Private Fingers in the Medicare Pot

A thousand curses upon the craven politicos who decided that private industry should get its sticky paws on anything related to Medicare. What a freaking mess! And it’s like this not because of the “government” the right wing so loves to hate but because of the programs that are run by private insurance companies.

No amount of federal regulation stops these SOBs from putting the screws on the customers.

A quick refresher course in the complexities:

Medicare consists of five programs. Medicare Part A covers hospitalization, hospice, and (in very  limited circumstances) some nursing home and home-health care. Medicare Part B covers doctors’ visits, some other types of health-care providers, outpatient care, durable medical equipment, home health care, and some preventive care. Each of these programs pays 80 percent and the patient pays 20 percent. Medicare Part C is a scheme roughly equivalent to HMOs and PPOs that strictly limit one’s choice in providers — something that can be very dangerous if you think you need a high-powered specialist and some insurance clerk says otherwise.

Obviously, 20 percent of the bill for catastrophic care or for a serious long-term disease such as cancer, MS, Parkinson’s, Alzheimer’s, or diabetes would quickly drain the savings of most elderly Americans. And since we all have to die of something, if you don’t go in an accident or by your own hand, chances are very high that the medical industry sooner or later will pauperize you. In the case of a married couple, this will mean that by the time one person dies, the other will be reduced to the most desperate kind of poverty, no matter how faithfully they have saved to support themselves in old age.

So, you’re pretty much forced to buy extra insurance, issued by private insurance companies, to fill in the gaps presented by traditional Medicare. This coverage is called “Medigap” or “Medicare supplemental insurance.”

You also are forced to buy one of the newer policies known as “Medicare Part D,” which supposedly covers prescription drugs but in fact covers almost nothing. A Republican scheme passed in 2003 and shepherded through Congress by a Louisiana representative who soon afterward retired into a $2 million-a-year-job with Big Pharma’s main lobbying group, Pharmaceutical Research and Manufacturers of America, Part D is one of the biggest rip-offs this country has ever seen. It seems to exist solely to clip the taxpayers and old people. George W. Bush’s Medicare administrator, Thomas Scully — now a lobbyist for the health care industry and general partner of an equity firm that invests in health care — threatened to fire Medicare’s chief actuary if he reported how much Part D actually costs the government. Medicare is forbidden to negotiate drug prices, a strategy that saves the Department of Veterans’ Affairs between 40% and 58% on its clients’ drugs. Between 2006 and 2013, this caused Medicare beneficiaries to spend an estimated $332 billion to $563 billion more than necessary.

My Part D carrier disallowed most of the generic drugs my doctors have ordered over the past 18  months and would not cover the full freight on the rest. To fill a prescription, you have to get prior approval before your doctor writes the prescription.

Once you’re in a Part D plan, you’re pretty well trapped in it, whether you like it or not. You’re allowed to disenroll or change carriers under very limited conditions, and — get this! — if your carrier stops covering a drug you need to take,  you can’t change to a carrier that will cover it!

That 85 percent of Part D patients claim to be satisfied with the scheme proves only that you can fool all of the people some of the time and some of the people all of the time.

If you are not permanently “on” some drug — as, for instance, I happen not to be — the monthly $20-plus premium pays for air. I would have been better off without Part D, because I could have purchased the antibiotic for the bronchitis, the steroid for the bronchitis, the double-strength omeprazole and sucralfate for the GERD kicked off by the steroid, and the muscle relaxant for the back pain cheaper had I been able to enroll in Costco’s cost-saving plan. But I’m not eligible for it or for Walgreen’s similar plan because, in cahoots with Big Pharma, by law these plans have been made off-limits for Part D customers.

However,  healthy Medicare beneficiaries decline to enroll in Part D at their peril. When (not “if”) you come down with some serious, expensive ailment, the cost of chemotherapy or meds for typical old-age hazards such as Parkinson’s could easily bankrupt you. And if you do not enroll when you become eligible at age 65 but delay until you’re more likely to need the coverage, you are gouged a penalty for late enrollment, in the form of permanently inflated monthly premiums.

Part C, which is an option, rips off the taxpayer with élan, to the enormous profit of the insurance companies that run the plans. Part C plans, which operate like HMOs, appear attractive to Medicare beneficiaries because they offer services like vision and dental care that are not covered by traditional Part A & B Medicare plus Medigap, and because at the outset they provided prescription drug coverage (the advent of Part D canceled that). The payment formulas overpay Part C plans by 12 percent or more compared to traditional Medicare. By 2006, these HMO plans had proved far more profitable to insurance companies than projected, at the expense of administrative costs that are far higher than traditional Medicare.

In summary: Part A and Part B (“traditional” Medicare) pay exactly as advertised, with no hassle. Traditional Medicare is rather expensive: $104/month (almost five times what I paid for better coverage through my former employer); it only covers 80% of your costs; and it does not cover prescriptions or long-term care. To take in the slack, you have to buy additional coverage from private insurers that jack you around and charge you through the wazoo while collecting money from the government for the privilege.

Okay. Now for the rant of the day.

Saturday comes in the mail a notice from Mutual of Omaha, the outfit that carries my Medigap coverage, a notice that my premiums are going up “due to the rising cost of healthcare.” Yes. My Medigap insurance will increase by $400!

“Please be assured,” we’re told, “that you are not being singled out for this increase; the premiums for all customers with coverage like yours are being adjusted.”

There’s a story I’ve heard before: when I carried my own insurance for a time. If you make claims on a policy, your premiums go up forthwith. Companies get away with this, even though it is illegal to raise your rates or cancel your policy because you made a claim, by assigning customers to relatively small groups, so that if one or two people in that group should have a spate of illness, everyone in that small group gets their premiums increased. This allows the company to claim it’s being “fair” while dumping customers whose care is beginning to cost something.

This increase comes as President Obama caves to the Republicans by cutting cost-of-living adjustments for Social Security beneficiaries. Ducky.

So now I need to find a new Medigap carrier.

Finding reasonably priced Medigap coverage is an astonishing horror show.

There’s only one given: each of the fourteen plans (designated A through N) has to offer the same benefits, and insurance companies are not allowed to screw with those guidelines or to deny the services specified in each one.

Otherwise…it’s raw chaos.

Rules are different in every state. So different insurers make different plans available in different states, at different rates. Availability of plans and their costs vary by county. Companies charge what the traffic will bear, and so rates for identical policies can vary by as much as $150 to $200 a month. For example, in Maricopa County the lowest price for a Part F policy issued to someone in my age range is about $137; the highest is $338. And there’s no difference in coverage!

The only way to find the rates available to you is to access a long, incomprehensibly complicated document issued by your state’s insurance department. To find the cheapest plan available to Arizonans, you have to download a FORTY-EIGHT-PAGE BOOKLET. This PDF provides each company’s rates for each of the 14 plans in the various counties within the state. Some insurers offer some plans but not others. Some insurers offer certain plans in some counties and not in others. Prices in rural counties are usually lower than prices in Maricopa and Pima counties, where the cities of Phoenix and Tucson reside. But this is not consistent. Nor is it in any way helpful.

In Arizona, FIFTY-FOUR COMPANIES offer Medigap policies. Every one of them offers the same effing policies for different rates scattered over two pages of figures. To figure out which one is cheapest, you have to sift through 42 pages of figures listed 7 columns to the page.

Once you’ve parsed this out, then you have to find out

a) how the company is rated (is the damn thing about to go belly-up?); and
b) whether they’re even still offering the plan, because some of them quit after the booklet goes to press.

Then you have to track down a phone number for whatever outfit you select to provide this coverage. Then you have to make your way through the infuriating phone trees and jump through hoop after hoop after interminable hoop to find out what they really charge, which is different from what the Insurance Department booklet says.

Last night it took me four hours to identify the dozen companies that claim to offer premiums lower than the new gouge from Mutual of Omaha.

I’m now paying $128 a month. After the increase,  I’ll be paying $165 a month.

Here, on a preliminary basis, are the companies that charge no more than $165 a month but are likely to charge me, at 68, less than that:

Some of these providers are outfits that no one ever heard of. So, before you start calling insurance companies, you have to track down their ratings, to see if they’re stable enough to be around over the next year or two. To do this, you can go to one or more of various rating agencies, such as A.M. Best or Standard & Poor’s.

So we’re told. But in fact, to look up an insurance company at some these agencies, you have to be a member! At Standard & Poor’s, you can look them up and be damned — many searches return a “not found” message, and those that are rated have so many tentacles you can’t figure out which one you need to know about.

This means you have to call your insurance agent — if you have one — and ask him or her to look up ratings for a dozen candidates.

My insurance agent, who has been a godsend, does not deal with Medigap coverage…for obvious reasons! Another guy I know who does claim to address Medicare referred me to a woman who tried to high-pressure me into a Part C plan; when I told her I did not want a Medicare Advantage plan, she persisted, even to the point of trying to tell me things that are untrue and that federal law specifically prohibits agents from claiming.

So in addition to the mind-boggling complication, the whole process is a minefield of scam operators trying to take advantage of confused and frustrated senior citizens.

It is just a freaking nightmare.