bureaucracy

Just shoveled a couple more piles of bureaucratic grief off my desk, finally. I’ve put off dealing with Medicare Part D and Medigap insurance, mostly because after the interminable hassles entailed in getting free of state service, I’ve developed quite the flinch reflex about filling out forms. The mere thought of having to fill out another form makes my gut clench. And the prospect of having to navigate still more bureaucratic shoals gives me a headache. Put them together: you get a case of insomnia that would keep Dracula awake at noon.

With the “have to go to class now” excuse mooted by spring break, this morning I forced myself to return to the Medigap application from Mutual of Omaha, an outfit that, from what I can tell, is among the least rapacious of the insurers selling these products in Arizona.

As you might guess, I’m less than fond of medical insurance companies. Several hellish experiences in the past have led me to regard the health insurance industry as the Evil Empire of Bureaucracies. Contemplating a DIY transaction with any of the dark angels that inhabit that place gives me the willies. When Mutual of Omaha’s application arrived in the mail, I glanced over it and then set it aside on my desk, where it’s been gathering dust and sinking beneath the steady sprinkle of still other pieces of paper I don’t want to handle.

But it wasn’t as horrible as I feared. Though the form was six crowded pages long, two pages didn’t apply to me, and so trudging through it consumed only a half-hour or 45 minutes. The worst part was having to sign a form giving the insurance company access to all my private medical records, no holds barred. Sign, wretch, or it’s no Medigap coverage for you! I just hate that. Once I had an insurance company demand that my doctor hand over twenty-five years’ worth of notes on every consultation and treatment I had ever had with him or any of his partners. As you can imagine, I found that deeply offensive. I still find it deeply offensive. Yea, verily, I find the entire lash-up that is the U.S. healthcare system deeply offensive.

Anyway, off it went. That will set me back $91 a month.

Next, it was on to the Medicare Part D (Prescription Drug Coverage) conundrum. After you’ve figured out which of the rapacious insurance companies will provide you with a Medigap policy (which covers the very large holes in Medicare Parts A and B) at the least extortionate price, you are required to sign up for Part D, another pushmi-pullyu program that tries to make up for traditional Medicare’s lacunae.

Healthy as a horse? Don’t think you need it? Well, screw you! If you don’t sign up the instant you become eligible for Medicare but instead wait until you think the chances of illness are higher, then you’re charged a stiff fine. So it’s get on the boat now or pay through the schnozzola for the privilege of swimming out to the boat later on.

As with Medigap, a mob of insurers offers up Part D policies. Coverage is pretty much uniform, but monthly premiums range from around $10 a month to over $80 a month. Because Medigap and Part D are regulated by the federal government, the plans offer the same general features. As far as I can tell, the major differences are the deductibles, the rules governing which meds you may and may not have, customer (dis)service, and the ways individual companies find to maximize the cost of meds for the customer.

Mercifully, the feds have a site that will conjure up a table comparing aspects of all the Part D providers in your state. When I said I was 65 and about to start Medicare in Arizona, this site disgorged details on 44 outfits selling insurance here. Ugh!

To compare these details, you have to call up a separate page for each company, wherein you find all sorts of microscopically printed information. It does allow you to compare apples with apples, but the chore is not easy. To simplify matters, I picked a half-dozen that looked like they had relatively decent customer satisfaction (reviews are rated, Amazon.com-style, with one to five stars; for Arizona, none achieved a five-star ranking overall and only a couple made it to four). The “details” pages break the ratings down into four categories: customer service, complaints, a vague “member experience,” and drug price and safety. Several other issues are also presented in more detail.

On the surface, dizzying. To arrive at something like a meaningful guess at a reasonable choice, I set up an Excel spreadsheet. In it, I created columns for the monthly premium, the government’s estimated total monthly cost for a typical well customer and for someone who suffers a serious illness, the deductible, and the four ratings categories.

Strangely, the premium bears only vaguely on the probable cost of medication for a serious illness, such as a heart attack or congestive heart failure. With most policies, the overall monthly cost of such an ailment ranges from $150 to $200. That’s not always true, though: if you’ve subscribed to Aetna’s $82.20/month policy, a major illness is likely to cost you $200 to $250 a month.

Once I’d entered the data, I sorted it by several criteria. Click on the tables to see them in a readable font size.

The results, I think, helped to clarify matters. On the lower end, where monthly premiums are vaguely within reason, the annual deductible is, with one exception, an astonishing $310. This means, of course, that if you’re healthy and, like me, take no medications, or even if you take only one or two in generic form, you’re paying for air: most of the time your costs will come in way under the deductible. Paying more to get out of the deductible pushes your monthly overall cost so high (as, for example, in the pricey Aetna plan mentioned above) that you’d lose unless you had a very expensive chronic condition like Parkinson’s or MS.

Interestingly, the plan sold by AARP, which vaunts itself as the champion of the elderly, ranks rather low by most criteria.

An outfit called Wellcare consistently comes up with good to high ratings. It does especially well in the important categories of performance ratings and of drug safety and cost. This company offers two plans in Arizona, the “Classic” and the “Signature.” From what I can tell, the only difference is that the “Signature” plan has no deductible. When you compare the two plans’ overall monthly cost, you discover that even though the no-deductible plan will run you $15 a month more than the plan with the $310 deductible, the plans’ overall monthly cost is almost identical. So basically, you can expect the same results from the $20/month plan as you can from the $35/month plan!

So, though I have yet to go out on the Web to read consumer complaints, I’m leaning toward the Wellcare Classic. The cost is on the low end, but apparently service and coverage are about the same as the higher-end Signature policy. Customers are better satisfied with Wellcare than with most other vendors: the performance rankings put it second behind the pricey Medco, but only by a quarter of a point. Wellcare is the only one of our selected companies to achieve 5 points in any category—and it does so in the important matter of drug safety. (You understand, these outfits are capable of dictating what drugs you can take, and they do so on the basis of cost, ignoring potential side effects and interplay with certain chronic ailments like diabetes.)

Once all these plans (not to say “schemes”) are cobbled together to provide adequate healthcare coverage, the cost is astonishing.

Medicare Part B will cost me $110 a month. People who are already enrolled get no increase from the 2009 premium of $95; those who come on board in 2010, however, get an inflation gouge even though, like other beneficiaries, they get no commensurate increase in Social Security. Medigap: $90.80 a month. Medicare Part D: $19.70 a month. Total: just over $220 a month for starters.

I do understand that many people are paying a much larger gouge to cover one person. But still… Compared to the $36 a month I’ve been paying for the same coverage with no deductible and with only modest copays, it looks pretty stiff.

And to figure this stuff out, you end up taking a swan-dive through the Looking-Glass. I fail to understand why it’s necessary to make this business so complex, so difficult, and so scattered that you have to build a freaking spreadsheet to parse out your best choices!

Despite regulation that is supposed to guarantee uniform coverage, it has taken hours of analysis and puzzlement to identify Medigap and Part D policies that look like they won’t cheat me and appear to provide tolerable customer service. The whole process has been confusing and difficult…and I think I still have most of my marbles.

Imagine the confusion this mess creates for less educated or more vulnerable elders—and the opportunities to prey on them! It’s just effing inexcusable.

Update

“Inexcusable” about describes it. The plot thickens: as it develops the government’s opaque site dispenses information most kindly described as incomplete. Check out the next revelation.