I’m Over 65 and Counting the Money

Not long ago, I retired from the clinical practice of psychiatry. One
of the factors that comforted me in making that decision was that I
was eligible to receive Medicare, so I wouldn’t have to try to obtain
some sort of expensive private health insurance or COBRA to tide me
over. Actually, I was 66, as I had to wait until my wife turned 65
this past July, for the same reason.

This transition would be easy, simple, and cheap, I thought. So, many
months I tried to look into Medicare to confirm that assumption. Even
at first glance, there was Medicare Part A, Medicare B, Medicare
Advantage, Medicare D, and Medicare Supplemental Insurance. Not so
simple, I was quickly finding out, and really not so cheap.

When we attended a Medicare educational seminar, which I had
originally thought would not be necessary, it was crystal clear that
most of the attendees could not understand their choices, charges, or
costs, despite the very clear and unbiased presentation. Even a
retired teacher, who helped choose health care plans for his school,
called me for advise after he turned 65. Why me? I was the director
of our medical school managed care mental health contracts and even
wrote a book about that experience (The Ethical Way: Challenges &
Solutions for Managed Behavioral Healthcare, Jossey-Bass, 1997). So I  should know about health care insurance. Right? I thought so, but here  I was, almost as confused as the rest. The advice of the seminar
leader seemed best to me: if you can afford it, choose the best. But
what was the “best”?

Knowing about for-profit managed care companies, I knew that I wanted  to avoid them — and the possible authorization problems — if I could.  In the end, we followed the example of my wife’s cousin, a physician  who worked in the actuarial side of health insurance. The choice  did include the managed care behemoth and AARP-related,
UnitedHealthcare.

So far, we are paying more for our insurance costs than we did before
Medicare. A medication that I thought was covered, was not. So I
paid for that. I know, I know. You can look up what drugs are covered
before choosing the Medicare D company, but this was such a common,  generic medication, I just assumed it would be covered.

Then, my first monthly prescription drug summary, which covered the
month before I even got that non-covered medication, arrived in the
mail. The “out-of-pocket costs” for me were $154.50, out of the
“total drug costs” of $232.33. With my monthly payment for Part D
Prescription Drug Coverage, was Part D even worth it financially
right now? I mean, that coverage was optional, but then again, I
could need coverage for more expensive medication sometime later this  year. A psychiatrist colleague wrote me that I’m not alone, that “90%  of folks don’t pick the Medicare D plan that would be best for them.”  Where did I go wrong? This is embarrassing, indeed.

But I did have to buy Part B. I also bought supplemental coverage,
not yet needed, fortunately. And, at least, Part A for
hospitalization was free. Whoops. I almost forgot to mention the not-
so-pleasant visit that I had to make to our local Social Security
office for this transition.

All this stuff could be found in the literature you receive, either
online or in the mail. I just received the 2013 version of “Medicare
& You” from the Center for Medicare and Medicaid Services. It’s 140
pages! On the same day, I received the 2013 booklets of the AARP/
MedicareRx Plans, which included the Abridged Formulary, the 2013
Evidence of Coverage, and the 2013 Annual Notice of Changes. Over 100  pages combined! I’m still not so sure that I understand them. And I don’t have beginning Alzheimer’s or any sort of common memory problems of the over 65. At least yet. Maybe some anxiety over all of this, but enough to account for all the confusion and possible mistakes? What have I gotten us into?

Just think. I’m just over 65, in pretty good health, not on any
expensive medications, and, I’m told, I should have enough savings for
the next 30 years (though that is by no means guaranteed). And I’m a
psychiatrist, knowledgeable about health insurance, but I’m still
anxious and confused. Now, we hear about proposed changes that may be  necessary for Medicare’s viability, at least if you believe the
politicians. So far, all those changes seem to promise less, and be
even more complex.

We have two children and four grandchildren so, of course, we worry
about their future and whether they will have the societal
benefits they may need as they age. I’m also liberal in outlook, took
care of the under-served all my career, have been an advocate of a
Canadian-style payer system (not too unlike what I thought Medicare
was), and have been an activist to reduce global warming. I want to fulfill Erikson’s highest psychosocial stage of development, to be as
generous to the next generation as I can.

Hence, the question and moral dilemma that seem to be forming. What
can I do to help Medicare? And Social Security (which I haven’t begun
to draw from)? Would I be willing to take less and/or pay for more?
Would that be more of my “fair share”? What if that jeopardized our
long-range, uncertain financial planning? I think there are other
ways I — and we — can contribute. Stay tuned.

Steve Moffic, M.D., 66, recently retired from clinical practice. He identifies himself as a “psychiatric gadfly.”