The Medicare Maze Gets More Twisted

It always seems like it’s in fashion to blame the government for anything that goes wrong with prices, with the system or systems, or anything else that people can blame them for.  We humans just need to have a reason for everything that happens; that’s just how we are.

There are, however, some things that can legitimately be blamed on the government, at least in part.  Then there are other things that there is nobody else to legitimately blame, like the cost of gas or the problems with taxes in this country.

One area that the government gets most of the prize for is the Medicare crisis.  People blame it on poor planning, poor communication, poor management and a million other reasons, but they always throw the government into the mix no matter what they feel is involved.

In looking at the effects of whatever is happening and whoever is responsible, it has become more and more evident that the Medicare system is a tangled maze that is confusing to the people who are supposed to be helped by it the most – Medicare beneficiaries.  Most of these individuals are seniors, many of them are vulnerable, and all of them depend on the benefits from Medicare to help them maintain an ongoing relationship with a physician.

Many seniors who are covered by Medicare are not aware of the gaps in coverage that leave them vulnerable.  For instance, one lady with cancer who used to have a $50 copay for her cancer medicine now has to pa $300 out of pocket per month for the same medication while on Medicare.  She finally worked out the details and was able to get most of this covered, however, when she gets to 9 months of medication, she will hit the coverage gap – the black hole – where she has to pay for these prescriptions out of pocket for the rest of the year.  The problem is that nobody warned her about any of this, and she is unable to afford the cost.  As a result, she will have to go without or go to Mexico for treatment because there are no generic medications to use instead of the brand name ones she is using. 

This is a confusing and frightening situation that many seniors are facing today, and it is unfortunate that the Medicare maze keeps getting more twists and turns rather than less.  Hopefully the government can make some positive changes that will help simplify Medicare, and, for a change, they can get blamed for something good.

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Understanding What is Happening With Medicare

When we look at the Medicare system of healthcare for individuals age 65 and above, it is important to look at the amount of coverage seniors receive, the amount of co-pays and other out-of-pocket expenses they are responsible for and just how it all works in today’s economy.

With the economy as it is currently, it has become very difficult for individuals and families to pay for the very basics, much less any extras.  Because costs have escalated enormously – especially during the past couple of years – people, especially seniors, have to make some truly difficult choices as to what they can and cannot pay for, and how it is possible to find the funds to do so.

Unfortunately, Medicare has become one of those things that seniors have to make difficult choices about.  With over 44 million individuals on Medicare, there is a lot involved in these choices.  For instance, AARP has stated that most beneficiaries of Medicare are under the false impression that the program is all-inclusive and pays for everything.  They do not realize that most Medicare recipients are paying at least 25% out of pocket for medical care.

If that isn’t bad enough, there is talk of raising the premiums for the plan.  So, in addition to paying co-pays for everything from doctor visits to prescriptions to hospital and nursing home stays, the monthly amount to keep individuals covered through Medicare could go up, too.

Every year for the past five years, Congress has raised the premiums for Medicare in order to cover payments to physicians.  Rather than fixing the system, Congress has continued to raise the premiums that seniors have to pay.  Unfortunately, this has put any seniors at risk and in a situation where they need to choose between medicine and medical care they need and food, shelter and clothing. 

It is right and fair for seniors to pay their share; however, it is not fair that the costs continue to rise constantly.  Congress needs to look for another way to cover these expenses and find a way to give seniors a break.  They are looking at different ways to get this done.

If you are a Medicare recipient or will be one soon, it is important to do your research, find out what is best for you, and determine what you can afford.  Visit www.medicare.gov or www.keepmedicarefa.org for information on Medicare coverage and premiums, plus the efforts to keep premiums fair and affordable

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