The New York Times Medicare Poster Girl: Why Is Retired Teacher Elizabeth Cooper Even Worried About Medicare Supplemental Insurance, Medigap or Part C?

Who's Elizabeth Cooper you ask? Elizabeth Cooper, according to the New York Times, is a 68-year-old former elementary schoolteacher, who -- as you also should -- weighs her Medicare supplement options each year.

According to the October 4, 2015 New York Times article in favor of private Medigap insurance in place of public Part C Medicare Advantage health plans, Cooper has "already" (in the three years on Medicare I guess the Times' author means) tried a couple of plans¹, including one Medicare Advantage plan, which

"lured her in because it had no monthly premium. But the plan required her to shoulder a significant share of her medical costs."

According to the Times, she is healthy now, but she has a history of skin cancer. In general Cooper's health condition should be between her and her doctor but since she consented to publish her health status in the United States "newspaper of record," I feel OK speculating on what Cooper means when she says

“I didn’t feel that would give me a sense of ease because of the co-pays and the possible unexpected expenses that can crop up."

So here's some total speculation to open up some discussion points:

1. It must suck to be a retired teacher in Alabama, Cooper's residence according to the Times, because no retired teacher (or other government employee) in the Northeast United States would have any dependence on any part of  crappy LBJ/Democratic-Party Medicare insurance; Alabama teachers better get a union. For the most part, Medicare is something government employees and politicians impose on the rest of us, not something they themselves use in retirement.
   
2. The New York Times says Cooper "backed out of "Medicare Advantage" during the trial period..." There are two trial periods. You can drop out after first signing up and you can drop out the first six weeks of every calendar year. But depending on your timing, dropping out of Medicare Advantage could cause a problem if switching to Medigap. Given her skin-cancer history, and apparent Alabama laws concerning private Medigap insurance, Cooper could have been denied a policy because of her pre-existing condition or charged more². But this would not have been the case if she dropped out right after first signing up so apparently that is what she did. That may or may not have been a good move given her condition but it would mean she never really gave her Part C Medicare health plan a chance.
   
3. The Times says Cooper "enrolled in original Medicare..." instead of Medicare Advantage. This is a total inaccuracy by the New York Times. Ms. Cooper could not have been on Medicare Advantage had she not already been enrolled in Original Medicare, both Parts A and B.
4. Cooper bought a private Medigap supplemental policy for about $135 a month that covers items like deductibles and her share of each bill. The Times says, quoting Ms. Cooper, "After having a few diagnostic tests this year, (my) decision already paid off. Had I been on the Advantage plan, I would have had to come up with the money for each test." So it also must suck to get skin cancer diagnostic tests in Alabama (because it's hot?) It's hard to believe a few diagnostic tests would have cost more than the $2000 Cooper spent on private Medigap insurance and a standalone prescription drug plan after she dropped her zero premium Part C plan. Maybe $500 would be the most: two outpatient procedures, each with a $250 co-pay on the zero-premium plan. But more likely two doctor visits at $50 each.
   
5. Does Cooper "lure" easily?

To be clear, if Ms. Cooper wants the budget dependability of Medigap (and is willing to pay for things like annual physicals out of pocket that are not covered by Medigap) or wants a preferred dermatoligist or preferred skin-cancer lab that did not accept the Part C plan she had inititally chosen or simply did not like managed care, these are all good reasons to pay more for private Medigap insurance. But please do not pretend her decision was based on finances. It is almost impossible for a zero-premium Part C Medicare health plan to cost more than the combinantion of private Medigap and Part D insurance and out of pocket costs under any health-need scenario I can think of... presuming you stay in the zero-premium-plan network... which is the point of managed care (the linchpin of Obamacare, by the way).

¹It would have been useful to know what else she tried: No supplement? Lousy retiree insurance? Another Alabama Medigap plan? Did she keep working past Medicare age? There are three years involved but only two are accounted for?

²Alabama Medigap policies and private Medigap policies in other states are also age rated, which is not allowed under the public Part C Medicare health plan program. You might not have known this just reading the New York Times endorsement of private Medigap insurance