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So many choices, so little time

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Window of opportunity to change your Medicare plan ends Dec. 31

By PENNY FLETCHER

SOUTH COUNTY — For many years I’ve written about the people in the communities of South County- their issues and challenges — as well as the unusual, and sometimes heroic or wonderful things they do.

I’ve done several stories about health care; described some of the latest and best procedures; sought out what’s available in our area for those with little or no insurance; and done investigation on what residents can expect from the State of Florida and the Federal government as well.

medicare
Penny Fletcher Photo
Consulting with independent Medicare Specialist Anna Lonas who comes from St. Petersburg to set up a table in the Kings Point Clubhouse periodically helped me decide which option to take. Everyone is encouraged to find an independent specialist who is not a representative of any one insurance company during their annual opportunity to change plans which falls between Nov. 15 and Dec. 31.
While it’s true the United States has some really good health care available, it is not accessible to many who need it most. And the difference between the health care ‘haves’ and ‘have-nots’ is painfully evident right here in South County.

I can make that statement without even consulting the World Health Organization because between Nov. 1, 2007 and Nov. 1, 2010, I had no health insurance.

Most people who get sick and go for tests and have treatments assume this is the norm for everyone, but it is not.

As I wandered through the maze of clinics and hospital wards – especially during a cardiac incident in the summer of 2009– I found hundreds of people in the same shape as I, and many far worse.

While it is true hospital emergency rooms must stabilize anyone brought in to keep them from dying, only certain county hospitals that receive a particular type of funding, including Tampa General and Manatee Memorial, admit patients without insurance to a floor after stabilizing them in the ER.

Expensive tests as an outpatient, like MRI’s, CAT scans and cardio tests?

Forget it. Show the insurance card that will pay in full or don’t let the door hit you on the way out. Unless of course, you’re prepared to fork over the $3,000 to $10,000 (or more) that these tests cost.

I’m basing these conclusions not only on my own personal experience, but on the other people I’ve met and written about in previous news stories, like the woman dying of cancer who slipped through the cracks of programs until it was too late for even the Patient Advocacy Center to help her; the heads of clinics like ECHO in Brandon and SunCoast Community Health Center in Ruskin whose CEO’s told me outright that Gov. Charlie Crist’s “Cover Florida” program didn’t give any help to the people who flood their waiting rooms every day.

Cover Florida, initiated in January of this year, costs between $300 and $500 a month for a single person, depending on which plan is chosen, but the deductibles are too high for people in the targeted income range and the maximum limits for hospital stays are way below the actual costs, causing bankruptcies and often loss of homes, simply because one family member got sick and thought their insurance policy would cover the bill.

Sure there are those who refuse to pay for health care coverage that make this problem worse. But they’re pretty much always young and healthy. People like me – usually between the ages of 55 and 64– or younger with a chronic disease, aren’t permitted to purchase policies at any price (even if we could afford to).

So what do we do? Most of us just continue to go without care until we hit the emergency room and that costs everybody more money in the taxes they pay to support the county-funded  hospitals that must- by law- admit and treat the uninsured.

The World Health Organization agrees that our system is far from perfect; with graphs  on its Web site showing that the U.S. is far from a leader in health care and/or mortality rates.

Yet the picture changes radically when you turn 65.

Rich or poor, healthy or riddled with chronic conditions, at 65 Americans can get health care through our Medicare system.

One of my doctors jokingly said I was finally entering the "Holy Land."

Unlike so many people who hate hitting the “Big 65,” I was like a kid in a candy store knowing that November 2010 had finally come. No longer could companies say I had too many pre-existing conditions to qualify for an insurance policy.

To me this meant I could finally get tests and treatment when I needed them.

Long before the big day arrived, I began investigating what the choices were and found a lot of things some people I know who were already on Medicare said they didn’t know.

There were so many choices: straight Medicare, with Parts A, B and C to consider. And prescription plan D. The supplementary policy issue; and/or Advantage Plans.

It all seemed very confusing which is why Medicare specialists say the majority of people “just say yes” to the government form that gets sent out about six months prior to a person’s turning 65. And they never examine the issue any further.

The little red-white-and-blue card simply asks if we want Medicare or not. Saying “yes” means you end up with straight Medicare and you may later find that isn’t what suits your particular needs. 

Having written so many health care stories and having interviewed people from local agencies, medical doctors, the Florida Governor’s office, and even the Department of Health in Washington D.C., you’d think I’d know enough to be able to sign up for my own Medicare plan.

Well, of course I could have done just that, like millions do.

But I understand the basics just well enough to know there are many ways Medicare-eligible residents can get more bang for their buck.

Making comparisons, not just once, but every year, is the key.

Experts explained to me that since a person’s health doesn’t stay static, it’s a good idea to check your coverage out each year during the annual window of opportunity for Medicare recipients to change their policies. This window opens Nov. 15 and closes Dec. 31.

Maybe a new medicine has been added to your daily routine. Or there’s been a change; for better or worse- of some condition. Any number of things could be a signal that a different policy could give you more of the benefits you actually use; maybe even for less money than you’re paying now.

I had heard about Medicare specialists, but I didn’t want to deal with a government agency or an agent for an insurance company. But was there another choice?

Wandering thorough the lobby of the Kings Point Clubhouse I found that there was.

There are people who register as independent insurance agents, which means they’re freelancers (like I am, only I do writing and editing and they compare policies).

The independent agent I met was Anna Lonas and I spent quite a long time talking with her and allowed her to make the decision for me based on what health conditions I have and what medicines I take.

I have friends who are paying much more than I am for 80/20 deals; where the insurance company pays 80 percent and they’re left to pay the remainder of the bill. What I found was that for the same cost as regular Medicare, about $110 a month, I could purchase an Advantage Plan that would cover 100-percent of my bills (after a rather low deductible) with co pays as low as $10 for my general practitioner; and most of the cost of all my medicines, even one I take for which there is no generic.

Since I’m not the kind who goes to a doctor for every headache or bruise, I wanted something that would cover the biggies best: like my cardiac event in 2009.

It took about 48 hours for my independent Medicare specialist to find one that fit the bill.

Since I paid nothing for the service, I asked how could this be?

Independent specialists are not paid by any one insurance company but register with all the major (and some smaller) companies that operate in a particular state. They’ll be paid by the company – not the client. It’s in their best interest to find you the best deal for your particular situation so you’ll keep coming back.

Sure, you can go to the Medicare site and do the comparisons yourself.

I tried that. On my third attempt, I realized I was getting different answers each time. One time I got a good price and coverage for the medicines, but the hospital coverage wasn’t right. I went back on line and tried to get more hospital coverage and ended up with my two most expensive medications left unpaid.

“People need to examine exactly what costs they’re paying out of pocket and how often they use that service,” Lonas told me. “Every prescription plan has the same standard coverage which is determined by the government. But one company may charge more than another for the same drug. There may be a plan that covers your more expensive drugs but when you see that it isn’t covering all your medications you automatically turn it down. That may not be a good solution because you may be able to trade off a couple of cheap prescriptions for a much lower out-of-pocket cost on something else that will hit you much harder, like specialists or hospital coverage.”

Once and awhile organizations like AARP have seminars in South County and bring people who can answer specific questions but I much prefer having a name with a face I recognize that I can call any time, without charge, knowing they don’t represent a particular company, but represent me.

To reach Lonas, call (727) 215-6237 or email her at alonas@jrstoner.com.

Or just Google in “Independent Medicare Specialists, Tampa Bay” and find one yourself.

Just be sure to do it before this year’s deadline of Dec. 31.

   

 

         

 

 

 

 

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