As boomers reach Medicare age, options and confusion abound

Bob Martin

is a retired Inquirer writer and editor

New Year's Day marked yet another milestone in the storied annals of baby boomerdom:

The vanguard of the generation that once lived by the slogan "Don't trust anyone over 30" just turned 65 and as such qualifies for Medicare.

For those like me who were born at the front end of the 1946-64 group, this omnibus government act looms ominously. Veteran boomers have enough trouble finding their cars in the parking lot. Now we're being tossed into a bewildering world of Medicare Parts A through D and Medigap Plans A, B, C, D, F, G, K, L, M, and N.

Our options are daunting. Take Parts A and B, also known as Original Medicare. I'm already confused. I thought this was a seafood restaurant at Second and Walnut that went bankrupt a few years ago. Anyway, these plans are supposed to cover hospital care and doctor visits and stuff called durable medical equipment. I guess that's for people with durable powers of attorney, so I'll probably need one of those, too.

Now comes a fork in the road. I could choose Plan C, which combines the offerings of Parts A and B and even Part D if I want it, all of which is provided by private insurance companies approved by Medicare. This deal is called Medicare Advantage, whose name gives it an unfair advantage over the alternative - something called Medigap. Plan C gives you the choice of participating in an HMO, PPO, or PFFS. I don't like PFFS because I once had a mortgage and bank account with this outfit and, like the fish place, it is now defunct.

My wife says we should choose Medigap. I take her word because she's a nurse. And because I've always stuck her with these insurance decisions. See, I've never really understood health insurance, which should be abundantly clear here. It's just not a guy thing. Some salesman starts talking about co-pays and deductibles and my eyes glaze over. Then he mentions coverage gaps and I perk up because I think he's referring to the Eagles' pass defense without Asante Samuel.

Anyway, my wife, knowing my weaknesses, sells me on Medigap by saying, "Look, it's just like having the health insurance we have now." That's all I need to hear.

Which brings us to Part D, which covers prescription drugs. You would enroll in this separately from Parts A and B, unless of course you also registered for Part C (Medicare Advantage), in which prescription drugs may or may not be included, depending on the plan you choose. I'm glad I made that clear.

Under Plan D you have to get your arms around the concept of "the four stages of coverage." Here it is:

As you progress from stage one to two, your co-pay for prescription drugs increases as the government share shrinks. When you and Medicare have jointly spent $2,830 in a one-year period for drugs, you move into stage three, also known as the doughnut hole. Now you'll pay 93 percent of the cost of generic drugs until you've shelled out $4,550 in true out-of-pocket (TrOOp) expenses. Henceforth (stage four) you pay 5 percent and the government pays the balance for the rest of the 12-month span.

AARP's website explains stage four this way: "After reaching your TrOOP limit, you leave the gap and enter the catastrophic coverage stage." This seemed clear enough to me until I realized that AARP wasn't talking about President Obama's 2014 combat phase-out plan in Afghanistan.

Obama also plans to phase out the doughnut hole under his health plan, but for now the government will pay $250 to any Medicare recipient entering the doughnut hole. Even Homer Simpson is perplexed by the moves. He likes the subsidy but reportedly said that "any attempt to reduce government support for doughnuts is socialism."

Tom Corbett was one of 13 state attorneys general who sued to overturn the Obama health-care plan on constitutionality grounds. Our governor-elect would have performed a far greater service had he sought to nullify the Medicare law.

His argument, so clear that even a 65-year-old could get it, could be that trying to comprehend Medicare constitutes cruel and unusual punishment for baby boomers, even those unimpaired by marijuana and LSD. The law is therefore unconstitutional, null and void.

If you need witnesses, Governor, I won't fight a subpoena.