It’s a mad, mad, Medicare system: Part 2

Medicare: a good deal for seniors, politicians and crooks

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  • Contributor
  • April 26, 2011

The following is the second report from Guest Contributor Glenn Tornell, who’s investigating the “mad, mad, mad, mad Medicare system” as a prospective enrollee and then – with any luck – a beneficiary. His first report on Medicare is here.

Bad news on the free scooter front in my first attempt to cash in on Medicare: apparently, commuting to the local golf course doesn’t pass muster – even if it’s more convenient and would slash my fuel bill.

That’s why it’s important to read the small print. The mobility experts at The Scooter Store told me I didn’t qualify because I needed to have a diagnosed medical condition that prevented me from accomplishing basic day-to-day tasks. Sloth, I guess, isn’t a medical condition yet.

Approaching 65 and retirement both abstract places for me I’m slowly learning my way around Medicare, keeping a keen eye out for all the wrinkles, traps and entanglements reputed to plague this behemoth social program.

I’ll soon be joining the 47 million other Americans riding this fiscal Titanic, racked by fraud and unimaginable unfunded liabilities. Despite the negatives – including political threats to replace or kill it (PaulRyanCare, maybe?) and the uncertainty of ObamaCare’s flickering shadow – I’m jumping in.

I’m doing it even though I know Medicare has a freaky Jekyll-and-Hyde personality. On one hand, it seems like truly a magnificent social program protecting and preserving the health of our senior citizens. On the other, it appears to be a ruse coming to a disgraceful end, a piggybank posing as a trust fund feeding the egos and largess of our parasitic politicians and the pocketbooks of Medicare scammers.

Maybe it’s both. I’m still trying to decide.

I’ve read reams of How-To articles, from official government documents (boring and often incomplete) to online rants and commentaries (wacko pros and kooky cons). I’ve talked with a half dozen insurance agents and schmoozed with gaggles of senior citizens.

Despite my delight in trashing most federal programs (unless they benefit me, of course), the bottom line, in my opinion: Medicare is spectacular deal for seniors, and apparently for politicians and criminals too. That’s why it’s so hugely popular.

A small problem: who the hell’s going to pay for it? I haven’t a clue.

Original Medicare – protection worth packing

Pardon the gun metaphor, but being enrolled in Original Medicare (kind of a personal protection program) is a bit like purchasing one of those cute Bond Arms Snakeslayer Derringers, capable of chambering both a .410 shotgun shell (like Medicare Part A) and a .45 bullet (like Medicare Part B). Reasonably priced – you can buy one for a little under $500 – this two-shot, double-barrel weapon (like Original Medicare), offers lots of security to keep the malevolent forces (medical costs) at bay.

If you’re covered by Part A & B, consider yourself decently protected. (I’m sticking with the gun metaphor because I’m trying to give Medicare recipients a sense of “empowerment.”) Need assurance that’s a bit more cerebral? Look at it this way: Parts A & B are simple. (But when you come to Part C and beyond, be cautious.)

In other words, to again quote my old muse, MAD magazine’s mouthpiece Alfred E. Newman: “You can be on the right track and still get hit by a train!”

Old age ain’t no place for sissies.

You really do need Medicare, simply because aging can be very unpleasant. (Case in point: the photo illustration that accompanies this article.) Very few of us will go gently into that good night. Even if you’re a health nut, a vegetarian, a power lifter – even if you take your daily aspirin, vitamins, fiber and Lipitor – genetics and bad luck can easily put you in the expensive lap of a health crisis.

As noted, I’m fond of Mr. Newman’s catch phrase, “What, me worry?” But I still wanted to get a sense of the perils I might face, so I called my local ambulance service, just to ask how much it would cost to haul my ailing body, God forbid, from my house in Fargo to the local hospital, about four city miles away.

The answer: $1,200 plus $18.50 a mile. (And I live just three blocks from the ambulance garage!) A taxi would cost $7 plus a tip. Okay, I might be dead by the time I get there, but think of the money I’d save.

If I required an air ambulance to Minneapolis from Fargo, a trip of about 222 as-the-crow-flies miles, it would cost $9,385 by fixed-wing aircraft and $18,750 via helicopter. Both prices follow the CMS Ambulance Fee Schedule, and can vary by provider. In other words, that’s normal.

The point is, medical costs are outrageous. But so is death.

Get this: The average lifetime cost of a severe heart attack, according to National Business Group on Health, is about $1 million. That includes charges for hospitals, doctors and prescription drugs, while indirect costs include lost productivity and time away from work. The average lifetime expense of a less-severe heart attack is about $760,000.

Even with basic Medicare (which typically pays 80 percent), that’s still bankruptcy territory.

Original-flavor Medicare

Medicare Parts A and B provide basic comfort, like a low dose of valium.

Together they’re called Original Medicare, a name that itself seems confusing. (Is the original better than the New and Improved?) It’s kind of a pre-paid insurance because you paid for it via years of mandated payroll deductions.

A is for – you guessed it – Part A

This is how it works. Lets say you’re 65 and you’re struck by a miracle: you’re pregnant. Don’t panic, you’re covered. (OK, you probably are covered by Part A.) All you have to pay is a $1,132 deductible before Medicare Part A foots the tab.

The average list price for a normal vaginal delivery without complications ranges from $3,000 to $7,000. You’re saving several thousands of dollars, which can either be applied to your newborn’s college savings account or for your pre-paid funeral. What a deal.

And if you’re going directly from the maternity ward to hospice or skilled nursing care – which is very possible – you’re also covered.

B is for ‘not free’ – and Part B

Part B is different. It’s optional – but not free – and comes with a $162 annual deductible. It covers doctor and outpatient costs and other medical services and supplies. Most people sign up for it. If you turn 65 this year, your monthly payments will be $115.40, which will be taken out of your Social Security check (if you enroll in Part B).

So, let’s say you go to the doctor for a common elderly complaint, toe fungus. You know, the stuff that turns your toenails yellow. It’s endemic to the elderhostel set. The average cost of a doctor’s office visit and a prescription for a fungicide will just about eat up your Part B deductible, but probably not your fungus.

If toe fungus grosses you out, skip this section.

If you know anything about toe fungus, you know it’s difficult to cure and pervasive among us seniors. Topical treatments, in my experience, aren’t effective. And oral drugs are hard on your liver and come with some complications.

A little free advice: Save your money. I’ll let you in on a secret. I have the cure for toe fungus and it’s probably in your pantry. It’s called vinegar, which costs about a buck a bottle at a dollar store.

My toenails were about the color of a rusty, faded school bus when I found my solution on the Mayo Clinic Web site and tweaked it for my personal use. Here’s what I did: I kept a bottle of vinegar by my bedside and put an old toothbrush in it. Every night I’d scrub my nails with vinegar (vigorously, like I was cleaning the oxidized terminal of a car battery) and every morning after showering. Within six months, the fungus was gone. And it hasn’t come back.

Enough about feet. Learn more it during the monthly foot care meetings at your local Senior Citizen’s Center.

Medicare tries the ‘prevent defense’

New this year to Medicare, you are eligible to receive free preventive care, some with and some without co-payments, along with a free “welcome to Medicare” physical exam.

As a result, a colonoscopy – which cost a fortune in pride – is now free. I bet a jar of Vaseline and a gallon of bowel prep that cost is the least of your concerns when the doctor tells you to pull your knees up to your chest. But it’s far better than colon cancer.

You may not want the ‘extra crispy’ Medicare

You can stop there if you want, with just Part A and Part B. It’s a pretty good deal. After that, Medicare typically picks up 80 percent of approved medical costs, and you pay 20 percent. (Medicare, however, does not pay for dental care, long-term nursing care, eye exams or glasses, hearing aids, cosmetic surgery or acupuncture.)

I didn’t know any of this stuff a month ago. It’s really not that complicated. There are some quirky items involved, like if you haven’t worked enough years to qualify for Part A, or if you have End Stage Renal Disease, or if you miss a Medicare enrollment period.

Start looking into Medicare about four months before your 65th birthday. If you’re confused, get yourself a copy of “Medicare & You.” You can even talk with a real person at your State Health Insurance Assistance Program office. Call 1-800-MEDICARE to get the SHIP telephone number in your state.

If you’re rolling in cash and don’t want to be bothered with all these petty details, the kind folks at SHIP can refer you to a professional Medicare counselor. For a couple hundred bucks, they’ll do all the legwork for you.

When Original feels so un-original

The insurance industry and statisticians suggest that us retirees are risk averse. We tend to hoard and mothball our assets more than our bolder and more fearless younger generations. It’s all about security, right? A warm fuzzy blanket, a cup of warm milk and reruns of The Andy Griffin Show. (If that’s the case, then, how come you see so much gray, white and blue hair at bingo parlors, racetracks and casinos?)

Here’s where your tolerance for risk comes into play. Like I said, Medicare’s a pretty good deal (which explains why a lot of folks were cranky during the health reform debate over the prospect of having it taken away). But it’s not perfect. The Original version has some gaping coverage holes (see above) and if you want covered what Original doesn’t cover, get ready to roll the dice on something with a potentially bigger payout.

I’ll try to decode those mysteries in my next report, starting with Medicare Part C, a private insurance program that debuted in 1997 to put more competition into the market. And then there’s the Medigap program, also called Medicare supplemental insurance, which didn’t get an alphabetized Part from Medicare. (It got 14 Plans.) And Part D for prescription drugs.

Oh, and did I mention Cost Plans?


Did you read Part 1 of the series?
It’s a mad, mad, mad, Medicare system