Since I started in the working world in 1977, I’ve always had employer-sponsored health insurance. Because my employer has been the negotiator, I’ve had little direct interaction with the insurance companies with the exception of two denials: a denial for long-term disability insurance since I had breast cancer in 2006, and a denial for an open-sided MRI from an HMO plan due to my claustrophobia in traditional MRIs. I had an HMO plan for only the one year when I was diagnosed with breast cancer, and switched back to a PPO Plan the following January. 

I’ve not really had to deal with the Government either as I’ve had continuous full-time employment since the start of my pharmacy career. My mother was disappointed when I quit my job working for the State of Oklahoma in 1984 to work at a private hospital, as she always said it was better to work for less money and get government benefits. As a civil service employee in New York, she always said that the “government will take care of you.”

A few months ago, my insurance status was about to change as I started thinking about a specific date for retirement. I’m a huge advocate for Original Medicare and expected to have monthly Social Security payments. But there were still a lot of decisions about a Medigap policy and Medicare Part D coverage.

Which brings me to my scorecard to-date: GOVERNMENT: 4, PRIVATE HEALTH INSURANCE: 1.5.

First I applied for Medicare Part A on-line in March and everything went smoothly. All questions were answered and my Medicare card appeared in the mail a few weeks later. GOVERNMENT: 1.

Next I applied for Social Security to start when I turn 66 in December (my retirement year). I filled out all the questions again on-line, but there was a notation that they might call for more information. And I did get a call!!! A real live person from Chicago wanted to verify my information (and tell me that I had applied too soon and would need to wait until August). There was a form to fill out to withdraw my request (so it wouldn’t start back in March) which she promptly sent me to fill out and return via email. But a few hours later, I got another call back. She was reviewing my application and noticed that I had been married before and my spouse had died. She said it was complicated but that I might be eligible for survivor benefits for the rest of 2020 until I turned 66 in December. Did I want to apply for those now? “Well, yes, I didn’t know I was even eligible!”.  GOVERNMENT 2.

When I finally settled on a retirement date, I needed to apply for Medicare Part B to start September 1 when my employer based insurance expires. Again, filled out the application on-line, received a form for my employer to complete verifying credible coverage, and my new Medicare card with Part A coverage and Part B starting in September showed up a few weeks later. GOVERNMENT: 3.

Next I received a letter that Social Security had incorrectly calculated my survivor spouse benefits but had caught it when auditing. So I would receive a deposit to equal the difference that was owed to me. GOVERNMENT: 4.

At this point I have Medicare Part A, Medicare Part B and Social Security all handled by the government with on-line access and a helpful Social Security employee in the Chicago office that realized I was eligible for benefits that I didn’t even know about.

However, I was still missing my Medigap policy and Medicare Part D. Medigap policies are private insurance that “fills in the gap” for what Medicare doesn’t pay. The plans are uniform for comparison and there are 36 eligible plans in Tennessee. Medicare Part D coverage pays for prescription drugs and there are 18 eligible plans. Although Medicare Part D is a government plan, it is administered through Pharmacy Benefit Managers from private insurers. So the standards are set by the government, but the plans are administered privately.

It took some time to figure out which plans were right for me, but that was only the start of the battle.

I applied for my chosen Medigap policy on-line but every time I tried to file the application, I got an error message that the system was down and to try again later. For four days, I confirmed the same information and “tried again”, all without success. I called customer service 3 times to verify the website was up and running, but they couldn’t “guarantee me” it would work as “customer service had no control over the IT group”. After a week of trying, I finally called customer service and asked to complete the application over the phone. However, they couldn’t take my bank account information over the phone (even though it was in my on-line application), so they said that when the website was back up, I could print the form with a voided check and mail it back to them. This is what I did on August 4, but on August 14th I got a payment book in the mail and the insurer still has not received my EFT authorization. So I used a credit card, over the phone to make my first payment.  PRIVATE INSURANCE: 0

For my Medicare Part D policy, the on-line transmission was fine and I was approved in a couple of days. The problem however, is that they started the coverage on August 1 instead of September 1 as listed on the application. I discovered it immediately and have sent 3 emails to customer service asking for it to be corrected. They have politely indicated that they have checked with the “sales” team, and it can’t be corrected since it is already in force. So I have double coverage for prescription drugs throughout August.  PRIVATE INSURANCE: 0

And we are not done yet with my Medicare Part D policy. The private insurer also keyed in dates incorrectly so I was notified by Medicare that I may be subject to a LATE ENROLLMENT PENALTY for the rest of my life since I didn’t enroll when I was first eligible in December 2019. But I didn’t need to as I had employer coverage through 8/31/2020. But the dates were keyed incorrectly by the private insurer, so there is more paperwork to be filled out to try to get it corrected. Just to be safe, I called customer service to report the error and filled out the forms and mailed them on 8/14. But the letter says if they are not received by September 3, I am liable for the PENALTY. PRIVATE INSURANCE: 0

I’m pleased to report that my Dental Insurance from a private insurer was approved without a hitch. PRIVATE INSURANCE: 1

Coming to the end of my insurance applications, my Vision Insurance appears to be in limbo. Although I was approved on 8/5, as of yesterday my application status still says PAYMENT PENDING. Since I gave them a credit card on 8/5, I’m not sure what they are waiting for. I’m just hopeful they figure it out before 9/1 when my current insurance expires. PRIVATE INSURANCE: 1.5

I can’t imagine that every person who turns 65 and wants to retire has to go through this massive maze. Both my parents retired at 62 and were always pleased with their Social Security checks and had employer pension-based health insurance. That was almost 30 years ago and it seems like we’ve made it more complicated and unworkable with these quasi-hybrid Government-Private Insurer webs.

And based upon my experience in the last few months it is GOVERNMENT: 4, PRIVATE HEALTH INSURER: 1.5. 

Game over.

Blessings, my friend
Agatha