Get some local advice during the Medicare enrollment period

Sunday, November 3, 2019
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Guest Column

I was looking forward to my 65th birthday a couple of years back – I would now be able to get Medicare.

Now that I have been through the process, I have found out it is nothing to be excited about.

During my years of teaching in Harlem and Stanford, I did not have to worry about my medical insurance. As soon as I signed my teaching contract, I gained health insurance. During the time I was at the News-Argus, I also had insurance coverage.

Approximately two months prior to my 65th birthday month, I got all signed up for Medicare Parts A and B. But then I found out I needed a supplemental insurance policy. If I did not sign up for supplemental coverage when I started Medicare, I would have gotten charged a higher premium for my coverage.

Next I found out I needed to sign up for a prescription drug plan. Of course, if I didn’t sign up for a prescription drug plan when first eligible there would be a late enrollment penalty.

Now on top of that, a person can, between Oct. 15 and Dec. 7, switch to new plan. With Medicare A, B, C and D and whatever else, things have gotten very confusing. The advertisements on TV have confused me even further. Now I hope this is right: Part A pays for hospitalization, Part B pays for doctor visits and other things, Medicare Advantage Plans are often called Medicare Part C. Individuals who sign up for Medical Part C still have Medicare, but most of the individual’s Part A and B coverage will come from their Medical Advantage Plan. Most times Part C also includes Medicare prescription drug coverage also known as Medicare Part D. Medicare Advantage Plans may also include dentists, eye doctors and hearing aides. One needs to be careful signing up for Medicare Advantage Plans as these plans often include HMOs and PPOs.

I did get signed up for everything I needed for Medicare. Now I have three insurance premiums to pay for: one for Medicare Part B, one for my supplemental plan, and one for my prescription drug plan. The years I have paid for Medicare by having it taken out of my paychecks only covers Medicare Part A, which I think is for hospital coverage, and Medicare only pays for 80%, with one’s supplement covering the rest (maybe).

I was proud of myself for getting everything done before I actually went on Medicare. I thought now everything should be taken care of. Boy, did I find out differently.

About six months after being on Medicare, I had some expenses, including being in the hospital for a day. In May, I had some tests run in Great Falls. I did not have an inkling something was wrong until the latter part of June. I started getting statements showing I owed money.

I had always given the intended parties both my Medicare card and my supplemental card. But, for example, the hospital was reimbursed by Medicare, but nothing from my supplemental insurance company.

I started to investigate what was going on. I called Medicare, and I was told by Medicare they did not show me having a supplemental policy. Next I called the insurance company and they said “yes” I did have a supplemental policy.

It is quite interesting (or more like confusing) how the system works.

Once a person has a claim, it is sent directly to Medicare. Medicare then pays its share, and then sends the rest of the cost to the supplemental insurance to pay. Because Medicare did not have a record of me having an insurance policy, the rest of the cost came back to me to pay.

It took almost 10 months for my supplemental insurance company to notify Medicare that “yes I did have a policy.” So now what? No one could re-submit to Medicare, so it could go to my supplemental insurance company. Lots of phone calls, but eventually most of my claims did get paid by my supplement.

That is except for three. I asked those three to submit them to my insurance. One said they did and was told that I did not have a policy with them. The supplement insurance company said it never received a statement from the provider. Eventually the three claims were turned over to collection agencies. I continued to try to fight them, even going as far as getting a lawyer.

Two things I have learned – nobody wants to fight insurance companies, and yes, I did get stuck with having to pay all three bills.

I know my experience does not happen very often, and I did not know the system well enough to figure out what went wrong quickly enough. I also wonder why we make this most complicated system available to our most vulnerable population, senior citizens.

My advice to all seniors during this special enrollment time is to “get some local advice and don’t turn to talking to an insurance agent you do not know, such as internet or phone agents.” This year I have read my “Medicare and You Handbook” from cover to cover.

I know I found out last year when I had to switch to a new prescription drug plan because mine was no longer offered in the state of Montana, the local Council on Aging has some very knowledgeable people to help you. No, they are not insurance agents, but they are very good and it costs nothing.

Doreen Heintz is a former reporter for the Lewistown News Argus.