my medicare card

It's the supplement, stupid!

| I'm here to attest: the US healthcare system is dysfunctional and crazy.

I should consider myself fortunate. After all, I have had what I thought was pretty good employer-provided health insurance while working and after I retired. But I have found through painful personal experience that how good you think your insurance is depends mostly on not really ever having to use it. That changes everything.

When I left HP I selected a PPO health plan (Preferred Provider Organization), reasoning that the flexibility would be good for someone with more than one chronic health condition. And for the years that I simply went to my doctor for regular check-ups and consulted occasionally with a specialist, this proved to be the case, putting aside that the cost of my insurance more than doubled in the six years since leaving HP.

Last year, however, I required a minor surgical diagnostic procedure, and that's when the gotchas reared their ugly heads. I quickly learned that the outpatient surgical center at the in-network hospital is considered out-of-network by the insurance company because the center bills separately from the hospital. And although I made sure the surgeon was in-network, it never occurred to me check on the anesthesiologist (yup, out-of-network) or the various technicians who administered run-of-the-mill tests (X-rays, EKGs, etc), also out-of-network. Suddenly costs that I thought should be covered became "deductible" and "out-of-pocket," whatever that really means.

This year I became eligible for Medicare, and the premium for coverage B is $96.40 per month, slightly more than half my current health insurance premium. (There is no premium for coverage A.) Not bad at all.

But wait, there's more! Medicare becomes my primary coverage, and my employer-provided health insurance becomes a supplement. The cost should go down dramatically, right? Wrong! It goes up! The supplement costs twice as much as the primary insurance! What's up with that? And no, I'm not making this up!

(The official explanation was that I'm now in a smaller, older group more prone to health problems. Yadda, yadda, yadda!)

The prescription drug coverage provided by my supplemental insurance is certified to be as good or better than coverage D under Medicare, so that's a benefit at least. But for everything else, the supplement really only covers an additional 10% of the costs beyond the 80% covered by Medicare. And then there are still those deductibles and out-of-pocket expenses.

So, on April 1st I become covered under Medicare, and my health insurance goes up 50% from the cost on March 31. What a deal! April Fool!

Swiss cheese has fewer holes than our health insurance system. The insurance companies are rolling in profits since they have so many clever ways to avoid actually paying benefits when you really need them. The system doesn't work for patients, nor does it work for doctors and hospitals. We need health care reform, and we need it now!

Last updated on Sep 1, 2016

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