JOHN BRUMMETT: To protect senior citizens
A friend was lamenting the circumstance of a mutual acquaintance in his 80s.
The gentleman in question was ailing from unexplained symptoms and getting no relief as he waited to see if his health-insurance policy would pay for the next test to which he’d been referred by his doctor.
I was aghast. This fine fellow was ill. He needed a diagnosis. He had a doctor’s referral for the test.
And, for goodness sakes, he was on Medicare, his government’s service for this very circumstance–aged beyond one’s productive years and into one’s high-maintenance medical phase.
I checked into it. It turned out the man in his 80s did not have Medicare. (He did eventually get the delayed test.)
Due to his personal financial situation, he had sought the cheapest alternative. So, he had eschewed the Social Security deduction for Medicare Part B and opted for one of these private options to Medicare, called Medicare Advantage.
Those are private health-insurance companies that take government money for your care and design policies charging you less, and sometimes nothing, in the way of a premium. Sometimes the private insurer throws in a lagniappe the government doesn’t cover–payment for, or toward, hearing aids or dental or vision care.
But, along the health-care way, you may find you pay more and get less.
These private plans vary, so I’d never make a blanket criticism. Perhaps you have one you like. Nearly half of today’s Medicare enrollees are on Advantage plans, and they can’t all be wrong.
I’ll merely tell you that, with traditional Medicare, you know your cost and you know what you’re going to get. And you’re going to be able to go to most any doctor or hospital in the United States whether you get sick at home or while visiting grandkids in Kalamazoo.
With these private options, your care may be managed in a way that limits your provider options, doesn’t apply away from home, charges you more in co-payments and utilizes “prior authorization” before paying for certain elements of your care and treatment.
I came of Medicare age gratefully, since I’d become self-employed at age 59 and responsible for my own health insurance at the dawn of the Obamacare premium explosion.
As my 65th birthday neared, I got about as much mail from Medicare Advantage companies as I got from lawyers after that woman ran me off the road that time.
Mailers adorned with logos suggesting they were from the government were soliciting my enrollment, promising free this and free that. But I knew these were those private options called Medicare Advantage.
I was so favorably inclined to the consistency and transparency of basic Medicare that I was predetermined to go with that, along with a Blue Cross supplemental policy.
Then I started paying attention to an old quarterback when he came on the television screen with a commercial. He was shouting at me that I wasn’t getting all I deserved under Medicare. He said for me to call the number on the screen and see if this or that–coverage for vision, hearing, dental, gym memberships–was available in my area.
I knew that the government only entitles you to Medicare Part A, which is hospitalization and major medical. I knew that Part B, for doctor-visit coverage and such, was available to everyone with plainly enumerated benefits and a standard premium taken off the top of your Social Security check.
It was not clear to me what my location would have to do with any benefits I deserved but wasn’t getting.
That’s because the old quarterback was not touting Medicare. He was not speaking for the government, but a private government vendor. He was touting a private insurance company offering one of these private options, charging less per month than standard and offering different and enticing benefits along with possibly greater costs for the insured.
It seemed to me that all of that needed to be made clearer to the targeted senior. I have nothing against private alternatives or freedom of choice. But I have plenty against a private insurer fast-talking the infirm elderly.
Now the federal Centers for Medicare and Medicaid Services agrees.
The agency has issued new regulations saying Medicare Advantage companies can’t use government logos in marketing, must submit their television advertising to prior review and must assert prior authorization only at the start of a medical case, not at various steps.
If you want to listen to an old quarterback on your Medicare, that’s your business–as long as the government that is paying the company he represents for the services he touts listens ahead of time to his spiel and approves it as accurate, accountable and adequately forthcoming.
John Brummett, whose column appears regularly in the Arkansas Democrat-Gazette, is a member of the Arkansas Writers’ Hall of Fame. Email him at [email protected] Read his @johnbrummett Twitter feed.