We senior citizens are noted for two things, diminishing physical and mental abilities. We cannot do much about the former except exercise, what I call “running from Father Time.” It is loss of mental capacity that keeps the advertising industry interested in us. Senior citizens have to be the reason for the waves of robocalls that are torturing all of us. They only need a <1% response to make money, given their low overhead. Shame on us! We are the reason your phone is always ringing.
Every year, during a 45-day period known as “open enrollment” (OE), we seniors are deluged with mailings from members of AHIP, “American’s Health Insurance Providers,” trying to lure us into a program called “Medicare Advantage.” I bit, one time, but was able to escape the grips of Humana by complaining directly to Medicare about its deceitful practices. I re-entered Medicare last June. I now ask myself this: “I spent the first 65 years of my life trying to get away from health insurance companies. Why would I voluntarily go back to them?”
The answer, of course, is diminished mental capacity.
One thing was obvious to me: The degree of advertising that goes on each year during OE can only mean one thing: Insurers are making boatloads of money on the program. I don’t feel up to a research project, but some things are easy to see. Insurance companies are reimbursed by Medicare for all of their costs, so there is a real incentive for them to exaggerate these costs. And they do, and the record shows billions in fines levied against them for such practices. (One example only.)But there are other things going on:
Cherry Picking: Wendell Potter was an insurance executive who left a cushy job with CIGNA to write the book Deadly Spin, about the health insurance industry. I’m kidding, of course! Potter was controlled opposition and never lost his AHIP backing. The book was a limited hangout, and as with all LH’s, we should take the good and discard the rest. He spoke of Medicare Advantage, and noted practices that AHIP engaged in to lure healthy people out of Medicare. They would offer public meetings late in night, in remote locations, and even on upper floors of buildings without elevators so that the people who responded would be the healthier ones. Companies who sell Medicare Advantage plans do not want sick people aboard. That’s a given.
(Further evidence of Potter’s status as controlled opposition: When ACA, or “Obamacare” was introduced, he quickly jumped onboard. This legislation was the most massive and cherished subsidy ever given private businesses by government since the invention of the windmill, written by the insurance industry for the insurance industry. Say what you will about the Trump Administration, and I’ll probably agree, but the elimination of penalties for failure to carry private health insurance was a landmark reform.)
False advertising: Last year during OE we were swamped with advertising from insurance companies trying to lure us into Advantage. One in particular caught my eye, that of Bright Insurance. In addition to the usual advertising techniques like exaggeration and borderline lying, Bright said in its brochure that enrollment in its plan would save seniors “thousands of dollars in health care costs.” That tipped it for me, and I wrote to the Colorado Attorney General about the false claim, which I said “crosses the line.”
Bright’s claim was based on two things that all Advantage plans offer, dental and vision coverage. Bright claimed to offset up to $2,500 in dental costs, and a few hundred for vision. That’s how they justify the claim. It’s a lie.
Humana had a similar plan, offering $2,000 in dental coverage. (I read the fine print on their $150 in vision coverage, which was really only worth only $5.00 towards purchase of a pair of glasses.) The dental plan really only paid $50 or so towards an annual checkup, and nothing else. If indeed that other $1,950 in coverage is available, it must be for events so rare as to be negligible, perhaps something like being hit by a flying fish while water skiing.
Early in 2019 I lost a crown while biting into scrambled eggs, of all things. It was a front tooth, leaving me with what I call an “Arkansas smile.” The repairs included extraction of the remaining base tooth, a long period of convalescence while wearing a temporary bridge, and finally a real bridge.
The total costs were in excess of $8,000. Humana paid … $0.00.
At one point they said a charge was actually covered, but was being applied towards my “Maximum Out of Pocket.” This was the point where I contacted Medicare to get out of the plan, which was advertised as “zero deductible.” It actually carried a $7,900 MOOP. (“MOOP” is an Obamacare concept designed to protect insurance companies.) Humana had merely changed the definition of a deductible to a “co-pay.”
Humana later backtracked, by the way, claiming that the dentist’s clerk had screwed up in filing the claim. They really didn’t cover anything in any manner. That was what they meant to say.
Bright’s dental and vision coverage are most likely worthless too, or perhaps like Humana’s, worth at most $55 per year. They are only in place to lure seniors of diminished mental capacity, like me, away from regular Medicare.
Behind the scenes: The means by which insurance companies are reimbursed by Medicare for Advantage plans are not simple. They involve the general health of the people who enroll, and vary even by locality. So what I offer here is a general and oversimplified example:
Most Advantage plans introduce members to “co-pays,” along with premiums and the usual AHIP mumbo-jumbo of deductibles and denied coverage. So, for instance, when I visited a doctor, I would have to pay $30 up front, and $200 up front for an MRI. (Regular Medicare only covers 80% of costs, so we are forced to buy “Medigap” coverage for the other 20%.) Essentially, the Advantage up-front co-pays are another form of Medigap, a way of insuring that we always have to pay something for care, be it in the form of an insurance premium or a co-pay. (That’s not a complaint about having to pay something. I am merely saying that there isn’t much difference in coverage between Advantage and regular Medicare.)
Advantage plans do not use insurance company coffers to pay benefits. When we sign up, we assign our benefits to the insurance company. So behind the Advantage wall, we are still in regular Medicare with an AHIP mask. Seniors are often surprised to learn that doctors who do not accept Medicare also do not accept Advantage. To the doctors, they are one and the same.
While under Humana Advantage, I saw a doctor regarding my stenosis, part of the physical deterioration that goes on with aging. I paid $30 up front. Humana was billed for the rest. Humana submitted the claim to Medicare, which reminbursed it in full. Humana then reimbursed the doctor what Medicare allowed less the $30 copay. Humana made $30 on the deal. Multiply that by the millions of people who are enrolled in Advantage, and who see doctors far more than I do. Most seniors I know see doctors monthly, if not more often.)
I am not sure how this works, but I currently pay $144.60 per month for Medicare B coverage, which covers doctor visits. I originally assumed, when joining Humana, that that premium would be assigned to them along with any benefit claims. The reimbursement scheme is, as I gather from brief reading, more generous and more complicated. This is why insurance companies are lining up at our mailbox each year to get us to join. It is just another profit center for them.
Medicare Advantage is just another AHIP scam on senior citizens. Most of us have days in our lives that we remember forever, such that first real love, first kiss, first time getting laid. Another is the day we turn 65 and kiss insurance companies good bye. That so many of us have been lured back into the AHIP trap only speaks of our general mental deterioration, part of the aging process.
PS: I started out my morning wondering how on earth “Medicare for All” will cost $36 trillion to put in place.It doesn’t make any sense! The US already has by far the largest per capita health care costs in the world. Much of that is courtesy of AHIP, which incentivizes high overhead and over-billing. The table below is from 2014, but only dollar amounts will have changed since that time. We are still, I assure you, number one.
Most of the other countries shown have some form of M4A, or publicly financed health care systems. Notice I did not say “free,” as these countries merely substitute tax dollars for private ones. The result is lower costs AND 100% coverage. Reasons for lower costs include centralized billing and lower administrative costs.
Notice Canada (red arrow). What changes as we cross our northern border into the land of aboot? In 1966 they kicked private health insurance companies out. Despite bad press here in the US, they will not be invited back. Canadian health care is not free, and like all large bureaucratic systems, including our own, is fraught with problems. We cannot escape problems, only minimize them. Indeed there are wait times in Ontario, the largest province. (Big Swede, who generally does not read to the end of blog posts before he comments, will cite below that Canadians come to the US for treatment in droves. Evidence does not support that claim. Don’t tell him.)
Back to the claim that M4A will cost $36 trillion (over ten years) to put in place – it might well be true. It is but one side of the coin, the other being that those costs are being transferred from the private side to the public side, and are not new costs. If the experience of every other goddamned country on goddamned face of the goddamned planet is goddamned repeated here, M4A will be a goddamned blessing.
Given that M4A is supported by Democrats, don’t get your hopes up. That party, after all, merely exists to kill hope.