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Medicare costs

Medicare Bills: OMG!

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Anybody who thinks Medicare is some sort of a bargain and that all us old folks are sucking off the public teat either doesn’t know what he’s talking about or is just batshit crazy.

Just paid my annual Medigap premium: it rose by $277! That was after the Part D, which covers nothing because I don’t take any meds, went up by $60 a year. Part D is provided by a private insurer, but Medicare recipients are required to subscribe to it on pain of a penalty that amounts to a heavy, recurring fine. Part B also rose this year, but Social Security rises to cover Part B increases even in years when there’s no COLA increase (we’re now in the second year with no Social Security COLA, because after all there’s no inflation. :roll:).

Not anticipating such a large jack-up, I failed to self-escrow enough to cover the increase, so I had to raid my regular savings to pay the bill. Another two months with no clothes! Guess I’ll be wearing black Costco jeans all summer. Damn!

Medicare now costs some 15 times what I was paying for similar coverage at the Great Desert University. And of course it doesn’t cover everything. The Mayo keeps sending me incomprehensible bills, and the various Medicare providers keep sending me incomprehensible statements. Piles of paper are swelling my file folders, and I have no idea what any of it means…it’s just impossible to parse it out.

What this means is that I have no idea what I need to pay my doctors out of pocket. And that means I can’t really ever get out of debt to them, because I don’t know what to pay. Even if I could afford to do so, I can’t pay the full amount of each statement and then pocket the amounts coming in from Medicare/Medigap, because the clinic’s bills don’t reflect all the pending charges; if I spend the Medicare checks on groceries, I won’t have anything to cover the new little surprises that keep coming in the mail.

Complicating matters, Medicare will not pay the Mayo directly, advertisements to the contrary notwithstanding. The Part B coverage is supposed to direct-deposit payments to the Mayo, but for some reason because it’s the Mayo they won’t do that. Hell, no! Instead, they dribble out checks to me by snail-mail, which I have to deposit and then disburse to the Mayo myself.

Needless to say, the potential for snafu is huge. There’s always the chance that some check will be lost in the mail or in the piles of paper in my house—because a blizzard of trash paper is always coming in from these insurance companies, it’s easy to lose an envelope with an actual check in it.

Mercifully, I can now scan checks and deposit them electronically. It’s almost as much of a nuisance as physically driving to the credit union, because my scanner is excruciatingly slow. And of course, it draws so much memory or power or whatever it’s doing, I can’t do anything else on my computer while I’m waiting for it to plod through the process. The CU’s system won’t accept color scans, but my scanner defaults to color. Sometimes even when I set it to scan greyscale, it defaults right back to color. So then I have to do the whole scan over again. One time it took over half an hour just to scan in one check so the system would take it—I could have traipsed to the credit union on the way home from campus in that time!

Dealing with this bureaucratic BS is a difficult nuisance now, while I have most of my marbles. I can’t even begin to imagine how the elderly frail cope with this tsunami of confusing, complicated, demanding crapola. If you don’t have someone in your life to help out with it, you’re SOL. And you can be sure you’re getting ripped off seven ways from Sunday.

There’s just no excuse for America’s healthcare system.

Just when you think it’s safe to go back in the water…

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Well, all that rhapsodizing about how much extra money resides in the checking account just turned into a dirge.

Yet another piece of paper came from the Social Security Administration, informing me that my monthly checks are about to drop to $974. That’s the net on $1,257 after the dings for taxes and Medicare: a 23 percent gouge.

Which reminded me that I still haven’t signed up for Part D, another hassle and hoop to jump through. That will have to wait until next week, since the next few days are going to be very hectic. And that I haven’t paid the Costco membership. And that I haven’t paid the COBRA bill for April.

At any rate, the cut in “pay” isn’t as drastic as it looks, because the $200 to $300 a month COBRA has been lifting out of my pocket has come from net income, and so it’s really about a wash. Medicare, Medigap, and Part D will add up to about $240 a month, about $40 more than this month’s COBRA payment that includes Delta Dental. So even though the paycheck drops precipitously, the amount I have to write checks for isn’t quite as high.

Except of course it isn’t a wash. Medicare is higher than COBRA, and it doesn’t cover dental care. Delta Dental will go away after the ARRAS discount ends, because its cost to private individuals is higher than the cost of routine care. To have enough on hand to cover the inevitable major dental work that comes with age, I’ll have to self-escrow something every  month to put into an account to pay for future dental disasters. How much, I can’t imagine. A crown costs about a thousand bucks around here, so I suppose that would be about $83 a month.

Because Medicare fails to cover dental care, I’m allowed to keep the COBRA coverage for Delta, which I will do until September, when the ARRAS discount expires. Meanwhile, in another week I’m getting a new crown on the tooth I broke when I bit down on an olive pit—it’s been patched with a large filling, since the ding didn’t hit the pulp and nerve, but the Doc agrees that it’s going to have to be fixed while I still have some coverage.

Mercifully, he says I shouldn’t need a root canal. Ugh!

Delta’s coverage is pretty piddly. I’ll still have to pay half the cost of the crown, around $400 or $500. That will have to come out of my year’s emergency savings, which I’ve kept in the bank for 2010 where it’ll be handy if I find I can’t live on my income during this especially penurious year. Thank God I have it! Otherwise I’d just have to wait until the tooth starts to rot and then have it pulled.

In the tax gouge department, I think it’s likely that I’ll get the money back next April, since I’ll earn so little this year that a) the cost of Medicare combined with the long-term care premiums, nine months of Delta Dental premiums, the crown, and God only knows whatever medical bills happen next will exceed 7.5 percent of adjusted gross income; and b) net earned income probably will be so low that I won’t owe tax on Social Security at all. But meanwhile, I have to live until next April.

Hmmmm…. Did you know contact lenses and the cost of over-the-counter contact lens solutions are considered eligible medical expenses? That’s interesting; I thought those were vanity items. They’ll also accept the cost of Lasik eye surgery and getting your teeth straightened. If you kept track of all the stuff you’re allowed to count as medical expenses and you didn’t earn much, you just might hit that 7.5 percent threshhold. On a $35,000 income, that would only be $2,625. If you’re not getting health insurance through your employer, then you can count your healthcare premiums…and in that case, $2600 isn’t very much. Even if you made something closer to a living wage, say 50 grand, health insurance premiums could easily combine with fairly routine care to push your costs up to the $3,750 that is 7.5 percent of that salary.

I wonder if health insurance premiums will still be deductible under the new regime? Since Medicare qualifies, it’s reasonable to think they’ll make the new required premiums deductible, too.

Doesn’t matter for me: Arizona intends to opt out of the federal healthcare plan, anyway. Our intrepid leaders opted out of Medicaid, so I expect they’ll get their idiotic way with this, too.

Nope… Money unhappens

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That six-month free ride for COBRA sounded too good to be true, and, as the saying predicts, it wasn’t. True, I mean. Called the Department of Administration again today to confirm what I thought I’d heard and learned that the “six” syllable actually occurred in the word sixty, as in sixty days.

You have sixty days after canning to enroll in COBRA and start paying up.

LOL! My scheme would’ve worked if I’d been born on March 7 instead of May 7. But in the cold cruel light of reality, it fell way short of its goal.

Oh well. At least I still have the $571 GDU dumped in my account today. Now all I have to do is persuade the federal government that it’s 2009 earnings (which it is), so that I don’t get nicked on the Social Security earnings limit. Even five hundred bucks will make a difference.

Medicare is going to cost a lot of money. Relatively. Yes, I do understand that $300 a month is a microscopic droplet in the bucket compared to what some people are paying for health insurance. But nevertheless, it’s more than eight times what I’ve been paying for an excellent plan, at a time when I’ll be earning a third of what I grossed on the job. With the ARRAS discount in force, Medicare will actually cost more than COBRA!

The base cost of Medicare Part B will be $110 a month. Parts A and B cover your basic needs, but leave your pants down around your knees: it’s an 80-20 coverage with rather limited hospitalization and no prescription meds. As we all know, one serious car accident, one heart attack, one stroke and 20 percent of the resulting medical bills will ruin you financially.

To take up the slack, you have to buy a “Medigap” policy from a private insurer. These policies, which come in a dozen flavors, are standardized, so that all policies issued in any one of the 12 available plans are the same. Only three—Plans C, F, and J—seem to cover all the contingencies well. Insurers charge whatever they feel like charging, and so in Arizona premiums for Medigap policies range from around $80 a month to over $300, depending on your gender and age. One outfit charges $417 to $560 for plan J—this is for supplemental insurance!

On the low end, a 65-year-old Arizona woman will pay between $107 and $163 to get into one of those three plans. Well, at least she did last year; I can’t get my hands on the 2010 rates, but I’m sure they’re higher.

Then you have to buy a prescription drug plan—and you have to get it whether or not you take any meds. If you don’t buy in as soon as you’re eligible, you’re penalized with a whopping fine when you go to sign up later. These plans run around $25 or $30 a month, and they don’t cover all drugs nor do they cover all costs of drugs; you still get to pony up a hefty copay for most prescriptions.

So: $110 for Plan B + $110 or so for Medigap + $25 for drugs and you’re at $245…at 2009 rates. Let’s add, say, 10% for inflation, and that brings us to about $270, for the cheapest plans on the market. By way of comparison, my cost for COBRA will be $185 a month; my cost for an employer-based EPO that let me go to the Mayo Clinic was $36 a month.

I guess you can get cheaper coverage by going with an HMO, which is what Medicare Advantage is. But having watched my mother die pretty hideously in the negligent hands of HMO doctors, I’m not going that way (it’s not in an HMO’s financial interest to treat you when you have a catastrophic illness; au contraire, what works for them is to deny you’re sick until it’s too late to do a thing for you, and then to withhold palliative care).

Interestingly, AARP’s much vaunted senior-friendly plan is far from the cheapest. They charge $187 for Plan C, $190 for Plan F, and $217 for Plan J. By comparison, the lowest rate I could find for Plans C and F was $107; four companies charge around $115 to $120, and quite a few are in the $150 range.

Well, I’ll be happy if I can keep the total cobbled-together cost of this pushmi-pullyu lash-up under $300. But I figure three C-notes a month is what I’d better budget for Medicare over the next two or three years…until it goes up.