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Evelyn Saguaro had a gall bladder issue that needed surgery, but her Medicare coverage wouldn’t pay for the procedure. But once she realized that she already had visited a California Health Insurance Agent to deal with what she called “her delicate matter,” she felt enormously relieved.

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Sixty-seven-year-old Evelyn Saguaro had the same problem her late mother had once been afflicted with. Besides her real gall bladder, she’d been born with a vestigial secondary one in which three cactus-like gallstones, each about the size of a quarter, had formed. Late in life, the vestigial gall bladder’s gallstones were starting to act up. Sharp pains would erupt beneath her breastbone immediately after she ate even a tiny serving of anything, and the acute pain made her sick to her stomach. When her doctor ordered tests to identify where the symptoms were originating from, he told Evelyn that her Medicare Plan only covered her original gall bladder, and since the stones had formed in the vestigial one, any procedure to remove them in “her unique case” would not be reimbursed. Her primary care physician kidded with her. “I suggest you refrain from eating,” he said. “Are you serious?” she asked. “No, a better idea might be to seek out a California Health Insurance agent.”

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That’s when she realized that she had done just that, two years previously. Was her Medigaps supplemental still in force? She headed on a beeline to the Visalia office where she’d purchased the Medigap coverage. Was the office still there? It was. The same agent, Glenda, was at her familiar desk. During their previous conversation which she’d somehow forgotten, Glenda had shared with her that she too had a “vestigial gall bladder,” with its associated symptomology not yet evident. Glenda had even belonged to an online organization, a regular support group called VGB Sufferers International.”

“Glenda, I’m so glad to see you,” Evelyn began. “Is my Medigaps policy still in effect?”

“Why wouldn’t it be, dear? Let me check.”

Evelyn waited expectantly. Suddenly her gallstone pain returned with a vengeance. “Is it? She asked, almost gasping.

“Of course it is, my dear Mrs. Saguaro.” A month later, Evelyn’s surgery was successful and her cacti-shaped stones were displayed on her mantle, and on the VGB Sufferers website as a digital photo – for all to see.

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Filling in the Medicare gaps can be tricky business for seniors, but it can be done with a little help from your California Health Insurance Agent.

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Esther Sirica, 68, was planning to have a surgery performed on her left foot’s hammertoe. She had joined a swim club for seniors and wanted to show off her feet. “I’d always wanted to be a foot model when I was younger,” she explained, “in my day; a well-turned ankle was just the beginning.”

But she wasn’t independently wealthy, and there were gaps in her Medicare coverage that she didn’t understand. “When I asked my primary care physician about the surgery, he said that I wouldn’t be covered. “It’s elective surgery on a pre-existing condition,” he asserted. But Esther wasn’t convinced. “Men used to find my feet lovely,” she told her physician, “except for THAT one.” She was pointing to her hammertoe, not the photo of President-elect Obama on the nearest wall.

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Esther quietly demurred amid the usual pleasantries, and begged her leave. A moment later she was off to find a second opinion. Her second opinion, an elderly physician who at least comprehended the surgery’s potential significance to the woman if not its urgency, did recommend the surgery, and perfunctorily checked out Esther’s Medicare coverage. “The surgery will cost $1,750,” he informed her.

“That’s not so much,” she said, assuming it was entirely covered except for her co-pays.

 “But Medicare will approve only about half of that, $825.00,” he added.

“Oh,” she said, with sadness suddenly re-encroaching upon her entire being, including the deformed toe.

Fortunately, Esther’s next visit was to her California health insurance agent, a valuable source for information on Medicare Supplement coverage for the past year or two. The nice young agent there had mentioned something called Medicare Supplement Insurance policies as a way to plug the disturbing Medigaps.

A month later, Esther was in the pool with the seniors, literally a new woman. A gentleman swimmer named Tony was looking at her foot when he noticed it. “Didn’t you used to have a hammertoe?” he remarked.

Esther Sirica flashed a big smile, her dentures clicking.

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Alfred was under the mistaken impression that Medicare was all he was entitled to, gaps and all. His California Health Insurance Agent Matt set him straight.

 Alfred H., age 104, lives in Escondido. He’s been blessed with relatively good health, although he fractured his hip while in an infantry unit, an imaginary one, when he fell out of his uncle’s pear tree, in 1918 when he was only 14.

 Alfred’s wife died in 1980, and occasionally his son Zeke, 73, stops by to visit. Zeke has had a succession of health issues, and retains Matt’s California Health Insurance Services, with Matt Lockard as his agent. Zeke has a Medicare Supplement Plan for 65+ seniors that serve his needs well. But Alfred has no agent and Original Medicare only witch is full of gaps. Suddenly, just in the past few months, his hip has been giving him trouble.

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 “I never saw you break your hip,” Zeke told his Dad, “did you take a fall recently?”

 “Nope,” Alfred said, “It happened before you were born.”

 “That sure isn’t recently,” Zeke agreed. “Are you going to have it fixed?”

 “Can’t,” Alfred said, “My Medicare will only pay for part of it. I went to see the doctor, he said I’d need surgery and the break is still there. In 90 years, it’s never completely healed.” 

 “It might get worse,” Zeke agreed, “you could end up like one of those old men and have to use a walker.”

 “I’m over 100 now, it’s too late. Medicare by itself is the best option for me.”

 “Why don’t you see my California health insurance agent, Matt Lockard?”

 Alfred drove over in his beloved Studebaker that still ran clean as a whistle. He spoke to Matt. Matt helped him understand how Medicare Supplement plans work.”

 The surgery was successful. For the first time in 50 years, Alfred called Lissie up on the phone. He’d known her from way back. “Do you want to go dancing?” he asked her.

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