I typically don’t pay attention to the news, especially not the political news.  I’ve been through the ‘intense political opinions’ period of my life.  In the end, not counting unintended consequences of legislation, I came to the conclusion that the only things that eventually happen of any significance are what the overwhelming majority of people want.  And even then things move very slowly, and often not at all  no matter if  one party has majority power.  So if I can’t change anything I personally feel strongly about, and nothing is going to happen quickly, the natural conclusion is that it’s not worth my time.  That being said, when something does interest me, I’ll peek into the political world for a moment.  That’s what happened just after the election of Joe Biden  when there was the big talk of changing the medicare eligibility age to sixty years old.  As a person who is just now turning 50, that would have a huge impact on my planning for the rest of my life.   At the time of this writing that concept has all but disappeared from the political discourse.  If it comes back or not is not the point.  What is important is what I did when the subject of Medicare at 60 first grabbed my attention for a passing moment.  At the time I did a google search or two to see if the medicare at 60 movement was going to have legs.   Of course, Google has a much longer memory than our political establishments and I’ve been seeing medicare articles pop up in my news feed ever since I did that initial search.  One of them caught my eye, and I clicked on it.  I was then in for the shock of my life.  

I had never looked into what was involved with Medicare before.  From my research I always understood the basic concept.  Medicare is the healthcare we get when we are retired.  Unlike the majority of the rest of the world where the government is the primary healthcare provider throughout the lives of their citizens, In America, we have a different structure.  Due to a unique set of circumstances near World War II, the Employers became responsible for providing healthcare to the country and culturally everyone who can is expected to work.  They can also be a part of a family unit where there is at least one breadwinner who pays for their families healthcare through their work policy.   But we don’t work forever.   At some point, because human beings wear out , we are expected to retire and move from producers to pure consumers in our economy.  At that point the federal government steps up and pays our healthcare because we aren’t working and there is nobody else to do it. 

It seemed to me that the system would be fairly painless.  Turn 65, register for Medicare, and then go to some of the many providers who take Medicare.  It should be that simple but I overestimated the Federal Government.  Admittedly I should have known better.  It turns out that Medicare is a byzantine maze of structure, costs, and partners.  It all seemed like a foreign language to me so rather than commit too much time, I thought it would be wise to sign up for a retirement and medicare webinar offered by our HR group.  The webinar was over two hours long, and it made everything even more confusing.   What made it so perplexing is that I work for the state, one of the few organizations that provides some form of healthcare after you retire, assuming you have enough time on the job to earn it.  The whole thing seemed like one of those video games where one choice has a thousand branches, and those story arc’s all have even more branches.  Some make unexpected turns and some wind back upon themselves.   

The most interesting aspect to me wasn’t the in’s and outs.   There were lots of Who’s, What’s and How’s.   Who handles your healthcare when you retire from the state but don’t get healthcare from Medicare?  What are the various options including things like Part A,B, C etc.  How do you register? Considering the questions, there seemed to be one area of confusion that I think only affected me.  I don’t mean things like Age, Qualifications, or employers.   What was missing for me was the most important part.  It was the “Why’s.”  

Some of the Why’s were somewhat self evident, and there are some I have very strong hypotheses about.   One obvious example is how the state is handling paying for your post retirement healthcare.   It used to be that if you worked for the state for five years, when you retired, you got full healthcare.  That has since moved to a program where you have to work 10 years to get ½ your healthcare paid for in retirement and 20 years to get all of it paid for. That was very clearly a cost cutting move because it could be very expensive for the state to provide healthcare for all of the people who have only worked for the state for five years in a world where most workers jump jobs every few years.   An example of a why that was never explained was “Why are there Medicare Advantage Plans?”   Medicare Advantage was just explained as an option with few details like “Medicare Advantage includes the “Silver Sneakers” program.  In the webinar we were told we could have Original Medicare or Medicare Advantage.  The gist of what they were explaining reminded me of when a friend from college used to say “It’s sorta the same, only different” when he was trying and failing to explain something. It was clear there were some minor differences, but even after hours of going over it, the real reason why it exists beyond free gym memberships for seniors didn’t quite explain why this complexity was part of our system.

It took some digging on my own to find out the Medicare Advantage story.  For the record it was a Bill  Clinton era initiative designed to bring free market based options to consumers.   Like all government programs it seems to work in theory.  Let private insurers handle Medicare and they can offer the recipients a selection of products that have a minimum universal standard of care, but also offer the consumer a choice in additional services.  In effect what was created was complexity beyond comprehension.  Insurance companies can now offer six different Insurance structures as a part of Medicare Advantage plans including an HMO (health maintenance organization), a PPO (preferred provider organization), an HMOPOS (HMO Point of Service), a PFFS (Private Fee-For-Service), an MSA (medical savings account), or an SNP (special needs plan).  Each and every one of these types of plans has different variations by different vendors. The HMO from Blue Cross is going to be very different from the one offered by Humanna.  On the positive side, it could be argued that the variety is there to meet the needs of different consumers.  On the more cynical side, it could be that the complexity is there to obfuscate the value of the options and drive more confused seniors to higher profit Medicare Advantage plans with bigger premiums.  

Other Why’s which weren’t addressed included topics like eligiblity windows. Without going too far down that rabbit hole you have to enroll in the programs a certain number of months prior or a certain number of months post your 65th birthday, and if you miss those windows there is an annual Open Enrollment.  All I could think was why isn’t it simply “If you can prove your 65, the Government will pick up the bill?”  I know, that’s not the well researched and thought provoking commentary I usually make, but considering the theoretical purpose of the program, it should be dead simple.  On this day in your life, you get covered automatically.  If you choose to use it, great, if you don’t that’s ok too.    I get that there is the question of primary and secondary insurers when two insurance companies are involved but that should also be automatic.   

There were a ton of other details, many of which were wrapped up in the ways Social Security was related to Medicare and the employer provided healthcare.  There were details related to premiums, co-pay’s, and covered items.  There were details related to when and how I could go back to work for the state after I retired and how that impacted my Medicare.  It went on for hours, literally, and even now my head is spinning.   

When we think of the Why’s that are missing, what we are really missing is the Medicare Story.  It’s much easier to remember something when there is a story attached.  We have to personify the policy and program parameters.   If I said the government’s Income-Related Monthly Adjustment Amount (IRMAA which is pronounced IRM’ah) premium ranges from about $150 to $500 plus dollars, that makes no sense.  If I say, the government doesn’t want to pay for healthcare for very wealthy people who can easily pay for it themselves, so they raise their out of pocket bill for Medicare and they call that rate the IRMAA, that resonates, or at least it’s memorable and explains why there are different fees.  The people presenting this information are not ignorant.  They know that they are presenting highly complex information, and they also know that even with multiple hours scheduled for the introduction, there still isn’t enough time to get it all in, so they just concentrate on the facts and skip the context.  Also,  I know from my work as a teacher that many, if not most people, just want the facts.  As my wife will tell you ad nauseum, I’m different.  I need the context.   It’s not just about understanding the system for the sake of pure knowledge. I know that context adds value to decision making beyond just the immediate options.    As an example, understanding the purpose of Medicare Advantage allows me to be on my guard against sales pitches from private for profit companies. I’ll continually be asking myself if the options they are pitching me with are for their benefit or my own.  I wouldn’t be asking that as often if I didn’t realize the whole point of Medicare Advantage was to develop a private sector based competitive market.  

Upon reflection, to get that kind of perspective about all things related to Medicare and retirement healthcare it’s going to take more work on my part.  I think I’ll have to have multiple one on one interviews with people who do this for a living. Webinars and articles have their place but simply don’t give you enough information.  I can see myself asking “But why is that the case?” and “What is the purpose of that?” a great deal.  It will be interesting to see if the benefits people from the state can actually answer those types of questions to my satisfaction or if I’ll have to find others.  
Earlier I said that having healthcare would change how I plan for my future.  That is because the second I am technically able to retire I intend to so I can get the retirement healthcare and maybe a small income stream.  It doesn’t mean I’m going to stop working.  Quite the contrary, it means I can get a more risky, and hopefully more fun job like opening up a retail shop or going to work for a startup that mostly pays in stock dividends.  To that end I still don’t have all my questions answered, but I have the big one answered.  It’s not quite 60, but if I don’t screw up and get fired, when I turn 61 I can retire and get state healthcare.   This means it doesn’t matter what they do in DC.  I’ll at least have some form of healthcare until I qualify for one of the impossible to understand Medicare Options.   You know, now that I think about it, maybe the best job I can get is working for the state’s retirement health plan office.  I’m sure that after a few years working there I’ll finally start to understand the Medicare System. 

Posted by Mike Peluso

Mike Peluso writes about the collision between between the business / professional world and life. He also writes about the journey involved with the Peluso Presents efforts including the Blog, Books, and Podcast so that others may benefit from his efforts. From Mike: I spend hundreds of hours working on these articles every year with no compensation other than support I get through donations. You can support with a tip and by Subscribing to the Podcast (and writing a review on iTunes would be really appreciated as well!) One time tips: www.paypal.me/pelusopresents https://venmo.com/pelusopresents

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