By Steve Dinnen
Medicaid saw some big changes with the passage of the recent federal budget and tax bill.
But Medicare was not part of that legislation, and that’s a good thing. It’s already laden with complexity that most Americans will face at some point in their life.
Medicare sounds pretty simple: You turn 65, you sign up. You can postpone it if you’re still working and have employer-provided coverage. (That’s called “credible insurance,” and no, COBRA doesn’t count.) But it doesn’t matter much because free health care for seniors isn’t really free — and it’s still a surprisingly complicated way to insure people.
Let’s review some of the basics with help from Nicole Jordan (pictured, top) and Marcie Strouse (bottom) whose firm, Capitol Benefits Group recently led a presentation on the topic at Gilbert & Cook, the financial planners in West Des Moines. They tell us first off that Medicare actually comprises several components.
Part A handles hospital coverage and is generally free of charge, although it has a deductible. Part B covers your visits to the doctor’s office. There is a monthly charge for this, starting at $185 and running up to $629 for high-income earners.
Then we have Part C, known as Medicare Advantage, combines Part A, Part B and usually Part D (for prescription coverage). There are no income limits to receive Medicare benefits, but you may pay more for your premiums based on your income level. Depending on your income, you might qualify for assistance in paying Medicare premiums. Medicare is available to all U.S. adults ages 65 and older. (You can start earlier under certain circumstances, such as having been on Social Security Disability Insurance for at least 24 months).
There are co-pays. There are deductibles. There are limitations to coverage. There are PPOs and HMOs. When it comes to prescription coverage, there are completely different deductions and co-pays, and prices vary depending on your insurance carrier.
John Bush, an insurance broker who specializes in Medicare plans at Senior Savings Services, said insurers can and do change prices during the policy year. (You might think that national health insurance sponsored by the U.S. government is actually run by the government, but in fact all Medicare Advantage plans are run by private insurers who have agreements with Medicare.)
You can switch carriers, and many people do. Ever-changing drug expenses spawn a lot of the shopping. If you’d like to explore your options, show your agent a list of your prescriptions so he or she can compare and contrast among the carriers.
In fact, it’s a good idea to check with your agent yearly to see if your plan still suits your needs. The plans change, and your medical needs change, so keep them in balance.
Frustrated Medicare users find options outside the U.S.
Dental care is a notable weak spot with government Medicare plans. It’s not covered by Part A or Part B and picks up only with Part C, Medicare Advantage. But there are a lot of exclusions and limits on how much you can spend on your teeth every year.
Dentists are not happy. Nor are thousands of American seniors who flock to Los Algodones, Mexico, every year for dental care at a fraction of the cost of what they’d pay out-of-pocket back home. An entertaining read about the dental care industry that has sprung up in “Molar City,” just a few miles from Yuma, Arizona, lies in the Aug. 4 issue of The New Yorker. The author noted that a quote for fillings cost just a quarter of what he encountered back home.
Drugs also are a huge source of complaints about Medicare. Prescription coverage falls under Part D, where insurers have leeway over which medications to include on their formularies and how much patients pay. Our neighbors to the north, Canada, has sprouted its own medical care industry to cater to U.S. seniors who are looking for drugs at prices and availability not allowed by Medicare.
Speaking of drugs, weight-loss drugs such as Ozempic, Wegovy, Monjauro have taken the nation by storm. Medicare covers them only if the patient has Type 2 diabetes. If you want them only to lose weight — like an estimated 40% of their users — Medicare won’t foot the bill.
Here again, foreign actors have come in to fill the gap. A self-pay prescription for a month’s supply of Monjauro costs around $1,050 at Des Moines drug stores. Pharmacies across Europe routinely knock half off. The Boots pharmacy inside the Dubai International Airport, just past the baggage claim, charges $472 for the exact same drug. No prescription needed. Ignore the air fare, and you’ve found a bargain.
