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Medicare is a maze -- here’s where to get help

Sanders health care

With my 65th birthday -- and eligibility for Medicare -- arriving in a few months, my mailbox is full of solicitations for Medicare Supplement and Medicare Advantage Plans. If I accepted all the free lunches and dinners I've been offered in exchange for attending these Medicare workshops, I'd be 10 pounds heavier.

The fact is, I'm experiencing a range of emotions as I approach this landmark age. How did I get this old? It seems like just yesterday I was entering the workforce and starting a family. On the other hand, hooray: No more high-deductible health plans or worrying about Congress overturning the ban on exclusions for preexisting conditions.

But it's sobering to discover that I'm still not finished navigating a potentially confusing and complex health care system. I'm facing some basic choices that will have significant implications for my quality of life for the rest of my life. I'm finding the Medicare system to be quite confusing and complex -- and I'm an actuary who has studied retirement planning for more than 40 years!  

I'm not alone. Raman Kolluri -- the father of a friend of mine -- is a retired physicist who has this observation on Medicare: "I do not quite understand how the whole health care system works, specifically Medicare. There are so many rules, exceptions, deductibles, co-pays, 'donut holes' and supplementary insurance that it's like a deep jungle without any walking paths."

To help readers who are also approaching their 65th birthday, I'm sharing some things I've learned in hopes you can also find whatever guidance you'll need.

Get help

Your first step is to spend the time and money needed to learn about your choices. Your new "retirement job" is to understand all you can about how to build your financial security for the next 20 to 30 years. It's not realistic to think you can make these choices in an afternoon, or that it's a good idea to select the plan that your brother/sister-in-law/neighbor selected.

Yes, Medicare and supplemental health care plans are complex. And it's entirely understandable that you'd be frustrated about this, but that's the unfortunate reality. To continue Kolluri's analogy, you're better off finding a guide who can inform you of the dangers of the Medicare jungle and help you find your way.

I consider myself an expert on retirement, yet I hired an independent Medicare consultant, Diane Omdahl of Sixty-Five Incorporated, to guide me through the various Medicare decisions I'm facing. I received a 50-page booklet from Omdahl's company that described my options, and I spent an hour on the phone with her for an informative briefing and discussion. I also exchanged a few emails with her for follow-up questions. 

All told, I've spent about 20 hours reading the materials and discussing them with my wife. I'm convinced that the money I spent on an independent consultant will easily be recovered several times over considering the money I'll spend on medical premiums and out-of-pocket expenses such as deductibles, coinsurance and co-payments over the course of my lifetime.

If you don't feel comfortable working with a consultant, you can also work with an insurance agent who represents health insurance plans. Just be aware that such agents will most likely receive a commission from your choice, so they won't be totally independent. It's also likely they'll just offer plans that will pay them a commission.

In addition, online insurance agencies also sell Medigap plans and can provide useful information, such as AARP and ehealthinsurance.com.

You can also conduct your own investigations using Medicare's significant resources, including a summary brochure, Medicare's plan finder and its star rating system of Medicare Advantage Plans.

State health insurance assistance programs (SHIPs), as well as your local Area Agency on Aging, can also help you make Medicare decisions.

Numerous excellent books on the topic are also available, including "Get What's Yours for Medicare," "Making the Most of Medicare," "Medicare for Dummies" and "Social Security: The Inside Story" (which also covers Medicare).

If you feel intimidated conducting this research and making your Medicare decisions alone, enlist your spouse or close friends and relatives to help talk through the issues with you and provide encouragement and support.

It may seem like a lot of work to do all your research and homework, but it's well worth your time. Chances are very good that at some point in your retired life, you'll need expensive medical services. When that time comes, the choices you make now might be the difference between life and death.