  My health seemed good, so I decided to take the chance.

About the time my Methodist U. policy lapsed, my doctor informed me that my PSA screening test result was out of the normal range.  He instructed me to have it tested again in 6 months.  I was concerned; what if the PSA level shot up and I couldn’t wait until I had Medicare before having my prostate treated?  The level only increased slightly when I was retested, though, and my doctor plans to just monitor the problem.  I haven’t had any other medical expenses, so the risk I took by getting less expensive, less complete coverage worked in my favor.

medicare-symbolA couple months ago I contacted my insurance agent again to start preparing for Medicare.  He explained the options: Traditional Medicare Parts A, B, and D alone, a Medicare Advantage Plan, or traditional Medicare plus a supplement.  Because I travel back and forth between two states, an Advantage Plan didn’t seem best for me, so I’ve opted for traditional Medicare plus Supplement Plan N.  My agent, Lou Wislocki, has helped immensely in explaining the pros and cons of each alternative.

The only piece I haven’t taken care of yet is signing up for Part D, the prescription drug plan.  Jane Gross documented on the New Old Age Blog her travails in trying to figure out the best Part D policy for her.  She wasted days in the process, and wasted even more time trying to understand her benefits once she selected an insurer.  She reports that only 5.2 percent of Plan D participants chose the coverage that would be most economical for them.  Sigh.  Since I really only have to be concerned about one medication at this point, Lou suggests I go with the cheapest plan which has that drug in its formulary.  My condolences to those of you on multiple medications who are trying to determine the best Part D coverage.

In America, Medicare eligibility is a marker of the transition from middle adulthood to older adulthood.  Now is as good a time as any to say that I’ve crossed that threshold.  Or I would regard my 65th birthday as the line of demarkation.  In that case, I won’t be an older adult until tomorrow.

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About bobritzema

I am a fourth-generation American of Dutch ancestry and am trained as a clinical psychologist. In 2012, I retired from Methodist University in North Carolina to return to my parents' home and provide them with assistance. I maintain part-time therapy practices in Grand Rapids, Michigan, and Fayetteville, North Carolina. I currently worship at Square Inch Community Church in Grand Rapids. I can be reached at bobritzema@hotmail.com.
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