What you need to know about Medicare

Retirement Health Care: Is It Medicare Or Medicrap?

I, one of tens of millions of baby boomers, was always under the impression that, if I was lucky enough to reach the ripe old age of 65, all of my health care costs would be covered under Medicare. I thought that was one of my entitlements, my payoff for working … and paying into Medicare… and surviving … to age 65.

I was looking forward to the day when I could drop my outrageously expensive private PPO high-risk health care coverage (which costs more than my monthly rent) and get what I was entitled to, get what I paid into for an entire working lifetime … Medicare. Three months before I became eligible for Medicare I decided to do some advance research on signing up for Medicare and also to see what my benefits would be.

Here is what I discovered … painfully.

I went to the official U.S. government web site for Medicare, medicare.gov. The government web site, medicare.gov, did an excellent job in describing and explaining what Medicare is and how it works. And how to sign up for Medicare. The devil, however, is in the details and the details are glaringly absent or extremely difficult to find and/or understand. I defy any human being in America, who is not a Medicare insurance specialist, to discover and comprehend the advantages and disadvantages of the various must-choose options under Medicare. It is impossible!

In essence here is what I discovered …

Plan A – covers hospitalization. Cost: free

Plan B – covers doctors visits. Cost: $110 a month

However, Medicare does NOT cover ALL the hospital costs or all the doctor visit costs. Medicare only covers 80%. You must buy a supplemental private insurance plan to cover the 20% gap. In my zip code (Los Angeles) the cost of a supplemental private insurance plan, to cover the 20% gap in hospital costs and your doctor co-pays not covered by Medicare, is over $200 a month. So now, my supposed “free” Medicare will cost me $110 plus $200 … over $300 a month. Out of pocket. But wait, it gets worse. Medicare does not cover the cost of prescription drugs! Zero coverage. What? No drug coverage? What kind of a health insurance policy is that? No drug coverage? The average number of prescription drugs taken by people age 65 and older is 11. None of which are covered under Medicare. So, that means you have to buy yet another health insurance policy to cover the cost of your medications. In my case, there were some 30 different “supplemental” prescription drug plans available in my area and it is up to me, the soon-to-be-65 individual, the soon-to-be-65 patient, the soon-to-be-65 consumer, to compare all the plans. Did I try to compare the plans? Yes. Did I get a headache? Yes. Was I able to figure out on my own which plan was the best plan for me? No. The information available is incomplete, confusing, and not at all easily researchable. Though the monthly premiums on these prescription drug plans were very reasonable ($35-$65 per month) NONE of the available plans I researched covered all the costs of my medications. They all had huge co-pays. Or the medications were not covered at all. The monthly premium and co-pays for my 5 meds would total up to as much as $350 … every month. I found out that the co-pays would be a lot less if I substitute generic brands for my meds ($7-$14 each). Aha, by switching to generic I could get my total Medicare related health care costs down from $650 a month to much more reasonable cost of about $300 a month. I solved the high-cost-of-Medicare problem, I had now successfully negotiated my way through the Medicare maze! But then, to my dismay, I found out that I cannot substitute my medications for generics as, according to my pharmacy, who looked it up, there ARE no generics for any of my cardiovascular meds. So, my must-have prescription drug plan would cost me a whopping $350 a month. Out of pocket.

So now, my “free” Medicare coverage insurance will end up costing me $650 a month (assuming I don‘t need any additional medications). About the same cost as any decent normal private health care policy that a reasonably healthy person had before they became eligible for Medicare. And, under Medicare, you end up with 3 different policies for your coverage (or 2 policies if you want to combine supplemental hospital and doctor coverage plus drug coverage, which is called “Medicare Advantage”, except you also can’t figure out which “Medicare Advantage” plan is any good or what advantages and disadvantages each plan has).

So, after paying into Medicare and achieving the retirement milestone of 65 years of age, you will end up getting nothing you probably didn’t already have. Under Medicare you do not get free and total hospital and doctor care coverage, you get no prescription drug coverage and worse, you will likely end up paying about the same as you were paying for your health care coverage before Medicare, unless you were getting free or subsidized lifetime health coverage from your employer. Or, if your free or subsidized health coverage from your employer stops when you stop working, then, under Medicare, you will be paying MORE. A lot more.

The government collected Medicare money from your paycheck (and from your employer) all through your working years. The government collected that money all through your working years specifically to cover the cost of your Medicare. Only it doesn’t cover the cost of your health care at age 65. Far from it. Instead of getting free and full health care under Medicare, at age 65 you may have to pay $600, or more, per month, out of your own pocket, to get proper and full medical and drug coverage. And, to add insult to injury, the government wants to cut Medicare benefits even further!

This is what baby boomers worked a lifetime for? This is what baby boomers get for paying into Medicare over an entire working lifetime? This is the payoff for baby boomers who survive to age 65?

This begs the question: is it Medicare or Medicrap? Is Medicare a giant government rip-off? Is Medicare a giant government rip-off of an entire generation of baby boomers? Is Medicare a giant government rip-off of baby boomers, aided and abetted by the private health insurance industry?

What you get: under Medicare you get 80% hospitalization coverage , 80% doctor visits coverage (which cost you $110 a month) and 0% prescription drug coverage.

Here’s what I think we SHOULD be getting under Medicare:

> 100% coverage for hospitalization

> 100% coverage for doctor visits

> 100% coverage or low co-pay for any and all prescription drugs

How about you? Now THAT’S the Medicare we want. And paid for!

How do we get it?

Is it Medicare or Medicrap? As millions and millions of us approach age 65, and Medicare, we baby boomers will have to decide … and deal with it. And we will. Starting right here. Starting right now. We baby boomers have power. Lots of power. We have education, we have money, we have loud voices, and we have tens of millions of votes. Baby boomers are not wimps nor are we victims. We do not tolerate injustice. We do not tolerate being ripped off. Baby boomers are activists. We marched, we protested, we changed the world. And now we are armed with email and cell phones. We baby boomers can bombard our senators and our members of the House of Representatives in Washington about issues that deeply concern us. Like Medicare. And demand they fix it. And demand they give us what we paid for! We baby boomers have power. Lots of power. Use it or lose it!

Andrew Lawrence is an original baby boomer, born in 1946. He is the author of numerous articles and books that make you smarter, richer, happier and sexier, including “How To Thrive After 65”. His web site is http://Andrew-Lawrence.blogspot.com