The confusing world of Medicare

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by BYRON HARRIS / WFAA

khou.com

Posted on June 14, 2012 at 11:10 AM

Updated Thursday, Jun 14 at 11:10 AM

Insurance is supposed to help pay for emergencies you can't pay for yourself.

And so it is with Medicare. But how can something cost you more with Medicare than it does without it?

The case of the wayward walker shows how important it is to shop carefully for Medicare policies.

Walking means a lot to Luci Brown, because with her severe diabetes, she hardly can.

Her solution: Get a walker.

But the 67-year-old found getting one under her Humana Medicare Advantage to be nearly impossible.

After repeated phone calls, burning up her sparse cell phone minutes with little to show for it, she declared the system to be "completely broke."

"They call this an 'entitlement.' It's not, trust me," Brown said. "I pay a hundred dollars a month, and there's no entitlement at all."

Brown said Humana Medicare Advantage told her a walker would cost a total of $348. She would have to pay 40 percent of that — $139 — as a co-pay out of her own pocket.

But then she saw an identical walker at Kroger for $99.95.

Then it went on sale for $69.95.

What accounts for the $278 price differential between Kroger and Humana?

In reality, it takes a near genius to make an apples-to-apples comparison of Medicare and Medicare Advantage policies.

There's original Medicare, Parts A and B, for hospitals and doctors; Part D for prescriptions; Medicare supplement policies; and Medicare Advantage, which may (or may not) include Part D.

All of these may have different costs and coverages.

Brown has learned the pluses and minuses of her policy through her own hard knocks, but says she learned from other Medicare clients that there are hidden minefields in many policies that are not always evident.

"You have to be your own advocate, because the people who are supposed to be there for you are not," Brown said.

News 8 connected Brown with a professional advocate, Lue Taff of the Senior Source. The Senior Source helps guide seniors and their children through the maze of Medicare and other issues at no charge.

Taff explained that Medicare Advantage is a program that works best when the client is healthy.

"If you get sick on your Medicare policy, you have to ask yourself first of all: Do all the doctors and hospitals that you're planning to use take any of the Medicaid Advantage plans you're planning to use?" Taff said.

In North Texas, the Baylor Health Care System does not even accept the Humana Advantage plan that Luci is on. Other plans have other quirks that might not be wholly evident to an uneducated buyer.

"Finding a social service agency, finding some professionals who are used to dealing with those questions, is the way to go," Taff said.

To begin getting a walker from Humana, Luci Brown first had to get a prescription from her Humana doctor, which took her two 20-minute phone calls, she said.

With her high co-pay however, she ended up not getting a walker from Humana at all. Instead, Lue Taff helped her out.

"There are several social service agencies in our community, and we all kind of work together to help seniors in need, Taff said.

Ultimately, Lue used her network to get Luci a walker free of charge.

Every fall, Medicare clients can change their plans. That's the time to tap into social service networks to explore the possibility of improving the plan you're on.

E-mail bharris@wfaa.com

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