Tuesday, July 29, 2008

My first day of using Medicare (and three red cards to carry)

So, today for the first time, I became a Medicare patient. I went to a dermatologist, and endured the sting and possible embarrassment of repeated blasts of liquid nitrogen over my face, scalp, and some of my body. I had to ask for restraint. Since the liquid is kept at temperatures simulated in my rogue screenplay "69 Minutes to Titan", the aftereffects stung for some time, like burns.

But the interesting part was “paying for it.” The office took my social security Medicare Card and AARP supplementary card and photographed them. Then they checked and could not find me on Medicare’s computer. I carried a third card, the AARP Part D, which I would need later.

Social Security’s own website produces a page on my account that says, in part:

You receive Medicare Part A (hospital insurance) based on your age.
You became entitled to Part A beginning:
July 2008
Medicare Medical Insurance (Part B) information:
You receive Medicare Part B (medical insurance) based on your age.
You became entitled to Part B beginning:
July 2008
Your current monthly premium for Part B is:
$ 96.40
The effective date for this Part B premium amount is:

It hasn’t added in my Part D premium yet ($33.70 per month) to the website, but I received a US mail letter saying that this amount would be deducted twice from my August social security payment.

However, the actual processing of Medicare for the DC area seems to take place at Pennsylvania Blue Cross and Blue Shield at Camp Hill, PA (Harrisburg), the data center run by EDS I believe.

The clerk said, “is this the first time you’ve used your Medicare?” I said yes, and he indicated that it usually takes one claim for Blue Cross-EDS to get around to adding a new retiree’s record to its own mainframe database. I’m not sure how that comports with HIPAA.

I then went to pick up my prescription for Aldara, which is a cream applying topical chemotherapy for actinic keratosis and early skin cancers (basal and sqamous cell carcinomas). It is sold by the Grace company but manufactured only in Leeds, UK, which makes it more expensive given the fall of the dollar. The dermatologist gave me a $25 mail in rebate coupon. That’s odd for prescription medication. A supply of about 20 packets would sell for about $625 without insurance. With Part D coverage (before the doughnut hole), the out-of-pocket cost is $30, but the $625 goes some way into approaching the coffee cup’s doughnut hole for later medications. However, the $625 may itself get a large discount from United Health Care, under AARP’s contract. It’s all complicated.

As I’ve noted, AARP (because of its enormous size and bargaining power with health insurance companies) seems to offer a much better deal (on part D and on part B supplementary) for just-65 retirees than can employers with their retiree health programs. For retirees of troubled companies like GM, this may be good news. AARP, even though it is mainly for those over 65, is giving a preview of how a single payer health system like Canada’s could be run.

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