Coffee heat rising

Good grief! Near-disaster with Medicare Part D choice

So in the wee hours of the morning, while enjoying another spate of insomnia, I decided to kill some time looking up Wellcare, the Medicare Part D provider toward which I was leaning by the end of yesterday’s exploration of that corner of the insurance industry’s corporate bureaucracy.

I thought that  exploration was through the Looking Glass? Ah, no, my friends: that was down the Rabbit Hole!

Turns out that in 2009 the federal Centers for Medicare and Medicaid Services enjoined Wellcare from enrolling new customers in its Medicare Advantage and Medicare Part D programs because of the egregiousness of the complaints against it. Says a Florida newspaper:

Regulators cited a long list of problems: deceptive sales practices, delays with urgent customer problems, forged enrollment documents and the highest complaint rate in the nation.

The “problems” have been going on for a while. In 2007, the FBI, HSS, and the Florida Attorney General’s office raided Wellpoint’s Tampa headquarters.

In a now-unsealed plea agreement [says Wikipdia], prosecutors and a former employee said the company inflated expenditures by submitting fake documents to the state. Under some mental health care contracts, WellCare was paid a flat per-patient fee and required to spend at least 80 percent of it on care. Any leftover amount beyond 20 percent was to be repaid to the state, but the bogus expenditures allowed WellCare to keep that surplus. WellCare agreed in August to repay $35 million, its best estimate of the total wrongly kept from 2002-2006. After the raid, the company restated its quarterly and annual profits, driving down net income by $32 million, and saw its top three executives resign. No criminal charges have been announced against WellCare or its officials but investigations by Florida, Connecticut and federal prosecutors are ongoing. The Securities and Exchange Commission is leading an informal investigation, and Wellcare faces numerous shareholder lawsuits and sealed whistleblower complaints, the company’s SEC filings say.

This is one of the best that Arizona offers?

Well, hell. I’m glad I looked the company up before I got myself into its Part D plan. But damn! this leaves me right back where I started before I spent several hours of my time trying to figure out which of these hideous outfits won’t rip me off or try to keep me from buying needed drugs.

There doesn’t seem to be anyplace you can go to get a straight story about these companies. The material at the Centers for Medicare and Medicaid Services website is highly technical—there’s nothing that seems helpful for consumers. The HealthMetrix Research site addresses Medicare Advantage programs, which don’t interest me. The National Senior Citizens Law Center (NSCLC) noted in October 2009 that Wellcare still appeared in the government’s listing of Part D providers even though it was still prohibited from enrolling new customers. Very few, if any, intelligible resources are out there.

The Center for Medicare Advocacy notes,

Medicare beneficiaries, their advocates and other helpers cannot be assured that the information provided to them on the Plan Finder is accurate. They need to drill as deeply as possible into the Plan Finder tool to ascertain whether reference-based pricing and other utilization management tools apply to their prescriptions. They need to check the plan web site and contact the plan customer service line to ascertain how the pricing might work. Even then, they cannot be assured that the plan they believe to be the lowest cost drug plan for them will, in fact, provide the most coverage at the lowest cost.

NSCLC advises people to talk to their State Health Insurance Assistance  Program (SHIP). In Arizona this office is staffed by volunteers. I’ve had a couple of good experiences with those folks and one that was not so great. The last guy I got on the phone was an utter moron. He flat refused to listen to the question I was asking him and instead nattered on and interminably on with stuff that wasn’t relevant and that I already knew. Another one, a woman, was very nice and personally supportive, but when you came right down to it she just wanted to chat—what she told me wasn’t especially useful or enlightening. A third person gave me some very good information. But you see the issue: I had to call three times and talk to three different people to get a cogent answer to a simple question.

I can see I’m going to have to blow another day trying to figure this garbage out. Beyond annoying…beyond frustrating…it’s infuriating!

Nope… Money unhappens

That six-month free ride for COBRA sounded too good to be true, and, as the saying predicts, it wasn’t. True, I mean. Called the Department of Administration again today to confirm what I thought I’d heard and learned that the “six” syllable actually occurred in the word sixty, as in sixty days.

You have sixty days after canning to enroll in COBRA and start paying up.

LOL! My scheme would’ve worked if I’d been born on March 7 instead of May 7. But in the cold cruel light of reality, it fell way short of its goal.

Oh well. At least I still have the $571 GDU dumped in my account today. Now all I have to do is persuade the federal government that it’s 2009 earnings (which it is), so that I don’t get nicked on the Social Security earnings limit. Even five hundred bucks will make a difference.

Medicare is going to cost a lot of money. Relatively. Yes, I do understand that $300 a month is a microscopic droplet in the bucket compared to what some people are paying for health insurance. But nevertheless, it’s more than eight times what I’ve been paying for an excellent plan, at a time when I’ll be earning a third of what I grossed on the job. With the ARRAS discount in force, Medicare will actually cost more than COBRA!

The base cost of Medicare Part B will be $110 a month. Parts A and B cover your basic needs, but leave your pants down around your knees: it’s an 80-20 coverage with rather limited hospitalization and no prescription meds. As we all know, one serious car accident, one heart attack, one stroke and 20 percent of the resulting medical bills will ruin you financially.

To take up the slack, you have to buy a “Medigap” policy from a private insurer. These policies, which come in a dozen flavors, are standardized, so that all policies issued in any one of the 12 available plans are the same. Only three—Plans C, F, and J—seem to cover all the contingencies well. Insurers charge whatever they feel like charging, and so in Arizona premiums for Medigap policies range from around $80 a month to over $300, depending on your gender and age. One outfit charges $417 to $560 for plan J—this is for supplemental insurance!

On the low end, a 65-year-old Arizona woman will pay between $107 and $163 to get into one of those three plans. Well, at least she did last year; I can’t get my hands on the 2010 rates, but I’m sure they’re higher.

Then you have to buy a prescription drug plan—and you have to get it whether or not you take any meds. If you don’t buy in as soon as you’re eligible, you’re penalized with a whopping fine when you go to sign up later. These plans run around $25 or $30 a month, and they don’t cover all drugs nor do they cover all costs of drugs; you still get to pony up a hefty copay for most prescriptions.

So: $110 for Plan B + $110 or so for Medigap + $25 for drugs and you’re at $245…at 2009 rates. Let’s add, say, 10% for inflation, and that brings us to about $270, for the cheapest plans on the market. By way of comparison, my cost for COBRA will be $185 a month; my cost for an employer-based EPO that let me go to the Mayo Clinic was $36 a month.

I guess you can get cheaper coverage by going with an HMO, which is what Medicare Advantage is. But having watched my mother die pretty hideously in the negligent hands of HMO doctors, I’m not going that way (it’s not in an HMO’s financial interest to treat you when you have a catastrophic illness; au contraire, what works for them is to deny you’re sick until it’s too late to do a thing for you, and then to withhold palliative care).

Interestingly, AARP’s much vaunted senior-friendly plan is far from the cheapest. They charge $187 for Plan C, $190 for Plan F, and $217 for Plan J. By comparison, the lowest rate I could find for Plans C and F was $107; four companies charge around $115 to $120, and quite a few are in the $150 range.

Well, I’ll be happy if I can keep the total cobbled-together cost of this pushmi-pullyu lash-up under $300. But I figure three C-notes a month is what I’d better budget for Medicare over the next two or three years…until it goes up.