Medicare 101

Posted by Goddess on October 23, 2009

I’ve been on Medicare since 1996 for my disability consisting of Crohn’s disease and back problems (due to the medications taken for Crohn’s) Did I want to go on disability? No, because I had a wonderful job as a floor nurse that I loved. But that’s yet another story about “don’t let your job define you.”

The bright side was that after struggling for years here and there without insurance, I now had a stable insurance that I could count on.

Medicare is great. There is not a lot of hassle with it, such as finding a doctor or pharmacy “in your network,” or needing to get certain tests or procedures “cleared before hand” although Medicare won’t pay for some things. All in all, it wasn’t that much of a hassle.

The downsides to Medicare were no prescription coverage and a 20% co-pay on everything. I say “co-pay” because Medicare only pays for 80% of medical care and the patient is responsible for the other 20%. And in the age of big insurance, most doctors want that 20% right then and there.

Believe me, that can be difficult for a person on a fixed income.

What I finally had to do was find a Medicare supplement. When I was married, one of my husband’s employers offered insurance, so that served as my supplement. But when he then found himself out of work post 9-11, I had to search for my own.

Medicare.gov is a great resource. I was able to find a very good supplemental insurance in North Carolina. Initially, I paid an extra $34 a month (on top of the $89 Medicare premium) and I had low co-pays and decent prescription coverage. When G.W. Bush passed the Part D Medicare prescription bill, my supplemental monthly premiums shot up to $84 a month. But in less than a year they dropped back down to $40 a month.

When I moved to Florida, I lost my supplemental insurance in North Carolina. I’ve been searching for a good supplement since. And there are plans that range from $0-$240 a month. The good news is that with my single disability income, I qualify for help from the state government to cover my $93 a month Medicare premium (it raises every year along with the cost of living increase)

However, even supplemental insurance will place a gap on your prescriptions, meaning, you’re allotted just over $2000 a year for prescriptions. If you go over that amount, you then have to pay that amount out-of-pocket before the insurance kicks back in under “catastrophic.”

So keep these things in mind as you head toward Medicare. Even with these flaws in the system, I’m still grateful. As a non-disabled person working 40+ hours a week, I wouldn’t be able to afford the insurance I have under Medicare. As a Medicare recipient, I’m still paying into the system (ok, technically, the state of Florida is, but I was before that) and I’m still paying a private insurer to cover the gap.

If that’s not the best argument for universal care, I just don’t know what is. It’s a win-win for insurance companies and all Americans.