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Mediscare: Everything You Wanted To Know About Medicare But Were Afraid To Ask

 

Mediscare

Everything you wanted to know about[
**]Mr. Medicare but were afraid to ask

Robert Carranza

Copyright © 2015 by Robert Carranza.

All rights reserved. No part of this publication can be reproduced or transmitted in any form or by any means, electronic or mechanical, without permission in writing from the author or publisher.

First Ebook Edition: December 2015

Shakespir Edition

Shakespir License Statement
This ebook is licensed for your personal enjoyment only. This ebook may not be re-sold or given away to other people. If you would like to share this book with another person, please purchase an additional copy for each reader. If you’re reading this book and did not purchase it, or it was not purchased for your use only, then please return to Shakespir.com and purchase your own copy. Thank you for respecting the hard work of this author.

About Mediscare

A heuristic novella about Medicare
for people turning age 65.

“A Pulitza for sure.”
- The New York Times Book Review

To Nancy

Contents

Chapter 1 – Should I go?

Chapter 2 – Where’s Mr. Medicare?

Chapter 3 – Who is Mr. Medicare?

Chapter 4 – Which is better?

Chapter 5 – Who Wants Extra Help?

Chapter 6 – Who’s Missing Whom?

Chapter 7 – Who Knew?

Chapter 1

Should I go?

When he opened the letter Erasmus was sitting at his kitchen table sorting through a pile of mail. He had been gone about a week. This letter began with a congratulatory remark about turning age 65. Erasmus had attached no special significance to his 65 birthday, about six months away; so when he came upon the word Medicare, he did not immediately make the connection. He knew very little about Medicare, but what he did know he had learned from friends already on it. Most of what he heard he dismissed as just talk. None of his friends ever said much about it, except for a few derisive remarks like “it was going out of business” or “the government should keep its mitts off Medicare.” The only thing he felt certain about was that it was a government medical insurance program for the elderly. Or was that Medicaid? The names sound too much alike, he thought. I guess they want some kind of formal acknowledgment that I’ve been taking advantage of senior discounts. AARP must have ratted on me, he chuckled. No matter. He kept reading because the letter’s opening statements intrigued him:

When you were a little boy and pleaded with your mother, “Ah, Ma, Do I have to!” She may have said, “Well, how are you going to learn your ABCs?” Now approaching age 65, you have come full circle and it’s time to learn about the A, B, and C of Medicare.

The letter’s upbeat tone informed him that he had medical benefits due him upon turning 65. These benefits would help pay for any future medical bills for the rest of his life, as well as any prescriptions he might take. The benefits were rightfully his, the letter repeatedly stated, and they would cost him a little more than a hundred dollars in monthly premiums. This got Erasmus thinking: The savings from my present health plan would be rather large. Or will I still need to keep both coverages? He wondered about his wife—was she also eligible? So he poured himself another cup of Churupampa dark roast and continued reading about the history of Medicare, which he learned was started by President Lyndon Baines Johnson. Harry Truman was the first Medicare beneficiary and nearly 20 million others followed him its inaugural year. Yeah, Erasmus thought. When ‘Give ’em hell’ Harry learned he had heart disease, he probably gave the first Medicare doctor hell. And from that time, Medicare doctors have been like an endangered species, or so I’ve heard. Oh well.

Erasmus was not one to give anyone a hard time, being mild mannered and not prone to getting upset or excited about anything contained in a letter. From where he was sitting next to a large window with a view of his expansive backyard, he glanced up from the letter to see a squirrel stuffing his face with pecan nuts. There were many nuts all around him. It was the season. Erasmus thought the squirrel’s dilemma was interesting, but not as much as his own. Reading further down the letter, he learned that his medical benefits were divided up into two categories. The part that dealt with treatments in a hospital was called Medicare Part A; the part having to do with care performed at a doctor’s office was called Medicare Part B. The letter apologized for the alphabet soup of letters associated with Medicare, then added: Medicare uses the word Part before its core benefits, as in Part A, Part B, Part C, and Part D. When a letter is preceded by the word Plan, it is referencing supplemental benefits to original Medicare. So Plan A refers to a type of Medicare supplement or Medigap plan, two words for the same type of insurance. Okay, he thought. So Medicare has many moving parts. This could get complicated. It got him thinking about all the things he’s heard about Medicare and wondered which of them were really true. The mention of Medigap plans was one thing he knew nothing about. So they were part of that alphabet soup. Did he have to take it? He wondered if enrolling in Medicare also meant he’d be signing up for Social Security. He knew of someone who said that it did. They took money out of his Social Security check, the friend had said. Maybe that’s why he said you have to have Social Security before enrolling in Medicare. Perhaps, he thought. It’s gonna get paid somehow.

But Erasmus was still working and not planning to retire for at least a couple of years. He was an engineer at a small firm and liked his job. Do I even need Medicare, he wondered. He recalled another friend, really a frienemy; a bumptious and rather impetuous fellow, who once stormed into a Social Security office intending to refuse to take Medicare. But after cooling his heels for about five hours (having ticket #984), he said he calmed down, or maybe just fell asleep. He said he had thought, or maybe dreamed?, that Medicare would reduce his Social Security benefits. Not so, he was informed. Being also a bloviater, the frienemy circuitously explained that he could pay for his Part B premium with automatic withdrawals from his Social Security benefits. I never quite understood what his gripe was all about, Erasmus thought. Did he say you get full Social Security benefits automatically when you enroll in Medicare? Umm, … The enemy of my frienemy is like an enema to me … Umm, haven’t seen that guy in awhile; maybe he’s no longer around.

Does enrolling in Medicare mean necessarily getting A and B? And what about C and D? Or, X, Y, and Z, he said to himself playfully. This Medicare stuff better not get too complicated or somebody’s gonna add a few choice characters — *%&!— to the discussion. Erasmus perused the rest of the two-page letter to see if some of his questions might find an answer. So Medicare has a trust fund, he learned, which he has been paying into all his working life. You don’t say, he pouted. And that’s why he no longer had to pay into the trust fund in order to get Part A benefits. That hospitalization benefit. You don’t say, he said softly to himself. He pressed his lips tightly while thinking: Why didn’t they do that same thing for B? That would have been cool. It had to do with the way Medicare was structured in order to get the national health insurance legislation passed by Congress on July 30, 1965, he read. The hybrid design of Medicare was the brainchild of some Democrat named Wilbur Mills. The initial legislation did not include physicians’ services, and once included, they were allowed to set their own rates. Oh yeah, Medicare has always been political.

It was about a quarter to nine in the morning on a Saturday and Erasmus wanted to blow through his pile of letters. He had a short stack of unfolded letters to his left, unopened letters to his right, and crumbled paper in a metal mesh waste basket below the table. But this cream colored letter had him staring at his backyard… Oh, look that squirrel has brought back a brown plastic braided sack. I guess he’s ready to bring in a haul … It raised more questions than it answered. It was an odd looking letter with only a post office box address, no phone number, and no signature. Instead it had a black-and-white photo of an elderly man with a somewhat bulbous nose and saddle pack jowls. His smile was Mona-Lisa like. From what he could see of his upper torso, he looked stout. Who was this guy? He probably had thick fingers and soft, fatty palms, which he might feel in a handshake because the letter was an invitation to meet. He wondered if this letter was the Medicare Summons Notice he had heard about. Hmm, Erasmus thought. Why should I meet with this guy? Other than it might save a trip to the Social Security office, meeting with this man who had wispy hair above his broad forehead, probably had little value, he thought. But then again, this guy appeared to be knowledgeable about Medicare with remarks that made Erasmus curious to hear more. He kinda understood that some points made in the letter were important to know about and maybe even act on. What’s more, the place where they’d be meeting was only a few miles away, just outside of a downtown district with plenty of restaurants and beer joints. And besides, if this is a notice to appear, did he really have a choice!

He held the letter with his left hand and took another sip. At that moment, he could hear his wife descending the staircase. A moment later she greeted him ‘mornin’ and headed his way into the kitchen and then past him. He mumbled back ‘good mornin’ and barely looked up. She was fully dressed, as though she were off to work. Her Armani widened her ambit. Oh yes, that appointment. In a moment now, she’ll be asking me if I’ve seen her car keys.

“Here.”

“What?”

“Your keys,” he said pointing to yellow (#5) napkins on the table top. With her keys embedded, they had formed the shape of a taco.

“I’ve been looking for those! You shouldn’t do that … making me late again.”

“Who what?”

“If you know where they are, goddammit, tell me.”

“Hey,” he said playfully, “I didn’t know you were looking for them. I, I —”

“I know, you just live here.”

“Hey, you in a hurry?” he said with a smirk.

“What me hurry?” she flipped back at him.

He considered her snarky remark and nodded, and then excitedly said, “I got this letter. Kinda peculiar. It’s about Medicare. You know about Medicare, right? It’s got a lot to say about it … how to get the benefits, and I think it’s worth looking into, but like I said, it’s a bit odd. I mean, I can’t tell who the sender is or where it really comes from.”

“You think it’s a scam?”

“Maybe. Can’t say. But it has already answered a few of my questions, but then it raises some more. I just don’t know what to think of it. Not sure if I should go see this guy.”

“Oh, so you want to meet with him?”

“Well, not really, but it is an invitation.”

“Fuhgettabowit!”

“Oh yeah?”

“Why go. You know where the Social Security office is. Go there.”
“Yes, but what an ordeal.”

“You mean last time? You confused her.”

“She Confucius to me.”

“Is that the letter,” she said bobbing her head.

“Here. Read it,” he said with an outstretched arm.

Erlinda took the letter and gasped. That was enough to freeze frame his tense expression. He wanted her attention back, but she looked too engrossed. He just repeated, ‘what? what?’ After a long pause, she looked at him with wide eyes. “I know this guy! I really think I do.”

“Oh yeah. How so?”

“He was with Ed the day he disappeared.”

“No way!”
“Really. I feel quite certain. I could pick him out of a lineup. He’s overweight for sure, but not probably obese. About 6 feet and although this pic is black and white his hair is mostly white with light brown swirling through it—a downy looking bird’s nest of a crown with a speckled bald spot.”

“You don’t say.”

“I was with my brother at that pink colored restaurant by Marlo’s. You know the one I mean? The name escapes me.”

“Yeah, that new one we keep talking about going to; the one with ceramic cacti along the entry way.”

“Yeah, that one. Oh, yeah, it’s called Herachos or something like that. We were talking, I mean Ed and I. It was meant to be a quick lunch for me, but I could see how troubled Ed was. He was detailing his final days with Shelly and what the divorce obliged him to do. He wasn’t ready to leave that house—

“I know. He talked about it all the time.”

“Yeah, so this guy walks up and hands Ed a folder with a clear plastic cover. He excuses himself, a gracious individual, and they talk for a minute or so.”

“What about?”

“Social Security. Ed told me they were meeting later in the week to go over what he had just handed him. Ed was thinking about taking Social Security, you know. So what I think is this guy is a consultant for Social Security. Ed said he was helping him decide whether to take Social Security.”

“Not Medicare?”

“No, Social Security. Ed had only good things to say about the man, so I don’t suppose he’s a nefarious character. What I’d want to know if Ed said anything to this guy that was revealing. Anything at all!”

“Like where Ed was headed to after their meeting?”

“Yeah. Or, if Ed looked depressed. I’m groping for more clues.”

“What are you thinking?”

“I don’t want to go there. It’s too dismal a thought.”

“Yeah. It’s not been a few weeks and we need to follow all leads, and the fresher the better.”

“I’ll read this letter carefully when I get back. Just leave it on the table. I’m late!”

A quick peck and she was gone. Erasmus looked through his kitchen window again. The sky was gray and clouds looked like a Rorschach inkblot, one that he tried to interpret—should I go or should I stay? He sang: If I go it may mean trouble, and if she goes with me, it will mean double. So come on and let me know … Nay, he thought. Even though he did not recognize the name of the meeting place, Erasmus felt okay with heading over there.

He placed the letter under the napkin holder and sat back in his chair. She’s going to wanna go. His lips folded inward. He listened to her car as she drove off. Did she take that muffin? His thoughts had turned to breakfast, but her gale force pronouncement blew away clouded thoughts on what to eat. He knew of a library on the same street with an address that placed it probably nearby. He was glad the library wasn’t the meeting place, for he wasn’t so much interested in a lecture on Medicare as much as a friendly conversation in order to get a few critical questions answered like ‘Hey, where did you stuff my brother-in-law, fat head! Well, okay, maybe not quite that way. Hmm, the date to meet was two weeks from yesterday, Erasmus pursed his lips. Should I draw up a list of questions or just wing it, he wondered. A question he thought of from reading the letter was one he had never considered before but now it made him feel a bit irritated: If Part B is supposed to be a voluntary program, how come it has a penalty associated with it? I wanna ask that one! But if things get crazy, I’ll probably forget to ask it. Better I write down the questions I might not ask otherwise, he thought. Let’s see:

  • Is it better to wait until your fall enrollment period instead of using your open enrollment period in case you want to make a change later on?
  • Is the Welcome to Medicare exam only for people with no pre-existing conditions?
  • I heard Medicare Advantage is free. Does that mean the company pays the Part B premium?
  • I heard Medicaid is a better deal, if you can find a doctor. Can I have both Medicare and Medicaid?
  • Is an opt-out doctor someone who no longer sees patients?

While looking out the window, he thought: Maybe the last one sounds kinda dumb. What am I trying to say here? … It should clear up by the afternoon. That’s when I’ll take Blakki for her walk around the pond. It was pretty much Erasmus’s only exercise on Saturdays when he and his black Labrador spent the most time together. It was a good time to be alone with his thoughts. For Blakki, he could not say, but in dog years, they were about the same age. So maybe they could channel each other’s thoughts on the subject … and, and she was taking Gabapentin. Maybe Part D is medical care for dogs, no? D for dogs, makes sense. And Part C is for cats! It was all starting to come together now. Amazing how far a little information can go. If not for myself and Erlinda, I should meet with this gentleman for my pet’s sake. Where is Froda anyway?

Chapter 2

Where’s Mr. Medicare?

The drive down Willow St. was a familiar one. After all, it was one of the feeder roads to downtown and one they both were on routinely. It’s a long, straight boulevard of one and two-story storefronts. As they approached the next intersection, a panhandler on the left-hand turn island waved. Erasmus knew the guy, but was too occupied to do more than nod back. Erasmus could tell that the address was very near the library and on the same side of the street, which was opposite them. So he whipped his Ford truck around while bypassing the panhandler who often received his benevolence. Erasmus was already looking down the street trying to figure out how far past the library this place was. The sun wizened panhandler gave his benefactor a nod back. As they passed the library, Erlinda blurted, “Wait! It must be down this driveway.” Next to the library’s parking lot was a gravel road along a cyclone fence. Erasmus jerked his wheel so that he could make a sharp right. He saw nothing. No building; certainly no address. He was about to say ‘no, this can’t be right’ when he saw a white stucco building off to his left side and behind a thicket of vines and ivy. Still no address. “This has to be the place,” she said, almost under her breath. He mumbled affirmatively.

“Ya know, this place sits so far back, I’ve never noticed it,” he said quizzically.

“Me too. I do recall … somewhat, though ”

“What?”

“This complex used to be part of a state agency, before this fence was put in and the land was divided.”

“Yeah. Before the library was here.”

Once inside, they could see they were in some kind of lounge. It had a rustic look. A bar faced them on the opposite side of the upside down, backward L-shaped room. A young man with torn jeans at the knee caps sat on a bar stool, elevated on a carpeted platform off to their right, playing a classical piece on his unplugged guitar. A threesome to his right were giggling profusely. A young woman nearest the bar in an ivory-colored flapper hat was rummaging through her purse. No one seemed interested in the guitar player’s music. Closer to their left sat a man, thirtyish, hunched over his laptop. Erasmus never understood how someone could drink coffee in the evening. Several feet from the coffee drinker was a brunette also with a laptop dressed from head to toe in brownish tones, which allowed her to blend in well with the hard-wood floor and wood paneling behind her. He saw no one else. They arrived only a few minutes past the appointed hour, so he expected to see the Medicare consultant with others, perhaps. They ambled toward the bar where a young woman with a tattoo of green vines and red tipped thorns on her outer wrist was counting bills.

“Ma’am, we’re here to see, err,” when Erasmus hesitated, his wife interrupted, “This guy,” she said while pointing to the picture of the Medicare man. The money counter squinted at the letter held head high in line with her short height. She looked up:

“I’m not aware of any presentations this evening, but let me ask,” she said and then headed toward a swing door. While doing so, she also pointed at a smallish man in a starched white cotton shirt sitting by himself at a table, not 15 feet away. Erasmus almost dismissed her gesture. Upon glancing backward, though, he noticed a cream-colored piece of paper on the table. Somehow he had missed taking notice of this fellow when he panned the room. The letter’s color got him curious. As he approached the man who appeared to be about his age, he recognized the letter—It was the same one!

“Excuse me, sir,” Erasmus began, “It appears we are here for the same reason.” Erlinda raised their letter with two fingers as though it were Exhibit A. “Is he here somewhere?”

“Oh yeah, him,” the smaller, bi-speckled man said. “We’re thinking he might have not arrived yet. There’s another fellow, he’ll be back in a moment, he’s checking on it. I’m Spinson Elmore.”

“Erasmus Ueli. This is my wife Erlinda. Have you met this guy before?”

“No, no. Probably like you, I just got questions.” I’ll be 65 soon and this meeting time was convenient.

“Sure. My big question is what happens to my wife if and when I take Medicare, ya know? I have other questions, and like you, I guess, this guy has made himself so accessible. We live just over in the Armistead district. We just had to check him out.”

“Sounds like we’re all turning 65,” Spinson said with a smile. “I’m a building contractor. Work my own jobs. This Medicare deal should work for me pretty well. But I’m not sure what I’ll be taking: A, B, and C or D or something else. I think A and B is the medical stuff, and D is for drugs, but C, I don’t know. You know?”

“Well, no—”

“There’s something called Medicare Advantage,” Erlinda interrupted. “I understand that it’s A and B with a few added bells and whistles. I’m not sure what those all are. That’s one question this guy can clear up if he ever shows up,” she said while over exaggerating her shoulder shrug.

“Oh, so you think C equals A and B,” Spinson said.

“Yeah, something like that. There’s some kind of logic to Medicare. We also need to get straight on drugs. Erasmus takes a few. I’m thinking he’s fine as long as he continues to work, but if he changes a prescription, what happens?”

“Maybe Medicare Advantage kicks in,” Spinson said. “It might have drugs.”

“We have drug coverage now,” Erlinda said. “We also wanted to ask about lock-out periods. We think there are certain deadlines associated with Medicare.”

“And penalties,” Erasmus added.

“Drug penalties, lock-out periods, and bears, oh my!” Spinson said, demonstrably widening his eyes. “It sounds treacherous out there in Medicare land. I just know I’ll be on Medicare soon and I want to look at all my options. If there are so many tricks and traps, I’ll want some guidance through the mine field. If this guy can provide good advice, I’ll take it.”

“He was highly recommended by my brother who was about to take early Social Security benefits before he disappeared several weeks ago,” Erlinda said nonchalantly. Erasmus gave her a surprised look, but wasn’t about to say anything. “So we think he must be some kind of expert on government programs. We’re willing to listen to anyone at least once and if his advice proves correct, we’ll be happy to go with it.”

“You know, trust but verify,” Erasmus said, smiling. “If this guy has the Cliffs Notes, we’ll be able to cut to the chase and—” He stopped talking when a man with long grayish sideburns in a plaid shirt walked up in boots heavy enough to draw their attention before he was close enough to shake their hands. The stranger looked directly at Spinson.

This new guy, the tallest of the group, cleared his throat before saying, “Mr. Medicare won’t be here. He got pulled away while driving here. That’s all I know. We’ll have to wait for another time. It’s over for today.” He looked at Erasmus and Erlinda. “Hi, I’m Zeke, Zeke Jamison.” They exchanged names again. “Looks like you two are severely disappointed,” Zeke grinned.

“Oh, not really.” Erasmus smiled. “I have time to figure things out. This actually was our first attempt.”

“Then you haven’t signed up yet? You can do so three months before your birthday month,” Zeke said.

“Good to know. Are you enrolled?”

“Actually I am. I took early Social Security and they enrolled me automatically. Got me my Medicare card just a few weeks ago. So I thought this scheduled meeting was timely. I know someone who’s got Medicare Advantage. He got Medicare Advantage, and I got Medicare, the A and the B.” Zeke showed them his Medicare card. “See red, white and blue, just like they said it would be. I’m feeling mighty entitled as of late, but wondering if I’ve been short changed.”

“How so?” Spinson asked before inviting the others to pull up a chair.

“Why did I get Medicare and my friend get Medicare Advantage?”

“Maybe ’cause you signed up for Social Security benefits,” Spinson said.

“Maybe, but that’s not right. I want all my options open. I want my choices laid out before me. I’m not saying I even want Medicare Advantage ’cause I don’t know enough about it. So I’m trying to understand the differences between the two, ya know?”

“I think it’s just a different way of getting Medicare,” Erlinda said. “No real difference. You get a few added stuff with the Advantage plans. Like dental care.”

“What else? I’ve got to know,” Zeke insisted. What he hasn’t yet figured out is that with his retirement plan in place he does not need to add anything more like Medicare Advantage or the supplements.

“Not sure. Where’s Mr. Medicare?” Erlinda raised her eye brows and looked to her left and right.

“Probably at this hour in some bar across town hanging out with Elvis, Santa Clause, Big Foot, and other celebs known for their cameo appearances,” Zeke snarked.

At that moment soft spoken Opal walked up to the group, almost behind Zeke. She caught Erlinda’s eye, though, and after another round of introductions, Opal said, “I’m wanting this guy to tell me about Extra Help. You know what it is?” she asked no one in particular. “I hear it might help me pay for my drugs. I tried to call about this but was put on hold way, way too long. Then this here letter arrived. So here I am.”

“I can’t say anything about Extra Help,” Erasmus said, “But I can get you an extra drink, if you like.” He smiled.

“Oh, that might be even better,” she said enthusiastically, which elicited laughter. “I don’t make much, so I might qualify for a whole lotta extras. I mean, well, this program is, I understand, means tested, which means someone might get pretty mean and nasty if they ask too many nosey questions about my income. I make custom-made baskets for floral shops and what I bring in is a sensitive subject, if you know what I means.”

“Well, we all means well here. You’re among mean, I means, kindred spirits,” Erasmus said jokingly.”

“Yeah, good to know,” she said. “So we’re all newbies to Medicare, uh? Who’s the resident expert here? She mimicked the raising of hands, but no one played along. “I heard you can keep your plan if you’re liken it. I’m liken my Obamicare plan real good. Cost me almost nothin’. Covers all my drugs, but now I have to start taking an expensive one, so I’m wantin’ to keep my Obamicare plan. I think Medicare comes with a doughnut hole—sweet nothin’. That’s why I want to know about the drug coverage extras.”

“That’s called Part D,” Erlinda said. “That’s your drug coverage. I know that much. Never heard of the doughnut hole. Sounds more like something Crosbee Cream would have, no?” She held back a chuckle.

“Yeah, that’s where I went first,” Opal laughed. I know all those people real well. “They were clueless, man, but hey, they make great coffee. Once I learn about the D, I’m gonna tell’em about it. I’m gonna say the D is for doughnuts. You wanna giv’em the D with the doughnuts, man. I’m gonna hav’em all sayin’ to their customers, ‘Would you like the D with those doughnuts?”’ She giggled and nearly wiggled off her chair.

“Yeah, you tell them the D is for Duragesic and Crosbee will start getting a steady stream of pain-killer lovin’ customers,” Zeke said with a wink and a nod.

While Zeke and Opal were talking several other people had been directed to the group. The enlarged group pulled two tables together and all sat, sharing their situations, and although none pretended to be the expert, they all tried to help one another. Mostly, though, they used Medicare as the platform to enjoy one another’s company. There was Mauldin. She was already on Medicare due to a disabling car accident. When she lost her job she went on COBRA for a while. She does not think she qualifies for her previous employer’s retirement plan, but she’s never asked. And since she’s never received any letters from the company, she’s not sanguine. “I don’t need to talk to those people,” she tells the group. Because she was already on Medicare, she often spoke up, leaning her thin frame forward while projecting her high-pitched voice, which sounded like a car squeal after slamming on its brakes. “You can get a flu shot for freeee!” she said excitedly after someone had started talking about annual exams. Her squeal stopped just as abruptly as a near miss, and then she’d resumed her quiet posture.

Hermenègildo followed her. He was a naturalized citizen from Mexico, not eligible for Medicare, although he didn’t know it yet. He would have to wait and work many more years before he’d be eligible. He had access to medical care in Morelia, where he came from, but was hoping to find it here where he now lived. “I can get you that drug in Morelia,” he said to Opal when she complained about U.S. prices compared to Canadian prices. “More cheap.” He smiled broadly. Hermenègildo, who said he liked the name Hermenè, though many of his close friends referred to him as Gildo and this group started calling him just Gil, said he was less concerned about minor care issues because he knew of a clinic nearby where everyone spoke Spanish. He said he would tell them sharply, “Speak ēng-gless.” His concern was about care that might involve multiple treatments. He also said to Zeke that he didn’t want to go back to Mexico in an ambulance. “You might be a charity case,” Zeke shrugged.

After Gil, came Gilsey who was retiring and losing her medical benefits from a company that had no retirement plan. She said she would take COBRA if it turned out to be better than Medicare. She didn’t know. She knew COBRA would be expensive and wondered if Medicare was any cheaper. “About a hundred five is all you pay, hon,” Erlinda told her. “Works for me,” Gilsey responded cheerfully. When they were talking about Part D, Gilsey let them know that she didn’t take prescriptions and had no intention of enrolling in Part D. Gilsey, with a head of dark brown undulating curls and graying strands swirling along the temples and neck like the froth of an eddie, said, “Both my parents lived into their 90s and took almost nothin’. Nowadays, they want you taking everything, you know, for precautionary reasons. They say, ‘Ask your doctor’ but they just want you on the most expensive drugs out there.”

“I hear ya,” Erasmus said. “Listen to this one. I overheard it in a pharmacy: This pharmacist says to his patient, “The side effects of this drug aren’t bad; I mean, not nearly as bad as the price! Looka here, see!

“Whoa, mercy me,” the patient says. “I’m feeling dizzy.”

“Let’s sit you down, here,” the pharmacist says. “The price can cause fainting.”

“There you go!” Gilsey said. “We shouldn’t just take whatever they offer.”

“I want them to tell me I can smoke marijuana,” Opal squealed while excitedly lurching forward. “I smoked, long time ago, to ease some pain. Worked too. Back then, we didn’t call it ‘medical marijuana’. We just called it dope, she giggled, but we weren’t the dumb ones. We knew!”

“Yeah!” Zeke said. “We knew its medicinal value. We just couldn’t prove it.”

“Yeah, we were just kids.” Opal said sheepishly. “Too high to know about controlled studies and all that science stuff.”

“Hey, but the kids were alright! I miss it. Been a long time. I’d smoke again if it were legal,” Zeke said.

“Well, I guess the joint that goes around comes around in the form of a ballot measure. So if they legalize it this time, you’ll be smokin’ hooch again,” Erasmus chortled.

“Imagine that!” Opal smiled. She jumped from her chair and with her air guitar instantly plugged in, sang, “Been-a-long-time, been-a-long-time, been-a-long-time, been-a-long lonely, lonely, lonely, lonely, lowww–

“Drum roll please,” Zeke interjected.

“… ownly time.”

Chapter 3

Who is Mr. Medicare?

Erasmus returned Spinson’s call after dinner. He sat in a black leather sofa chair, across from a large screen TV, in his sunken den. It had been almost two weeks since their initial meeting at Lance’s Lounge. The recorded message was short: “Erasmus, Spinson Elmore here. Mr. Medicare will be at Critter Park on Sunday. Call me. I have more to say. Bye.” About a week before, when the group of Mr. Medicare seekers departed, some of them talked about meeting again in two weeks, so this call was not a surprise. Perhaps, Spinson wanted to suggest a date and time. By the tone of his voice, Erasmus thought Spinson sounded a bit anxious.

“Well, Spinson, I was expecting to hear from Mr. Medicare myself. I just expected to get the letter directly. When did you say yours arrived?”

“Just today, Erasmus. I hope you plan on going. I’m sure this Mr. Medicare guy can answer all of our questions and more.” His emphasis on the word “more” was apparent. Erasmus wanted to stop him there, but Spinson’s words were as linked together as box cars on a fast moving freight train. He kept talking about Mr. Medicare’s impressive letter and apology for not showing up for their meeting. Eventually he came around to ask if Erasmus knew where Critter Park was. Erasmus told him that it is the same park where he walks his Labrador. Then without a pause, he asked Spinson,” What more do you think Mr. Medicare might be able to talk about?”

“Well, Erasmus, that question gets to the heart of what I aim to talk to you and your wife about. I wanted to wait until we meet again, though. Seeing how you’ve asked the question I must tell you, well, when Erlinda said Mr. Medicare was with her brother on the day he disappeared that remark just made me weak in the knees. You see, Mr. Medicare was with a cousin of mine the week of his disappearance.”

“You don’t say!”

“Yeah. It’s been five weeks now and most of my time is spent talking to whoever I know he knew and may have spoken to or visited with the week of his disappearance, you know, trying to make headway. Mr. Medicare, I think, met with Phil the day before. So he might have something noteworthy to say. I cannot bypass any opportunity to meet with Mr. Medicare. My cousin Phil said to me that he was planning to meet with someone in a bar later that week. I did not think anything of it, except that a bar was not a customary place to have such a meeting. I did not know at the time that Phil was meeting with Mr. Medicare. I learned that later after seeing Phil’s letter—the same one we both have received. I’ve never questioned Mr. Medicare’s integrity. He is not a suspect in my view, just an obvious, hmm, person of interest. I will, of course, ask him my Medicare questions, but the first questions will be about my dear cousin. I have a picture to show him. He’ll recognize Phil from the photo. I’m sure. It has not been that long.”

“So that’s the real reason you want to meet with Mr. Medicare, uh?”

“You bet and it must be the same for you and Erlinda. I mean, I was floored when she said that about her missing brother. I knew I wanted to pull you two aside, but decided to wait. I mean, there was too much going on at that time to bring it up, and the subject was, of course, too personal. Really, I wasn’t planning on talking about it now, but you asked. I wanted to bring it up when we were together at the park. I think we should share notes.”

“Yeah, we should,” Erasmus said while nodding.

“Maybe we could meet at the gazebo, say, an hour before he arrives. You know the place I’m talking about?”

“Sure. Know it well. When did he say he’d be there?

• • •

At about a quarter to two, Blakki forced a pigeon to reconsider its intention to enter the gazebo, which was situated near the circumference of an outdoor music and garden venue of about ten acres. It had a bandshell and the gazebo on opposite ends of an oval promenade. The whole area was pretty much empty with an occasional person meandering through. There was no activity there to hold anyone’s attention, except for Blakki’s. Erasmus and Erlinda sat on the gazebo’s circular bench, which was along its inside circumference. That faced them in the direction of the white sea shell façade of the bandstand stage. It was visible, somewhat, through the gazebo’s lattice dome. When Spinson arrived he brought his wife Reedi. After the introduction of Reedi and a round of pleasantries, the topic of missing persons was brought up.

“Phil wasn’t upset about anything. He’s always held a positive outlook on things, a laidback kinda guy, and one looking forward to his retirement. Not like your brother. I know Phil like a brother; we grew up together in the Bay Area. If Phil was stressing out about anything I’d have known about it. He wouldn’t have kept it from me. I can see you’re groping for connections, Erlinda, but our only obvious connection is with Mr. Medicare who appears to be Mr. Social Security as well. Do you know if the two had met before?”

“No, no I don’t. He never told me how he heard about Mr. Social Security or Mr. Medicare or whoever he really is. Are you thinking they might have first met in a group meeting like the way we have?” she asked.

“Yeah, maybe. That appears to be his modus operandi. Phil appears to have met with him at first with others. You can see from this letter with his scribbled notes. Look at the date. See?”

“Yeah.” Erlinda and Erasmus said almost in unison. “We don’t have a similar letter from Ed,” she added. “I was working under the impression that the meeting I was at was their first and only meeting. Knowing a little more about their meetings might help us establish a pattern.”

“Yeah, patterns, connections—that’s the way we connect the dots,” Reedi interjected. “What concerns me the most is that it was Mr. Medicare who reached out to Phil and Ed. They responded to his letter, just as we are today.

“That concerns me too,” Erasmus said.

“I’m starting to wonder if Mr. Medicare is on the up and up, you know,” Reedi said.

“Well, Reedi, you know I think I’ll have to talk to the police about him,” Spinson said. “And if I need to, I’ll put a private investigator on his tail. But right now I’m not suspecting him of anything, you know, bad. I’m thinking he is who he says he is. That’s why I’m not overly concerned about who he really is, although foul play is not completely ruled out. It’s just not tied to Mr. Medicare, probably. It’s just eerily coincidental that he’s met with two missing people in the same week of their disappearance. How do you explain that? I can’t.”

“So if he asked to meet with you privately, would you?” Erlinda asked Spinson.

“I am mightily curious to see what happens today. Will he be asking any of us to meet with him one-on-one or will it be the other way around. We need to know that—

“Yeah.”

“Yes.”

“Ohh, yeah.”

“We should probably hold back,” Erasmus said. “Let’s not ask to meet with him individually, but let’s see who does or if he asks if anyone would like to meet with him privately. Maybe he’ll even ask one of us.”

“Oh, gosh!” Reedi said. “I’d pee in my panties.”

“That ain’t gonna happen sweetie ’cause you’re not approaching 65!”

“Oh yeah, in my excitement I forgot. What about you!”

“Well, Spinson, if he did ask you to meet, I’d go with you,” Erasmus said.

“Good to hear, but I might want you in the bushes. I’d steer the location to a place I know well and plant you nearby. And then if I felt like I wanted you to follow me out the door, I’d drop a hanky or something.”

“Umm, Spinson, I know a place where my husband can hide inside a decorative waterfall,” Erlinda said.

“Okay, sounds like a plan,” Erasmus said.

Reedi blurted, “Hey, haiku guys, haiku …

I hear the hidden dragon,

I see its smoldering passion,

Fire extinguisher sound.

“Guh, Reedi, that’s awful,” Spinson laughed. “Go back to slam poetry.”

“Oh dear, all this stealthiness talk freaks me out,” Reedi said. “We shouldn’t be meeting with this guy if it could turn into a fiasco. I agree that we’re dealing with some odd coincidence, but I’m—

As she was about to say that she did not believe it was smart to probe for any possible nefarious intentions, she noticed Zeke enter the gazebo. Zeke, being Zeke, charged in already talking, then shaking hands and continuing to talk quickly with his elephant nose like arms swishing up and down and around. This went on while he held court, then Gilsey walked in with her friend, Manot. She was soon followed by Mauldin and Opal. Soon after those two entered, a new person, Salim, walked in by himself. He said he was a vet and wanted to know if Medicare offered him a better deal. No one could answer that question until another new person, Sasha, walked in and while listening to the others offer their opinions interjected, “Your VA benefits are supplemental to Medicare. Sir, you won’t lose your VA benefits,” she continued, “by signing up for Medicare. You’ll still have access to VA clinics and doctors. When you go to a clinic with your VA card, the people there will know that Medicare is your primary, or the first payer, and your VA plan picks up its share.”

“Oh, that’s good to hear,” Salim said. “Hi. I’m Salim Elchoue.”

“Sasha Goodenough,” she replied. Before she could say more about herself, Zeke asked, “I know about A and B and I’ve heard about not taking B—

“You mean delaying your enrollment in Part B?” she asked.

“Yeah, I think so. So what I’m wondering is: Might it be better for me to delay A and not B. That would be reversing the two. You follow?”

“Well, you know that Medicare Part A is paid in full by having worked 40 quarters in your lifetime. Part A was funded from your payroll taxes. So I don’t see any particular reason to delay enrolling in Part A. Now Part B comes with a premium. So it’s customary to delay Part B while you’re working, assuming you have medical coverage from your employer. Is that your situation?”

“Well, Yeah, I am working, but already have retired with company medical benefits and I do intend to continue working for another couple years at least, then I, well, I’m still con—

“Is Medicare, Obamicare but for old farts like us?” Opal interrupted.

“No, no. Medicare and Obamacare are two separate health plan programs. Medicare has a long history dating back to the Johnson administration while Obamacare is insurance for those under age 65 and offered by private health insurance companies. It’s just starting to find its sea legs. You’re correct, though, in thinking that Medicare primarily serves older people. What you all should read now is a publication called, Medicare and You. It’s a government publication, of course, and can be found at Medicare’s website. You can also listen to it as a podcast. It’ll give you a firm foundation on the Medicare system and all its moving parts. I’m mean it tells you how everything fits together—Parts A and B, the supplements, Medicare Advantage, Part D for prescriptions; it defines all the terms you’re going to hear about; it talks about how medical care gets covered; what gets covered when, the limitations, and other caveats, billing issues—everything. You need to read it, not cover to cover, but get familiar with its contents ’cause, um, the man you’ll be meeting with does not like to hear dumb questions.” That quieted everyone for a moment.

“Yeah, we don’t know his name, so we call him Mr. Medicare,” Erasmus said. “So that letter with his picture on it—is that the letter called the Medicare Summons Notice? The letter doesn’t say anything about a summons, but I was thinking this meeting might be obligatory for anyone turning 65.”

At first Sasha looked puzzled. “Oh, oh, no. You are referring to something correctly called the Medicare Summary Notice, which has nothing to do with any type of meeting. The Medicare Summary Notice is a letter you get every three months once you’re on Medicare and are using medical services. It lists all your claims that Medicare is paying or, in some cases, not paying. You want to pay attention to this letter, if there’s ever a question about what services were being paid or received. You don’t have to wait to get the MSN; you can actually go to MyMedicare.gov and you’ll find the same information there. MyMedicare is a good place to go to keep tabs on things like claims or update your prescriptions or to communicate with Medicare about any kind of issue or file an appeal. But you’ll want to be registered first.”

“I heard not many doctors take Medicare anymore,” Gilsey said.

“That rumor has been perennial, but most doctors do take Medicare. Still, it is possible that you’ll want to see a specialist who doesn’t take Medicare or doesn’t take Medicare usually. It’s important to ask any new providers if they take Medicare before undergoing any treatments. It’s possible for a doctor to accept you as a Medicare patient, even though he doesn’t normally take Medicare. In such cases, a doctor can charge extra for his services, which you would be responsible to pay for unless you have a supplement that picks up the excess charge. Any doctor who takes something called assignment is not going to charge extra for his services. So you may want to ask whether a new doctor takes assignment,” Sasha said while raising two fingers of both hands to signal quotation marks around the words takes assignment.

“Oh,” Gilsey said, “this is starting to sound like legalese.”

“Well, you can go to Medicare’s website to find out if a particular doctor takes assignment or Medicare. You can also get the same assurance by asking your own pointed questions,” Sasha smiled. “The variance in billing practices is just something to be aware of.”

“Okay, got ya,” Gilsey shot back. “I’ve got another one for you: I understand Plan A has a deductible, so that deductible works like any deductible … like the one I have now?”

After some hesitation, Sasha began by scanning everyone, fixating on their eyes, “First, let’s get clear on terminology. Everyone jokes how Medicare is an alphabet soup of names, and so it is. But the method to this madness can be understood. When we talk about Medicare’s core programs, we use the word Part before each letter. So, we can say Part A and Part B when referring to original Medicare and Part D when talking about the prescription drug program. Part C is another way of saying Medicare Advantage or privatized Medicare. When we talk about Medicare supplements or Medigap plans we never link those insurance plans with the word Part; instead, we always, always say—Plan—before any supplement letter. So we say Plan F, never Part F. As a supplement or core program, Part F does not exist. So, Gilsey, I think when you said Plan A what you meant to say was Part A, a core program. Part A has a deductible. And even though there is such a supplement called Plan A, it is not associated with the word deductible. Supplements are not core plans; they are private company enhancements to original Medicare. So Plan A refers to a supplement and a noteworthy one at that, but we can save that for another time. Now to your question: You’ve been used to having a deductible that operates for a calendar year. The Medicare Part A deductible does not. It operates for a benefit period. You can experience more than one benefit period in a calendar year, although most of us, at least most of the time won’t do so. If we do, it will be because more than 60 days have gone by before we have to re-enter the hospital. Thus a new benefit period begins and another Part A deductible to pay.”

“Whoa, thanks for making clear that fine distinction,” Spinson said. “My doctor recommended a colonoscopy once I go on Medicare. I hear they’re free when you sign up for Medicare, no?”

“Spinson, there is a regimen of preventative health services available to you when you first enroll in Medicare and in subsequent years. However, I must emphasize that they come on a schedule, which may be annual or come at longer intervals. Depends on the treatment we’re talking about. A colonoscopy is offered as a preventative service but not annually and since your doctor is recommending it, he may have diagnostic concerns, which would take the colonoscopy out of the box of free health care. When you first go on Medicare you can have a Welcome to Medicare exam. What the exam consists of is itemized in the Medicare and You handbook. The important thing to be clear about this exam is that it is not done to examine any kind of existing ailment—it is not diagnostic. It is purely a preventative measure as are all Medicare annual exams.”

“Good to know,” Reedi said. “Spinson just has hemorrhoids. I think his doctor was just interested in covering his own butt.” Spinson winked at his wife and quickly added, “He’s fastidious.” She went on, “Spinson doesn’t take any drugs, so we don’t see any reason to sign up for Plan, ah, I mean Part D.”

“Sure, that’s reasonable. After all, why take on another premium cost when you see no immediate benefit. So there’s one good reason to enroll anyway. Part D comes with a penalty charge for those who did not enroll when they first became eligible and who did not have their own prescription coverage deemed to be as good as coverage as Part D. Medicare calls this type of drug coverage credible coverage. Here’s an example to help you understand how the penalty works: Let’s say you are turning age 70 this year and have yet to enroll in a Part D plan, even though you have had no credible coverage. But this year, you are starting to take an expensive drug. Medicare will assess a penalty charge for every month that you were eligible for Part D. That means from your 65th birthday onward. The penalty charge is one percent off of a national standard premium for a Part D plan. In other words, the plan from which the penalty charge is derived does not actually exist. This year the national standard is about 34 dollars, so we’ll say the penalty charge is 34 cents per month. That’s means 34 cents times 60 months—the time for which you have been unenrolled in Part D and had no credible coverage. This penalty amounts to about $20 for that five year period of time. Now let’s say you’ve chosen to enroll in a Part D plan with a premium of 25 dollars. Medicare will tack on the twenty to your premium, making your actual premium cost about 45 dollars instead of 25 dollars for the year. In all subsequent years, the penalty charge is re-assessed in the same way. So if the national standard premium goes up, the percent penalty will also go up. And so there is the potential for an ever increasing penalty charge year after year. Regardless of what Part D plan you subsequently switch to, the penalty charge will follow you.”

“For the rest of your life!,” Reedi said with wide eyes.

“No, just for as long as you don’t get your drugs from your friendly ‘n’ nayyy-borly Canadian pharmacy,” Opal chimed in.

“You want drugs,” Gil said, “I can get you drugs more cheap.” Opal hugged Hermenègildo and then danced around him. Let’s go,” she said while holding onto his outstretched hand with her outstretched hand. “I need help now. I don’t have to show them no stinkin’ Part D badges!

“That reminds me,” Sasha said, “there are certain, shall I say, windows of opportunity, you all should be aware of. Medicare has various enrollment or election periods. You’re coming up to your first one if you’re turning 65 and are new to Medicare. I guess that’s pretty much everyone here. We should go over them, so that you don’t miss any deadlines.” By this time, Mr. Medicare was more than a half hour late, but no one seemed to notice. They all were so impressed with Sasha they let her keep answering their questions for over an hour and then some of them left. Before everyone left, she had agreed to meet again to say more about how Medicare works.

Chapter 4

Which is better?

Sasha arrived at Lance’s Lounge about a half hour before their meeting time. She’s the punctual type and sat at the end of a long oak table reading notes from a binder. It was a Saturday morning and she could hear rain dripping from the black willows outside the room she secured, a meeting room to the left of the bar. When the pitter patter from dripping leaves stopped, it was as if she had been given the signal to move her tall, lean body quickly around the rectangular table while placing papers at several spots along the table’s center. After adjusting her platinum blonde hair tied in a bun, she resumed counting, finger to tongue, loose leaf sheets of paper. The papers were there to reinforce what she was going to talk about. Her intention was to cover the basics of Medicare by soliciting questions and showing how their questions relate to subject areas of Medicare. In this way, she was hoping to show how most questions can be answered referencing Medicare and You. Spinson and Reedi were the first to enter the room and they saw her sitting at the table, reading from a binder. After an exchange of pleasantries, they learned she’s on Medicare. Spinson thought she looked too young. Gilsey came in next and was followed by Hypatia, a new person to the group. When greetings were exchanged Hypatia shook Sasha’s hand and said, “Ooooh, cold hands.” Sasha shrugged. “I know, there’re always cold. My husband says I should say in my own defense: ‘Of course they’re cold, I’m a reptile!’ but that’s not my style.”

“Well, we certainly appreciate the time you’re giving us this morning,” Hypatia said. Soon the room filled with just about everyone Sasha expected. She took control of the room and the chatter quieted like the pitter patter of rain from the trees over hanging the roof. After making some introductory remarks, she asked for questions to which Mauldin immediately shot back, “What’s the difference between Medicare supplements and Medicare Advantage? Which is better?” Her question threw Sasha into a kilter over her planned intentions, for she didn’t like the way Medicare and You obliquely covered the topic. So she decided to abandon her game plan and wing it, at least for this one question.

“To the question is it better to get a Medicare Advantage plan or Medicare supplement, I must say that’s making an apples to oranges comparison. Medicare Advantage plans are not supplements the way Medigap plans are. Medicare Advantage, or if I may say MA, is the privatized version of original Medicare, a government program.” Several heads nodded. “MA plans are equivalent replacements for what you get with Medicare A and B. But they do not provide supplemental, wrap-around coverage to Medicare. Supplements do.” She panned their faces. Everyone appeared to be paying attention. She wanted to emphasize one key item and so said, “And there is no such thing as supplemental coverage for MA plans, although there are separate products that can enhance its coverage like accident policies.

“Name a good accident plan,” Spinson asked.

Sasha deflected that question for another time—there’s always a question you’re not prepared or don’t want to answer she thought—and continued, “Whether you stay with original Medicare, which is your default Medicare insurance when you first get Medicare, or switch to Medicare Advantage during your open enrollment, you’ll still be paying the Part B premium. That’s why you shouldn’t be thinking a ‘no premium’ MA plan is a great deal.” Mauldin looked glum and Sasha knew she needed to say more. She flailed a bit for a better response and then said, “Um, having prescription drug coverage with an MA plan is for many the single most important reason to go with an MA plan when the plan has no additional premium.”

Sasha thought that response nailed it and sat back to scan the group. From her experience as a high school teacher, she knew that key statements would often have to be repeated or written out in order to stick. And there would be no time for all that. Still she felt good about all the attentive faces. So she decided to enlarge her response to flesh out the reasons why some people might choose to stay with original Medicare while others might prefer to go with a Medicare Advantage plan. She thought, this one question could take up the entire morning to answer fully. Oh well. Sasha had her biases but knew she wanted to keep this discussion fair for her audience. “There are, of course, advantages and disadvantages to both MA and original Medicare. Let’s go over them. Let’s go over the pros and cons when weighing the value of staying with original Medicare or switching to a Medicare Advantage plan, also known as Part C.”

Erasmus looked a wee pouty. I guess Part C is not for cats after all, he chuckled mildly.

“So what are the key advantages of going with a Medicare Advantage plan? Can anyone hazard a guess?” She did not expect to hear any robust responses, but wanted to hear what people had to say because it helped her gauge their level of understanding. She heard not a peep. Then someone whispered, ‘More cheap.’ She scanned her audience but could not determine who thought Medicare Advantage plans were cheaper. “Sure, people are always concerned about costs. Okay, let’s talk about premiums. Many MA plans have a premium, but some do not. Across the nation, plans with premiums have shown remarkable stability, perhaps a slight reduction or increase in recent years. Some MA plans have prescription drug coverage and still have no premium. So when you compare a supplement that’s coupled with a stand-alone drug plan to an MA plan with drug coverage and no additional premium, it is understandable why some people—those who take prescriptions— might prefer MA plans.” She could see how at the second pass, her words were sinking in.

“What about medical benefits?” she asked rhetorically. “Medicare Advantage plans provide the same medical benefits as original Medicare, although MA plans also provide several ancillary benefits, such as hearing and vision screenings and dental care. These additional benefits are all above the neck. That’s an easy way to figure out what more you’re getting with Medicare Advantage. I must say, though, that dental or vision plan offerings may be more limited than what you would expect to find with other stand-alone dental plans available to you. If dental, vision, or hearing benefits are important to you, you’ll want to scrutinize the insurer’s offerings. Also, and this is noteworthy for some people, some MA plans may also offer non-health benefits, such as transportation to your doctors and clinics. And some may offer memberships in gyms.” Sasha was starting to feel more at ease. She could see that she held everyone’s interest. “These extras, however, are not nearly as important as the drug coverage you can get with many Medicare Advantage plans because original Medicare does not offer a prescription drug benefit.

“I should say something about pre-existing exclusions. Now, everyone here, I think, is about to turn 65, so this plus for Medicare Advantage is not so important to you at this time, but it may be in future years. What I’m getting at is that you can enroll in a Medicare Advantage plan regardless of your health history with one exception and that is for people suffering from end-stage renal or kidney disease. Why that one disease was singled out I can’t say, but it will keep you out of Medicare Advantage plans.”

“You must be talking about what happens during open enrollment, right?” Erlinda asked.

“Yes, we talked about that word ‘open enrollment’ last time when I mentioned the different election periods you’ll eventually come cross. Thank you, Erlinda, for asking. Outside of the open enrollment and guaranteed election periods, supplement insurers ask about your health history.” She thought this would be a good time to start talking about important disadvantages of Medicare Advantage plans and paused before saying: “While no one here may be disabled, I should mention that Medicare Advantage plans are available to the disabled who are not yet age 65.” While saying this she saw Mauldin wave. “You see, you can get a Medicare Advantage plan, or a Medicare supplement A plan, even if you are under 65 after meeting the Medicare eligibility requirements. With the supplements, the only letter plan that you have access to before 65 is generally Plan A. Recall that I said Plan A has some special attributes? That’s it, mainly.

“While all this sounds pretty good, there are some caveats to be aware of. I mean, there are about 20 different Medicare Advantage plans here in our area, as there are in many other regions of the country. Now unlike Medicare supplements, they will vary in their benefits. The differences may be slight or significant. So the out-of-pocket costs for each plan under consideration need to be looked over carefully as their deductibles, coinsurance, and copays are not necessarily the same for every category of coverage. You will find noteworthy differences, perhaps one that may prove to be costly. That’s because Medicare Advantage plans are not federally mandated to have the exact same benefits from one company to another. And I might add, even though they have an overall equivalency with original Medicare, they can both save you or cost you more than what you would have paid if you had stayed with original Medicare when dealing with any particular treatment.

“The easiest way to understand this is by looking at the hospital deductible. That’s Part A. So this year it is about $1,200. When you look at the copays for a hospital stay with Medicare Advantage, you might see a $300 copay per day for the first five days. Spend only a few days in the hospital and you’ve saved money over what you would have paid with original Medicare, but spend five days there and you’ve racked up $1,500—more than original Medicare’s deductible. So the equivalency can work sometimes for you and sometimes it will work against you.” She paused long enough to see if it was soaking it in. No one was staring at the ceiling or listening to the pitter patter as it started up again. Good. “In the past, MA plans charged their members more than original Medicare for chemotherapy, renal dialysis, and skilled nursing home stays. These are costs that are not easily discerned. What should be evident, or it will be once you start using your MA plan a lot, is that more you use it, the more it cost you, although they have maximum out-of-pocket limits, which original Medicare does not. I must add that studies indicate that sicker people to tend to leave MA plans to avoid the high out-of-pocket costs. Remember, MA plans have no supplemental coverage themselves to escape the higher costs. Okay, any questions so far?” She scanned the room. Good, she thought. Everybody looks like they are hanging in there.” She plowed on:

“Many Medicare Advantage plans provide coverage only if the insured obtains treatment from the plan’s network of health care providers. You may have heard of HMO and PPO type plans. I’m not going to talk about networks just yet. Let’s save that discussion for another time. If someone wishes to see a doctor outside the network, though, the insured will pay a higher percentage of the total cost, but this only can happen if the plan allows for out-of-network coverage; otherwise the plan may not cover any of the cost of treatment. The Achilles heel of MA plans is their networks. Oh gosh, I said I wasn’t going to talk about networks. Oh, but I should say now that doctors, well, they will come and they will go, as Stevie Nicks might say. What I mean is that they may choose to leave a plan at any time or as the insurance carrier might want. Your plan’s network may have a doctor you’ve seen in the past, perhaps even recent past, but then she’s gone. Poof! Just like that. There’s no way to know whose coming or going. This has caused a widespread issue among beneficiaries, which has garnered enough Congressional attention to bring about a bill that would prevent insurers from dropping doctors from their networks in the middle of a plan year without due cause or with little forewarning.”

“What’s that bill!” Erasmus demanded.

“What’s the name of the bill? It’s called the Medicare Advantage Participant Bill of Rights Act. Oh, just as an aside, not all MA plans have networks, but all plans in our area do have networks. So if you get referred to a doctor who is not part of your plan’s network and you want to switch plans, know that your opportunity to switch is limited to the fall annual enrollment period, unless you somehow qualify for a type of special enrollment period. Remember what I said about special enrollment periods? You get one if your plan decides to skip town, so to speak. What else? Oh, you must follow the rules of the plan you joined to have a claim paid, such as pre-authorization of surgeries. Plans can legally deny payment for covered, I repeat, covered services if you do not follow their rules. It can happen!

“Okay, I don’t want to sound alarmist. I do need to emphasize that Medicare Advantage plans can and do change continually. So they should be reviewed or lack of attention could prove to be costly. Basically, there are more moving parts to some MA plans and by this I mean that a change in one component could force you to dump the entire plan. So for instance, if an expensive drug gets dropped mid-year from your plan’s formulary, then that so-called no premium MA plan suddenly becomes very expensive. Or if a plan reduces its network service area, you might be forced to change doctors or stop going to a certain clinic. This may appear to be arbitrary, but an MA company can withdraw from a particular area at any time. Even individual doctors can take your MA plan one time and decide not to take the very same plan the next time you seek treatment, even though the doctor may not be moving or dropping the plan’s carrier. And apart from any network, Medicare Advantage plans limit coverage to a certain geographic area. This is a distinct disadvantage for those who are frequent travelers or snow birds.

“There’s one more looming caveat that’s harder to speak about with any precision. I’ll call it the Great Unknown. So with Obamacare, we should expect federal subsidies to MA plans to be reduced year by year. How this reduction will affect MA plan benefit stability is harder to say, but the insurance industry’s association expects reductions in benefits and higher premiums this year with more to come in the next decade. So far, this prediction does not appear to be happening in any significant way. But we should expect to see a degradation of capitated payment rates to providers. And insurers are expected to reduce the size of their provider networks. There I go again scaring up the networks.”

“What is that capi-pay?” Mauldin asked.

“Oh, I was referring to how Medicare Advantage pays doctors. MA plans reimburse doctors differently than the way original Medicare does. They receive a fixed amount per member per month. It’s more than you want to hear about now.” She thought any lengthy response to that question might get too political, so she held back, for it would become hard for her not to let her biases creep in. This was not the time for that. Besides she felt thirsty, but didn’t want to slow her momentum as it appeared that everyone was engaged. Still, she interrupted herself to let anyone order another drink. She noticed that the morning light coming from the upper windows had shifted and was now coming in more diffused throughout the room. She wondered how much more time she had.

“Since I’ve been talking about the downside of things, allow me to continue in this vane with Medicare supplements. What are the big downsides of the supplements. Anyone have an idea.” No one spoke up immediately, then she heard faintly the words: ‘More cheap, not’. She momentarily held back before saying, “Okay, let’s talk about premium rate stability. With the supplement carriers, the annual premium rate increases will vary from company to company with some companies performing poorly too often. Their rate increases can be steeper than you’d expect or can afford to bear. This rate instability has not been an issue for Medicare Advantage plans. Also, generally, your supplement and Part D premiums together will be higher than MA plan premiums, with or without drug coverage. But don’t get too focused on premium costs because your total out-of-pocket costs, when considering how much you’ll be using your plan’s benefits, may be lower with supplements than with MA plans, especially for the heavier users.

“Okay, I mentioned this already, but now I’ll talk about it in inverse fashion. Medicare supplement plans do not offer the extra benefits above the neck that Medicare Advantage plans do because their coverage follows original Medicare. In other words, if Medicare pays the supplements pick up their portion. Write that on your forehead.” She smiled. “Some supplement companies, though, may offer ancillary benefits, such as a membership to gyms through an association, such as AARP. Also, as I said before, supplements do not offer prescription drug coverage. This is not necessarily a disadvantage, but it appears so when you consider the additional premium cost of a stand-alone Part D plan. When you look only at your drug out-of-pocket costs between a stand-along Part D plan and a Medicare Advantage plan with drug coverage that has ‘no premium,”’ she said with raised dual fingers mimicking quotation marks, “then the out-of-pocket cost of the stand-alone Part D plan is often cheaper.” She thought, okay that requires further explanation through examples, which I’m not prepared to undertake. I better stop there. So she mentally did a Michael Jackson moon walk. “Okay, moving on. Unlike Obamacare plans, supplements can still take into consideration pre-existing conditions. Your medical history gets evaluated and this can lead to a decline. Also, even when a supplement carrier accepts you, the company may have waiting periods for pre-existing conditions for a certain period of time like six months or less. Okay, let’s move on to the advantage of Medicare supplements, unless anyone has a question.”

“So you don’t have to wait for a certain month to change supplement plans like you do with Medicare Advantage?” Mauldin asked.

“Yes, Mauldin. With the supplements, you’re not locked into calendar year election periods. You can change plans whenever you like, as many times as you like as long as you can answer ‘No’ to all the health questions… . Okay, something else, unrelated: Unlike Medicare Advantage plans, each supplement letter has the same exact benefits regardless of the company you get it from. So you don’t have to scrutinize, for instance, one company’s F plan against another company’s F plan. They are the same.

“And speaking specifically about the F plan, which happens to be the most popular of the supplements, your out-of-pocket costs are reduced to the premium—no copays, no coinsurance and no deductibles to pay. This is almost true to a lesser degree with some of the other supplement letters. With the F plan, your annual out-of-pocket cost is your premium and nothing more. Of course, this means you’re seeing a doctor who takes Medicare. And this also means that your out-of-pocket costs will be substantially less than your maximum out-of-pocket costs for any MA plan.

“Supplement plans have more flexibility. You can see any doctor who takes Medicare. Yes, you heard right—no provider network to bother about. You can travel anywhere in the United States because you’re not tied to a network. You can drop your plan and pick up another one at any time of the year because there’s no annual enrollment period. Let’s see what other noes can I mention. Oh yes, there’s no drug coverage either. I said that before, right? But even so, sometimes the only problem an MA plan has is that a particularly expensive drug gets dropped from the plan’s prescription formulary, then you’re having to find a new plan while making sure all your doctors are in its network. Supplements allow one to switch out the drug plan when such problems occur without having to dump one’s supplement because the two insurance plans operate independently of each other. That’s a good thing,” she smiled, recognizing that she had shown her hand.

“Okay, one last big and I mean BIG deal: No provider networks!” There I go again, she said to herself. Actually, supplement plans that have the word Select before them do have hospital networks. That’s one way to lower your premium. And you’re still free to see any doctor who takes Medicare.

“Which brings to mind, you may have heard otherwise, but doctors who take Medicare are widespread, at least in our area,” she said at a quickened pace, “even doctors who say they don’t take Medicare can accept it just to see you. This is not to say that some people somewhere have had problems finding Medicare doctors. I’m just not aware of any area where Medicare doctors are scarce.”

Then a waitress came in with a tray of drink orders, which Sasha took as the right time for a time out. After breaking off the discussion, she talked individually with Mauldin and then Manot about their concerns. Soon after that, she announced to all that Mr. Medicare would be at a music venue next Saturday. She urged everyone to attend. He’s a ‘dynamic’ speaker she said. “You will not be disappointed. You will walk away feeling empowered to act with confidence.” She went on this way for several minutes and then mentioned that she’d be there too.

Chapter 5

Who Wants Extra Help?

While on their way to the Blues Lagoon, Erlinda continually praised Sasha. She thought Sasha was wonderful and could not see how Mr. Medicare could upstage her. “She was just terrific,” Erasmus agreed. “We are in for a real treat with Mr. Medicare if he’s half as good as she says he is.” Although the place was nearly across town, the Uelis were okay with that. After all, even if Mr. Medicare didn’t show up, Sasha would be there to answer questions just as before. It was another Saturday morning and the Blues Lagoon opened at 11 A.M. When they arrived about 11:20 for the 11:30 appointed time, the place looked empty. The Lagoon had a large open-air, covered stage off to one side of a bar, which allowed for patrons to see bands play while drinking or eating along a wide balcony. Below were more tables. The place had a light scent of cedar. At this time, as one would expect, there was no live music or any music coming from a silver juke box across the way, and nothing from overhead speakers. Every once in a while muffled sounds could be heard from the kitchen, opposite the stage. Mr. Medicare had chosen a good place to hear someone talk without a microphone.

The Uelis found a nook in the restaurant they thought might be where Mr. Medicare would choose to meet, for it had a table that was tucked into a large horseshoe shaped booth. No one else from their group had arrived yet, but as soon as they sat down in walked Mauldin almost immediately followed by several others. Soon enough the chosen area was abuzz with their chatter. Opal walked in with Sasha who had brought a laptop. Gilsey also brought one. With Sasha in the room, people started asking her questions, but she demurred and then busied herself with a waitress. When she came back, she announced, “I’m so sorry to have to say this, but I do not think, well, I know actually, um, Mr. Medicare won’t be … here today.” She looked down at the floor before saying anything more and the room quieted, even the muted sounds emanating from the kitchen stopped. “He got pulled away by an emergency. That’s all I know.”

No one said a word, then after a long pause Opal asked, “Can I ask a question about prescription drugs?”

“Why of course.”

“Last time you said the Medicare website was a good place to find a drug plan that pays. Can you show me how to do that?” Opal wanted to know how to get financial help paying for her prescriptions, but Sasha misunderstood her request. Once Sasha began talking, Opal realized she had been misunderstood but became reticent.

“Sure. That might be an excellent way to begin since it’s now just us. Let’s go to Medicare’s website. I’ll show you how to find the lowest annual cost Part D plan from there, if that’s okay with everyone,” she said as she typed into the browser’s address box: www.medicare.gov. No one said a word, but several people nodded their approval. Opal, seeing how she was unable to undo the direction of the presentation started feeling restless.

After Sasha and Gilsey had arrived at the Medicare website, Sahsa looked up. The group had tightened up around both laptops at opposite positions of the oval table. She saw that Opal, who was viewing from Gilsey’s laptop, was tinkering with her cell phone and assumed she had pulled up the website from her cell phone.

“Notice these three green bars,” she said while they viewed Medicare’s home page. “The one on the left, Find health & drug plans, we’ll click on it. That takes us to the page where we can do either a general search or personalized search. For demonstration purposes, I’ll keep the search general, which means it will be anonymous. However, you guys can and should do a personalized search once you’ve registered on this website. By doing so, you’ll only have to enter your prescription drugs one time. After that, with your user name and password, you’ll only have to update your prescriptions as needed, perhaps once a year. Okay, so for today I’m going to put in my zip code in the general search box. Now I click on Find Plans. Okay, we see Step 1 of 4: Enter Information, which means for this group, we will click on the radio button: Original Medicare under How do you get your Medicare coverage? You can also click on I don’t have any Medicare coverage yet and you’ll get to the same next step. The two optional boxes under Original Medicare, we’ll leave unchecked. Okay, so having done that, we next click on I don’t get any Extra Help. Down here,” she said pointing her index finger.

“But I want extra help,” Opal finally said softly. Hypatia, sitting to her left, responded by saying in a much louder voice, “I need a whole lotta help.”

“That’s fine,” Sasha said. “We can do a variation of this search for you two once I finish up here. For the time being, let’s continue.”

“Works for me,” Hypatia squealed. “I gotta take Nexium, but my plan doesn’t cover it,” she said unhesitatingly. “I need something else.”

“You have Extra Help?” asked Sasha.

“I think so. What’s that?”

“It’s for people with low incomes. I was going to say that you can make an appeal directly to the company you have the plan with,” Sasha said, “which you might need to do, or wait until the annual enrollment period to switch plans, but with Extra Help or low income subsidy, you can switch plans anytime.”

“Great to hear. Even monthly?”

Opal looked askance at Hypatia while continuing to text. For Sasha, their requests got lodged in the back of her mind as issue items that would not fit easily into her standard Part D presentation and would have to be addressed afterward. “We now click on Continue to Plan Results. Step 2 of 4 is where we enter our prescriptions. This rectangular box below Type the name of your drug is where we do that. For our purpose, I’ll enter one drug because all prescriptions get entered the same way. Allow me to input Lisinopril, even though it may not be your particular drug. Notice how this website opens a dropdown box once you’ve typed in several letters of the drug’s name,” she paused and looked up at Gilsey who mumbled, ‘yeah I see.’

“I typed the letter L and then I and immediately got five drug names. None of which we want. So I add the S and Lisinopril pops up on top. Hit your down cursor to select it and click ‘Enter’. We now see a pop up box, which allows us to enter both the dosage and frequency of our drug. In this case, the dosage defaults to 10 milligrams and we’ll take it. We’ll make the frequency once a day, so that means the quantity becomes 30, which is already there, and we’ll accept the frequency of ‘Every 1 month’. Notice that the type of pharmacy defaults to the retail outlet. When you input your own drugs, you can switch it over to mail order. Okay, we now can click on Add drug and dosage.”

“What is LIS? Is that like Extra Help?” Hypatia interrupted.

“Why yes, Hypatia. They are two names for the same program. Okay, you can see how Lisinopril shows up below, My Drug List. For some of you, the entering of prescriptions continues, but for now, we’ll stop with one entered drug and click on the brownish bar, My Drug List is Complete. Oh, notice how we can see that Lisinopril is a generic drug—more on that later. Okay, so we are on step three where we choose our preferred pharmacy—the place where we will get our prescriptions filled. However, this website does not indicate that your chosen pharmacy is, or should I say ‘will be,’ in your chosen plan’s network. At this point, it can’t since we haven’t picked a plan, but even when you see your results it still won’t. Even when you click on any one of your available company options, the screen you view won’t tell you whether or not your selected pharmacy is in the company’s network. And your pharmacy does need to be … in your plan’s network,” she paused for emphasis and slowed the pace of her last four words.

“I like this compounding pharmacy down the road from me,” Hypatia said, while Opal placed her cell phone on the table and looked at her.

“Then you’ll want to be certain that it’s in your plan’s network,” Sasha said quickly. “The best way to know for sure is to call the company and ask. Now even though your results page won’t tell you if your chosen pharmacy is in your plan’s network, if it happens to be a national pharmacy like CVS, it most likely will be, but you’ll want to check anyway. Eh-nyway, this choice can make a difference in your annual out-of-pocket cost, but I’m not of the mind that you’ll see a great difference in costs between pharmacies. You can do this search as many times as you like just to see how different pharmacy store selections result in different total costs. With just one drug, I wouldn’t expect to see much variation in costs between companies or carriers. Most people, though, have a preferred pharmacy and just go with that choice. For now, let’s pick CVS since its 0.5 miles from my location and move on. Note, though, that as you increase the distance, you will come up with other choices. We can now Continue to Plan Results. We are now on step 4 of 4 and close to seeing the results page. In the center box, under Summary of your Search Results, we’ll check the first, the top box because we are going to be looking for Part D plans. Later, when we talk about finding a good Medicare Advantage plan, we’ll be exploring the other two boxes. For today, we can ignore them.” Sasha noticed that Opal was on her cell phone again. She thought, when did I lose her?

“They said I enrolled late, am I going to have to pay that penalty?” Hypatia asked.

“No not at all. Being on Extra Help is one way to avoid the penalty,” Sasha said while glancing up from her screen. “Okay, so now look at the column on the left. Under Refine your Search, we see a lot of options and each option has a plus sign next to it. Let’s look at these options. All of these options are ways to limit or refine your search results. For most of us, we don’t want to place limitations with one critical exception. So notice how we can limit our monthly premium by selecting a dollar amount that we don’t want this search engine to go above, but this is not the best place to do that. Let’s ignore that option and move on. Really, guys, the only option we want to look under is the one titled: Select Drug Options. Click the plus sign and notice the second box: Have all my drugs on formulary. We’ll check that box and that’s the only box we want to check. That’s it.”

“What’s a formulary?” Hypatia asked in an excited voice. Opal groaned.

“Oh, that’s just a fancy word for a list of drugs. We are letting the search engine know that we only want to see drug plan choices from carriers who have all of our drugs in their Part D plans. In this example, since we are inputting only one generic drug, we expect to see many, many options. And we will. Okay, so now we have two boxes checked, one in the center of the screen and the other one under one of the plus signs off to the left. Time to Update Plan Results.” She points to the top of the narrow left column. Gilsey dutifully follows along and makes sure others viewing her screen also keep up. “This step is important otherwise the results page will show plans we won’t want to consider. In this case, it’s not a concern, but when entering many drugs, you don’t want to overlook this step. The updating has been done and we now Continue To Plan Results from this burnt orange bar. Voila! We have it!” The group verbalized a few mild hurrahs and everyone looked pleased, except Opal who continued to peck out text on her cell phone. As though oblivious to what just occurred, Hypatia blurted out, “I started getting money to help pay my rent this month, is that going to count against me?”

“Actually no, Hypatia,” Sasha said. “Rental vouchers are non-countable sources of income. You’ll be fine… Okay, you are now on the Your Plan Results page. Ignore Your Current Plan at the very top. There’s nothing there you can use. We’ll just be looking under Prescription Drug Plans. Notice that there are about thirty plans to choose from—way too many for us to evaluate and we won’t need to. We’ll probably find the plan we want within the top two or three companies. That’s true, in part, because this results page defaults to the insurance carriers with the lowest total annual drug cost, and the cost of a plan is what most people rank first in their considerations. The carriers are listed from lowest to highest, which is the order you want to see.”

“What about my life insurance policy?” Hypatia gasped to which Opal’s jaw dropped to her chest.

“No, no. You should be fine with that too,” Sasha said without looking up at Hypatia. “So let’s go over the columns and I’ll show you how to evaluate your options. The far left column, for most of us, will be the most important column to take note of because it tells you how expensive the plan is going to be. Here we see the annual cost in terms of what Medicare calls “retail” and mail order. The dollar amount includes the plan’s premium and copays or percentages, if that applies to you. It also includes the calculation of plans with deductibles. That’s why you are looking at your total out-of-pocket expense. The number shown would be the annual cost if the results page showed costs from January through December. However, since we are not looking at plans at the beginning of the year, we are seeing results for the beginning of next month through December, which I’ll be able to say more about in a minute,” She noticed that Opal was still on her phone and wondered if she had lost her completely.

“I never applied for Extra Help,” Hypatia giggled. “How did they know I wanted it?”

This time, Sasha felt she could continue while ignoring Hypatia’s last question. “First, though, moving on to the next column, we see the monthly premium. Although, the premium is important as a cost factor, it is less important than the overall annual cost. Still, it is a number to take note of. The third column shows the deductible or lack of one and the copays-slash-coinsurance—that’s a percentage cost of a drug, which may apply to you especially if you are taking drugs that you inject yourself with. One thing Medicare’s results page does not do well is list the drug copays by their tiers on this screen. There are cost levels called tiers. The generic drugs, the cheaper drugs, fall under the first two tiers, one and two. The brand drugs are generally found under tiers three and four. Both generics and brand drugs have two tier categories, which are called preferred and non- preferred. The preferred tiers are going to be cheaper than the non-preferred tiers. So you’ll find preferred generics listed as tier one drugs and preferred brand drugs, as tier three drugs. Your tier five drugs are given a percentage cost. So although this screen has the room to show the copay cost for each of the drug tiers, instead they have chosen to abbreviate the cost structure. That’s okay because we can still see the copay cost of each drug listed as well their tier from another window. I’ll get to that in a minute.”

“What’s a tier?” Opal asked while glancing at Hypatia.

“It tells you the cost level of a drug,” Spinson shot back.

“Good, Spinson. There will be a test afterward,” Sasha said matter-of-factly. “So, in the fourth column, we can see that all of our drugs are found in the plan’s formulary, which is essential, and we can see whether or not any of our drugs have restrictions on how they are prescribed. In the case we are reviewing, there are no drug restrictions, but for many of us once we input our prescriptions, we will find that some of our drugs do have restrictions. So we’ll want to know what those restrictions are. This will help us decide which plan to choose. Let’s click on the word “no” anyway just to—

“Did they know I was getting SSI?” Hypatia interrupted, but Sasha ignored her and continued:

“ … A new window opens up and we can see that Lisinopril is a tier one drug, which we already knew, but from this screen we can see more. We also can see that there are three types of restrictions that can apply to a particular drug. If a drug is shown to have a prior authorization restriction it means that your doctor is going to have to contact the insurance company to get the go-ahead in order to prescribe it. There are various reasons why this might be so. For now, though, I just want you to be aware of what prior authorization means. Your drug could also have a limit on the number of pills you can take per number of days. This could be as few as one per day. Is this important to you? Who knows. Ask your doctor.”

“Okay!” Opal squealed as she took a call and walked off. Sasha, didn’t let that bother her and kept talking.

“And the other restriction, called step therapy, means that the insurance company may want you to try a lower cost drug first before advancing to your chosen higher cost drug. If the lower cost drug is acceptable to you or your doctor, fine. No problem. Otherwise, there is an internal appeal process that can be initiated. Let’s hold off that discussion for another time. I have a separate session on the topic I call ‘making an appeal’. Okay, so we are back to the results page and in this next to the last column we see that this plan has a star rating of 3.5, which can be described as a good rating. The very best rating is a five and the very worst is a one. Most of the plans are going to be given ratings in the middle range or 3.0 and 3.5. The ratings help you to understand what plan members think about the quality and service they have received from this carrier.”

“Hey, Sasha, with this life insurance money I’ll be getting, I won’t need this plan anyway.” Sasha’s forehead wrinkled while continuing to look at her screen, but said nothing to Hypatia. “I might just drop it.” Hypatia mumbled to herself.

“Oh … you’re the beneficiary. In that case, yes; there is an opt out process, which we can go over together in a minute, but allow me to continue. I’m almost done here. So I would say the star rating system can be useful when you are weighing your preference for two plans that are almost equal in their appeal. Perhaps a plan with a slightly higher star rating will help you make a choice. Okay, so if you were ready to enroll in a plan, having reviewed these columns, you could do so by clicking on this Enroll button. Or, you could call the carrier or go to the carrier’s own website and enroll that way. The fastidious individual who is taking more than a few cheap generics may want to verify everything they see here by calling the company. That’s the best way to get the corroboration and other assurances you may want.”

Opal had come back in time to hear Hypatia’s last remark and with some hesitation asked in a voice much louder than before, “This here website is good for finding a cheap drug plan when you take expensive drugs and have to pay like up the nose for them and want to pay less ’cause the expense is eating away at your cat food budget, which is what I’m been reduced to ’cause some of these drugs I’m taking are like sending me to the dumpster and if this website helps me find a way to pay for it and all, then that’s what I want to hear. You know?”

Sasha misunderstood her question and said, “Well, yes, but let’s go over that issue separately, just you and me after I finish here. I want to say one more thing about reviewing your results. So we are back at the results page and this time we’re going to click on the plan’s name, which opens a new window. This window has additional information or ways of viewing your results. You can see how your drug costs are broken out. One thing to point out is this color bar graph. Scroll down a bit, Gilsey. When people are figuring out their total insurance costs, it is nice to know what their approximate month to month costs will be for prescriptions, which this bar graph nicely illustrates. For those who fall into the coverage gap or so called doughnut hole, they will be able to see the months for which they will be paying the full cost of their prescriptions. So allow me to add a few more drugs to our plan results, just to provide a more robust color chart. Okay, done!” Gilsey followed her lead, but also took on a few requests, so her chart looked different. Opal went back to texting.

“Now going back to the results page and clicking on the plan’s name, we can see from this graph that in August we enter the doughnut hole, but not fully. Then the gap continues for a few months and then the burnt orange or brownish gap color drops way down before going away, and for the rest of the year our monthly costs level off considerably, which the blue bar depicts. That’s because we left the doughnut hole and entered the catastrophic phase where we get the lowest copay drug costs.” Sasha noticed that Opal had gone back to fiddling with her cell phone and felt bad.

Immediately after the presentation, she brought her over to her laptop so that Opal could understand how Medicare’s website was relevant to her situation. While at Medicare’s home page, she said to her, “Opal, you’ll click on this radio button: I applied for and got Extra Help through Social Security. Which of these other radio buttons apply to you, you’ll know from your eligibility notice. Did you bring that green or yellow letter?” Opal crumpled with her rump half off the seat, one hand grasping the table’s rim and the other the chair’s back with her head barely above the table top. She looked up at Sasha with a bemused expression as if to say, ‘You kidding.’

Chapter 6

Who’s Missing Whom?

At about a quarter to noon, Zeke asked no one in particular where they thought Sasha might be. “Is she in the building?” The group had expanded a bit without losing any of the original people. They assembled this time at the Mustang Bar & Grill. It’s one of their places in rotation. The preferred time to meet has always been 11:30 A.M. Saturdays. Sasha is usually one of the first to arrive. No one responds, so Zeke asked again, “She drives a sky blue Volvo. You see it out front, Spinson?” He shook his head and then took lemonade from the waitress with a tray of drinks. These Saturday morning meetings with Sasha have been going on weekly, for nearly a dozen times, always under the same circumstances: Mr. Medicare is scheduled to show up, but fails to do so, which is fine with everybody because Sasha has been so wonderful with her presentations. Over the weeks, the group has become quite knowledgeable about Medicare. Over time, the camaraderie has kept the group together. Since this has never happened before, the group is feeling a bit lost, then Opal shatters the comity:

“She has disappeared like my neighbor,” she moaned loud enough for all to hear. She sat at a table with two others, which was closest to the back wall. Everyone else looked intently in her direction. Erlinda looked at Erasmus and they both glanced at Spinson. “What do you mean ‘like my neighbor’?” Spinson asked from across the room. Opal remained silent. She could see she had everyone’s attention. Spinson, Erasmus, and Erlinda, who sat farthest from Opal, moved to the table next to her. This time Erlinda asked softly, “You have a missing friend?”

“Oh yes,” Opal looked upward at no one in particular. “It’s been nearly six months now since I last saw her. I was in her house, and we were talking about her paintings and then she noticed the clock and said she was off to attend a meeting about Medicare. That’s when she showed me that letter.”

“The letter with the photo of Mr. Medicare!” Erlinda said and Erasmus gulped hard on his drink.

“Yes, yes. She asked me if I wanted to go with her, but I said I was busy. Besides, I didn’t know why I should go.” She flashed a forlorn look. Everyone in the group had moved closer to Opal, some were sitting at her table, others standing, pressing in.

“Is that when you last saw her?” Erasmus asked.

“No, I saw her again later that day. I guess after coming back from that meeting. I had no time to visit with her again … that was a Tuesday. The day after that we traded ‘hellos’ from our porches and that was the last time I saw her. Every day I look in her direction, just to see if I can see evidence of activity, you know. Nothing. The house is closed up like she’s on vacation. Her car is never there anymore.” By this time Opal had slumped, looking downward again, and Salim who sat next to her whispered comforting words.

The area of the restaurant where the group huddled was on a raised platform with a low railing on the entry side, which provided them with a little more seclusion from other areas of the eatery. The hardwood floor also creaked a bit more whenever patrons and wait staff moved about. Zeke stood up and while walking away from the group in his heavy boots shouted, “And I thought I was the only one!” This got everybody’s attention, of course. Suspirations were almost audible. Eyes widened everywhere. People kept looking back and forth at one another. Expressions of angst and alarm were frozen on their faces. Zeke continued, “My twin sister (Zoe) has gone missing too! And just about the same time as Opal’s friend. And the circumstances are the same. I mean, she had met with Mr. Medicare days before she vanished. Now we have three people missing and all have a connection to Mr. Medicare. What on is going on here!”

Erasmus, Erlinda, and Spinson kept looking at each other, then Erasmus stood up and momentarily looked downward while parting his hair. “Zeke, Zeke, and all of you,” he said, taking a long pause before continuing, “We are faced with a mind boggling situation. I don’t know how else to express it. But, friends, it’s not just Sasha missing, and Zeke and Opal’s missing people, Erlinda and me also are missing a loved one and so is Spinson.” Gasps were audible and someone started to moan. “Now is not the time to panic,” he said while raising his flat palm. We just need to figure out what is going on here. How is it that some of us are missing dear friends and relatives who have been with Mr. Medicare and until now no one was aware of this—what we all had in common.” He paused before adding, “Whether this enigmatic person we have come to call Mr. Medicare has anything to do with it is, of course, front and center.”

“Yeah, who the hell is this guy anyway!,” Spinson shouted. “You think just some of us here are missing people in our lives, huh? I want to know who else … speak up! Is there anyone else missing someone. Anyone else? Com’n!” Quickly, hands went up, voices were affirmative. Gil said quickly and softly, “Me too.” His frozen expression of fear looked like it was painted by Edvard Munch. The group started talking to one another in hurried voices. Soon it became evident that everyoneeveryone—in the room had a missing loved one and all missing persons had met with Mr. Medicare the week of the disappearances.

They started asking each other about their missing person’s particular situation. When was her disappearance? What was the last thing he said to you? Said what? Say that again. Really? What was she doing? Did she want you to go? How long ago was that? You thought you saw her car drive by one time? I’m sorry, can you repeat that. Oh my gosh! You got a call? In the middle of the night! Such hair raising discussions were too much to bear. Crying could be heard. Moaning was audible too. The gnashing of teeth. The wringing of hands. The pounding of fists. The pulling of hair. And the anxious chatter had grown louder. Everyone tried to comfort one another. Moist napkins were strewn on the tables. Any diner coming upon this scene would have probably thought: I don’t want what they had. Indeed, it was all there on display for this one waitress to see, the fear and dread of a group unaccustomed to seeing one another with anything other than contented expressions and in good moods. This only accentuated the anxiety in all of them. Zeke kept pacing the room while venting to know one in particular. He looked like a mad man occasionally shouting at the wooden rafters (or like someone on a cell phone). He stopped to stare at the waitress entering their area as though she were a succubus. She looked away, placed a tray of drinks on a nearby table and fled.

“Where is Joe!” Mauldin said imploringly as though the strength of her anguish might divine the answer. Then she stood and while speaking to no one in particular she panned the room as she walked slightly away from everyone as if to give a Shakespearean soliloquy.

“You know you’re missing someone bad because you feel their presence all around you,” she said while looking downward. She looked up quickly toward the ceiling and then pivoted to look directly at Manot who was mere feet away. Manot looked away from her. “It’s easy enough to understand why. As soon as I walk into the house, he’s there,” she said, shaking her head after reversing her pivot and then walking slowly about the room. “His navy blue overcoat hangs, not more than five feet from me when I open the front door. I hesitate, but I know I can smell him if I put the collar up to my face,” she sometimes stopped pacing to look intently at someone else. “Which I’ve done way more times than I care to recall,” she said bending forward at the waist. “I know if I check the top left breast pocket, I might find Walnettos caramels. To get past the entry way, I must pass the scuffed up Rockports he wears while in the yard. Then it’s the same in the kitchen. Hand-written notes to himself, and for me, are held to the refrigerator by tile magnets, an alligator, rabbit, and lamb. A Gazette article about a New Year’s eve event now long past is still pressed against the frig, it’s yellowed edges as curled as a fall leaf, waiting to flutter to the floor. He placed it there and shall remove it. Not I.” she said emphatically with her chin up. “It makes no sense, I know. His favorite cream-colored coffee mug with the U.S. Open logo is still next to the toaster where he last placed it. Unwashed, I know, but I choose not move it either. So there it sits, with a light brown stain at its base. Even the utensils and appliances that I use, I must say as I look around: He bought that one for me about three years ago, and that one this year, and that one, oh, it’s quite old, and that toaster, many years ago, ten perhaps.

“And it gets me thinking about the past. We never use that juicer anymore, but we once were into juicing veggies. It started with an enthusiastic friend, then we liked doing it and kept it going until, ah, not sure why, but I still buy carrot juice on occasion. The microwave was the last thing he built a shelf for. There are certain cabinets I will not open! When I see something of his I haven’t used in a while, it brings up memories. Yes, I tend to enter the house through the kitchen door these days, even though it’s a little less convenient. Not sure how long I’ve been doing it. Am hardly aware of the change in this habit. I’m inconsistent. Depends on my underlying mood, I guess. Something I’m not so much aware of and don’t want to be. A deep dark current runs through my subconscious, I guess. It’s just that so much of his stuff is in the garage. His tools, you know? I go in there, of course, but not often when I first come home from wherever. I think I want to pretend it was just yesterday I last saw him. He was out on an errand while doing yard work. He should’ve come back already with a new garden hose or something. He’d want to know where the measuring tape was. So I set it on the counter. There it is. Waiting, like me. It was just yesterday. Oh, where is he? We are waiting. The grass is waiting—to be cut. His shoes are waiting—to be worn. Our TV is waiting to be watched, by him. I hardly turn it on anymore. The room is full of animate objects now. Heck, the entire house is a lively bunch of grim faces. They are, like me, just waiting for him to walk in the house, greet us all warmly, and go about his chores or whatever he planned to do before leaving. I say to myself ‘But I can’t help you’ as though this thought gets communicated to the TV, the measuring tape, his ceramic mug, his coat, his shoes, and everything else staring me in the face demanding to know: Where is he? I try not to respond, but I’m spooked. I never expected to be alone, well, not like this. Not the way it happened and, actually, I am not alone. I have so much company surrounding me, and they all speak to me! Not in words, mind you, only in unspoken thoughts, not real words, just interpreted feelings, I guess. I can’t do anything about it. I mean, they intrude my mind. They demand my attention. I look away. I cry. I demand they look away! And they demand my attention!! For Christ’s sake!!!

“What do I do? I don’t know where he’s gone! Stop looking at me that way! I have nothing more to say to you. I’m as confounded as the rest of them. In my more rational moments, which have become less and less, I think, ‘I should put the rake back in the shed.’ Nay. He’ll be here later today, wanting to use it. The leaves are piling up. The truth is nothing is getting done around the house. I’m also not cooking and I’m losing weight. He’ll like that.” She smiled. “I know, I’m losing more than pounds, but I can’t help myself. We were a couple. I meant, we were tight. We did everything together. So he was my best friend. No one comes by anymore. His golf buddies do call, but that only makes me cry. The calls have become less frequent. I keep telling myself. You have to get out more. Mingle. Go to church. Reconnect. This house is driving you crazy. I mean, I’m talking to the walls too much. The TV doesn’t work for me anymore. I’ve got to get out of this house. I guess, that’s why I’ve kept coming back and that’s why I’m here today.

“I will go back to St. Paul’s. Yessiree. It’s been a long time. Walk up its brick steps, open its heavy wooden door. O Lord, glimpse the ornate alter from afar, amend. Walk slowly toward it with my steps echoing softly throughout the chamber. Reach the first pew and genuflect before the Glory, my God. Reach for the hymnal and place it against my breast bone. Open it. Sing: ‘Be thou my Vision,”’ she hesitated. “Oh dear God I hear you now,” she sang in a clear high voice and repeated, “‘Be thou my—,’ but stopped to say in a lower voice: It’s been a while.” She cleared her throat, and began again. “Be Thou my Vison,” her voice grew stronger, “O Lord of my heart, Naught be all else to me,” her voice climbed higher. “Save that Thou art, Thou my best Thought, by day or by night, Waking or sleeping, Thy presence my li-ght.” With her now crackling voice she sang louder and louder until she was shouting the lyrics no longer on key, sometimes repeating words she did not think she punctuated quiet right or verses were started over when she lost track of what she just sang.

Erlinda then walked up behind her, put her arm around her shoulder, and asked her to sit. “Please Mauldin sit. Please, here. Just sit,” Erlinda said. Mauldin understood the request and stopped singing. She sat meekly, crying streams down her cheeks. Erlinda tried to comfort her. Erasmus looked at the two sitting by themselves. “Who goes not missing we take for granted, until who we take for granted goes missing,” he said under his breath to himself. Everyone in the room was focused on Mauldin and Erlinda, sitting with their postures bent forward, heads nearly touching. Erlinda was now doing the talking, but in a voice too soft for anyone else to hear. The two were being watched ruefully, which allowed them to momentarily put aside their own distraught feelings. No one else said anything. The room had become quiet as if everyone had left the room and only their apparitions lingered, even the creepy creaky floor boards had quieted, for Zeke was sitting down too and now the distant sound of Highway to Hell could be heard emanating from speakers in another area of the restaurant. DON’T STOP ME! Yeh, yeh. Erlinda had shepherded Mauldin to a table at the center of the room. The others were huddled around them with their backs to the railing.

Gilsey then gasped. She had looked up toward the railing, due to an inexplicable feeling that she and the others were being watched. The soft sound she made got Gil to turn his head. “Ejola!,” he exclaimed. That was enough to get others to look in the same direction. Hushed trepidations rippled through the group as their postures froze as stiff as icicles. Now everyone was staring at a husky man leaning against the railing, looking back at them with that peculiar, thin-lipped smile. He looked exactly like the picture on the letter! Maybe his hair looked a bit whiter and wispier. Reedi felt warm wetness in her crotch and crossed her legs; Zeke felt a myocardial infarction coming on and crossed his heart. Everyone was too discombobulated to say a word. The silence grew louder and louder like a bad case of group tinnitus, swirling around their brains, giving each one that deer-in-the-headlights look, for Mr. Medicare had finally crossed their path.

Chapter 7

Who Knew?

“I am so, so, so grateful to be with you today,” he said while leaning forward with his rump against the rail. His pink puffy hands were clasped together, resting on barrel-like thighs. “I know it’s been a long time coming and you deserve an explanation,” he said apologetically while maintaining eye contact, which he did sometimes with widening bloodshot eyes. His reassuring words put everyone immediately at ease. The first impression that everyone got was of his weak voice, one that seemed to issue forth from deep within his throat. It was low and faint when he clipped off a trailing word before continuing. Still, he projected well enough to be heard in this environ where there were no distractions or competing noises. He also spoke slowly in a measured voice, which made everyone nearly con-cen-trate-on-e-very-syl-la-ble. At least, that’s how he got started. Soon, though, his pace picked up and he started speaking more fluidly as he started talking about why he was AWOL for so long.

“Sasha knows I won’t show up at presentations with her in the same room. I just won’t. She always spoils it for me and my audience. Initially, she did come with me, but after a while she learned a lot and once she become quite knowledgeable about Medicare, she started to interject her own thoughts while sitting or standing off to the side; or worse correcting me on my less-than-perfect answers. She likes my presentations, at least she tells me so; it’s the Q&A she says I still need to work on.” No one cracked an expression, for his audience wasn’t sure what to make of him.

“Oh, she’s a quick study, and much better at audience participation. This I’ve come to accept. At times over the years, she says she saw me struggle, well, I would beg to differ … I’ve been doing these presentations for several decades now. At some point, she started interfering too much, nearly running the show, so to speak, taking control, and making it difficult for me to carry out my planned syllabus. This infuriated me, and we eventually had a falling out. Her job initially was only to set up the meetings, which she has always done, but because she knows where they are taking place, she often arrives before me. I’ve warned, ‘Do not show up at this meeting.’ And she dutifully nods, but then shows up anyway. She says she can’t help it. She loves giving presentations herself. I know when she’s at a meeting place because upon my arrival I’ll see her car in the parking lot. At that point, I just leave. I know well enough, she’s capable of delivering a good presentation, maybe not quite with the flair I can impart, but she’s good, real good.” The group appeared to nod in unison at this remark and as he felt his presence less threatening, he moved off the railing and closer to a table mere feet from the rest of them who were now relaxed enough to sit. “Over the years, this arrangement has worked out for the two of us, I guess, because she often double-books me anyway.” He laughed and then someone asked if Sasha was his wife. He nodded, to which someone else asked why he never signed his letters. It was a contractual agreement with the ‘Treasury’ was the way Albert Goodenough put it. No one questioned him further about it and the discussion moved on. Albert then explained that he would go over each person’s case so that each one of them knew how to proceed with Medicare and what their best options were. He said his intelligence gathering (Sasha) had yielded the information he needed to correctly assess the situation of each one of them. He then called out Manot’s full name:

“Manot Comte, my friend, I understand you’ve retired from a company that doesn’t provide employees with a retirement medical plan.”

Manot nodded, “RMY Industrial.”

“I start with you because your window to enroll in Part B is closing at the end of this month. Allow me to clarify: You should apply for Medicare A and B now. You should apply in order to avoid a penalty associated with Part B. You see, there is a penalty charge associated with Part B for people who do not initially enroll once they have become eligible and have no other acceptable coverage.

“You’re now 67 and retired, correct?”

“Yes,” Manot said with a nod.

“You have eight months after your retirement month to enroll in Part B or the penalty comes into play. It’s not one you’ll have to be concerned about because I’ll make sure you’re not going to miss your deadline. I’ll make sure of that,” Albert assured. “I just want you and everyone else to know that Part B, like Part D, has a penalty for late enrollees. Depending on your situation your enrollment period could end three months after your birthday month or as long as eight months after your retirement month if you continued working and because of that, delayed taking B. In your case, Manot, you never enrolled in Medicare upon turning 65, right?”

He nodded and said, “I have COBRA.”

“Sure, but COBRA doesn’t protect you from the penalty, Manot. As a retiree, you may have thought Medicare wasn’t for you because you had COBRA.”

“The company was going through some changes and COBRA was what they offered. I was waiting to see what they came up with. That’s all,” Manot said glumly.

“And for some reason your company appears not to have informed you about anything. No problem. You’ll be accessing a special enrollment period. You’ll also be able to enroll in other types of voluntary insurance. I’ll explain this fully when I help you with your enrollment in Medicare right after I finish with the rest. Stick around.” Manot nodded again and this time tipped his cap. Albert then turned to Zeke.

“Zeke Jamison, my friend,” Albert said with all the respect and dignity he could impart to his voice. He always added ‘my friend’ to the end of his initial greeting.

“Your case is the simplest of anyone’s here. Essentially, you don’t have to do anything. Your retirement medical plan provides you with drug coverage that is considered credible coverage. You follow me?”

“Yes, now I do. I have incredible coverage,” Zeke said with a smile.

“And you don’t need to consider a Medicare Advantage or Medicare supplement plan because your retirement plan will pick up your shared Medicare costs. Well, it may leave you with some smaller amount of cost sharing, but probably not enough to look into replacing it with a Medicare supplement, like the F plan, unless it was for some reason really expensive and the supplement saved you substantially. You’d also then want to consider the difference in costs between your current drug costs with that of a stand-alone Part D plan. Your total savings with a Part D plan and supplement should be significantly greater than your current plan before dropping your present coverage would be advisable. Once you drop your retirement plan, you may not be able to get it back.”

“Oh my, so all this mail I’ve been getting about this Medicare Advantage plan or that one, I can toss out. Glad to hear that. I was confused about that pile of mail. I thought there might be something in there I needed to know about.”

“No. Your fine. Normally, I tell people with retirement plans to visit with their company’s benefits administrator to hear what they have to say about benefits for retirees once they go on Medicare. Most should ask if their prescription drug plan provides credible coverage, but it’s not usually a concern for most retirees with company retirement plans. They also want to be clear on how their retirement benefits change from what they currently have and at what cost. Their company may have a menu of options to choose from.”

Albert, then called out Opal’s full name.

“Opal Cenica, my friend, I understand your income is low,” he said. She mumbled affirmatively. “Together after this meeting, we’ll determine your eligibility for the Medicare Savings Program.”

“What’s that?”

“It’s the way to help pay for all or part of your Medicare premiums and, possibly, other out-of-pocket costs. If you qualify for an MSP, you’ll automatically get Extra Help. Did Sasha tell you what Extra Help pays for?”

“Yeah, I think so,” she said, but looked more unsure than certain.

“How much it pays will depend on your income and assets. And there are exclusions to what’s counted.”

“Like what?”

“We can go over the details privately, okay?”

Reedi’s gasp was audible.

“I don’t want to get your hopes up just now,” Albert continued, “So even if you did not qualify for Extra Help, there are other options out there like the state pharmacy assistance or drug manufacturer pharmaceutical assistance programs, and there may even be community-based programs as well.

“Good to know!” she chirped.

“For now, I’ll just say that you will be filing for both Medicare A and B and, uh, there may even be a Medicare Advantage plan that’s right for you, but I’m getting ahead of myself. Let’s get through the first steps. Okay? You are self-employed, right?” She mumbled affirmatively.

“Salim Elchoue, my friend, I understand you are a vet. That means you only need to apply for Medicare A and B and do nothing more. No supplement; no Medicare Advantage. Your military benefits become supplemental once you go on Medicare and you’ll also have, as you do now, prescription drug coverage. You have a question?”

“Yes, that’s what I understood, but the nearest VA hospital is not close by and sometimes the appointments are scheduled too far out. This is not ideal. I wanted to know if I have other options?” Salim kept his gaze on Albert’s broad nose.”

“Sure. You may. There’s a program called Veterans Choice,” Albert said before reaching into his breast shirt pocket to pull out an accordion like card holder. “Some vets can go to non-VA medical facilities. If you did not receive a letter stating you’re one of these eligible veterans, you can call 866-606-8198 to learn more. The program is for eligible vets who live more than 40 miles from a VA facility or have to wait more than 30 days for an appointment. ”

“Great. I’ll call’em,” Salim said. The two smiled at one another and then Albert added that a Medicare Advantage plan might be another option before moving on to Mauldin.

“Being already on Medicare means—” Albert said before being interrupted.

“I already know what to do,” she huffed. “Sasha explained the difference between the supplements and Medicare Advantage. I know I want a supplement.”

“Good to hear you know what you want, Mauldin,” Albert said. “You should know that until you turn 65, your supplement choices are limited. Your only option is Plan A. Did you know that?”

Mauldin looked perplexed before uttering, “Oh.”

“You may instead want to look into Medicare Advantage plans. And if you do, you’re going to want to look at your prescription costs carefully and whether or not all of your doctors can be found in the Advantage plan’s network. And you’ll want to do so soon because next month will be your last month to enroll in either a Part D or Medicare Advantage plan. For people like you—getting Medicare before age 65 due to a disability—your window to enroll in either a Part D plan or Medicare Advantage plan ends after your third month of Medicare eligibility or your 27th month.”

“Oooweee, I was forgetting the D. I have a deadline for Part D. Now I’ll have to pick a D plan, oooweee.” She paused before saying: “But I still want that supplement.”

“ You mean Plan A?”

“Yeah, that one.”

“Okay, there’s no deadline for enrolling in the supplement A,” Albert said, “Once you have Medicare A & B in place, you can pick up the A supplement, but if you have any questions about it, let’s talk afterward. We can even set up a separate time to go over Plan A if you like.” Upon hearing that Reedi’s eyes widened.

“Spinson Elmore, my friend, I understand you have no employer coverage, right?”

“Yes, Albert, but I do have a plan through my wife.”

“So, this means, Spinson, you’ll be enrolling in Medicare part A, and delaying Part B until she retires and then you both can consider your options at that time. You’ll have a special Part B enrollment period at her retirement. And it will apply to anything else you might want to enroll in. So, you won’t need to look into Part D now and maybe never. When she retires, you may want to look into supplements or Medicare Advantage plans, or possibly neither if her current plan becomes your retirement plan. She’ll want to talk to her benefits administrator several months before her retirement about her—

“That’s Reedi,” he nods in her direction and she smiled nervously at Albert.

“ … and you. It’s possible the cost of her plan for you won’t come at a good affordable price. So for now just be aware that your retirement options with her company may be different from what they are today and, anyway, things can change by the time she retires. Retiring any time soon, Reedi?”

“Oh, no. I work for the state and have many years before being led out to pasture.”

“Okay, you two will have several medical plan options upon retirement. So when the time comes, you’ll want to make your preference clear to your retirement office several months before your retirement date.”

“Okay, thanks for the heads up. We’ll keep that in mind,” Reedi said while Spinson looked at her pleasingly, for he knew she was good with such details.

“Hermenègildo Ruiz, mi amigo,” Albert said with voice rising. “Your options are limited. I understand you are not eligible for Medicare Part A at this time. How long have you lived in the US?”

“No more, no, more than a year.”

“Okay, five years is the minimum. Although you’re now paying into the system through payroll taxes, you’ll need to continue doing so for a while longer. You’ll need to have paid that FICA tax for ten years before you can claim, at no additional cost, Part A benefits or you can marry Gilsey.” Gilsey smiled as mild laughter could be heard from others.”

“And speaking of Gilsey Armstrong, my friend, excuse my peculiar sense of humor?” He didn’t wait for her response. “Sasha tells me your employer coverage will be ending once you retire and so like so many others, you’ll be going on full Medicare and your choices run the full gamut, which is what? This is not a test,” Albert said, smiling.

“I’m catching on, Gilsey said. “So take Medicare A and B, at least initially, and then either get a supplement or replace Medicare with an Advantage plan. And if I go with the Advantage, then I don’t get Part D ’cause I’ll have it already, right?”

“Good, good. Yes, Gilsey, that’s basically correct. Those are your considerations, but you can also stay with original Medicare and just pick up Part D. And if you choose to go with MA, you’ll be sure to pick one with prescription drug coverage. You’ll want one with drug coverage unless you have some other credible option, which I’m thinking you don’t have, right?

“Correct, I’d want it.”

“So, if you like, we can calculate what your fixed costs would be with Medicare Advantage and with a supplement, and then gut check your tolerance for risk. It comes down to considering what can I afford verses what am I willing to take risks on.

“Yeah, I’m aware of all the ‘what ifs’ that no one can calculate. Sasha went over the pros and cons of both Medicare Advantage and the supplements. She covered a lot of material. I guess a lot depends on what I’ve got in savings, no?”

“Sure.”

“Well, let me get back to you on this one. I wanna review my notes, Gilsey said with a hesitant sounding voice.

“Sure thing,” Albert said before looking directly at Erasmus who had been cracking his knuckles, but stopped upon hearing his name.

“I understand you’re not retiring yet?”

That’s right, Erasmus said with a nod. “My retirement plans have to be put on hold for a few more years.”

“And because you presently have medical benefits,” Albert continued, “the customary course of action for people like you is to, as we say, take Medicare Part A—enroll, and delay enrolling in Part B until you retire. Several months before you retire will be the time to consider your retirement options. Then again, you work at a small firm with under 20 employees, so that means if you take Part B now, Medicare becomes your primary insurance, which makes your company plan supplemental or the secondary payer. You follow?”

“Yeah, … hey, my company should then, you would think, be willing to pick up the cost of my Part B premium, seeing how it surely is cheaper for them than to continue being the primary payer!”

“You’re saving them money by not delaying Part B until retirement, so they may choose to do so.”

“Yeah, I’ll see what they have to say.”

“And once you retire, you may want to continue with your company’s retirement plan or look at other options depending on cost and benefit factors. We can go over when the time comes. Your only task now is to apply for Medicare Part A and don’t worry about Part D at this time,” Albert smiled.

“Because I have drug coverage already through my company?”

“Right, Erasmus. It’s probably credible coverage.”

Erasmus, thinking that Albert would quickly move on to another person, asked: “What about my wife, Erlinda? What does she do?”

“Well, she’s presently on your company plan, right?”

“Yes, yes.”

“Well, then, nothing changes for her. It may when you retire, or she turns 65herself, but for now, she coasts.” The Uelis glanced at each other and she whispered to him ‘I knew that.’ Erasmus shrugged.

“Let me know when either event happens, okay?”

“Hey, you got a phone number?” Erlinda jumped in forcefully. “You’re kinda like a mystery man to us. We have some other questions unrelated to Medicare for you. Care to address them?” Erlinda said with a firm voice and constant eye contact. No one else said a word while Erlinda spoke and the room got quieter.

In a soft, low voice Albert said, “But of course.” Then he pulled a chair away from a table and sat down while facing everyone. “I know there is one compelling question I have not yet to answer, which I intend to address now.” It was as though the air in the room had decompressed and the buoyancy of the room shot up, nearly separating the roof from its frame. “You want to know what’s happened to your loved ones.” Everyone’s posture had inflated, heads rose, eyes lit up. “And you all want to know if I had anything to do with their disappearance.” The room became even quieter, such that inaudible sounds could now be heard: a house fly landed, a cockroach behind a two-by-four stopped twitching its antennae. Albert paused while taking a piece of lint off his knee cap, and it landed with a loud thud (to an ant about a foot away carrying a humongous bolder of cornbread). “Well, I do.” Somebody’s stomach could be heard gurgling.

Albert began speaking slowly, “When I meet with folks, as I have now with you, I give rather direct advice. If asked whether I think a supplement or Medicare Advantage is best for whomever I’m talking to, I’ll even make a recommendation after going over their options in detail. And sometimes, people take it and sometimes not. It’s the same for Sasha. Some people listen to what I have to say about their individual situation and then want corroboration. Same with Sasha. I’m rarely told that someone wants a second opinion, but, I know, that’s what some want. So, I say …” Albert paused and pulled a folded loose leaf lined paper from his breast pocket. “I say, you can take my advice and run with it or you can try to get the affirmation you need from your local Social Security office. Here’s the address. He placed a stack of cards on a table.” Albert straightened his back and said very quickly with eyes wider than before, “That’s where they all are now!” The room exploded with gasps, cries, and words of astonishment. Once everyone quieted he looked at the lined paper and without looking up said, “Erlinda, your brother’s number is 8,198, 435,232,119. Zeke, Zoe has the number …”


Mediscare: Everything You Wanted To Know About Medicare But Were Afraid To Ask

  • Author: R A Carranza VIII
  • Published: 2015-12-10 16:50:11
  • Words: 23435
Mediscare: Everything You Wanted To Know About Medicare But Were Afraid To Ask Mediscare: Everything You Wanted To Know About Medicare But Were Afraid To Ask