In a comment to my recent post about planning for the pending layoff/retirement/whatever-we’re-calling-it, Abigail asks about the costs of Medicare, which I estimate will be around $300. I’ll be eligible for Medicare in May of 2010. So, between the December 31 canning date and May I’ll have to take COBRA, which will cost about $480 a month.
Medicare alone doesn’t cover all your costs: it’s an 80-20 plan. The older you get, the shorter the odds that you’ll suffer a catastrophically expensive illness. Heart bypass surgery, for example, can cost $170,000; 20 percent of that would be $34,000, which you have to pay out of pocket. Cancer treatment can quickly mount into the hundreds of thousands of dollars. Clearly, if you have to pay 20 percent of costs like that, a major illness—almost inevitable in old age—will pauperize you.
To protect yourself, you have to buy a supplemental policy called “Medigap” insurance. You also are required—it’s not an option—to take and pay for prescription drug coverage under Medicare Part D. By law, Medicare Part B and Medigap insurance provide no prescription coverage. If you decline to sign up for Part D when you start Medicare and then later change your mind, you are gouged royally for the privilege of signing up later.
To be fully covered, you have to cobble together coverage with the standard Medicare Part A (which is free), Medicare Part B (which costs about $100 a month), Medicare Part D (which evidently runs about $30 to $65 a month but which, if you suffer an illness that requires expensive drug therapy, will leave you holding the bag for upwards of $4,350), and Medigap insurance (provided by private insurers, apparently ranging in cost from an average of about $100 to about $285 a month—it’s next to impossible to find out what the actual costs are). By the time you’ve added up Part B, Part D, and Medigap, you end up with a monthly cost of about $300 a month. That amount will never go down, and you can be sure that like every other cost else in life, it will continue to rise.
At this time, the combined cost of full Medicare coverage is about 12 times what I pay for my employer’s EPO plan, which covers my doctor of 30 years. Since 1987, he has practiced at the Mayo. The Mayo Clinic, because of Medicare’s low reimbursement rates, now refuses to accept new patients who are covered by Medicare. They will keep you if you’re already an active patient, but if you walk in off the street and you’re covered by Medicare, they won’t take you.
You can opt out of the public system and instead buy private insurance through Medicare Part C. These plans are basically HMOs, and they are dangerous. They’re extremely restrictive—you have little or no choice as to which doctors you see, and like all HMOs they’re not in business to take care of you; they’re in business to make a profit. Consequently, it’s in their interest to limit the amount and quality of healthcare you get and to direct you to the cheapest providers.
Now, the problem is that hospitals in Arizona are about as good as schools in Arizona, which is to say “not very.” It was at one of our major regional health centers where I waited over four hours with acute appendicitis and never saw so much as a triage nurse. When I finally got to the Mayo’s ER, they slapped me into surgery instantly. In another major hospital, my mother-in-sin underwent successful aortic surgery but almost died because, while recuperating in a hospital room, she had a heart attack that went unnoticed by anyone but a CLEANING LADY! Her life was saved because a maid happened to wander into the room and figured something was wrong.
Only one hospital in Arizona consistently gets top national ratings, and it’s the Mayo. That’s why you need to retain your choice of doctors and medical facilities, no matter how much that privilege costs you.