Tuesday, February 03, 2009

Medicare Advantage

The Hobo Philosopher

Medicare “Advantage” Plans

I’ve been seeing a good many doctors lately. If you are approaching 65 years of age and looking into your options you had best be aware of what is going on. Announcements similar to the following are already in many Doctor’s offices in our area, the Florida Panhandle. We found this bulletin pinned to the wall of the doctor I visited yesterday.


The government is attempting to basically privatize Medicare by offering a Medicare Advantage Program. On the surface currently marketed Medicare Advantage plans appear to offer large cost savings but fail to inform the consumer about hidden reductions in payable benefits. This is nothing more than a managed care program. Medicare pays the insurance company a set amount of money to care for you for the year. Any money left over is their profit. The incentive is for them to not recognize or not pay for services you may need or receive. The insurance company will be telling you what you may or may not do, NOT Medicare. Humana, an insurance company, has already begun marketing in this area. Others will follow as this will be very profitable for the companies. They are urging patients to change from Medicare to their company. On the surface, as currently marketed, the plans will appear to offer large cost savings to you. What they fail to tell you is that this is a managed care program, and any dealings you have will be with the insurance company and NOT Medicare. Initially, they appear to not limit your using the doctor of your choice. As a managed care program they will eventually, if other areas of the country are an example, most likely limit your choice of physicians to their participating physicians, or charge you a much higher co-pay (a penalty) if you go outside their list of physicians. The companies will make their money by decreasing what they approve for your care and increasing your cost. They will have the final say as to what tests are allowed for your care. Any appeals or complaints must be directed to and handled by the insurance company! If past history is any indicator, they rarely if ever reverse their decisions on appeal. The result is a much higher hassle factor and higher cost to you. Since 1984 Medicare has told physicians what they can charge the patients. This office, mandated by Medicare rules, MUST deal ONLY with the insurance company. There is no appeal process to Medicare!!! With traditional Medicare Part B you have federally guaranteed appeal rights
Please compare carefully any insurance proposals with your traditional Medicare Part B before making a change. Be sure that you make clear to the agent that your physician does not participate with their company. This does make a difference.
REMEMBER, the insurance company and insurance agent selling you this policy are making money. See it in clear and concise writing. Do not accept promises. If it sounds too good to be true, BEWARE.

The Following is a humor column I published in the Franklin Chronicle several months ago when my wife and I were trying to wade through our health care options. Although my column was meant to be funny and entertaining, I think I nailed the Advantage Plans pretty well.

The Eastpointer

Medicare – Free Health Insurance!

By Richard E. Noble

I will be turning 65 years old in a few months. For the first time in my life I will be eligible for some kind of health insurance. I guess I have always been eligible, I just couldn't afford it. But now because I am 65 I am a candidate for Medicare - "free" health care. Wow, isn't that great? I can't believe it.
But for all you Baby Boomers behind me, I will review what I have found out so far.
First of all Medicare comes in several parts. It is kind of like an alphabet puzzle. There's Part A, Part B, Part C, Part D and possibly some other parts that I am not aware of yet. It seems that part A of the Medicare is the "Free" part. I haven't really read what Part A actually covers but who cares - it's free.
Part B is going to cost me $100 dollars a month. It is also going to cost my wife $100. That's $100 per month ... each. Okay, so that's $200 per month. But what if I don't have $200 per month? Don't worry they will deduct it from my Social Security check. So now our already meager Social Security income will be reduced by $200 per month.
But the $200 per month doesn't cover all my potential medical bills. It only covers 80%. So I need to buy another policy to cover what the Medicare isn't going to pay. This is called a Medigap policy. Medigap policies are varied alphabetically also and they run from A through L.
“A” is the no-frills not much better than nothing category. B is slightly better than A and C is the slightly better than B. B costs more than A and C is a little too much for anybody. After C it is Disney World and Never Never Land.
Any Medicap policy will cost me between $100 and $300 per month. That is $100 to $300 each. My wife will need her own policy. And that is in addition to the $100 each that we are already paying for Part B. But even if you can afford F or J you still won’t be covered for everything. And no matter what you pay this year it can all go up next year. You must also watch out for the way your Medigap policy is rated. It can be community rated, issue rated, or attained age rated. It could cost you big bucks if you don’t find out what these ratings mean. And once you start paying your Medigap insurance company don’t stop. If you stop for more than 63 days you will have to be “reborn”.
But unfortunately a person is still not covered for any drugs that he might need. And drugs involve co-payments and "donut holes." The co-payment means that I still have to pay some of the costs even if I have the insurance. Let's just skip the donut holes for now - it's too complicated. But basically a donut hole means more money that I have to pay even if I have all this insurance.
For me to be insured against drug co-payments and expensive drugs will cost me another $40 to $100 per month. You can’t buy donut hole insurance even if you work at Dunkin’ Donuts.
So, that's another $40 to $100 each.
So where are we here? I need $200 for me and my wife for Part B. I need $200 to $600 for what part B doesn't cover. I need $100 to $200 for co-pays and phenomenal drugs with no donut holes. We need $500 to $1000 per month in order to be covered by Medicare.
Unfortunately I can not afford this "free" insurance any more than I could afford the "free-enterprise" insurance. In fact I don't see much difference between the free insurance and the pay insurance. I can't afford either of them.
But we do have other options. We can pay the $200 per month for Part B and get a special insurance by some insurance company (probably with a main office in China or India) that has teamed up with the U.S. Government and Medicare. They will take over the management of my Medicare Insurance. This is some form of “privatization” thought up by the Bushomanics, I presume. With this special policy I will be covered for some things and not covered for a bunch of other things that I will have to pay "out-of-pocket". If I have any problems I will have to fight this Hong Kong insurance company rather than call my Congressman. This ploy lets my Congressman off the hook. And if I get hospitalized for any length of time I owe somebody $3500 minimum. If my wife and I both get sick at the same time we will owe this person or group $7000 each year.
I have another option though. I could skip the "free" Medicare insurance entirely and keep all of my Social Security check. If I get sick I can die - just like they used to do in the good old days; or I can go to the hospital and tell them to send me a bill. If I don't die from the MRSA infection or Septicemia infection that I catch at the hospital (195,000 people die every year from things they picked up while in the hospital or from medical mistakes), I can get a job – if anyone will hire or pay me in my sick and advanced age - or send them payments from my Social Security check.
In the meantime, we can take the $200 per month that we didn't send to the Government for Part B and go to Biloxi once a year and see if I can win a jackpot. Maybe if I win a jackpot in Biloxi I will have enough money to buy some "free" Medicare insurance. Of course maybe with the fines and penalties for joining late, I won't be able to afford it then either - even with the jackpot money.

Richard E. Noble is a Freelance Writer and has been a resident of Eastpoint for around thirty years. He has authored two books: "A Summer with Charlie" which is currently listed on Amazon.com and "Hobo-ing America" which should be listed on Amazon in the not too distant future. Most recently he completed his first novel "Honor Thy Father and Thy Mother" which will be published soon.

This is another "gem" from my dealing with "Advantage Plan" salesmen.

The Hobo Philosopher

Used Car Salesman - and Medicare

By Richard E. Noble

"Hello Richard, I noticed that you hit on my web page the other day..."
"I did?"
"Yeah, you were looking for information on Medicare gap coverage and Advantage Programs."
"Yes, that's true. I have been."
"Well, my name is, Elmer Gantry and I am an insurance broker. I think I can help you."
"Well, I certainly need help. I was thinking of the Medicare gap coverage policy. What's the cheapest gap coverage policy that I can get?"
"Are you wealthy?"
"Then I would advise you to skip the gap coverage and get an Advantage Program."
"Well, I have been studying these Advantage Programs for some time now and they are too confusing - one covers this and one covers that and another doesn't cover anything."
"Well, to tell you the truth they are all pretty much the same. I would just pick one and get it."
"They don't look all the same to me. My wife and I have put several side by side and studied them."
"Well, that's true they differ marginally on this point or that point but they are all cheaper and in my opinion better than any of the expensive gap coverages and provide more benefits than conventional Medicare."
"Well, I asked my Doctor and was told that he will not accept any Advantage Program. I've read that doctors and hospitals all over the country are refusing to accept these Advantage deals."
"That's not true. But of course, your Doctor won't like Advantage. He wants to make a bunch of money that's why. You know what the problem with our health care system here in the U.S. is?"
"Well, not entirely."
"It's millionaire Doctors. These Doctors want to get a check from everybody. Of course they don't like the Advantage Programs. Do you know why?"
"It's because under the Advantage System their outrageous charges are going to be cut. The insurance companies ain't going to pay them anything they want. The Doctors are going to have to tighten up and start living like the rest of us - no more free ride for millionaire Doctors."
"To be honest with you, I find your analysis a little difficult to believe."
"You don't think Doctors make too much money?"
"Well, I know some Doctors make a lot of money - like brain surgeons and heart specialist but my little family Doctor isn't getting all that rich from what I can tell. And Doctors have to go to college. That costs a lot of money. And then they have these ridiculous internships and on top of that they have expensive mal-practice insurance that they have to buy. I read something recently that said that the average Doctor leaves college with over 130 thousand dollars of debt. And as far as I know it is not yet against the law for people to make money at what they do. If I were going to single out one group to blame for our current problems in health care, I think that I would blame insurance companies. For example how many years of college did you have to put in to become an insurance salesman and what is your mal-practice monthly premium?"
"Well, I'm no millionaire and I work hard for my money."
"I'll bet that there are as many millionaire insurance brokers as there are millionaire doctors. And do you really call it "hard work" to be sitting on your butt in a big old easy chair trying to sell some confused old people insurance? If we are going to start cutting people's paychecks, I'd start with yours. What did you do before you became an insurance broker - sell used cars and mobile homes? How many lives did you save last year?"
"My friend, health insurance saves lives. Last year when me and my wife were vacationing in Mexico, I got and attack of appendicitis and ..."
"Wait a minute ... an ex-used-car salesman and you and your wife are vacationing in Mexico?"
"I'm not an ex-used-car salesman. And, you know, you don't sound like you need any insurance."
"Oh I need it. Now that I'm 65, I sure need it. And you guys know it. That why you guys in the insurance business have agreed to turn all the old folks over to Medicare. You know the odds. The vast majority of people have no problems until they reach 65 and that's when you guys drop everybody's coverage and turn us all over to the government. And now that you got the government paying the premiums you want a piece of that action too. More corporate welfare or corporate socialism or whatever you want to call it. You guys sop up all the gravy and the taxpayers get to pick up the bill when you’re done slopping at the troth. You win and the American people lose - again!"
"You know, I don't think that you need my help."
"You know what pal, I have had a hundred phone calls before you. For the first time my life seems to be valuable to somebody. I have been bought two free dinners by insurance salesmen. Not one Doctor has offered to take me out - even to lunch. I have had three insurance salesmen come to my house. I may need someone to help me figure out this new scam but I sure don't need you in particular - any ex-mobile home salesman will do."

A little Something is Mr. Noble’s latest creative output. It is now on sale at Amazon and locally at Downtown Books along with Honor Thy Father and Thy Mother, Hobo-ing America and A Summer with Charlie. Richard Noble is a freelance writer and has been a resident of Eastpoint for 30 years.