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Column: If You’re Coughing Up a Lung, Is One Health Plan Better Than Another?

Not that I seek your sympathy, but I felt exhausted on Sunday, had a throat full of knives on Monday, and was convinced on Tuesday that coughing up a lung is a medical option.

I lost my voice and had to postpone a reportage trip to the Bay Area, but I didn’t want the week to be a total loss. So I started reading a book called The Measure of Our Age, which explores the challenge of aging well amid age discrimination, systemic gaps, and crippling healthcare costs. And I dove back into the Medicare maze I wrote about earlier this month, and faced a deadline for choosing a health plan.

As if that wasn’t enough to keep a sick man busy, I was in the midst of a blood pressure scare, but let me back down first.

I recently agreed to participate in a study on the effects of air quality on cardiovascular health in people with heart disease. This included installing two air purifiers in my home. As part of the contract, I have to measure my blood pressure every day with a device that sends the results to a lab, and my readings have been consistently high.

So I emailed my cardiologist, who sent a prescription order to Express Scripts and told me to supplement the high blood pressure medication I was already taking. Then on August 20th I received a text message from Express Scripts saying my Rx would be delivered by August 29th.

This company is based in Arizona, which as far as I remember is next to California. But I’ve found myself being told it could take a week or more for drugs to travel 400 miles, yet the company still insists on calling itself Express Scripts. Maybe the name is an acronym for Pony Express Scripts, but even then, a three-legged mule could make the trip in half the time.

I went to the drug company’s website to see if I could speed things up and had to first enter my username, which I don’t remember, followed by my password, which I don’t know, and decided to tempt it would rather lead death than stick to the rules of survival. So I trust the horse.

As for Medicare, a big thank you to all the readers who sent me stories and advice on navigating the system, with its alphabet soup options, some of which don’t include the coverage you’re likely to need as you age – prescriptions, seh -, hearing and dental care.

Mark Schubb said he has a college degree but feels Medicare is “designed for torturing and gaslighting the elderly…”. And NEVER ask anyone to explain the RX cover DONUT HOLE or your brain may overheat.”

“I retired after practicing law at a major law firm for over 30 years and consider myself to be of moderate intelligence and ability,” said Michelle Oullette. “But it took many hours of reading a book on the internet on the subject and speaking to two insurance brokers to sort of understand it. What can a person with no legal background do?”

(One solution is to call 1-800-434-0222 and speak to a counselor at the government-sponsored facility free of charge Advice and advocacy program for health insurance companies.)

I’ve heard from readers who only have basic Part B insurance, which costs $164.90 a month. And I’ve heard of readers paying up to $750 a month for various add-ons. Some have touted Medicare Advantage plans; others despised her.

“Medicare Advantage is terrible,” said Laurie Brenner. “It requires that you negotiate, seek and manage limited options in the worst of circumstances when you are ill and afraid.”

Gwendolyn Poindexter said that thanks to IRMAA, she was “shocked to find out that I’m paying more for my health care in retirement, on a steady income, than when I was working.”

IRMAA is the earnings-related monthly adjustment amount that counts toward Medicare’s Part B base rate of $164.90 for individuals who earned more than $97,000 per year from their work. And Poindexter was one of several readers who let me know in advance.

“Many seniors pay $578.30 just for Part B, not $164.90,” wrote a frustrated retired dentist. “And there’s IRMAA on all Part D drug plans, adding $77.90 to the cost of each plan.”

For John Tickner, a retired insurance man and resident of Thousand Oaks, none of this is confusing. He says he helped create the first supplemental insurance plan in the 1960s and thinks Medicare has been largely successful and cost-effective. He’s helping residents in his senior living community figure things out, he said, “and I can assure you that the vast majority of people who are on Medicare love it.”

As I wrote earlier this month, I was informed that I had enrolled in Medicare Part B and would be billed beginning in February. This was due to a mistake by me or the government when applying for Social Security checks, and I still haven’t solved this mystery.

But as someone with employer health insurance, I was advised to cancel Part B before I would be charged for it. So I called Medicare and had to wait on hold for a few minutes before an agent told me to call Social Security instead.

Do you face the Mad Hatter at a certain point?

“Thanks for waiting, someone will be helping you shortly,” one shot said, while another reminded me there may be 50 million other Social Security recipients waiting in line.

While waiting, I came across this passage in “The Measure of Our Age” by MT Connolly, founding director of the US Department of Justice’s Elder Justice Initiative: “Many Americans are surprised to learn two things about long-term care. The first is that Medicare doesn’t cover it, making it the biggest financial risk most Americans face.”

So unless they have expensive long-term care insurance, Connolly says, they have to rely on family or friends, or throw away their wealth on purpose, to be poor enough to qualify for Medicaid. And the second surprise on the subject of long-term care?

“You may be asked to leave a long-term care facility for a number of reasons,” Connolly writes, including the possibility that Medicaid will not be accepted there.

Getting older is hard enough to negotiate without all of that, and I’ll be speaking to Connolly about her book on September 6th, by the way Chevaliers in Larchmont Village.

After 45 minutes on hold, a Social Security representative informed me that I would be mailed a Medicare Part B opt-out form. Meanwhile my voice came back and an early surprise arrived from Arizona. I didn’t see a horse but the package was left at the door.

A small victory on the long and winding road.

steve.lopez@latimes.com

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