Part D — for duplicity

The following story is a small tale among volumes regarding the insanity of health care in this country.

Mine happens to be about Medicare, which is supposed to be one of our brighter lights.

I am having trouble seeing the light. The problem isn’t my vision, which happens to be my “presenting” medical problem.

You see I take two pressure-lowering eye drops to ward off glaucoma and possible blindness.

I’m 68 years old, a month away from 69, and I’ve been covered by a Medicare Med Advantage policy (through Oregon Regence Blue Cross/Blue Shield) for four years. It’s worked pretty well up until now.

Still in good health with no need for drugs, I had not enlisted in the Part D “drug coverage.” Then, a couple of years ago, the eye specialist said I needed the eye drops, and I paid out-of-pocket for the small vials. Xalantan vials cost me $86.96 and Istalol cost $129.06.

The total came to $216.02 out of pocket — every five or six weeks.

But late last year, understanding “drug coverage” to mean, well, “drug coverage,” I added Part D to my plan and saw my monthly premium rise. I figured I’d more than make up the modest difference when it came time to refill my eye drop prescriptions.

Earlier this month, I put Part D to the test. I renewed my prescriptions fully expecting to see most of my out-of-pocket costs vanish, save for modest deductibles.

The result: With “drug coverage,” the Xalantan cost me $75.00, the co-pay. The insurance, paid a staggering $11.96.

But the real surprise was the Istalol. It actually cost me more, $144.94. MedAdvantage’s Part D paid zip.

I’m still not entirely sure why, even after talking to the predictably pleasant Regence Med Advantage customer service representative. The price apparently had gone up or, because I had Part D “drug coverage,” I no longer qualified for a small discount through the state’s senior drug discount program.

So to review, without “drug coverage” I paid $216.02 for drugs; with “drug coverage” I paid $219.94. I can manage it, but it is evidence of a system gone mad.

I have since discovered there are bureaucratic explanations about generic and non-generic, and “tiers” of drugs and “formularies,” etc. My vial of Istalol lasts 40 days, which exceeds some 30-day limit.

You need to be a student of fine print to figure it all out. And, as I say, my eyes aren’t all that great to begin with.

Let’s face it, this country needs plain-and-simple, universal healthcare. Not “insurance” but healthcare.

Get rid of the flim-flam, the drug company’s wheeling and dealing with doctors, the formularies, the Big Pharma lobbyists, the donut holes, the tiers and the deductions.

The good news for me is that I’m among the fortunate who can afford these scams, at least for now. I worry about those who can’t, and I worry about a government whose patch-work, contrived program deceives and rips off its people.

Health Insurance follows Airlines' model

What’s happening to my Medicare “med advantage” insurance is a little like what’s happening to the airlines industry.

Regence Blue Cross/Blue Shield sent me a required notice the other day titled “How Your Plan Will Change for 2009.”

The good news, such as it is, is that my monthly premium will remain the same: $75.

Not to forget that BC/BS pays for a menu of services beyond what’s covered by Medicare. I still make modest monthly Medicare payments too. And of course, like you, I’ve been paying into Medicare all my working life.

Now the bad news. It’s like the airlines charging for your checked bags, a pillow and blanket, lunch and god-know-what-next (Oxygen masks? Peanuts? Seat belts?)

The insurance notice tells me that out-of-pocket maximums have been raised 33 percent.

The inpatient copay for hospitals now applies to the first five days, rather than three.

Skilled nursing facility care had no copays for the first 25 days. Now it’s $25 per day.

Copays for doctor’s office visits go from $5 to $10.

On and on it goes. There are 13 other hikes. Add them up and this is not nickel and dime. It’s more like $25 and $50 per item per year. The only way to avoid them is not to need medical care. At age 66, I’m finding that isn’t possible.

Don’t get me started.

Last year I might have been able to afford this sort of gouging. This year, given the Republicans’ masterful handling of the financial industry, that’s no longer the case.

When is this country going to get health care right?

Frankly, I’m not holding out a lot of hope for Barack Obama’s making this significantly better. After all, how much of what we pay the insurance companies goes into the pockets of lobbyists? Gucci Gulch isn’t going away.

While the government is into buying banks, it should do the same with insurance companies. And it should go all the way. It should run them for the people, not the plutocrats.

Let’s face it, we need universal health care coverage. That’s the only way health care in this country will be, as Obama proclaimed in the last debate with “The Maverick,” a right, not a privilege.

Regence returns my call

I got a call back today from three executives at Regence Blue Cross. They were responding to my complaint about their Medicare Advantage supplement’s premium jumping 67 percent for next year.

A couple of days ago here on the Red Electric, I recounted my experiences with Regence MedAdvantage customer support . Because I wasn’t satisfied, I decided to track down one of three Regence executives I happened to be seated with at a recent Community Health Partnership honors banquet. I phoned and left a message for one to call back.

All three did, on a pre-arranged conference call. I was impressed.

We talked for about a half hour about the surprising jump in the premium from $45/mo. to $75/mo. You may recall that the customer service representative told me that premiums for the non-profit are based on claims from the previous year.

Last year was not a good year, insurance-wise.

My executive trio told me that there’s some discretion in setting premiums, and they readily admitted that the hike for next year is hard to swallow, but necessary.

I joined the program early this year when, at reaching 65, I became eligible for Medicare. If I had joined in 2005, the year the Medicare Advantage programs began, I would have a different perspective on next year's increase. Amanda, my customer service rep, told me that premiums could drop, but, because she had only been on the job a year and a half, she didn’t have a clue whether they ever had.

Fat chance, I thought.

I was wrong.

My conferees informed me that indeed the rates had dropped. My $45 premium was the low over four years. In 2005, the premium was $79, in 2006 it was $72. It turns out that 2006 was a very good year, as Frank Sinatra used to say, so management decided to pass the savings on in 2007, hence my $45 premium, which I took to be the norm.

So my advice to this august group was to level out the peaks and valleys of the premiums to avoid the appearance of a bait and switch. In the highly competitive health insurance industry, low rates are a selling point. That $45 snared me.

“We don't like to whipsaw our members," said Mike Becker, Regence vice president of public policy and community affairs. "Leveling out the premiums is exactly what we’ve been talking about,” chimed in Alison Nicholson, manager for individual sales.

Good, I replied.

I had a few other ideas, which I won’t bore you with and which you probably won’t be interested in, at least until you turn 65.

Suffice to say, I feel better about Regence Blue Cross — for now.

Fixing for a MedAdvantage/health care fix

Since turning 65 earlier this year I have entered the uncertain world of Medicare. Stories about Medicare, it seems, are part of the lore of aging.

My transition from my pre-senior Kaiser Permanente coverage to Regence Blue Cross MedAdvantage was seamless back in February, when I entered seniordom.

I signed up for the Regence program because it looked like a pretty good deal at $45 a month, plus the $93.50 I pay monthly for Medicare.

But about a month ago I realized that each year I would be buried under a blizzard of fliers from competing Medicare Advantage programs, which envelop and supplement Medicare’s spartan coverage. No doubt Regence has been out trying to woo other seniors away from their own coverage and over to the Blue Cross/Regence program.

Of course the advertising blitz comes at a price, born by us, the enrollees. The marketing campaigns have absolutely nothing to do with our health care. Trust me, they don’t do this in Sweden, Denmark, New Zealand and Canada.

Then, in the middle of this flurry of brochures and sales pitches, I received in the mail my “2008 Annual Notice of Change” from Regence. That’s innocuous sounding until you realize that the primary change was in what I would be paying.

Starting January 1, my monthly rate will go from $45 to $75.

I blinked, but my eyes did not deceive. That’s a 67 percent increase. Over the year, I will fork over an additional $360 to Regence. An extra dollar a day.

Did someone say “bait and switch”?

Suddenly I realized why I was getting all those fliers from the competition.

Fortunately, I can afford to pay more. But where will this stop? Will Regence gouge me another 60 or 70 percent next year?

And what about all those folks who can’t afford the increase?

“Fixed income.” means exactly what it says, “fixed.” I’ll bet the CEO of Regence isn’t on a fixed income.

The health care system clearly is in a fix and needs desperately needs one.

I decided to give Regence a call.

My ploy was to play stupid. “There must be some mistake,” I said to poor Amanda, a Regence customer services representative who answered the phone. (Good news — she didn't sound as though she was fielding my call in sunny Bangalore.)

“You have to understand we are a non-profit company," she explained. "We base our rates on what we paid for claims in the previous year. If we save this year, our premium will go down.”

“Will it go back down to $45?” I asked.

Amanda, wouldn’t commit.

“Has it ever gone down?”

Amanda didn’t know. She’d only been a customer rep for 18 months, but, she added, “A lot of people don’t understand how insurance works.”

“Well,” I said, “either Regence isn’t making itself very understandable or I’m beginning to understand all too well.”

She agreed that the rate increases were tough to budget for. I suggested that Regence customers be warned well in advance that big rate hikes like this one were possible, even inevitable.

She said she would pass my “excellent” suggestion on to her supervisor.

Finally, I asked her whether she had been getting many calls like mine.

“Oooooh, yeah,” she said wearily.

Weep, Lyndon Johnson, who signed Medicare into law in 1965. Clearly the days of free or low-cost medical care for seniors are numbered, at least under the Bush administration and probably under any administration beholden to the insurance industry.

And, looking to 2008, which candidate is least likely to be so beholden? Here's a clue. Watch for others.