The ABCs (and Ds) of Medicare: Back to the Basics

Why do so few people in Medicare brochures wear glasses? (Sometimes the men do.) Why do so many of us aging Americans view 65 — the age at which we qualify for government-sponsored healthcare (thank you, LBJ) — as a natural end to our full-time working years? Who could have predicted that learning the ABCs would be a task not only for toddlers but for those of us toddling toward retirement, too?

“Don’t let the alphabet confuse you,” a BlueCross BlueShield Minnesota rep told me last January during the first of my phone calls to learn more about Medicare. Back then, I thought understanding the multi-pronged program would be child’s play.

“Parts A and B are original Medicare,” he explained patiently, while I pictured him holding up colored wooden blocks. “Part C is an advantage plan. Part D is prescription drugs.”

D is for drugs, I told myself: I can remember that!

The ABCs of old age

Turns out, there’s so much more. I have learned that the weightiest decisions about Medicare — whether to enroll in a Medigap or an Advantage plan, when to enroll in Parts B and D without facing a lifetime penalty, which private insurer to use — can all be delayed since I plan to keep working full time, with employer-provided healthcare, after I turn 65 in July.

Still, my months of research have changed my perception of where I am in life. Wrinkles flank my mouth and crease the bridge between my eyes. My right hip hurts from over-exercise. I feel the beginning twinges of arthritis in my hands. Or am I finally just acknowledging the obvious?

“I’m officially old,” I texted my lifelong friend, who turns 65 in May, six weeks ahead of me. “Just enrolled in Medicare Part A.” (That’s the part that covers most hospitalization expenses and is free at 65, provided you’ve worked long enough to qualify.)

“If I didn’t tell you today, I LOVE YOU!” she replied, reassuring me that I am really only “young-old.” Age reveals the importance of family and friends, the relationships we nurture because we need one another as we feel our way forward, toward the inevitable end time.

Marketing Madness

An unmarked white envelope fell out of my newspaper the other morning, an ad to join AARP. Did all subscribers get these, or is generational marketing that sophisticated? My mailbox hasn’t been so stuffed with ads —invitations to Medicare 101 classes, appeals from insurance companies whose chief executives earn multiple millions of dollars a year — since I aged out of the desirable demographic of 18 to 54 years old.

The first piece of Medicare mail has proven the most useful. A tall, laminated, two-sided flyer from UCare, it looks and functions like a large bookmark and has sat atop the growing pile of brochures for months. One side declares in oversized, old people–friendly type what steps to take six, four and three months before you turn 65; the other side urges you toward the research you should do anyway if you plan to keep working past age 65 and are fully insured.

Three key points that months of research has taught me:

First: Other than Part A (the standard hospitalization coverage), Medicare, contrary to assumptions, is not free. Nor is it the Bernie Sanders vision of a single-payer, government-sponsored program. A former colleague of mine retired nine months before turning 65. Despite careful budgeting and the blessing of her financial advisor to walk away from a six-figure salary before she qualified for Medicare, she said the monthly cost of post-retirement healthcare coverage surprised her: “It’s expensive!”

Second: If you have healthcare through your employer, and plan to keep working past 65, determine whether the prescription drug coverage is “creditable,” meaning it at least equals Medicare Part D; that’s the only way to delay Part D enrollment without a penalty once you have turned 65. (Given that a trusted neighbor contradicted the advice from a BlueCross salesman, I have fact-checked this several times.)

Third: “Original Medicare” — Parts A and B — covers only 80 percent of your expenses. That means you have to figure out the distinction between a Medigap supplemental plan and the relatively new (since 1997) Advantage plans, which are cheaper, more bound to a network of providers and recently have been in the news for denying claims. Heavily marketed, they appeal to healthy, young-old people like me because of their emphasis on fitness programs and coverage for fashionable eyewear.

We ego-driven Baby Boomers don’t feature ourselves ever sliding into decrepitude or suffering the indignities that a more expensive Medigap plan would cover.

Medicare’s Promise and Potential

Just as I started saving for retirement at age 27 and have counseled my grown sons to do the same, I have spent months now researching how Medicare works and what health coverage I may need heading into these years when the uncertainty of life has never looked more certain.

Key to keeping the fear at bay has been talking to people who have crossed the bridge:

  • My politically conservative confidant who favors UCare because he won’t buy health insurance from a for-profit company like United HealthCare.
  • My friend who thinks Advantage plans are overrated and overmarketed; she uses a more expensive Medigap supplemental plan because it serves her wherever she travels, including overseas.
  • My buddy who swears that the free services of a broker — who, of course, is getting compensated by insurance companies — bring clarity to the head-spinning confusion of Medicare options. He laughed at my insistence on doing my own research (“that’s so like you, Amy”).

For those of us who have earned enough and had the discipline to save throughout our working years, Medicare opens a door to the final active stage of life. However much I may mock the glossy brochures — color photos of women walking in the woods, a laughing couple out on bikes, a man lingering in a bookstore, two women talking over coffee — I have to concede that the calmer life they portray looks good.

Nothing in the stack of marketing materials tells me how to decide when to leave full-time employment. How I’ll fill my time or discover a new identity. How my husband and I will belt-tighten once a tidy sum of money no longer drops into our checking account every other Friday.

Most of us know that retirement requires a baseline of financial planning; but emotional and spiritual planning are just as important.

Connie Zweig, Ph.D.

What I do know — and what one of my older sisters predicted — is that my view of work is shifting, almost without bidding, as I edge closer to the time when healthcare coverage no longer ties me to a demanding full-time job. Allowing others to control my schedule, always carrying the worries with me, rarely getting a full night’s sleep: It’s all less appealing and less physically possible as I age.

“How we retire, and how we imagine retirement, may be more important than when we retire,” says Connie Zweig, Ph.D. in her 2021 book The Inner Work of Age: Shifting from Role to Soul. “All this emphasis on working and doing . . . stresses that purpose comes through productivity and doesn’t appear to include more service-oriented doing or more contemplative, spiritual development,” she writes.

Maybe the Medicare brochures with all their bicycles and coffee breaks are marketing more than overpriced health insurance, after all. Maybe it’s time to listen, to see the end of work-as-identity as a new beginning. As a time when I finally will be free.

Take a Book, Share a Book: Make a world of difference

A transplant to the city after raising my sons in a small town, I measure the quality of my urban neighborhood in ways that a Zillow description likely would overlook. Shoveled sidewalks in the winter. Tended flower and vegetable gardens during the summer. Friendly people, of course, and Little Free Libraries.

The dinosaur decorations and reachable door handle make this box accessible for children.

The half-dozen free-book boxes that I encounter on my milelong walk to work speak to me of neighbors who not only like to read — a value instilled by both my parents — but who are generous and want to share ideas.

Owning and maintaining a Little Free Library is a rewarding hobby for parents who want to see others enjoy the books their children have outgrown or aging former English majors and empty nesters like me who have reached the point in life where our reading years are numbered. Why not pass along the many books I have collected over the years and ones that I will never read again?

In that spirit, here are rules — or tried-and-true suggestions — for launching your own public book box.

Rule 1: Make your book box official

“Little Free Library” has become a generic, all-inclusive term for any wooden or plastic box attached to a stand that holds giveaway books on a public sidewalk. In fact, just as we say Jell-O when referring to gelatin or Kleenex when we mean any brand of facial tissue, Little Free Library is a trademarked term, dating back to 2013. It also is a nonprofit organization and a brand that sports its own tagline: Take a Book. Share a Book.

I was put off, initially, by the expense of ordering a ready-made box or a build-your-own Little Free Library kit from the website; costs start at $260 for a box of unfinished wood and an additional $80 to $180 for the ground post. Instead my husband, a handy guy who likes to build things, constructed our book box out of salvaged lumber and a cottage window we were replacing in our house.

I didn’t realize that purchasing a structure from the Little Free Library organization would have netted a range of benefits — including access to a 13,000-person private Facebook group for Little Free Library Stewards and the option to buy deeply discounted books to keep the mix of offerings fresh and appealing. More important, the purchase would have enabled me to support a global organization, based in Hudson, Wisconsin, whose mission includes “championing diverse books,” “removing barriers to book access” and supplying stocked Little Free Library boxes to “high-need areas,” including Native communities.

Registering your homemade book box as a Little Free Library gives you a range of benefits and helps support literacy worldwide.

The board of directors models the diversity that the organization promotes and includes literacy experts, academics, and nonprofit and business leaders — book lovers, all.

Clearly, my $400 to $500 investment in official Little Free Library materials would have been money well spent. Turns out it wasn’t too late. After poking around the website, I figured out how to register my homemade box with the organization, which will put me on the Little Free Library map and get me a numbered “charter” sign for what I will soon, officially, be able to call my Little Free Library.

Soon to be an officially chartered Little Free Library, the book box that my husband built (painted to match our house) has become known in our neighborhood for its well-organized and diverse array of books.

Rule 2: Keep it up

I use metal bookends to keep the books upright in my library, and I straighten the books every day, sometimes rearranging them — a la the endcap displays at either end of grocery store aisles — to draw people’s attention to a good read that apparently has been overlooked. (Who wouldn’t benefit from Anne Lamott’s Plan B: Further Thoughts on Faith, for example, especially if they’ve already read Traveling Mercies?)

Because my library looks tended and cared for and ripe for exploration, it has become a true library, a neighborhood resource, a place where people stop by not only to find a good read but to donate good books: Behold the Dreamers by Imbolo Mbue and Small Great Things by Jodi Picoult were two recent contributions that I previously had enjoyed.

Messy shelves do not invite browsing.

I dog-walk through my neighborhood every morning, often deliberately coaxing my willful beasts down the blocks where I know Little Free Libraries stand. I’ve lost count of the number of times I have strolled past boxes that look appealing — their design mimics the architecture of the house or they’re painted a cheerful array of colors — only to find empty shelves, a disorganized mass of magazines or a shelf stocked two-deep with books so I can’t possibly see the contents while holding dog leashes.

So, I move on. Any library that is poorly stocked or is a public trash can for materials the owners otherwise would toss is not worth repeat visits.

Rule 3: Curate your selection

I have taken religious tracts (My Utmost for His Highest and Investing in God’s Business: The “How-to” of Smart Christian Giving) to book boxes at the Episcopal, Catholic and United Church of Christ churches in my neighborhood. I reluctantly recycled a Bible that was falling apart — holding off for a day to be sure it wasn’t a knee-jerk reaction to the forced churchgoing of my childhood, where I was always bored and eventually came to wonder (and then resent) why both God and the ministers were male.

A neighbor once teased me about “censorship” after I posted on Facebook about recycling a Women’s Health magazine (“My Little Free Library, my rules”) showing an impossibly thin young woman and the headline: “Bikini Body Now.” It isn’t censorship, I shot back, it’s called curating — and, in fact, such discernment is essential to maintaining some measure of quality in the materials you showcase outside your home.

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This donation got tossed into my recycling bin. I spent too many years struggling with media-driven rules about women’s bodies to inflict this on a neighborhood girl.

I’ve rejected and recycled waterlogged novels, books with the covers held together by rubber bands, advanced uncorrected proofs, a dated state bicycle map, a Lutheran hymnal, romance novels, cookbooks from the ’90s and academic texts. A Little Free Library cannot be a dumping ground, especially if you want your neighbors to see your box as worthy of the literature and thought-provoking nonfiction — like Caste by Isabel Wilkerson, novels by Russell Banks and Jane Smiley, The Art of the Wasted Day by Patricia Hampl — that they have read and are paying forward.

A retired high school English teacher down the block makes that clear with this handwritten sign on her book box: Please respect the spirit of this Little Free Library and only put books in here that you have enjoyed and you believe someone else would, too. Do NOT put in books that you merely are trying to get rid of.

Rule 4: Commit to the investment

My younger son recently brought over a bag of books that he no longer wants; those are stacked in a corner of the living room, waiting for winter to pass and more walkers to be outside so we can refresh our book box selection. I recently brought home another copy of The Late Homecomer: A Hmong Family Memoir by Kao Kalia Yang that I grabbed from a table of free books at the university where I work.

That now sits on a kitchen shelf my husband and I have devoted to books-in-waiting for the Little Free Library. Goodwill stores have proven to be a worthwhile place to shop for $2 hardcovers and paperbacks for a buck.

Literacy is literally everywhere: This unregistered book box (not officially a Little Free Library) is at my favorite dog park, Battle Creek, in the Twin Cities.

During the pandemic, people have been raiding some of the book boxes in my neighborhood — “Little Free Library Shenanigans” was a recent headline on — and likely trying to sell the books at used bookstores. The problem is pervasive enough that it merited a story on the Little Free Library website, where Half-Price Books has declared it will never knowingly buy books filched from a free library.

Once my charter membership is official, and I become a “steward” of the Little Free Library ethos of generosity, I can order book labels or a rubber stamp that says, “Always a Gift; Never for Sale.”

That speaks to the true purpose of a public library and to the trust — in our neighbors, in all of humankind — that we Little Free Library stewards aim to instill in our communities.

What ‘Merry Christmas’ can really mean

Every year, for many years, I have mailed off roughly the same Christmas gifts to my siblings: a funny dog book or wall hanging for my sister Penny, who dotes on her four dogs; “crazy Cat Lady” trinkets to my oldest sister, Debbie, a cat lover whose husband used to volunteer at a shelter to help socialize feral cats for adoption; and a Minnesota-themed calendar or T-shirt or hat to my brother in Boston, who likes to showcase his Midwestern heritage.

They, in turn, would send me boxes of See’s candy, wax-wrapped aged cheese, frosted cookies in a holiday-themed tin — gifts that I appreciated but really do not need.

This year, I decided, would be different. Crossing my fingers that I wouldn’t appear dismissive of their past efforts, I emailed my siblings before Thanksgiving and asked that, in lieu of material gifts, they give to one of two nonprofits in my name: a local community services organization for which my husband and I deliver Meals on Wheels every Friday and a feminist policy-based organization that is gearing up against threats to Roe v. Wade.

“With the pandemic pressing in on us again and racially based divisiveness rocking our country, I am more aware than ever of the privilege we were born into and from which we continue to benefit,” I wrote.

“To that end, David and I respectfully ask that you take any money you would normally spend on the lovely gifts of food you send us for Christmas each year and instead donate that amount in our names to one of these causes.”

Each of my siblings generously supported the food shelves, youth employment and senior classes at Keystone Community Services, one noting that our father and stepmother received Meals on Wheels for a time. Soon after my initial request, I wrote again, saying that I would like to donate to their favorite causes and elevate the reach of Christmas beyond its consumerist underpinnings.

In the process, I got to know my sisters and brother better. Just as a budget reflects a company or a country’s core values, where a person chooses to donate money says a lot about that individual’s priorities, and about how they see themselves.

Access to the outdoors

My younger brother, L.J., showed himself as the Bostonian he has become since marrying a native of the city some 28 years ago. “Please donate to the Rose Kennedy Greenway,” he told me. “It is a great urban park that adds a lot to downtown Boston.” The public space and programming commits to “providing a park environment that is welcoming to racially, culturally, and economically diverse residents and visitors,” according to the website.

With food trucks, fitness classes, fountains and open green space — typically concentrated in the more affluent neighborhoods of our nation’s cities — the Greenway looks like an inviting place for people of all ages, abilities and economic classes to play and hang out.

An ADA-compliant carousel at Rose Kennedy Greenway makes a “spin” safe for everyone.

I’m not surprised that equity and inclusion in the natural world is an important value to my brother — raised, as we were, in a community with ample municipal and state parks and in a family that prioritized fitness and outdoor exercise — but we’ve never discussed it. Less politically liberal than I am, my brother revealed a side of himself I otherwise might not have seen. “Thanks for donating,” he said, pronouncing this philanthropic gift exchange “a nice idea.”

Dog-friendly diet

My sister Penny’s overt, over-the-top love of dogs is a running joke in our family. We love to recount the time her father-in-law said that after he died, he wanted to return to Earth as one of Penny’s pampered dogs, the ones who get soft-serve cones at Dairy Queen and homemade dinner so enticing that I once mistakenly ate it myself.

No surprise, then, that Penny’s choice for my donation was Colorado Pet Pantry, a food bank for pets that allows low-income people, or those whose luck has temporarily turned, to keep their animals rather than surrendering them to shelters.

Colorado Pet Pantry is a food shelf for animals whose owners might otherwise have to give them away.

“Being the dog lover that I am, I’m drawn to charities for pets,” she said. “This charity is unique in that it helps people to be able to keep a beloved animal they maybe otherwise couldn’t. That just spoke to me as a nonprofit worth supporting.”

What matters most

The morning after Christmas, I survey the leftovers in the fridge and determine that I can take a break from cooking that day. I recycle the plain brown wrapping paper that my younger son used on his thoughtful gifts of books. I force myself out, despite the cold, on my daily dog walk, trying to counteract the intake of overly rich food.

No Amazon boxes to break down and recycle. No cursing at the amount of plastic wrap that shippers use. No pondering whether to freeze or give away the pounds of candy and exotic edibles that my husband and I, as older empty nesters, do not need to consume.

Instead, I look over the website for the Retreat Center of Maryland, a 5-year-old organization that aims to bring yoga and other wellness practices to people with autism or Parkinson’s disease and other populations that the industry historically has not served. This is my sister Debbie’s choice for my Christmas gift, a nod to our mutual love of yoga. One of her neighbors, a volunteer yoga teacher in prisons, serves on the board.

My stepsister, Mary, my only sibling still living in Minnesota, chose Vine: Faith in Action, which matches volunteers with the needs of people ages 60 and older. In-person and online exercise classes and programs on topics such as diabetes, financial exploitation of seniors and healthcare directives have helped the Mankato-based organization continue to grow and serve.

“I want the gift of time,” I used to tell my sons every Mother’s Day. Now I want this practice of Christmas donations to become a tradition, bringing to life a quote commonly attributed to John Wesley, founder of the Methodist church in which my siblings and I were raised:

Do all the good you can, by all the means you can, in all the ways you can, in all the places you can, at all the times you can, to all the people you can, as long as ever you can.

As a Unitarian, I no longer celebrate Christmas as a religious holiday. Still, I watch myself get caught up every year in the trappings and trimmings, the whirlwind of shopping and spending. Today, as December draws to a close, I can say, “Merry Christmas” and mean it, knowing that my brother and sisters and I shared what I believe is the true Christmas spirit.