What is the best thing about turning 65? Being eligible for Medicare.
What is the worst thing about being 64? Almost being eligible for Medicare.
I am currently in the second category and being bombarded with mail and phone calls from insurance carriers trying to persuade me to sign up for one of their Medicare Advantage plans.
It started last fall, and a new mail solicitation arrives at least weekly, sometimes more frequently. The solicitors also call my house, my office and even occasionally my cellphone. Most of those calls are prerecorded, so you don’t even get the satisfaction of being ugly to the person on the other end of the line.
This marketing blitz is yet another example of how personal privacy hardly exists in the age of computers and the internet. Someone — probably several someones — that I have done business with in the past knows my date of birth, my address and my phone numbers and has sold that information to these insurance companies, or sold it to a data broker who resells it. The insurers know that sometime between April and my 65th birthday in June, I will be signing up for Medicare. They also know that given the inertia that most people have when it comes to insurance, if they are going to hook me, they better hook me now.
Surprisingly, I have not received many of these solicitations via email or in targeted online ads. All I can figure is that I have not done many Google searches about the topic, although I just broke that habit looking up some numbers for this column.
Hospitals, physicians and other medical providers complain that Medicare doesn’t pay nearly enough. The low reimbursement rates are among the factors that have pushed Greenwood Leflore Hospital to the edge of insolvency. Its survival plan is heavily dependent on getting that reimbursement rate up by being designated a “critical access hospital.”
Someone is obviously making money on Medicare, though. It’s the private insurance industry. The companies’ heavy marketing to me, just one of some 3.5 million people who will turn 65 this year, makes that obvious.
A couple of years ago, the Kaiser Family Foundation reported that insurance companies on average had a gross margin of $1,600 a year on every Medicare Advantage enrollee. That was about double the margin they were earning on their insureds who either purchased individual coverage or received their health insurance through their employer.
The same Kaiser study found that Medicare Advantage plans provide no real savings for the government — and that may be a generous conclusion. Other research has indicated that it costs the government more to have senior citizens enrolled in a Medicare Advantage plan than it does to have them in traditional Medicare, in which the government pays providers directly rather than going through a middleman.
Best I can tell, Medicare Advantage is another one of these privatization efforts that sound good in theory but end up being mostly a mechanism to shift government money to major political donors, which the insurance industry is.
For the consumer age 65 and up, the lure of Medicare Advantage plans is that they generally have lower premiums and provide benefits — such as dental, vision and hearing coverage — that are not included in original Medicare.
The downside is that Medicare Advantage plans restrict the medical providers the insured can see for non-emergency treatment. Each insurer has its own network of doctors and medical facilities, and if your preferred provider is not in it, then tough luck.
The way I’ve heard it explained is Medicare Advantage is a good deal if you’re healthy but a bad one if you’re not.
Currently, I’m healthy and take no medications other than a daily baby aspirin. The running joke with my primary care physician is that he doesn’t expect to make much money off of me.
But that can change quickly once you get to life’s fourth quarter. Is that occasionally stiff back just normal wear and tear or the early sign of a malignancy? Is the inability to put on weight the blessing of a high metabolism or the curse of pancreatic cancer? Is dementia in my future? In many cases there’s no telling until it’s too late to do much about it.
I have decided to not take my chances. When the times comes, I plan to sign up for original Medicare and purchase the necessary supplements to avoid the risk of a catastrophic claim.
Initially that’s going to cost me more than if I went with a Medicare Advantage plan. If I get sick, though, I’d rather deal with those who have no profit incentive to deny my care or to restrict from whom I receive it.
Besides, the Medicare Advantage marketers have made me suspicious with their glut of overtures. There’s something fishy if they want me this badly.
- Contact Tim Kalich at 662-581-7243 or tkalich@gwcommonwealth.com.
