Editor’s Note: Journalist Philip Moeller, who writes widely on aging and retirement, is here to provide the answers you need in “Ask Phil.” Send your questions to Phil.
Check out his Recommended Reading section with links to notable stories and reports at the end of today’s column.
Denise – Ga.: I chose to not take Medicare Part B or D because I was insured under my husband’s plan with the U.S. Postal Service. He passed away at the end of July at age 60 and had retired in 2014. I worked more than 40 years and started taking Social Security at 62. A few days after he passed away, I found in the piles of unopened mail a card from Medicare letting me know about Parts A, B and D. A Medicare card was attached and the information said if I did nothing, they would send me a new card with the free Part A. I received a letter telling me they would be “adjusting” my Social Security check with a $121.70 deduction for Part B. Now two payments will be deducted for July and August. How can I get my money back? I have called them and visited the local office twice, but got no explanation for how they could take money from my Social Security check when I didn’t ask them to, nor did I sign anything saying I wanted Part B.
I am now a widow and am dealing with the costs of his final month-long hospital stay, our regular bills and his burial. Facing all these expenses, I then find that they have taken money, and they say there is nothing I can do about it. Are they correct? And despite this coverage that I supposedly have for the month of August and September, I don’t even have a Medicare card! I was told that would take four weeks. I would not use it anyway for fear of confusing the situation. I feel robbed!
Phil Moeller: Denise, I am so sorry that you lost your husband. It is hard enough to deal with that grief, but then there are all the bills and real-world pressures coming at you. And now you are slammed by this unpleasant surprise from Social Security! So, if at all possible, take a few deep breaths and take to heart that there are people who can help you with this problem. I have shared your story with the folks at the State Health Insurance Assistance Program (SHIP), who provide people with free Medicare counseling. While they evaluate your situation, here are some things to keep in mind that might help you.
First, your note did not say how old you are now. You say you chose not to get Medicare, so I assume you already have turned 65. But if you just turned 65, it’s standard for Social Security to send you notice about Medicare enrollment. Social Security administers many aspects of Medicare including the enrollment process and handling the deduction of Part B premiums from monthly Social Security payments. So the fact you received such a card is not a surprise or a big deal. Further, your failure to return that card in a timely fashion does not necessarily mean that Medicare was correct to sign you up for Part B and begin to subtract the monthly premiums for Part B from your Social Security. However, it might have been correct. And the answer to this question likely can be provided by an insurance benefits person at the Postal Service where your husband worked.
Health insurance for postal workers is provided by the Federal Employee Health Benefits Program (FEHBP). It generally provides strong coverage and, I’m assuming, covered you as a retiree’s spouse while your husband was alive. The key question here is what happened to your coverage when your husband passed away. It’s not uncommon, for example, for Medicare to become the primary payer of health insurance claims for retirees, and retiree coverage to become the secondary payer. If this were the case with you, signing you up for Medicare would have made sure you had primary insurance coverage if you had faced any health needs right after your husband died. I don’t know the details of your policy, and there are a lots of FEHBP plans just in Georgia. Before getting in touch with SHIP, I’d suggest you look through his paperwork and find the exact FEHBP policy he had. If its provisions aren’t clear to you, you can talk them over with a SHIP counselor and get help communicating with the proper USPS benefits office. The counselor also can work with you to make sure you have the health coverage you need for the future. And if it turns out you did not need Medicare, SHIP should be able to help you get a refund. I wish you the best of luck here. Please let me know how things turn out.
Judy – Calif: I’ve had 12 physical therapy sessions paid for by Medicare to treat separate problems in my hip and neck. This exhausts what Medicare will cover. I also have Federal Employees Health Benefits with Blue Cross-Blue Shield, which is an expensive full-fledged policy that covers up to 75 physical therapy sessions annually and for which they told me I’m eligible now that Medicare has been exhausted for this particular benefit.
What I’ve just learned, however, is that physical therapists are forbidden by law to accept payment from any insurance program other than Medicare nor from me personally once I used my Medicare allotted sessions. This law literally denies me the right to obtain treatment I need and can pay for. It’s beyond me to see how this benefits anyone. It would not cost Medicare a cent for me to receive the additional therapy I need, and in fact, my not completing treatment may lead to other, more expensive kinds of interventions they will end up covering. I’d hoped to find physical therapists who have opted out of Medicare, but if I understand correctly, the profession is forbidden to opt-out, which means no physical therapy is available to anyone on Medicare other than the paltry number Medicare allows. No matter how severe the need and how capable of paying for it a person might be. This seems to be an utterly insane situation: A patient with the means to pay for well-accepted and medically necessary treatment is prevented from doing so by a law that forbid providers to deliver it. It turns out that Medicare is permitted to render absolutely useless the generous FEHP physical therapy benefits some federal retirees have paid a lot to have. I fail to see whose interest this serves: not that of patients, nor providers, not even Medicare. Is there anywhere to apply pressure to address this?
Phil Moeller: Judy, this doesn’t seem right on so many levels. Are you hearing this from your physical therapist or someone else? I suspect that either someone is making a mistake here or your private insurance plan has a provision that, despite what you’re hearing, prevents it from paying. This would more likely be the problem than a Medicare prohibition, according to a health expert at the Center for Medicare Advocacy who was briefed on your situation. You should reach out to the CMA and see if a counselor there can help you. Best of luck, and please let me know how things turn out.
Tina – Md.: Is anyone aware of how the changes happening to Medicare have affected the physicians who were accepting Medicare patients? Many physicians in this area have closed their door to accepting new Medicare patients. Many of the patients who are new to Medicare (as a primary insurance) are having problems finding a physician who will take them as a patient.
Phil Moeller: There is a lot of anecdotal evidence of doctors being unhappy with Medicare for any number of reasons. The biggest ones are enormous reporting requirements and modest physician payment rates for the items that Medicare insures. I asked Medicare for details on the percentages of the nation’s doctors participating and am still waiting for a response. In the meantime, Medicare has a useful Physician Compare tool that will locate all physicians in your ZIP code accepting Medicare payments in full. I ran the tool and found 128 physicians within five miles of your location.
Richard – Pa.: Are there any changers for senior citizens for hip and knee surgery?
Phil Moeller: Yes. Medicare has begun a large test of what it calls “bundled care” for hip and knee transplants. Actually, this being Medicare, the program is called Comprehensive Care for Joint Replacement. Under the test, all care needed for the procedure and recovery and rehabilitative care is combined among a team of care providers at participating hospitals. The hospitals have agreed in advance to accept a single payment to cover all costs. Depending on the quality of their care, they may later receive additional payments from Medicare or be required to repay Medicare for spending deemed excessive. Right now, only 67 large metro areas are included in the test. In Pennsylvania, the only two participating areas are Pittsburgh and Reading. If you receive care from participating hospitals in either of these areas, you might wind up participating in the test, but CMS says you can’t apply to participate. You would be selected and then would have the choice of whether to participate in the test or not.
Do you and your family have an extra $400,000? That’s the latest estimate of what it will take a typical 65-year-old couple of pay their health care and long-term care bills during the rest of their lives. These are out-of-pocket costs and do not include what’s covered by Medicare and other insurance. (Howard Gleckman for Forbes.)
Mylan Pharmaceuticals has become the latest in an all-too-lengthy line of drug companies that seem to be maximizing profits at the expense of the consumers they ostensibly exist to serve. Besides jacking up the price of its branded EpiPen injector, it now turns out the company also acted to block or at least delay another company from producing a generic version of the product. (Ed Silverman for STAT.)
Looking out for yourself in the hospital is hard enough even if you’re not distracted by your health condition or perhaps even fighting for your life. Here’s a useful checklist of things you and your family members should do even before you get admitted to the hospital. Take them to heart — particularly the need to have someone who can make health decisions for you when you’re not able to do so. (Judith Graham for Kaiser Health News.)