The following is an excerpt from Phillip Moeller’s Get What’s Yours For Medicare: Maximize Your Coverage, Minimize Your Costs, out now on Simon & Schuster. This is the final installment of a three-part series on Medicare coverage.
Let this story be your cautionary guide for the more practical roadblocks that Medicare may erect. Phyllis is pretty much always the sharpest tack in the box. While she loved being a partner in a big corporate law firm, she finally retired from the firm when she turned 75. Like many sharp tacks, however, Phyllis was no match for Medicare. And when she explained her problems to me, she repeatedly used the phrase “No one told me.”
Fortunately, Phyllis’s efforts to properly enroll in and use Medicare have not had disastrous consequences — no financial or health care catastrophes. She got covered in time, seems to have avoided late-enrollment penalties, and more or less got the coverage she wanted. But as she makes clear, these results are due primarily to her remaining healthy and needing to take a grand total of one prescription medication — an inexpensive blood pressure pill.
Phyllis’s employer did provide her notice of the impending end of her employer health coverage. But its statement did not explain the specifics of her existing coverage and the things she would need to replace with Medicare.
Phyllis never would assume what a legal client needed or how opposing lawyers might behave. But she, like too many other Medicare newcomers, did assume that Medicare was a relatively straightforward process.
At the outset, she didn’t know she needed to contact Social Security and not Medicare to enroll in Medicare. She didn’t know about prescription drug coverage or that it was called Part D of Medicare. She didn’t even know that Medicare Advantage plans existed. And she didn’t know that her cell phone needed to have a full charge before calling Medicare for help, because her wait times often would be so long that her phone would run out of juice while she was still on hold!
No one told her. “I had Part A,” because she already was receiving Social Security retirement benefits. “I thought all I needed was Part A. I thought I could get Part B automatically. I didn’t know I needed to apply to Social Security for Part B.”
Phyllis’s first phone call with the Social Security Administration (SSA) began to make her see that thirty days was a laughably short time frame, even for someone as skilled as she in figuring out how things worked. Social Security, it turns out, does a lot of Medicare enrollment work and is the official Medicare traffic cop when it comes to determining if people have enrolled for various parts of Medicare on a timely basis.
Adding Part B, which covers doctors, outpatient and medical equipment expenses, along with Part A hospital insurance, would provide her with what’s called Original Medicare coverage. It also would qualify her to purchase other types of Medicare insurance, including a Part D drug plan and either a Medigap policy or a Medicare Advantage plan.
After waiting on hold for more than an hour, Phyllis was told by the SSA representative that she could apply for Part B online. She was uncomfortable with that, so the rep provided her detailed instructions about how to download and complete a Part B application form. This guidance included how she should address and mark the envelope to make sure it went to the right place. She did this weeks in advance of her employer coverage ending. After waiting and waiting for a response, she finally called the local office again, waited on hold for more than an hour a second time, and was told no one at that office had ever seen her application form.
During the first of what became three trips to a Social Security office, Phyllis tried to sign up for Medicare. The office was located in a congested area, with street parking whose meters permitted no more than two hours of parking time. So, Phyllis thought it would be prudent if she scheduled an appointment. The Social Security website provides information on how to do this, but she was told by someone in the local office that it did not do visits by appointment.
Being a walk-in, as she later learned, guaranteed long delays. And when she wanted to go refill her parking meter and avoid a possible parking ticket, she was told she would lose her place in line if she left the office. Phyllis found another Social Security office farther away, where parking was not a problem.
While she was signing up for Part B, no one told Phyllis about the need for Part D prescription drug coverage or even about the existence of Medicare Advantage plans, which are formally designated as Part C of Medicare. They have become an increasingly popular alternative to Original Medicare, and now are the choice of more than 30 percent of Medicare users. More than 40 million people have Part D drug plans. But the first that Phyllis learned about signing up for a Part D plan was shortly before being dinged with a late-enrollment penalty. Four months after signing up, she had still not seen any evidence that she actually had a Part D plan, and acknowledged that penalties might still be possible.
Phyllis wound up with Original Medicare, the hoped-for Part D plan, and a Medigap policy. This is one of two classic paths into Medicare. The other involves a Medicare Advantage plan, usually bundled with Part D drug coverage. She later admitted she chose her Medigap insurer because it was the only company that answered the phone when she called.
“All my assumptions were wrong,” she says. Although her coverage didn’t begin until August 2015, Phyllis quickly realized she might have made key mistakes, and began a new round of research to get ready for Medicare’s annual open enrollment period, which runs each year from October 15 to December 7.
Open enrollment is the annual equivalent of a Medicare do-over. It permits people to choose new plans, usually with no adverse coverage or pricing consequences. It’s a great deal, but like much else about Medicare, people often don’t understand how it works.
No one told them. Read my book, and consider yourself told.
Phillip Moelerr is the author of Get What’s Yours For Medicare: Maximize Your Coverage, Minimize Your Costs. He writes about retirement for Money and authors the Ask Phil Medicare column for PBS. He also is a Research Fellow at the Center on Aging & Work at Boston College and the founder of Insure.com, a leading site for insurance information.
The views, opinions and positions expressed within this guest post are those of the authors alone and do not represent those of CBS Small Business Pulse or the CBS Corporation. The accuracy, completeness and validity of any statements made within this article are verified solely by the authors.