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Medicare

Good grief! Near-disaster with Medicare Part D choice

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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!

Medicare Part D: Another adventure in Wonderland

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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.

Tracking down an insurance policy

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Now that Medicare is coming up, I have to find an insurer from whom to buy a Medigap policy. Yesterday I found an unexpected and valuable resource for insurance consumers, which I’ll describe below.

First, by way of background for those who have not yet enjoyed the privilege of trying to navigate the astonishing maze that is Medicare, the system works like this:

You can choose “Traditional” Medicare, a type of indemnity plan cobbled together with Medicare Part A (which covers approximately 80 percent of most hospital bills and which is free) and Medicare Part B (covering a certain amount of but not all of your doctor’s bills, at a cost of about $95 a month); or you can choose an “Advantage” plan, which is basically a private HMO with all the benefits and risks associated therewith. Most people feel the “traditional” plans are worth the extra cost.

If you go the “traditional” route, you must also buy a “Medigap” policy to cover the significant amounts that the government policy does not provide for. Medigap policies are standardized plans that come in a dozen flavors, from Plan A through Plan L.  An hour or two of poring over the rules and features will reveal that Plans C and F are probably the only way to go—these are the plans that cover most or all of the things that Medicare proper does not cover. I’ve decided that Plan F is best, because it not only picks up the 20 percent missed by Plan A, it also will cover so-called “excess” charges for doctors who think they should make a living in the practice of medicine.

Now. Because these plans are farmed out to private insurance companies, the market is just. freaking. insane! The plans are all the same; insurers are required to offer identical plans with identical benefits. But the prices are all over the map. Here in lovely Arizona, for example, you can pay anything from $93/month to $417/month for the same plan!

The state Insurance Department hands you a booklet showing premium comparisons. It’s forty-six  pages long!!!!! You have to sift through fifty-three insurance companies, trying to figure out which offers what plans for how much, and which companies are reliable and which are likely to rip you off or give you a runaround.

It takes hours and hours to parse through all this stuff.

I figure I can afford $150/month at the outside. Thirteen companies in Arizona offer Medigap policies for $150 or less. So, I made a table, preparatory to telephoning every one of these corporate horror shows. In it, I made room for a price comparison, notes on conversations with CSRs, and notes on Google, Better Business Bureau, and Consumerist reports. Then I spent about four hours trying to track down information on the thirteen likely vendors.

While stumbling around in Google, I came across a consumer service offered by the Texas Department of Insurance. Go to this page and you can search for an insurance company. Because Texas is famously huge, most insurance companies of any significance do business there. Enter, for example, something like “Lincoln Heritage,” and up will come a long page showing contact information (including headquarters addresses and phone numbers, plus names of company officers), financial information spanning the past three years, links to four financial rating organizations, a summary of the company’s history, and…ta da! complaint records!

Yes. Texas tells you how many complaints each company has registered in each of several underwriting areas and also calculates a “complaint ratio” and a “complaint index,” showing how the company’s complaint history compares with those of other insurance companies.

This, as you no doubt recognize, is platinum-plated data.

Thanks to the Texas Insurance Department and the Better Business Bureau, I’ve narrowed the preliminary search down to five companies with clean complaint histories and a likelihood of staying in business for a while:

Assured Life: $97/month
Loyal American: $138/month
Sterling: $139/month
United of Omaha: $93/month
USAA Life: $129/month

Amazingly, the cheapest companies appear to deliver high-quality service—Assured, run by a fraternal organization, and United of Omaha, associated with Mutual of Omaha, have the cleanest complaint records all the way around. So I’m hoping one of those will do.

The cost of this is just breathtaking: take $96 for Medicare Part B and add a bare minimum $93 for Medigap and you’re already up to $189, more than I’m paying for COBRA! And then I still have to buy Medicare Part D, the prescription plan, which is around $50 a month with a $250 deductible!!!!!

What I don’t understand is why the pathetic State of Arizona, whose administration by and large is a joke, can manage to provide employees an EPO for $39 a month that covers almost every doctor in the state (including the pricey Mayo Clinic) and provides prescriptions with a $15 copay, but the vast and powerful federal government can’t manage to engineer better rates than this. Now it must be admitted that if you had to pay the full freight for COBRA, that EPO would run almost $500 a month, and that the retirees’ cost for it is $400 a month.

So…maybe $240+++ a month that of course I do not have and will not have for the duration of 2010 is a bargain. But still….

Nope… Money unhappens

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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.

Did money just happen?

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Whoa! I think I just stumbled onto something amazing. Remember how SDXB told us “money happens”? Well…the stuff appears to be materializing as we scribble.

Well, not so much!
See the update here.

Yesterday I was talking with the people at the state Department of Administration about COBRA, which is administered through their agency.

The Great Desert University did another of its little numbers on me. Despite handing me a contract that says my last day of work was December 31, they “termed” me (the bureaucrat’s salubrious term for “terminated”) in their system on January 10. Because the eligibility for the COBRA discount ended on December 31, this would have rendered me unable to pay for health insurance, except that (thank God!) the Obama Administration extended the stimulus discount for those who are canned into February.

In the course of conversation, the ADOA rep remarked that during the first six months of COBRA, you’re covered whether or not you’re paying every month. For me, the payment under the ARRAS discount would amount to about $200.

I said, “So, if I haven’t paid for the first couple of months and then I’m in a car wreck and break every bone in my body and they cart me off to St. Joe’s emergency room, I can pony up the back payments and be covered?”

“That’s right.”

Hm. Come to think of it, I’ve heard that before.

Now, my Medicare card came in the mail yesterday afternoon. On the first of May—three and a half months from today—I will automatically go on Medicare. At that time I’ll want to sign up for a Medigap policy.

According the the reams of paperwork I have here, Medigap insurers cannot zap you for whatever pre-existing condition they can dream up if you have “no gap in coverage” with your prior insurance.

“No gap in coverage.” That is exactly the ADOA rep’s wording. She said, “Don’t worry. You have no gap in coverage between your state insurance and COBRA,” even if you’re not paying the first few premiums.

So. Because Medicare starts less than six months from the start of my COBRA coverage, in theory if I never paid a penny in COBRA premiums, I still would be covered right up until the time the government program takes over, and, because I would have “no gap in coverage,” the private sharks who run the Medigap insurance programs would be unable to screw me because 20 years ago I broke a wrist when I fell on the rocks in the bottom of Aravaipa Canyon while hauling a 30-pound backpack.* And there would be nothing they could do to claim the stress attacks engendered by working for Our Beloved Employer are some sort of excuse for why they shouldn’t cover me.

This sounds too good to be true. But it gets better!

As dawn cracked, I got on the phone to Medicare and tried to formulate this question for the rep who answered: Is it true that if I don’t pay for COBRA I would still be “covered” technically so that I could get Medigap without being zinged for pre-existing conditions.

Irrelevant, says she. Here’s the deal: When you turn 65, you have six months of open enrollment, during which time you can select a Medigap provider who has to take you without regard to pre-existing conditions.

You catch my drift, right?

If I remain “covered” by COBRA for six months whether or not I’m paying the premiums and I attain Medicare in 3 1/2 months, then effectively what I have here is free health insurance for the next several months. There’s no reason for me to pony up the $200/month COBRA premium.

Eight hundred dollars would just about cover the increase in power and water bills over the summer—my combined bills go up by about $200 a month during June, July, August, and September.

With enough in the bank to pay the summertime utility bills, my 2010 budgeting problems disappear into the overheated desert air.

My health is excellent. Except for my neurosis about Arizona State University, I have no health problems at all. I often go six months to a year without seeing a doctor. So it makes good sense to take a chance—especially since no real risk is involved—and quietly not pay the COBRA premiums unless something drastic happens.

Meanwhile, because in direct contradiction to my contract the state carried me on its payroll until January 10, they deposited another $517 into my checking account! This happened because, contrary to what HR told me, in the two December 31 paychecks PeopleSoft did not pay off everything ASU owed me: the five hundred bucks represents pay for the two days in December that I worked past the final 2009 lagging pay period.

I think I’ll be able to argue that this is 2009 pay, so that Social Security will not ding me for it—although from the blank looks I’ve gotten from ASU functionaries about this matter, it’s pretty clear that no help in proving it will be forthcoming from those quarters. But I’ll cross that bridge when I come to it.

Let’s see here… $800 + $517…that’s $1,317 of money happening!

*No joke! Blue Cross/Blue Shield once actually told me it would not cover me for any broken bones or back problems because they believed the hairline wrist fracture and a later X-ray of a foot showing mild osteopenia meant I had osteoporosis (even though I decidedly did not and still do not).

Retirement healthcare update

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A new development in the hoop-jumping contest that is figuring out how to get full coverage under Medicare:

The volunteer snail-mailed two thick brochures on Medigap—over a hundred pages, to go along with the hundred pages or so of data to be mastered before signing up for Medicare. Took an hour to shovel through the new stuff.

She apparently was wrong on two counts: First, COBRA is regarded as “credible creditable (!) coverage,” meaning that if you continue your employer’s coverage through COBRA between the time you’re terminated and the time you reach age 65, Medigap carriers can’t refuse to cover you for pre-existing conditions. And second, she didn’t know that attained age premiums (which start low but rise as you age, ending up costing more than you would have paid if you’d selected a pricier product to start with) are illegal in Arizona.

{sigh}

Well, I’m glad I finally got my hands on what appears to be definitive information. It’s a shame elderly people are expected to plow through over two hundred pages of dizzingly complex and confusing material just to sign up for something as basic as health insurance. And mighty annoying that the only people you can get on the phone are unpaid volunteers who themselves are a bit confused!

😯