Something Very Weird about My Health Insurance

[MineralMan]

I'm six months away from Medicare now, and my mailbox is chock full of pretty brochures from health insurance companies clamoring to sell me supplemental insurance to cover the 20% Medicare Parts A & B don't pay. Other brochures want to sell me a Medicare Advantage plan that even includes vision, dental, and hearing aid coverage. Either way, it'll cost me from about $100-$120/mo. to sign up for one of these things, plus the $100 or so I'll be paying for Medicare Part B, taken out of my Social Security payment.

That's pretty cool for me, of course, but it has me wondering about something. Among the offers is one from Blue Cross, which is my current health insurance company. At age 64, I pay them $711/mo. for lousy coverage, and still have the 20% burden until my health care costs hit $5000 each year. Plus, I have a $1000 deductible. I've never met even the deductible, so all of my health care, plus $711/mo. comes out of my own personal pocket.

Now, Blue Cross whines about the rising cost of health care every time they send me a notice that they're...once again...raising my insurance rate or cutting one benefit or another. They're getting about $8500/yr. from me, and I don't use any of the insurance, thank goodness. I like being well.

So, when I turn 65, they'll be happy to pay all of the 20% Medicare doesn't pay, and will only want $100/mo. from me. No deductible. They're all very excited to sell me this supplemental coverage...all of the insurance companies. And that brings up the very real question: WTF?

Why is it that when I'm 64, they seem to want to price me right out of my insurance coverage, but when I turn 65, they want to sell me a reasonably-priced package to cover that 20%? I mean, it's not like my health is likely to improve over the next couple of decades. It's not like they aren't going to have to start paying out 20% of the cost of my colonoscopy and probable MRIs and the like. See, I haven't gotten any of those things, because I'd have to come up with the first $1000 and the 20% over that.

I've thought about it, and I actually know the answer now. Medicare pays way less money for every procedure than the insurance companies do. The providers have to take the Medicare allotment for whatever they do for me. It's a lot less than the insurance companies have been able to negotiate, since they're in collusion with the providers anyhow. So, the insurance companies can offer me some pretty enticing packages for a small fraction of what I'm now paying for my health insurance. They're not doing it grudgingly, either, given the pretty 4-color literature they're sending me daily. They're going to make money on the $100/mo I'll be paying them.

Again, Medicare pays less per procedure than the insurance companies do. Much less. And that brings the price of health care down to a level that allows profitability for the insurance companies who provide supplemental insurance at bargain-basement rates.

Some will say that the doctors and hospitals don't like Medicare. Well, in the Twin Cities here in Minnesota, they love it. Medicare patients pay the operating costs of all the excessive number of hospitals and services that are available here, while regular patients put off health care because they can't afford the deductibles and co-pays. Yes, the health care industry here relies on Medicare patients to pay the bills. They couldn't survive without them.

The bottom line: If Medicare were available to all, those insurance companies would still be out there selling supplemental coverage to people. People under 65 would pay a higher premium for their Medicare, and the insurance companies would still profit from the supplemental insurance, as they do now with us old folks. Medicare would still control prices for procedures, as it does now, and costs would go down overall, but the hospitals, labs, and clinics would be busier, since people could afford to get health care.

Single-payer health care. It works. Everyone benefits. Everyone gets health care and all the providers get paid and the hospital beds are full of people who need health care. The insurance companies should be pushing for this. Why aren't they? Because they're in collusion with the health care providers. This artificially drives up prices for health care.

Can we sell this? I think we should be able to. In any case, that's the system I'll be using, beginning in July. I wish everyone could get it.

[flyarm]

1. Oh my goodness..you have a cadillac plan!! and are you UNION?

seems to me you cross the threshold of a Cadillac plan!..do you feel rich now?

[MineralMan]

3. Yah, right. I'm an individual customer. I've worked for myself

since 1974. And it ain't a Cadillac plan in any way.

[flyarm]

8. i should have added this..

:sarcasm: :sarcasm: :sarcasm:

I know it isn't cadillac..but in the present insurance profit bill..you would meet the cadillac plan threshold!..and so many of the DLC types here would call you rich ..as i have seen over and over here at DU by the DLC types..and then they would tell you..hardly any Americans have plans that meet that threshold..

of course they are either in 1. denial or 2. being paid or 3. delusional

[TicketyBoo]

38. No, this wouldn't be a "Cadillac Plan."

Not by any assessment; not with that high deductible.

High premiums do not a "Cadillac Plan" make.

There's no way you'd be taxed on premiums you're paying yourself.

[FarCenter]

2. Even though the per procedure prices are lower for Medicare --

they can make up for it by charging for more procedures.

[MineralMan]

4. Sure...Yeah... Like my Dad says:

"I lose money on every sale, but I make it up with the volume."

[MineralMan]

5. Single Payer Health Care for Everyone!

This is the Health Care Reform we need. And we need it now!

[truedelphi]

6. Here's hoping you get great coverage on the supplemental,

And congrats on living long enough to take up our government on MediCare.

I think one reason that never gets pointed out about MediCare being able to survive financially - plenty of people along the way succumb to diseases like cancer and accidents (and of course military service in the dangerous war theatres.) Their money is kept by the Medicare vault in the sky, or in Washington D.C. or wherever.

My parents' generation saw people living in record numbers to be in their early to late seventies (And once you live to 78, you can pretty much count on another six years, statistically speaking.)

But my generation is burying plenty of people long before sixty. My mom, age ninety, still has her two best friends. I have lost both of mine and I am not yet sixty.

[MineralMan]

7. You know...it's amazing...

My M-i-L has had several expensive procedures and has paid exactly $0 for all of them. She has Medicare Part A and B and a Blue Cross supplement that costs about $100/mo. The supplement is paid by the company her husband retired from, even after his death.

Zero. I'm studying the supplement literature, but tossing the Medicare Advantage brochures, since they're too HMO-ish to suit me, even though they add vision and dental to the mix at almost no additional cost.

And yes, I'm lucky to be celebrating my Medicare birthday. I've lost friends from my generation, too.

[truedelphi]

10. Tell me what you know abt this -

Are you stuck with your supplemental choice? Or can you get a "re-do" if you are not happy?

[MineralMan]

13. Yes. Once a year you can change your supplemental policy.

That is my understanding, anyhow.

[truedelphi]

22. Good to know that. I had heard you were stuck if unhappy

But once a year is a good idea.

[TicketyBoo]

39. The BCBS premium varies

from state to state.

It is closer to $200 a month here. ($193.90 until April when it will probably go up). It's gone up every year I've had it except last year.

[Tailormyst]

9. So mote it be!

[MineralMan]

16. I hope it's possible. It's what we need.

[Edweird]

42. It is.

[Tracer]

11. The simple explanation:

When you turn 65, BC only has to pay 20% instead of 100% (presumably).

20% of 8500 = $141 per month.

[MineralMan]

12. Not exactly...

Now, BC only pays 80%, after I pay the first $1000. I pay the additional 20%. I've never even used up the whole deductible, so BC has paid nothing, except for one year when I had a hospitalization.

When I go on Medicare, they will only pay 20% of a much-reduced cost for any care I relieve.

[RebelOne]

14. I am eligible for medicare, but I am opting instead for my employer's

health insurance. For $200 a month, I receive medical insurance, dental, eye and life insurance.

[MineralMan]

15. That's not bad, but I haven't had an employer since 1974.

[gleaner]

48. You might want to check and see ...

if you can't have both. I have medicare, but my husband has private insurance because he isn't old enough to get his medicare yet. He carries me as a dependent on his insurance. They factor in my medicare and act as a supplemental policy. They pay some of the deductibles they give me prescription coverage that lets me almost afford my medications and if they cover something that medicare doesn't, the still pay for it. Medicare sends them the EOBs electronically and they pay their share then send the EOBs to me. One would pay for things that the other would not. Medicare usually pays for flu shots and pneumonia shots and other immunizations. Private insurance does not. Medicare has that stupid Bush prescription plan which helps no one but you could elect to use your employer's plan for your meds.

It is the best of both worlds if you can do it.

[boomerbust]

17. I'm on Medicare

And this is what I would do. Forget about the supplementals and get a policy to cover dental and vision, which Medicare does not cover, and seems to be the most expensive yearly expenses that I pay for out of pocket.

[MineralMan]

19. Thanks for the advice. Most of the Medicare Advantage

programs include dental and vision. That'd be great, but I don't like the HMO-style structure of the plans. I'm still looking for he best supplemental insurance for my particular situation.

[MineralMan]

18. OK, does anyone have experience with any of the major

supplemental policies? I'd be interested to hear praise or criticism.

[REACTIVATED IN CT]

20. I'm not there yet myself at age 62, but lots of

smart folks I used to work for went with the AARP plan. That was several years ago, but they were all very happy with it. (They were partners in a top law firm from top law schools and I was their benefits administrator)

What you have to do is look at the A-L varieties of policies that are allowed to be sold and decide what level of coverage you want. Then look at that policy across several carriers. They have to have the same benefits, so I would be looking at premiums and the rating of the carrier at that point.

Have you read this yet ?
http://www.medicare.gov/Publications/Pubs/pdf/02110.pdf

[MineralMan]

24. My parents were on that one for a couple of years, but found

that they had to wait too long for appointments and got turned down for too many things.

[REACTIVATED IN CT]

30. How did their Medigap coverage cause a delay in getting

appointments ? Was it a Medicare Advanage plan ?

[MineralMan]

31. It was one of the Medicare Advantage plans.

My mother needed back surgery, and they wouldn't authorize it. They switched the next year to a straight supplement, she got the surgery, and her severe back problems were gone. The Advantage plans have the advantage that they can disallow stuff that's going to cost them money.

I think my parents prefer that the advantage be on their side of the court.

[REACTIVATED IN CT]

35. OK - that makes sense. The AARP also sells

the A-L straight Medigap plans. That's what the lawyers bought.

[MineralMan]

36. Thanks. I was just looking over their plans, and requested

more information. I'm going to be doing a lot of that, I'm thinking.

[Tracer]

26. I do.

I have Medicare and BCBS Medex for $91/mo.

In the past 5 years I've had a lot of medical problems. Just this past July, I was operated on again and spent 4 days in the hospital.

As of today, I have received ABSOLUTELY NO BILLS from anyone. Not Medicare, not Blue Cross, not any hospital and not any doctor.

I'd say that is pretty good.

[MineralMan]

27. Thanks. Switching to that will probably be the very easiest

think I could do, since I'm already a BC customer. I appreciate your advice.

[Blue_In_AK]

33. My mother-in-law had the AARP supplemental insurance

which didn't cost her much, and between them and Medicare they covered the entire cost of her final illness - quadruple bypass surgery and a month of extended care in the CICU. Sadly, she didn't survive, but there were no outstanding bills at the end. And her charges were over a quarter million.

[TicketyBoo]

41. Yes, I have BCBS.

But it can be so different from state to state that I doubt my input would be helpful.

As for Advantage Plans, the second or third year they were available, the guy from Humana was selling them hard. They were FREE. (They get the premium from your Social Security check which normally goes to the government for Medicare). I had been on Medicare for several years, so I asked him to compare the coverage to this feature or that feature. He said confidently, "Forget everything you know about Medicare!" That right there was enough to convince me to shy away from Advantage Plans. I called my eye doctor (I go every month), and his bookkeeper, the gal who does the paperwork for Medicare, said that almost all of their patients who had it were going back to Medicare because of the co-pays they required.

I'm sure that every Advantage Plan is different, but they evidently do not have to go by Medicare rules. And that "Free" Humana plan isn't free any more. They get you hooked and figure you'll never change, and for a lot of people, I imagine they're right.

The Part D drug plans are sneaky, too. You have to reevaluate the plan each year because the coverage changes, and what's right for you this year may not be right for you next year, even if your medications don't change. It's kind of a shell game, and you have to figure out which of 40-some plans (in our area, at least) holds the pea. It's not pretty, but it's better than nothing.

[MineralMan]

45. From my understanding, I can use my VA benefits for prescription

drugs, as long as I go to their center to buy them. I'm still looking into that.

[PatSeg]

55. Medicare has an incredible website

You can put in your information and it compares all the plans for you. I was very impressed.

[Tailormyst]

21. You should send that to your local paper.

[MineralMan]

23. Too long for them. It's on my O So Minnesota blog, though, and

that gets quite a bit of traffic.

[jpak]

25. Deal with it - the Kill-The-Bill crowd has done it's work and this is what we ALL

will have to deal with from here to eternity...

[MineralMan]

28. I'm not convinced of that, my friend.

I'm thinking an entirely new approach is what's needed. Something simple, and easy for everyone to understand. Something like Medicare for All. Everyone can understand that one, since everyone knows someone on Medicare.

You can give up, if you wish. Not me.

[jpak]

32. Don't get me wrong - I want Medicare for all, but political reality is that

getting there will not be easy and or transformational.

incremental - yes

messy- yes

I know that might disappoint lots of folks that want change yesterday, but that is the way of the world...

[MineralMan]

34. Progress is always that way. Always has been.

Being a successful progressive means you're patient. Otherwise, you burn out.

[dflprincess]

50. How would the current insurance scam Congress is pushing

keep us from having to deal with this? We'll still have "coverage" from private insurers until we're old enough for Medicare and then we'll still have to buy Medigap coverage.

Unless, of course, Rahm and his brother Zeke get their way and do away with Medicare completely. Then we'll all be stuck with nothing but the private, for profits until we die - or run out of money to pay the ever increasing premiums we'll be charged.

[Ignis]

29. K&R

The system is so ridiculously broken, and it leaves consumers/citizens/voters feeling like they have no one on their side.

This is why people are going to stay home in droves in 2010 unless we pass real HCR.

We don't need a band-aid. We're bleeding out. Help us!

[TicketyBoo]

37. "Can we sell this?"

No.

It's exactly what I've been writing to my Senators Nelson and (Republican) Johanns, but I didn't stop there. I wrote to Lieberman, Baucus, Landrieu, and Lincoln, too. And maybe some I've forgotten.

The bureaucracy is already in place to administer it, cutting startup costs to nil. Of course, it would have to be expanded enormously, but it would still be cheaper than that 2,000 page of crapola that would have to be implemented with this new plan.

It makes too much sense for it to happen, I guess. Government has to make it complicated.

[laughingliberal]

40. K & R nt

[TicketyBoo]

43. See why people LOVE Medicare?

I admire you for being able to pay those enormous premiums. I couldn't have done it.

[MineralMan]

44. I can't do it, either, frankly. I have just one more quarterly payment,

which, like the last one, will be paid for with a cash advance on a credit card. Nobody can afford those rates. Nobody. It's obscene.

When I go on Medicare, it will be like getting a $500/mo. raise.

We must do something about this. We must!

[TicketyBoo]

52. Won't they accept actual credit card payments?

Most companies will accept automatic payments via credit card, at the very least. It'd be cheaper than paying cash advance fees.

[amborin]

46. you should get the colonoscopy asap!

[The Straight Story]

47. Well now they only have to cover 20% vs 80%, and that is on a reduced amount

Since, I am guessing, bills to medicare are negotiated lower.

So they have to pay 60% less, not including how much less the negotiated amount is - so maybe 70% less in total.

Kick in some tax benefits they might get....and they will still turn a profit from you :)

[Name removed]

49. Deleted message

Message removed by moderator. Click here to review the message board rules.

[bertman]

51. That's good information, MM. I'm not far behind you so I'm gonna start studying up

on the options. (Not that I'll ever get to 65 if I keep getting so worked up over the way our Democratic party is failing us).

Thanks for posting this. Rec.

[emsimon33]

53. Yep, you got it in a nutshell!

Excellent explanation.

[stubtoe]

54. This is brilliant. Thank you!

Bookmarking, K&R, etc etc.