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Health care

The High Cost of AARP Delta Dental

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Well, I expected the AARP Delta Dental plan I enrolled in last December to cover little more than the occasional cleaning, which, when paid for out of pocket, is $93 at my dentist’s office. But what I didn’t expect was to have the plan effectively land me in a hole that would take two years to climb out of.

Here’s how this comes to be:

You pay $450 a year for dental coverage. Each year, this is supposed to give you three “free” cleanings—each of which costs you a $20 copay. After a full year’s waiting period, you’re eligible for a discount of about 50% on crowns and other expensive procedures. However, in addition to the waiting period and the copays, there’s a $100 deductible that has to be met before even a routine cleaning is covered.

I need a new crown to replace an ancient one that’s been broken for years. Delta will not cover a crown until you’ve been in  the plan for a full year.

So, to arrive at the point where you can replace a broken crown, you have to spend $450 for the first year’s premiums, then re-up for another year, to the tune of another $450, and pay $200 in deductibles. Then, the most that will be covered for the crown will be half the price. Think about that.

My dentist charges $1,150 for a new gold crown. His charge for a routine cleaning, which one would normally do twice (not three times) a year, is $93. Over the course of two years, then, a patient with decent dental health but who needs an old crown replaced would pay $1,522 for cleaning and a new crown. What would this cost if you purchased AARP’s Delta Dental coverage, compared to what it would cost if you were uninsured?

Interesting. You pay $233 more for the same services and products, and for the privilege of having to wait a full year to get your crown fixed. The cost to get the crown plus routine medical care, if you just decided to pay for it, actually would be $186 less (i.e., $1,336), because you wouldn’t have to wait a year to be eligible for the Delta’s 50% discount.

Clearly, you’d be ahead to simply put aside $450 a year in a fund dedicated to paying dental bills. Assuming, that is, that you have decent dental health—no gingivitis, cavities, or teeth about to fall out of your head. If even a single year passed without a major dental event, the amount that would accrue in savings ($714) over the two years you have to subscribe to be eligible for coverage on a crown would cover two-thirds of the crown’s cost—not the measly 50 percent (if you’re lucky) that Delta covers. At the start of year 2 (assuming you fund your savings with a lump sum), you would have $714. If the second year passed with no dental crises, then at the start of year 3 your dental savings fund would have a beginning balance of $978.

Hmmm….  Makes the $50 tab for that Braun electric toothbrush that really keeps your teeth clean look like quite a bargain, doesn’t it? It pays to take care of your teeth!

I just canceled the Delta Dental plan. Since I signed up for it in December, even though I’ve never used it, they’re gouging me for premiums through March.

If you’re retired, think twice about Delta Dental! And remember, just because a product has the AARP brand associated with it doesn’t necessarily mean it’s the best choice for you.

Bureaucrats and the Workman Waltz

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Another monthly bill just arrived from Wellcare, the provider of my Medicare Part D (prescription drug) coverage. For the second time in our year-long relationship, they announce that I owe not one but two payments at once.

What’s happening here is Wellcare wants direct access to my bank account. They want me to give them my account number so they can engross monthly premiums whenever they feel like it. When I point out that I can EFT the money to them through my bank, they try to say my only alternative to letting them into my account is to pay by check, which I do not care to do. When I push back, I’m told well, yeah, sure I can pay by the credit union’s BillPay function, but it won’t post for a week or so, which means I have to pay well in advance.

O.K. That’s what I’ve been doing. Wellcare bills a month in advance. On January 10 I EFTed the February bill, which was due February 15; it cleared my account on January 12. How do I know it was actually the bill they claim is unpaid? Because they jacked up their premiums by four bucks, and last month’s bill was the first at the increased price. So I know that payment cleared my account, a month and three days before the due date.

Fortunately, their phone lines (presumably to a call center somewhere on the far side of Malaysia) are open until 2:00 a.m. EST. Sooo….

One ringie-dingie…two ringie dingies…about 40 ringie-dingies’ worth of  climbing around the aggravating phone tree…

And we reach a human being with a distinct but unidentifiable accent and a voice that makes her sound about fourteen. This is entertaining.

After making a pass at trying to suggest I must have missed last month’s bill, she caves at the revelation that the payment that cleared my account was for $23.80, not the prior premium amount of $19.70, and she allows that yeah, they received it.

Now she attempts to explain why they sent a bill demanding $47.60 even though they received my last payment on time. Her ever-so-slightly fractured English delivers an explanation along these lines:

The reason you were billed twice is that your last bill was sent out before you made your January 12 payment.

{moment of silence}

“Wait. Let me get this straight:

• You send me a bill.
• When I receive the bill, I pay it.
• Because I pay the bill promptly after I receive it and not before I receive it, I get double-billed on the next statement?”

“No, no! that’s not it,” says she. “It’s that the bill you have right now was printed before we posted your last payment.”

“Ah. Yes. Of course. I understand.”

Hee heeeeeee! I personfully refrain from remarking that maybe they shouldn’t assume, a month and three days before a bill is due, that they’re not going to receive payment.

Hilarious!

Well, in the same envelope came an announcement that they’re dispensing with monthly statements and sending coupon books, which makes so much sense a person wonders why on earth they haven’t always done it. Actually, one wonders why Wellcare won’t let you pay a year or six months at a time, as the Medicare Part B insurer does. Wouldn’t that a) put a heckuva lot of subscribers’ payments in their investment accounts in advance of a heckuva lot of due dates and b) eliminate a surprising amount of paperwork and hassle for all involved?

So that was a fun way to expend some time. The only thing more amusing is the Workman Waltz.

This morning the roofer had tons of asphalt shingles piled on the ridge of my roof and, while I was taking a 7:30 a.m. walk with La Maya, had a vast dumpster dropped on my driveway. I’d asked to have it put as close to the west edge of the driveway as possible, so I could get my car out. What I didn’t realize is how huge the container would be. There was no way I could squeeze my car past it, even if it weren’t placed so close to the eaves that I couldn’t open the garage door.

So the minute I shoot into the house, it’s on the phone to the roofer. He calls the trucker back, and they good-naturedly move the damn thing so I can remove the car from the garage and park it on the street.

Yesterday, when plans for this dance were being laid, RooferDude said he was going to have his crew rip off the existing shingles today, unless it was raining. I pointed out a 30 percent chance of rain was predicted for today, and I didn’t want the roof removed if it was gonna rain. He agreed that they would put off the job until Tuesday, by which time the rain was expected to pass and a freeze warning would be in place.

So with the car parked on the street, I’m sitting here building next summer’s freshman comp courses, when Cassie starts to bark at some mysterious thumping. Look outside thru the windows. Trucks.

A half-dozen Mexican guys are on the roof, getting ready to prize off the shingles. Weather report says there’s now a 40 percent chance of rain today; I put it at 100 percent, since La Maya and I got sprinkled on while we were circumnavigating the park. I trot outside and ask them what they’re doing, because their boss said they weren’t supposed to be here today.

One, and only one, of the men speaks fluent English. He says, “Well…well, but it’s not raining.”

I say (stepping around a container of salsa someone has dropped and left spilled all over the middle of the accessible part of the driveway), “Well…well, but it’s GOING to rain. And I don’t want that roof torn off there when it’s just about to rain and we’re supposed to get thunderstorms!”

“I’m calling the boss!”

“Bueno.” I go inside and dial up the boss, too. He doesn’t answer my call, but apparently the crew foreman gets through; he tells them to stand down. They climb off the roof and go away, bearing the busted-open salsa container, which I placed in the back of one of their pickups.

An hour or two after they left, it rained. Pretty generously…certainly enough to cause a leak, if they’d pulled off the shingles and not nailed down enough plastic tarp to cover half of Disneyland. So far, none of the high winds and pyrotechnics one expects with a Sonoran Desert thunderstorm have come up. But the night is young.

And dark. My car is parked on the street out in front of my house, about as vulnerable a spot as you can find this side of the parking lot at the nearby Metrocenter Ghost Mall, which has the highest rate of car theft and break-ins in the city. One leaves one’s car parked outside around here at one’s peril.

RooferDude says he’ll have the job done in a couple of days. We’ll see about that.

Image: Songbird Perched on an Asphalt Shingle Roof. TriviaKing. Creative Commons Attribution-ShareAlike 3.0 License.

Best Guide to the Medicare Maze

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If you or someone you’re close to is about to walk into the labyrinth that is Medicare, take a look at the December issue of Consumer Reports, now on the newstands. This month CR is running the best, clearest guide to Medicare I’ve seen to date.

Medicare’s rules are astonishingly complicated and booby-trapped with land mines. The government and a vast slew of vendors send you hundreds and hundreds of pages of information and sales pitches. As well-intentioned as most government writers are, the copy they pour out is verbose, involved, sometimes contradictory, and often impossible to figure out.

CR has boiled the entire mess down into two pages of do’s and don’ts. Their article explains why you should get signed up for Medicare before you turn 65, how Medicare Part B works and what will happen to you if you fail to sign  up in a timely way, how to avoid being screwed out of Medigap coverage—and why you really need it—and what the advantages and disadvantages are of Medicare and Medigap.

It’s crystal clear, easy to understand, and mercifully brief. This thing should be offprinted and sent to everyone who’s coming eligible for Medicare.

Hmh. I’d forgotten how much I enjoyed Consumer Reports before I let the subscription lapse. Now that I’m feeling flush again (sort of…), maybe I’ll re-up. It’s a useful resource for the frugalist and the wily consumer. If you’d like to subscribe, you can click here to subscribe online at the same rate the magazine is offering on its blow-in cards. Come to think of it, those of us who are running monetized PF blogs ought to be able to write off the cost as a business expense.

🙂

Back to the Future…

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{sigh} We have seen the future, and it is…the Dark Ages. The Party of No has wrested control of the U.S. House of Representatives from the Party of the Half-Baked. No hope for relief from the metastasizing mean-mindedness and outright viciousness that have invaded our body politic is to be found, anywhere.

Here in Arizona, voters have approved a measure that exempts citizens and businesses from the national healthcare plan. The comically moronic Governor Jan Brewer (she of “uhhhhhh………..tee hee!……..uhhhhhmmmmmm”) was re-elected, of course, and the craven pol who presided as superintendent of public instruction while Arizona’s school system sank to the bottom of the national rankings is now, God help us, the state attorney general.

Now I’ll have to say, I wasn’t pleased with Obama’s healthcare plan. Without a national option, it’s just another iteration of what we already had: it threw us into the lion’s den with a pride of hungry insurance companies. We needed an option to make something like Medicare available to everyone who wished to accept it. Medicare is expensive — even after the state’s insurers raised their rates, my employee plan cost an eighth of what I’m paying to be fully covered under Medicare. However, for what I’m paying, coverage is better. If I fall ill and have to go doctors frequently, my overall costs will be much lower. Requiring everyone to sign up for full coverage with private insurers while blocking insurers from shafting people who really need care simply guaranteed that everybody’s costs would go up, coverage would be no better than what we have, and the well-heeled insurance industry would be joined by every other well-heeled industry in mounting a no-holds-barred campaign against the Obama administration.

Accepting compromise on healthcare was stupid. If the Democrats couldn’t swing a national healthcare option, then they should have dropped their plan until they could.

As for the Afghanistan mess: We were in Afghanistan long before Obama came along. Matter of fact, it seems to me we entered the war in the Middle East because a certain pack of lies emanated from a previous administration. Afghanistan was where the perp was hiding, but instead of going after him, we took it upon ourselves to depose a dictator who was formerly our ally, not because he was much of a threat but because, said our then-President, “This is the guy who tried to kill my dad.”

So…now we have in office some folks who think it’s acceptable to stomp on the head of a woman who disagrees with their doctrine.

Time to get out our brown shirts and iron them. And if you still believe you’re in the middle class, say good-bye to all that.

Gotta love those insurance companies…

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Wellcare, the outfit I selected (among dozens) to handle my Medicare Part D insurance—that’s prescription drug coverage—just sent me a package to plow through: TWO HUNDRED AND TWENTY-FIVE PAGES of dense, incomprehensible copy to try to figure out!

The booklet you’re supposed to start with, which explains annual changes to the plan, is twelve pages long. Apparently every single year you have to study all this garbage, try to decide if you can live with the changes they’ve come up with, and, if you can’t, try to find another insurance company whose terms you can live with, if any such thing exists.

This year they’re raising the prescription drug coverage from $19.70 to $23.80, or $285.60 a year.

That doesn’t sound like much, except for the fact that you don’t get much for your $285.60 a year. The yearly deductible is $310, so in fact before this thing starts to pay for prescriptions, you pay $595.60 out of pocket. Then it only covers $2,840 until you reach the “doughnut hole.” When your prescriptions have racked up a $2,840 bill (easy to do if you have cancer, diabetes, MS, Parkinson’s, or any of the numerous other ailments of old age), then you’re screwed. You then have to cough up $4,550 for your meds, at which point you reach what Congress in its wisdom has decided is the “Catastrophic Coverage” stage. Then you pay $2.50 for the drugs the company approves, $6.30 for brand-name drugs (many drugs do not come in generic form, you know), or 5 percent of the total cost. Again: Five percent of cancer drugs could add up to one whopping bill.

So really, you’re paying almost $600 for what amounts to only $2,840 worth of coverage. For the cost, it’s very chintzy.

All these plans are about the same: they’re required to provide approximately the same coverage with about the same terms. So, buying a more expensive plan won’t help you, except insofar as some plans apparently are a little more or a little less generous about what types and brands of drugs they’ll cover.

To figure out whether anyone else is offering a comparable drug plan for a lesser price, I’ll have to get a ten- or fifteen-page list from the state SHIP department, plow through that, negotiate telephone punch-a-button mazes to order up information from several insurance companies, and then plow through thirty- to forty-page piles of paper from each of those. Like I have time to do that, and like I could understand what any of that verbiage means, anyway.

Medicare Part D coverage is highly restrictive. To keep you from understanding exactly how restrictive it is, insurance companies have set up a complicated four-tier system involving generic, “preferred generic,” “preferred brand,” and “nonpreferred brand” drugs. It is so baroque as to be incomprehensible. According to the booklet my company sent, some drugs, apparently chosen arbritrarily, can cost you nothing if you order them from WellCare’s pharmacy. Once you start ponying up cash or daring to do business with the nearest drugstore, though, the least you will pay is $36. Yes: per prescription.

Some generics and “preferred brand” drugs can cost you $123 per prescription! Then you get to the Tier 3 “generic and nonpreferred brand drugs,” where you’ll pay $282 per prescription!

Think of that: $282 for a bottle of pills.

To further confuse matters, they move drugs from tier to tier. This year, we’re told, “Some drugs will be in a lower cost-sharing tier; others will be in a higher cost-sharing tier.” So, if you have a chronic disease, chances are you’ll have to change drugs once a year as the companies jack up the cost by moving them up a tier or two.

Evidently they’re supposed to give you some sort of discount on drugs once you tumble into the doughnut hole, but that’s not evident in the 12 pages of daunting gobbledygook in the summary booklet. It says here that the new healthcare legislation, which our Republican friends are campaigning to get rid of, “continues to close the coverage gap, or ‘doughnut hole,’ by reducing the percentage of cost-sharing for beneficiaries in the gap. Effective January 1, 2011, drug manufacturers will provide a 50 percent discount on brand-name drugs and the government will provide a 7 percent discount on generic drugs for those who fall into the coverage gap (Sec. 1101, HR 4872). This is in addition to a $250 rebate, effective in 2010, for beneficiaries who reach the coverage gap.”

All very nice, but it doesn’t change the fact that the doughnut hole amounts to $4,550 and that if you get seriously ill, which all of us will unless we drop dead of a heart attack or are killed instantly in a car wreck, you’re going to be out the cost of your premiums plus the cost of your deductible plus the vast out-of-pocket costs of the doughnut hole. For my modestly priced plan, that would amount to $5,146, not counting the costs of copays ranging from $12 to $235 per prescription.

What we have here is one real good reason why I don’t want to go to the doctor for my bellyache. Don’t know what I’d be getting into…and if it’s anything that requires a lot of drugs, well…

After a month and a half of general misery, I’m pretty sure that whatever is ailing me is probably serious. If it weren’t, it would have passed by now. But with Social Security confiscating an entire month’s benefit—$1,275 gross, $975 net—after my having struggled through a whole summer without enough income to cover my expenses, I’m flat broke. I simply do not have money to pay for doctors and drugs.

What this partnership with despotic private insurance companies actually insures is that seniors will delay going to doctors as long as they can. That actually pushes up costs, because by the time you get to the doctor whatever is ailing you will have reached an advanced stage, which will cost more to treat.

Some puppies are pleased that we lazy, greedy old bustards who oughta get a job won’t see a cost of living increase from Social Security in 2011, for the second year in a row. WellCare’s premium is the smallest part of my Medicare bill. If it’s gone up $4, you can be sure the much more expensive Medigap policy will go up even more. I’m already ponying up $90 a month (God only knows what it’ll be in 2011) to another private plan to cover the many lacunae in the government plans (Part A and Part B), and Part B itself, costs $111 a month for rather skimpy coverage.

With Part D, you have the option of taking a chance that you won’t get sick and won’t need a lot of drugs before you croak over. There’s no law that says you have to buy Part D coverage. (If you think the game doesn’t play out in favor of the table at Vegas, then by all means take this bet!)  But if you don’t get it at the first opportunity when it’s offered to you, then the cost goes way, way up: effectively, you’re punished for not buying insurance from private corporations until you think you’re actually likely to need it.

Nor is there any law that says you have to buy Part B. But you’d be a fool if you didn’t, unless you’re already so poor as to qualify for Medicaid. Part A is roughly the equivalent of major medical. It doesn’t cover much.

So far it appears the Medigap coverage works pretty well, though I haven’t used it except for the useless follow-up care for the torn rotor cuff, which I can’t afford to have repaired because I can’t afford to take a semester off my part-time job. So to date, I’ve paid $90 a month for air. Presumably next year the cost of air will even higher.

For $111 a month plus all the Medicare taxes I’ve paid and still pay on every dime I scrape together, Medicare should cover everything—without forcing beneficiaries to open their wallets wide to the rapacious insurance industry.

How to Choose the Perfect Office Chair

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This is a guest post by my friend Kenneth F. Muhich, D.C., of the Stetson Chiropractic Clinic

Is any one office chair perfect for everyone? Experts in ergonomics will tell you “no.”  The perfect office chair for you depends on many factors, such as your height, weight, posture, areas of pain, and what your chair will be used for.  How many hours per day will you be in it? And does your work entail computer, phone, or paper work?  As you can see there are many variables.

As a doctor of chiropractic my main concern is the patient’s posture.  Recent research has shown a direct relationship between many health problems and a forward neck posture.  With more and more people spending more and more time on computers, cell phones, and other electronic devices, health problems are beginning to pop up.  Some of these health conditions include disc herniations, loss of concentration, reduced immune function, and cardiovascular, respiratory and gastrointestinal problems.

Human bodies were not designed to sit in chairs for hours at a time, yet this is what our modern age has brought us five to seven days a week for six or eight or more hours per day.  Welcome to the wonderful world of health problems and premature aging.

So, since you’re spending most of your waking hours sitting in front of a desk, it’s in your interest to find the best office chair for your body. An ergonomic chair gives you the most adjustable options for your body. But these chairs have so many options to select! If you are looking for the best office chair for yourself, what are the guidelines you should use?

What is Ergonomic?

The term “ergonomics” comes from two Greek words: ergo, meaning work and nomos, meaning natural laws. Ergonomics works with your body’s makeup so the chair fits your body’s posture.

A correct office chair for you should be adjustable in many  ways to fit your body.

• The chair should rotate 360 degrees.
• The depth of the seat should be adjustable.
• The chair height should be adjustable.
• The chair seat should tilt front and back.
• An adjustment to tighten or loosen chair seat tension should be available.
• The chair’s back should tilt front and back.
• Arm height should be adjustable up and down.
• The distance between the arms should be adjustable in and out.
• The arm pivot front and back should be adjustable.
• A lumbar air pump should be available.

Some specialists in ergonomics frown on chairs with arm rests, because they may make it hard for you to get close enough to the computer. This is another matter that depends on the user’s size, body characteristics, and preferences. Each workstation problem can be solved by working with a specialist in ergonomics.

Putting Your New Chair to Work

Once you have chosen your chair and it feels great, you must integrate it into your workstation.  Although many believe that the chair you’ve chosen is the most important device in your workstation, there are other factors to consider.

The overall workstation, including chair, desk, computer, and desktop tools, can be the most modern and up-to-date in the industry, but if you abuse it, you will have health problems. With your ergonomic chair, some of these problems are easy to solve.  For example, when you sit at your workstation your computer should be in front of you.  The top of the screen should be no further than 24 inches from view, controllable by chair positioning.  Don’t forget to use a glar- reducing screen, which helps with eye strain.  Arms and hands on your board should be relaxed and just below the level of your heart. Knees should be either level with or slightly higher than your hips.  All of these can be made correct with your new ergonomic chair.

The height of your work surface should be between 24 and 32 inches. This is a variable based upon the individual’s height. Raise or lower chair or work surface to find the most comfortable position.

Now Get Up!

You have your chair and work surface perfect, right?  Now consider one other thing.

Sitting at your workstation for hours without moving causes stasis, which for individuals may mean vascular problems, muscle tightness, headaches, fatigue, and numbing of the work brain. The solution is to get a kitchen timer or something similar and set it for 30 or 45 minutes. When the alarm goes off, simply get up, walk around your workstation, and take a few deep breaths. This will do wonders for you and your job.

A proper office chair can mean the difference between a comfortable place to work that is safe, healthy, and productive or drudgery blighted with repetitive strain injuries and postural health problems.

Go find yourself an ergonomic chair and enjoy your job and a healthy life.

Images:
Aeron Chair. Public domain.
Computer Workstation Variables. Integrated Safety Management,
Berkeley Lab. Public Domain.