When the federal government implemented the Medicare prescription drug, or Part D, plan in January 2006, the focus was to provide beneficiaries with drug coverage, something previously available only through private supplemental plans. But the government also allowed private insurance companies, approved to sell Part D, to sell their own comprehensive health plans that replace traditional Medicare.

Last winter, when an agent selling private Medicare plans called Perkins' mother, Gertrude Jenkins, who was then living at home, Perkins listened to the agent's spiel.

His mother, 88, also of Fort Wayne, was taking only a few medications at the time. The $12 monthly cost for Part D "looked really good," Perkins said. Her co-pay for doctors' visits was just $20.

But in October, his mother broke her hip, requiring surgery, hospitalization and rehabilitation. Perkins was then told the hospital could not get the private Medicare company to approve in-hospital rehabilitation, something traditional Medicare covered when she broke her other hip a few years back.

So it was off to a nursing home for rehabilitation. That's when the real shocker came, Perkins said: "There was only one nursing home in Fort Wayne that was in [the company's] network."

If he moved her to an out-of-network facility, any one of Allen County's 24 other nursing homes, the out-of-pocket cost for his mother would be $150 per day, or 10 times the cost of the in-network one.

If his mother had kept the traditional plan, Medicare would have paid all costs for the first 20 days in the nursing home, and all but $124 a day after that. Medicare pays part of the cost up to a possible 100 days for a nursing-home resident who comes directly from the hospital.

Mary Jo Burden is the bookkeeper for Woodview Healthcare Center in Fort Wayne. What once involved billing one single Medicare source has turned into hours spent sorting out what is covered and for how long by various private companies.

"The problem is when they go to the hospital or a nursing home. People are looking at their outpatient costs - their doctor's visits - and the Part D costs. They are not being told what may or may not be covered under the private insurance. It's probably there in the fine print, but most people don't know what to ask."

Fred Taube is a volunteer counselor with the Senior Health Insurance Information Program, which assists older adults with insurance issues. The program has fielded some complaints about private policies, particularly early on, he said.

At one nursing home, an agent sold residents a private plan. Taube said nursing home officials told him not only did the agent fail to ask permission to meet with residents, the policy sold did not cover that particular nursing home.

"When I first started doing this and when someone would come in and go on Medicare," Taube said, "I'd say, 'Here are the 10 standard Medigap [Medicare supplemental] plans.' I'd tell them to call the agent, get a quote and then pat them on the head and send them on their way.

"Now you've got to tell them about Medigap, preferred providers, private fee-for-service companies - and there are two or three [permutations] or combinations of each of those. It's very confusing."

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