!!!Things That REALLY Piss Me Off
(I’m from the government, and I’m here to help you!)
​ If ever there was a perfect example of an oxymoron, the subheading above is it. If you were to ask almost anyone who is not of retirement age or who is not engaged in work related to Medicare how much Medicare costs a typical retired senior for a year, you would almost certainly be met with a chorus deriding the fact that Medicare is a free ride for seniors who pay almost nothing for their healthcare and who are sucking dry the pocketbooks of our country’s young. Until recently when I retired and went on Medicare, I would have been one of the loudest voices singing in that choir, but what I am about to relate to you now is a prime example of how we (and that most certainly includes yours truly) sometimes form what become core beliefs and opinions based on so called “facts” that are in fact so far from the truth that they bear little resemblance to reality. Medicare is a prime example of what I’m talking about because if you’re not on Medicare then you don’t have the faintest idea or clue what its really about or how much it costs those that are on it. 

In fact, what I am about to explain to you is the ultimate convolution reaching a level of convolution that could only be attained by our federal government which, as we all know, is the undisputed master of convolution. I find it very difficult to imagine that anyone outside of the federal government could come up with a medical insurance program with a more confusing and nonsensical system than the Medicare system currently in place. I’ve heard it said before that a donkey is actually a horse that was designed by the federal government. Believe me when I say that you couldn’t do what the feds did with Medicare (or the horse) even if you tried!    

When my wife and I, along with a few other folks from my firm, recently signed up for Medicare, it marked the beginning of a very interesting and shocking educational process which in the end blew away almost everything I thought I had known about the federal healthcare insurance system for seniors known as Medicare. It was sort of like hearing that the world was flat, not round, or that the Reverend Al Sharpton had gotten his own TV show. (Oh, yeah….like that’s really going to happen! Wait a minute….what was that? Al Sharpton what? No kidding….you’re serious? Some network was crazy enough to give the Rev his own show? What’s that? You say it was MSNBC? Well at least it’s not like a real network did it!)

As we began our basic research, what we quickly found was that the information was of such complexity that we felt the services of a healthcare insurance consultant would be advisable if we were to successfully navigate the maze of options and do what was best for each of us respectively. I say “each” of us respectively because when it comes to Medicare and its many “parts”, what may be best for one person may not be best for someone else, and the term “someone else” includes even spouses. And so, we brought in a healthcare insurance consultant who had been a consultant for our firm for many years. 

To begin with, it’s just plain wrong that I should find it necessary to retain the services of a consultant to help understand Medicare. And it’s not that seniors are dense or stupid, but rather that our government invented a healthcare insurance program for seniors that’s about as easy to navigate as a blind man with ear plugs driving around the streets of Washington, DC! It’s the exact same thing with your taxes and the IRS. In that instance, and unless you file a basic short form, you need a Certified Public Accountant. In both of these cases the consultant acts as an interpreter to help you better understand what is essentially a foreign language.

Remember when you were a kid and you and your friends would invent all sorts of stupid games with rules that you made up along the way? You know, someone would yell out something like, “Let’s play space cadet!” And of course no one had ever played such a game before, but that never stopped you, and over the course of the next twenty or thirty minutes you just started making up rules like, “Ok, when a spaceship is in port you can’t shoot at it, and when you have to stop to sneeze or pick your nose, you can’t attack the guy….ok?” And everybody always agreed right away to any suggested new rule because it didn’t matter, and that’s because there were so many rules that no one followed them. Well, Medicare is quite a bit like that….way too many rules, most of which make no sense and seem to change by the minute.

One of the first things I was surprised to learn was that Medicare was not just a single healthcare insurance program as I had originally thought. (It figures that I was surprised by this because I was also previously surprised to learn that Amnesia was not a village in the South of France!) Anyway, remember the old adage? “Drink deep or taste not of the Pierian Spring. A little learning is a dangerous thing.” The guy who wrote that must have been thinking about Medicare and me at the time because of how little I really knew (or understood) about Medicare. Medicare actually has four very distinct parts all of which are offered to the public as four totally and completely separate insurance policies. This makes about as much sense as buying a car from four different dealers which is then delivered in four totally separate pieces to those dealers and which you then need to pick up and assemble in your garage! It’s as if someone consciously decided that doing it all in one policy would be too simple and make too much sense!

A description of Medicare sounds very much like the assembly directions you get when you buy furniture from Ikea. First is what is called Medicare Parts A and Part B. Part A covers hospital visits and related costs, and Part B (from what I can figure out so far) covers the cost of physicians, outpatient services and medical supplies (such as diabetes testing trips and insulin syringes which together can have a retail cost of $500 a month). For these two policies the folks at Medicare deduct from my monthly Social Security check approximately $210, and that doesn’t include my wife whose coverage is totally separate from mine. The amount they deduct has to do with your income, and when I first went on Medicare I was more than a little surprised to learn that they based my premium deduction on my earnings from a few years earlier, when I was working full time, and not on my current income now that I’m totally retired.  

Next we have what’s called “Medicare Supplemental Insurance”, and there are several types of plans all named with different letters of the alphabet. I’m still more than a bit hazy about what these supplements cover and why there are so many of them, but I’m told it’s a safety net of sorts for things that are not covered by Parts A and B that might otherwise, as they say, slip through the cracks. (I wonder if they ever considered patching up the cracks in Parts A and B and just getting rid of the supplemental coverage, but I guess that would make too much sense.) Some of these “cracks” include services such as some doctor visits, lab tests, home health care, screenings, inoculations and skilled nursing, and these policies are provided only by private insurance companies, not the government as you might think. (Go figure!) One of the odd things about my supplemental insurance policy (which, by the way, is what is called “Part F”) is that it reimburses me for the $150 deductible of my Part B policy. (Tell me that’s not a head scratcher!) Okay, so now I have some idea of why I have Part F, but that must be a pretty wide crack with a whole lot of things slipping through because that policy costs me an additional $190 per month (on top of the $210 per month noted previously) which I pay monthly and directly to Highmark Blue Cross who is but one of several private insurance companies that provide this supplemental insurance. And again, that’s just for me and does not include my wife.   

But we’re not done yet. Next we have Part D which is pharmacy or prescription insurance coverage, and that’s another $56 per month which I pay directly to Humana. Last year I paid about $65 a month, but this year the same policy with the same company is nearly $10 a month less. (And no, I have no idea why.) There are some prescription policies with premiums of $150 or more per month, yet some of the most expensive policies don’t provide coverage as good as many of the less expensive policies. (Did I say it was going to make sense? No, I said the federal government was involved, so what do you expect?) And now you’re probably thinking, Hmmm…. $56 a month premium. That’s not really all that bad. I wonder what he’s bitching about. I’ll tell you what he’s bitching about. There is this innocuous, innocent sounding term called “the donut hole” through which can pass more money in a relatively short period of time than a box of Ex-Lax through an elephant’s colon! And by the way, it has nothing whatsoever to do with donuts. A more appropriate name probably would have been the “black hole’ because that’s how it can suck up your money.   

The donut hole is a portion of your Part D prescription policy for which there is no coverage regardless of what policy you may have, and it applies to all policies and all insurance companies. It works like this. Once you have reached the point in any given year where your Part D insurance company has paid out roughly $3,300 for your prescriptions (it’s a number that changes every year), you’re responsible for the next $4,850 (and that amount seems to go up every year). And then, if you manage to spend your way through and out of the donut hole in a single year, your Part D policy kicks back in again and you are then responsible only for five percent of the retail cost of your prescriptions for the remainder of that year. For you younger folks reading this who may not yet have reached the age where we older folks spend almost as much time picking up prescriptions at the drug store as you do texting, let me tell you that if you’re on the right (or wrong) medications, $4,850 for prescription drugs can get eaten up in less time than Donald Trump can come up with a new insult for a minority group. And that’s especially true for insulin dependent diabetics (like me) whose monthly retail (out of pocket) prescription costs may run a bit more than $700 a month while I’m in the donut hole! (The Air Force buys planes for less!) 

Now when you add up all of my out of pocket costs (premiums, copays, deductibles donut hole and other related costs, it all adds up to about $11,000 a year and, to reiterate, that’s only for me! The total of my wife’s insurance premiums plus deductibles and copays is a mere $3,000 because her meds are much less expensive. But more importantly, she doesn’t make it into the donut hole (Thankfully!). In summary, for a retired married couple the cost of what I (and younger people) thought was almost free healthcare insurance actually costs us in the neighborhood of $14,000 a year! Perhaps even more interesting is the fact that the private insurance my wife and I had through my office prior to my retirement was an excellent policy which, for both my wife and I, cost about $11,000 annually, roughly $3,000 less than what we are now paying! (Microsoft just informed me by e-mail that I’ve exceeded my allowance of exclamation points for one paragraph.)

It was traumatic enough to learn that what I once thought was essentially free was going to cost my wife and me $14,000 a year, but then we began the laborious process of signing up for Medicare and researching which of the countless number of Parts C, F and D policies would best serve our individual circumstances. We quickly learned that the type and number of prescription medications you use has a major impact on which Part D policy is best for you, and that meant that what might be good for the goose would not necessarily be good for the gander. In other words, my wife and I ended up with different Part D policies from different companies because we take different meds which are covered differently by each insurance company. Our insurance consultant recommended that we go with a Part F policy rather than C, and on his recommendation we chose Highmark Blue Cross. (I have no idea why we chose Highmark, but that’s what our expert said to do, so we did it!)

There is a great lesson to be learned from all of this chaos, a lesson offered many times in past years, but none the less a lesson which never seems to take hold. It’s one of the few things the right wing conservatives in this country got right, and that is that less government involvement, especially in large programs such as Medicare, is usually much more effective, less expensive and generally better for the country and its citizens. And that doesn’t hold true just for insurance. It’s true for almost everything. That being said, there remain certain things in which the government needs to be involved regardless of the inherent inefficiencies of their involvement. I’m talking about things like national defense, uniform national education standards, anti-crime enforcement and how many sheets of toilet paper you should be able to use at one “sitting”. But the formation and administration of large scale, national service programs?….No, No and No! A good adage to remember is that there is very little that government does that the private sector can’t do better and less expensively.” (Talk about words to live by!)

So to sum it all up, next time you and your friends have a few beers and decide that it’s time to dump on seniors and the so called “free ride” they get with Medicare, remember another old adage. “There is no such thing as a free lunch.” 

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