When it comes to their health care coverage, Elizabeth O'Regan, Henry Daniels and Francis Gruill are satisfied customers - and wouldn't want anything that comes out of the health reform debates in Washington to change that.

The three Waterford residents are among the 38 million senior citizens and 7 million disabled Americans covered by Medicare, the federal health insurance program that began in 1965. Medicare spending by the federal government comprises 13 percent of the entire federal budget, according to the Kaiser Family Foundation, a nonprofit health policy and research organization, and nearly 20 percent of all health care spending in the United States.

"It's a very, very valuable program, and it's greatly appreciated by those who have it," said Judith Stein, executive director of the Center for Medicare and Medicaid Advocacy, a Willimantic-based nonprofit that works on behalf of Medicare and Medicaid recipients nationally. "Their families are also benefiting."

For some seniors, the health reform proposals pending in Congress have become a source of anxiety that the good coverage they receive through Medicare might be curtailed.

"We're happy with what we've got," said Gruill, "and I certainly don't want the government to change it to make me unhappy."

Stein said many seniors are understandably protective about Medicare. From her perspective, neither the House nor the Senate version would have the dire consequences on the average Medicare recipient the critics are warning about. Some of the changes, such as eliminating the so-called "doughnut hole" in prescription coverage through Medicare, would benefit Medicare recipients, and savings would primarily be exacted through levies on the privatized Medicare Advantage plans rather than on basic Medicare, as well as on fees paid to hospitals and nursing homes, according to a Kaiser report.

Stein believes Medicare Advantage plans are often overpriced and less flexible in the types of coverage for home care and some other services than regular Medicare.

"If I ruled the world," Stein said, "I would have Medicare for all."

For most people, the Medicare premium cost is $96 per month. The program covers 80 percent of the costs of their doctor visits, physical therapy, and most prevention care, 100 percent for lab services, and all but the first $1,068 for hospital stays. Co-pays for outpatient hospital services vary depending on the procedure.

Satisfied consumers

For O'Regan, Daniels and Gruill, their own experience tells them that this is one government program that works. Through heart attacks, common ailments, surgeries, stress tests, cardiac therapy and routine check-ups with their chosen doctors, the three have found Medicare covered most of the cost of the care they needed. All three have so-called Medigap private insurance as a supplement to cover the co-pays.

"If I was to look for insurance, this is what I'd purchase," said Gruill, 87, a retired state Department of Transportation engineer. His primary care doctor, he said, is the same one he went to when he had insurance coverage through his state job.

In the 16 years since he enrolled in Medicare, Gruill's biggest health care expense was for a heart attack in 1987. Since his recovery, he's been diligent about exercising three times a week, taking his blood pressure daily and watching his diet. Every year he goes back to his cardiologist for a check-up.

In addition to the heart attack, Gruill has also tapped Medicare for Lyme disease care, cataract surgery and treatment for a kidney stone. He takes two cardiac medications daily, covered by Medicare Part D.

Some seniors opt out of traditional Medicare, and choose privatized managed care programs called Medicare Advantage that first became available in 2003. Of the 550,000 Medicare recipients statewide, 80,000 have Medicare Advantage, according to figures provided by the Centers for Medicare and Medicaid. About 3,100 Medicare Advantage customers are in New London County.

Sally Ritchie, Waterford's director of senior services, said Medicare Advantage policies often end up costing more than staying in traditional Medicare and paying out-of-pocket for uncovered expenses or a Medigap policy. Still, many seniors consider it worth the expense to know that all their bills will be paid if they end up in the hospital.

"Their peace of mind is important," she said. "We meet with people who say, 'I'll go without things to keep this coverage.'"

Daniels, 78, a retired parks and recreation director for the town, has had few problems with his Medicare coverage in the 13 years since he enrolled. But his Medigap supplemental policy, he said, has taken care of the costs Medicare wouldn't, such as some of the periodic treatments he needs for a blood disorder. He estimates he and his wife spend a total of about $5,000 annually on their health care costs, including Medicare and Medigap premiums, dental and eye care.

"I've had good health insurance my whole life," he said. "Everyone should have some sort of basic coverage. It's an issue that shouldn't be political."

For Elizabeth Regan, enrolling in Medicare at age 65 meant she could afford to get sick. For 15 years before that, said Regan, an 82-year-old former dancer, she had no health insurance.

"I danced all my life," she said, "and I just stayed healthy."

Nine years ago, though, she had a heart attack and needed a pacemaker. Then six months ago, she had a stroke and needed a coronary artery stent.

"I didn't have any worries when I had that" about the bills, she said. "When you're sick, you don't need that."

Complaints about Medicare coverage for hospitalizations, access to doctors and routine care are relatively few, Stein said. The most frequent complaints her organization handles for Medicare recipients, she said, involve covering fewer treatments than doctors recommend for chronic illnesses such as diabetes, and sometimes refusal to cover needed home care.

Lack of dental care is another shortcoming, Ritchie said. Medicare provides no dental coverage, leaving seniors to pay out-of-pocket or go without. Some of the Medicare Advantage plans do cover dental services, however.

"It's a big issue when you don't have dental," she said. "I've heard of people pulling their own teeth out with pliers, more than once."

j.benson@theday.com