When Help Hurts – A Medicare Supplement Saga

One who has no sense shakes hands in pledge
    and puts up security for a neighbor.
Whoever loves a quarrel loves sin;
    whoever builds a high gate invites destruction.
One whose heart is corrupt does not prosper;
    one whose tongue is perverse falls into trouble.

  • Proverbs 17:18-20

If you have watched television lately, you have seen advertisements for Medicare plans that pay you back about $150 dollars each month, give you free dental and eye glasses, eliminate co-pays, and at no extra cost or in some cases without having to pay anything.

Why do these wordsmith artists pick on the elderly?  Their plan may be good for the 65 year old just entering eligibility and in great physical condition for that age, but I have been told that if I leave my plan, I can never go back to it.  I have a good plan, managed by people that I trust.  I will shop for a new pharmacy plan, but as for the medical, the plan I have is sufficient.

And maybe these people are legitimate. My problem is that the alarm bells go off when a claim is made that no one other than this one company can provide what they provide and you get something that you do not have to pay for. But they are careful how they word it – they let you think they said something when they really did not say it.

As for their promises of getting great coverage at no cost, or no additional cost, you never get something for nothing.  The plans that have zero premiums essentially pay for nothing and by the end of the year, you are further in the hole.

As for giving you money back, if you are using Medicare Part A and B, the government removes about $150 dollars from your benefits and you never get a statement that states that.  If you switch to a Medicare Part C plan, then the government will not take that money out of your account anymore and you get more money in your SSA payment.  That is the money that the advertisements talk about, but then you must pay premiums to the insurance provider.  Those premiums may be higher than the money you get back.  If not, the insurance company may not pay for services like Medicare does.  In the end, you may pay a lot more. If you are very healthy, it may pay for itself – short term, and once you are no longer healthy, the other plans will be unavailable.

I inquired about dental.  No Medicare dental plan pays for itself unless you have more than two teeth cleanings during the year and something more than one tooth filling.  If you anticipate crowns, bridges, etc., then a dental plan may be worth it, but even then, maybe not.

But then, we got our plans at near 65 years of age, and before my wife had open-heart surgery and end stage kidney failure.  We got Medicare plan F supplements.  The supplement pays everything that Medicare does not pay (not including pharmacy).  We never ever see a bill or pay the doctor or hospital anything.  No annoying financial counselors coming by before we leave the hospital.  We walk into the hospital or the doctor’s office, and we walk out without being asked about co-pays or bills or anything else.  Occasionally, the nurse will ask how we got such a sweet deal.  Of course, our premiums are more than some of the other plans, but it makes life easier and it is not much more, about one doctor co-pay more.  And there never is that, “Can we afford to go to the doctor another time this month?”  Under the “Not so” affordable health care program, by the time we paid the huge bill, we could not afford to go to the doctor.  Okay, we could skip paying for food, and with no food, who needs to provide electricity to the refrigerator or gas to the stove?

The point is that if we dropped the plan that we have and immediately went back to it, my wife would pay double due to the medical issues or not be eligible for the plan at all, and my premiums would be based on being near 70, not the entry age of 65.

Notice that the advertisements do not say what you think that they say.  Some plans have this.  Some plans have that.  But no plans have both this and that.  You get money back, added to your Social Security check, but then you pay the insurance company that much or more.  And some plans restrict you to a small number of plan doctors.  In my wife’s and my experience, changing doctors due to insurance changes costs a lot in the long run, rerunning tons of tests that the previous doctor had already run.

Now as for the pharmacy plan, the Part D, I look at that every year and choose the cheapest plan.  When the insurance company fails to pay and we start paying hundreds of dollars for a month supply of 30 pills, then we look elsewhere the next year.  Even with the same company, they put you into a plan, without your permission that will cost you more money.

But the thing is that I spend an hour or two inputting all our medicines into the computer.  The computer then tells us which plans cost the least considering premiums plus medicine co-pay costs and donut holes.

A donut hole is when the insurance company, on a whim, decides that you have taken more of that pill than they think you should take and your $20 per month medicine suddenly becomes $400 per month or more.  Notice, this decision is made by an accountant that is looking out for the insurance company’s interest and not the doctor treating your ailment.

When we went into a donut hole two years in a row on a medicine that my wife had to take daily, we begged the doctor to change the medicine to an older drug, one that is cheap enough to be below the insurance company’s radar.  And oddly, the older medicine works better.

Now the government wants to create their own donut holes, anything to take advantage of the elderly.

My wife will hear a new advertisement that phrases things a little differently.  She gets excited.  Then I must watch enough TV until I see the ad and then explain to her how they carefully worded what they said.  Since they were careful, they do not go to jail, but they are still taking advantage of seniors.

Soli Deo Gloria.  Only to God be the Glory.

3 Comments

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  1. Gregory has Medicare through me since our insurance is what I had through school— at 62 I can’t join yet but I must say, I’ve not heard of plan f— I absolutely hate all the rigamarole — one needs a team of expert just to figure it out!!

    Liked by 1 person

    • They do that on purpose. Plan C is a substitute for plans A and B if you do not want the government Medicare. Plan F is a supplement that pays everything Medicare does not pay – deductibles, co-pays, etc. Ours does not have pharmacy, that is part D. Another trick that they never tell you is that if you start with a part C or a part F and then you change – like when the laws change, adding coverage options – you can never go back to ANY C or F plan. The thing I don’t like is that the government makes it hard to understand, so you have to go to a broker for help, but the broker is out to get you into an expensive plan so that their commission is higher. Should I say “allegedly” a few times?

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