Movies have always been a passion of mine and I am certain that with a little theme song flair from John Williams and his orchestra our lives would be far more interesting.
When I encounter situations that require a difficult decision, (cue the ominous string section), I fall victim to visions from one of my all-time favorite movies: “Indiana Jones: The Last Crusade.” After having passed a series of death-defying challenges and witnessing the demise of those before him, Professor Jones (Harrison Ford) is forced to make a pivotal decision. He must choose one chalice, the Holy Grail, a cup which holds the fate of his father’s life, from a room full of options. A wise choice will grant him and his father endless youth, a poor choice could result in what my twelve-year-old self would only describe as… evaporation.
While Indiana ultimately went on to make the right decision, many of my patients choose poorly during the annual crusade that is Medicare Open Enrollment. As to be expected, some invariably fall victim to ornate craftsmanship and dazzling jewels- only to find not all that glitters is golden. While the result is not quite as gruesome as what befalls several villains in the movie, there are times that I question which is actually more painful.
I’m going to take advantage of this week’s column to encourage all seniors on Medicare to take a thorough look at all the available healthcare plans. Consider me your “Grail Diary” as I guide you through the basics and help you make an informed decision about your options for the upcoming plan year… without getting your head chopped off.
First, the basics: There are essentially three options for Medicare Coverage.
1. Traditional Medicare: Featuring both Part A & B coverage (on an 80/20 split), this standard form of Medicare coverage does not include a prescription drug benefit. However, referrals to see specialists are not required and there are no limitations on your provider network.
2. Medicare Supplements
(AKA MEDIGAP): These plans essentially act to fill in some of the gaps left out by traditional Medicare. They typically provide some amount of prescription drug coverage and often times will help cover some of the out-of-pocket costs one has with traditional Medicare including office premiums.
3. Medicare Advantage Plans: Essentially a Medicare replacement, these plans provide both A & B coverage along with part D coverage (prescription coverage) at an additional expense. They replace traditional Medicare coverage levels and replace them with different levels of coverage depending on your plan choices and the out-of-pocket premium you pay. Medicare also pays these plans directly for your care. There are HMO and PPO forms of these plans which have varying limitations on what doctors you can see.
Every year on October 15th, Medicare beneficiaries begin the quest to make changes to their plans for the upcoming year. This includes changing Part D plans, Advantage Plans, or even going back to traditional Medicare.
Needless to say, this is an ideal time to evaluate your options even if it means crawling through a rat-infested sewer in search of the truth. To aid you in your journey, here are a few more etchings and tracings from my life’s work:
1. “Only the Penitent Man will Pass”— Humility is an important quality when evaluating insurance plans, as one must realize that these insurance companies are much better armed than the consumer and their sole objective is to make money. Thinking that you can get the drop on them will likely end only slightly better than Mr Donovan’s ‘volunteers’. If they are offering to provide you with excellent coverage in one area, chances are they are sacrificing elsewhere. You are likely to get only what you pay for.
2. “Only in the footsteps of God will you Proceed”—Far be it for me to compare your doctor to God, but ultimately we are just about the best ally you have as we deal with these plans on a daily basis. Some plans and companies are terrible to deal with while others are pretty reasonable. Your Doctor does a lot of the battling on your behalf, he knows better than anyone how to spell it out for you.
3. “Only in a Leap From the Lions Head will he Prove his Worth”—almost all plans allow you to plug in your prescriptions and evaluate upcoming costs for the next plan year. Whether you plan on switching or not, take the time to do this before Open Enrollment is over. Every pebble of knowledge in your hands will help identify the right path forward. Ultimately, the process isn’t complicated. With a little bit of faith in your own homework, you can save yourself lots of time, money, and aggravation if you choose wisely. Everlasting life, however, may be a bit much to ask.
Questions for White Coat Notes?
Write me at DrPortu@ShorelinePhy
sicians.com. You can also find me on Facebook by searching “Dr. Carlos Portu, MD.”
Dr. Carlos Portu is an Independent Primary Care physician specializing in Internal Medicine serving East Naples and Marco Island, Florida.