From Plan A and B to “donut coverage,” choosing a Medicare plan is frustrating — especially when considering the costs of a cancer diagnosis.
Can we talk for a moment about the alphabet soup otherwise known as Medicare here in the United States? This coming October, I will be eligible and required to sign up for Medicare after being on Social Security Disability Insurance for the required 24 months with the additional five-month waiting period.
Now I realize it’s only May, but I am a planner. I like to have some sort of control and knowledge of my situation, especially when it comes to insurance and living with an incurable illness requiring more than your average person’s medical care.
Since my metastatic breast cancer diagnosis in 2014, I have had insurance coverage through my state’s marketplace, and I’ve come to know mostly what to expect and what is covered. But now, I must say, this Medicare business is daunting. I really don’t know how seniors deal with this monumental task of delving into the world of Medicare. I’m so confused with all the choices.
There’s Part A and Part B or Original Medicare; Part C, also known as the Advantage Plan; the drug plan, Part D; and the Medigaps, Part G, Part N and the no-longer-available Part F. Then there’s this thing called the “donut hole,” which is a coverage gap where once you’ve paid a certain amount out of pocket of your yearly limit, your drugs are covered again. I know I’m probably missing something with all these letters floating around in my head.
Let me just start with A is for aggravation and move right into B is for bureaucracy, C is for cancer treatment, D is for drugs, F is for futile, G is for goodness gracious, I’ve made it to N, and I need a donut now.
One needs to channel their inner Kinsey Millhone, the private investigator from the late Sue Grafton’s alphabet book series, to navigate this broken system designed for seniors. It is definitely not geared for those on disability. And I want to know who on Earth is responsible for naming this system? Do the donuts have sprinkles or are they glazed?
Now I know I must take Part A and Part B, that’s a given. The premium will be deducted from my Social Security. It’s the rest of these letters causing me all the confusion. I’ve been advised by health care workers, whom I respect and trust, to steer clear of Advantage Plans, which are basically HMOs. Yet when I spoke with two different insurance brokers regarding my options, the Advantage Plan was their first suggestion because of lower costs. Cost will be a huge issue for me when it comes to choosing a plan, as well as in-network providers. I know I will need a drug plan that will cover my specialty medications, Part D. But will it cover my medication, or do I need donut hole insurance too? I know I will need a plan that will allow me to see specialists of my choosing, so that is a big no to Part C or Advantage.
OK, we are finally getting somewhere. I think for now I have narrowed down my decision to a Plan G or Plan N with a side of Plan D. Unfortunately, the cost of these plans for someone under age 65 can be up to 10 times higher in my state than for those 65 and older. Some states do not even offer coverage to those under 65, so I guess in that respect I am fortunate that California allows it.
From what I’ve been gathering in my detective work, I’ve discovered that across the board all supplemental plans, regardless of the monthly premiums, have the same coverage. There’s still more investigation to be done to “insure” that I won’t be found crying in my alphabet soup when the time comes to make the switch. In the meantime, I prefer a maple-glazed old-fashioned donut to a donut hole any day of the week, even if it does have sprinkles.
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