Even if you’re not old enough for Medicare yet, you might read today’s post anyway. It’s a little lesson in what is, essentially, universal healthcare – a single-payer system (sort of) for elders.

Medicare Parts A and B function most like a single-payer system. Part A is free; you pay Medicare for Part B. The 2008 premium increase will be 3.1 percent, raising the cost to $96.40. There is no alternative; this is the basic Medicare coverage and although Part B is optional, you cannot purchase a Medigap policy without it.

The six-week enrollment period for Part D, the prescription drug coverage, begins today and lasts through 31 December. Most companies that supply coverage are increasing premiums for next year, but there may be bargains; I found one. If you want to investigate changing carriers, the Medicare website has a good Part D tool to help you figure out which ones cover your drugs in their formularies and what the premiums are. There is a full explanation here.

As long as I was doing the research for Part D, I thought I'd check out my Medigap policy, the optional supplemental coverage most people buy to fill the gaps in Medicare A and B. My premium increase for 2008 is 11.6 percent. Maybe I can do better.

The Medicare website has a simple tool for finding carriers that offer Medigap coverage in your state, but it is a lot less useful than the Part D tool. It lists only the companies, with their phone numbers and links to their websites. To find coverage details and premiums, you must telephone each company and in my case, for the Plan I want as a resident of the state of Maine, there are 19 to choose from.

I haven’t phoned yet because first I wanted to know the rules under which one is allowed to switch Medigap carriers and if there is an enrollment period as with Part D.

Unfortunately, this is information is not available on the Medicare website, a poor state of affairs that took me more than an hour of clicking around to realize. Then I waited on the 1.800.MEDICARE line for 40 minutes and spent another 20 minutes with a representative to learn the following:

1. You may switch carriers any time if you have been enrolled in a Medigap plan for at least six months


2. The new carrier you choose must agree to cover any pre-existing conditions covered by your current carrier; some may not


3. You have 30 days to change your mind about new coverage after agreeing to it


4. You will be asked by your original carrier to sign a document stating you want to cancel the coverage


5. If you do not purchase the new coverage within the 30-day period, you cannot return to your original carrier; you will need to find a new one

I asked the Medicare representative if I had somehow missed finding this information on the Medicare website. She says it is available only by telephone, so you might want to print out that list for future reference. [TIP: The 1.800.MEDICARE line is open 24/7, so it would be smarter than I was to telephone, when you need information, at off-hours.]

And now, a word about the alternative Medicare Advantage plans: These are private, comprehensive policies approved by Medicare that replace all Medicare parts. They are sometimes called Part C and many cost less than A, B and D combined.

However, a number of Advantage carriers have recently been caught in deceptive and/or fraudulent sales practices that led some beneficiaries to lose all their coverage for several months. In addition, co-pays are often shockingly higher than with regular Medicare and many physicians do not accept Advantage plans. So beware if you are considering this type of coverage and investigate thoroughly.

There is another reason to think carefully about purchasing one of these comprehensive plans. In reality, Advantage plans are a sneaky attempt by the federal government to privatize Medicare. To promote this backdoor approach to privatization, Medicare pays lavish subsidies to the private carriers, as this New York Times editorial explained last April:

“The authoritative Medicare Payment Advisory Commission estimates that the government pays private plans 12 percent more, on average, than the same services would cost in the traditional Medicare fee-for-service program. The private plans use some of this money to make themselves more attractive to beneficiaries - by reducing premiums or adding benefits not covered by basic Medicare - and siphon off the rest to add to profits and help cover the plans’ high administrative costs.”

In other words, the one-fifth of elders who purchase Advantage plans with lower premiums are subsidized by the rest of us who buy traditional Medicare plans (and other taxpayers).

So ask yourself this: in a time of soaring medical costs with one-sixth of Americans unable to afford any kind of medical coverage, do you want to support a system that gives billions of dollars in additional, undeserved profits to private insurance corporations while charging off those profits to traditional Medicare recipients?

It’s an important, ethical question related to the greater good.

In case you lost track of the original purpose of this post (I did while writing it), today begins the enrollment period for Part D, the Medicare prescription drug plan, which runs until 31 December. If you want to keep your current plan, do nothing. If you want to see if you can get a comparable plan at a lower cost, use the form at the Medicare website.

And if you want to see if you can lower the cost of your Medigap supplemental plan, it’s a lot more work than choosing a Plan D, but may save you money on premiums.

[At The Elder Storytelling Place today, Lia recalls the remarkable differences there can be in parenting a story titled Adrian Pascal and Jellybeans.]