Monday, November 30, 2009

The healthcare game, how she is played


I was fortunate enough to have worked long enough for two large corporations to retire from both of them with full-service pensions, and in retirement, to be covered (at a price) by private healthcare insurance. That is, X dollars would be deducted from my pensions each month to cover the cost of health insurance premiums. Each company’s literature said it would pay 80% of my family’s healthcare costs, and I would be responsible for the remaining 20%. I also was fortunate enough to be able to retire several years before either one of us was eligible for Medicare. Had I retired prior to 1990, I would have received healthcare coverage in retirement from my employers without any monetary contribution whatsoever from me. To receive this wonderful perk all I needed was to have been born ten years earlier. Mrs. RWP, who was a registered nurse employed at a hospital before she retired, receives no healthcare coverage at all from her former employer, not because she is covered under my insurance as my spouse (she is) but because her former employer (did I mention it was a hospital?) offers no healthcare coverage whatever to its retired employees.

The company I worked for longest (let’s call it company A) was designated as my “primary” insurance, and the other company (let’s call it company B) was designated as my “secondary” insurance. So I thought (naively, as it turns out) that company A would pay 80% of our medical expenses and company B would pay the other 20% -- after all, 20% was far less than then 80% they said they would pay -- and any “out of pocket” payments from me (other than the monthly premiums, of course) would simply vanish.

Wrong, kemosabe.

We were informed by company B that since it covered the same 80% as company A it would pay nothing at all. I was still responsible for paying the remaining 20% of our medical costs.

When I/we became Medicare-eligible by virtue of turning 65, another layer of confusion came along. My “secondary” insurer (company B) became my “tertiary” insurer, my “primary” insurer (company A) became my “secondary” insurer, and Medicare (the U.S. government) became my new “primary” insurer through mandatory (translation: involuntary) deductions from my monthly Social Security payments. Medicare also became Mrs. RWP’s “primary” insurer through the same sort of mandatory (involuntary) deductions from her Social Security payments. The word “tertiary,” as far as I have been able to determine, is a word meaning “so far down the list in terms of payment responsibility that it has no value whatsoever and can be completely ignored from this day forward.”

I supposed that the portion of our medical expenses not covered by Medicare would be covered by my new-secondary, old-primary insurer. I am evidently a slow learner. Alas, it was not to be. It was “same song, second verse.” We were informed by company A that since it covered the same 80% as Medicare it would pay nothing at all. We were also informed by company B that since it covered the same 80% as Medicare it would pay nothing at all. I was still responsible for paying the remaining 20% of our medical costs.

In one eighteen-month period the two of us underwent one shoulder surgery for a torn rotator cuff, two knee surgeries to insert artificial knee joints, and two eye surgeries for removal of cataracts. Actually, all of that happened to just one of us.

In addition to being slow on the uptake in general, I was also slow to realize that the deductions for healthcare insurance from both of my corporate pensions were buying me exactly nothing. The bills from the hospitals, surgeons, ambulance companies, anesthesiologists, radiologists, laboratory work, and physical therapists for my 20% opened my eyes. A year ago I stopped authorizing insurance premium deductions completely from my two pensions and the money began going into my bank account instead.

At the beginning of 2009 we joined a Medicare Value Advantage HMO Zero-Premium something-or-other that became our “primary insurer” (it administers Medicare funds for the U.S. government) and things improved somewhat. The only healthcare insurance deductions we currently have are the Medicare premiums the government takes out of our Social Security payments, currently $96.00 per month apiece. That’s $1,152 per year from each of us, or $2,304 in all for two people.

Before this year, our five monthly prescriptions also took a chunk out of our income. Things have improved a bit under the new plan. This year, four prescriptions have been paid for in full, and a fifth one costs us $29.00 per month at the pharmacy. Beginning in January 2010, however, the four fully-paid ones will cost $3.00 each per month and the other one will increase to $39.00 per month. In addition, this year I was able to submit receipts for certain over-the-counter (OTC) non-prescription drugs like aspirin, acetaminophen, and a few other items and receive reimbursements of $12.00 each month. That stops in January 2010 as well. Everything considered, our personal outlay per month in 2009 was $17.00 ($29.00 for one prescription and a $12.00 reimbursement for OTC); in 2010 it will be $63.00 per month (four x $3.00 plus $39.00 plus $12.00 OTC non-reimbursed). My calculations say that is a net increase of $46.00 per month, or $552.00 per year. And this is before any of the increased taxes to pay for the proposed new healthcare legislation even enter the picture. Fortunately, Congress decided to cancel a planned annual increase in Medicare deductions for 2010. Unfortunately, Congress also decided to cancel an increase in Social Security payments. You win some, you lose some. We will have to come up with an extra $46.00 every month, beginning in January 2010, to pay for the very same prescription and non-prescription medicines we took in 2009.

The hurrier I go, the behinder I get. Still, we have it better than a lot of people.

We were also notified by the Medicare Value Advantage HMO Zero-Premium folks that as of January 2010 the dental portion of the insurance will cover only “routine” items such as periodic X-rays and cleaning. Coverage for fillings, root canals, and extractions will cease. So the pendulum, it seems, has begun a long swing in the other direction.

Only God knows where it will stop. I’m sure things will get a lot worse before it does.

This has been intended to enlighten any of you who suppose that everything will be hunky-dory, healthcare-wise, once you become eligible for Medicare.

I hate to burst your bubble, but somebody had to do it.

5 comments:

Putz said...

how come the very exact thing that has happened to you,,,,happened to me????? i had two rotator cuff surgeries and had to pay 20%, i did drop one of my health care packages when i retired, but i am still for reform, and the poor to have health care and believing that has caused hate from my neighbors[ DID YOU HEAR THAT MAX HALL FROM BYU ACTUALLY HATES THE UTES]

Rosezilla said...

Having not had insurance in years, my bubble was burst long ago. Although I think I paid a lot more when I did have insurance. When you pay out of pocket, they will sometimes lower the payment, making it less than someone paying premium, deductible and 20%. Ironic, ain't it?

Dr.John said...

I have medicare and through my former employer supplementary insurance. All most all of my considerable medical bills were paid last year. Sometimes something works and sometimes it doesn't.

Yorkshire Pudding said...

Thank heavens I live in England where we have a National Health Service. Although some people moan about the service, my family's experience has been very positive. Whenever we needed good healthcare, we got it free of charge though of course everyone pays via National Insurance contributions deducted from salaries. When you need healthcare the last thing you want as an accompaniment is financial strife.

Sam said...

You don't want to get me started...but just remember the words of PJ O'Rourke: if you think health care is expensive now, just wait 'til it's free.