My experience with Medicare, Peggy's attempts to get Obamacare


First Medicare

I’m about to start my second year on Medicare (the US government's healthcare insurance program for the disabled and people over 65), and I’ve learned two things. One is that I love my Medicare Supplement insurer—State Mutual of Georgia—and the second is that I loathe my Medicare drug insurer—Humana—and its lame-ass online pharmacy, RightSource. I just switched my drug insurer to Express Scripts, which has the highest customer satisfaction rating of any stand-alone drug provider, and, like Humana, has its own pharmacy. After what I pay for my four prescriptions is figured in, I’ll come out cheaper paying Express Scripts $55.90 a month instead of the $12.80 that I’m currently paying Humana. My total Medicare insurance costs for 2015 will come to $3,500. Medicare is what happens when the government takes what should be an easy to understand insurance program and throws it to the wolves, that is to the private insurers that hide the true cost to consumers behind a wall of options, legalese, and acronyms. It is not for the good of the individual that scores of companies offer scores of impossible to compare plans.

I started Medicare two months after breaking my back last November. I had plenty of time on my hands, so I began to study my Medicare options in the naïve belief that it would be fun and interesting, but it turned out to be a nightmare, the understanding of which would require a team of lawyers to evaluate and compare 120 page insurance contracts, one after another after another. This is why most people buy their Medicare policies from private agents. The downside of doing this is that these agents are themselves largely ignorant, and their primary goal isn’t to help the consumer but to make money by selling the policies of the very few companies that they represent. It’s also true that not all insurance companies sell through agents, and those that don’t can offer better prices because they don’t have to pay commissions. State Mutual of Georgia is one of them. You either buy from them yourself or not at all.

Dealing with Humana’s pharmacy—RightSource—is so bad that I would qualify it as abusive. The policyholder part of its website is all but undecipherable, and filling every order for every drug is so time-consuming and tedious that I never know if I will ever receive my order, but certainly not in less than three weeks. RightSource is such a joke that I have come to wonder if it's in Humana’s interest to deprive customers of their drugs. After it repeatedly “lost” or delayed order after order placed by my friend, Walt, on the behalf of his senile parents, Walt stopped even trying to use his parents’ insurance, and started paying the full costs for their drugs himself. The last straw for me came when someone at UPS stole my monthly order of oxycodone, and RightSource took it out on me by refusing to ever again ship me oxycodone. They knew the loss wasn't my fault, but they simply didn't want to be bothered with trying to ship narcotics to someone who had had a problem receiving them.

Obamacare, aka The Affordable Care Act

As tedious as Medicare is, it’s a hell of a lot better than what most people have. Unfortunately, Peggy is 63, and she can’t start Medicare until she is 65. Since she recently retired, she will hopefully go on Obamacare, which, like Medicare, is a government program that is run by private insurers. She initially tried to go on Obamacare when she retired this summer, and to this end, I (being the one who handles her business) registered her with Obamacare in March, but even though I started five months early, I still couldn’t get her a policy before she retired. This was due to the failure of Oregon’s Obamacare website whose creators are now being scrutinized by the feds to discover how all those millions could disappear without anything but an unusable website to show for it. Because she couldn’t get on Obamacare when she first retired, she bought a catastrophic insurance policy that is nonrenewable and expires on December 31.

Applications for Obamacare for next year opened on November 15, and I started an application for her on the national site on the 18th. No sooner had I set a username and password than I was locked out of the account that I had just created. I called their toll-free number, and an agent spent a couple of hours trying unsuccessfully to fix the problem. I spent many more hours over the next two days talking to different agents without ever getting logged-on. The last agent gave up, and said he would fill out the form himself and snail mail it to me. I didn’t see how this would enable us to buy a policy when we couldn’t even compare the policies (when I try to look at them online, all I get is six blank pages with the following words at the top of the first page: “Here are your 59 policy options”), but it seemed better than nothing. He was almost through with filling out the fairly long form when the software reloaded and all of Peggy's information was deleted.

I finally tried to create a whole new account for Peggy by using another email address, and this seemed to work, but when I tried to finish filling out the required form, the pages wouldn’t load. This has happened everyday since, so I haven’t been able to finish setting up her account, and I still can’t see the policy options, something that I should be able to do without having an account.

This is but a tiny taste of the state of insurance in America. If you work for a big company, you probably have insurance unless that big company is a franchise like McDonalds in which case you have no insurance; you don’t make enough to buy insurance; and the taxpayer is left to pay your medical bills through a program for the impoverished called Medicaid. On the other hand, if you’re disabled or over 65, you probably have Medicare. If you're not insured at work, or impoverished, or old or disabled, your insurance policy consists of hoping to god you don’t get sick because, unless you’re rich, you’re going to wind-up in bankruptcy court if you do. No matter how long and hard most people work or how much they save, few people can stay solvent when they’re too disabled to continue working, and they owe a half-million or more in medical bills, medical bills being the leading cause of bankruptcy in America. Obama promised to put an end to all that, but the dumb-fuck can’t even get a website up and running no matter how much time and money he throws at it. 

20 comments:

All Consuming said...

It's all shite on a stick, the whole damn options for most people in America, and I feel for you both immensley. Two parties over here are working their damnedest to try and fool people into thinking insurance would be better than the NHS, so that everyone has to pay, or you can't afford it and potentially die because you can't afford an operation or medication. The world is full of devious jerks who care only about money and not a fig for anyone else but themselves, and Obama is doing a fine job of letting down everyone who voted for him from what I can see. Not that the alternative is any bloody better. We have the resources on earth at the moment to feed every person, and treat their health ills without it costing from here to high heaven but the pharmaceutical companies would rather watch people die and make money from selling drugs at extortionate prices and the governments are all in on it. I'm sorry to hear yor exasperation dear. *hugs him.

Stephen Hayes said...

I have three years to go before I have to step onto this pile of dog shit. I hope the problems are worked out by then, but I'm not optimistic.

Elephant's Child said...

Aaaargh. And echoing All Consuming. We all have Medicare and those of us who pay tax contribute 1.5% of our income towards it. And the poorest amonng us get to visit the doctor free and get reduced price scrips. Hospital treatment is covered. X-rays and other diagnostic treatment is not. Dentisty is not.
So many of us ALSO have private insurance. Hugely expensive, sadly necessary and designed to ensure that everything you need isn't covered.
And our current guvermint is trying hard to tinker with Medicare to make it more expensive and less accessible - and holding your country up as an example they would like to emulate. Hiss and spit.

kylie said...

I'm sorry it's such a nightmare!

Linda said...

I hear these stories and believe every word. If I had to do anything to get Medicare, I have forgotten it! Maybe I had to sign something??? I was automatically enrolled somehow. Then, I was automatically eligible or Medicaid. Nothing has been easier, and I have no idea why it is easy.

Peggy is lucky to have you to negotiate the treacherous web pages and try to figure this out even if you have not figured it out yet.

Blank web pages? Who has he hired? I know someone who could do this job in a snap, but how many years has it been that these web pages have not worked? He works for NASA.

Someone needs to take a class in web design. What do the people with whom you talk think is the problem?

Paula Kaye said...

I haven't really had to deal with Medicare yet. Richard had medicare and he used Express Scripts for his meds until Hospice took over. I have medical insurance that is provided by the company he worked for and it will be good until I turn 65. I haven't been to a doctor in over 8 years (yes, I am one of those nurses!) so I really feel the money I pay for health insurance is a giant waste that I could use elsewhere. But everyone tells me I would be crazy to drop it. I will have to ponder what I will do when I turn 65....I think it is the pharmacies and insurance companies that rule the world. Unfortunately!

Mim said...

I have Medicare stories that would make your hair curl.. My husband has to have Medicare but can't also get supplemental insurance so has to have double coverage. And Medicare won't pay anything since he has other insurance. No when we try to get off Medicare, cause we already pay for private insurance, they won't let us. This goes round and round and round. Argh!

Charles Gramlich said...

You know, it just shouldn't be this hard, which means that someone or many ones are deliberately throwing monkey wrenches in the way of people. It is disgusting and sure makes me wish for a hell where they would be punished for their inhumanity.

Tom Sightings said...

Thanks for relating your experience. I don't know much about medical insurance (you expect me to read 300+ pages of instructions for Medicare and Medicare advantage?) All I know is that my monthly premium went down from $800+ a month on private insurance to $400+ a month on Medicare (which includes some dental insurance). Luckily, I don't take many drugs. But last year I got two prescriptions. One cost me $3.80; the other cost me $206.15. Go figure!

One question, though, regarding Elephant Child's comment. How can we expect to pay 1.5% of our income for medical care when we actually spend more than 10 times that amount? Something like 16% of our economy goes to health care, so somehow we've got to pay.

Snowbrush said...

"Obama is doing a fine job of letting down everyone who voted for him from what I can see."

Did you hear about him chewing gum at state functions in China, a company in which gum chewing in public is considered rude (as I wish it were here)? That's American arrogance at its worse. Either that or the man's as dumb as the last Bush.

"I hope the problems are worked out by then, but I'm not optimistic."

I like it better than the insurance I had through Peggy's hospital employer, but that's because I have Medigap Plan F, which makes things simple by picking up every expense that Medicare covers but doesn't pay in full. My only gripe has been with Humana and with the absurd number of complicated options that the private insurers offer. I would advise you to stay the hell away from the Advantage Plans and go straight to the Medigap Plans because the good ones aren't only only better, they're easy enough to compare that you can actually tell what you're buying into.

"And our current guvermint is trying hard to tinker with Medicare to make it more expensive and less accessible - and holding your country up as an example they would like to emulate."

The conservatives here would like to turn Medicare over entirely to private insurers. As they see it, whatever benefits the wealthy is good, and the rest of us don't matter.

"If I had to do anything to get Medicare, I have forgotten it!"

I wish I were one of these people who could get a lot of business done while stone-cold drunk and not even remember what a chore it was! Actually, I didn't have to sign-up for Medicare either because I was already on Social Security, so you probably were too.

"Richard had medicare and he used Express Scripts for his meds"

Did it work okay? They have the highest approval rating of any insurer that's listed here in Oregon, yet it's only 87%. I don't buy off Amazon for a merchant who's under 97%.

"I haven't been to a doctor in over 8 years"

Let's see...a mammogram, a Dexa Scan, a PAP smear, a flu shot, shingles vaccine, pneumonia vaccine, maybe a tentanus shot, a colonoscopy... Wouldn't you feel stupid if you died because you didn't get one of these shots or procedures? Well, if you died, I guess you wouldn't.

"I really feel the money I pay for health insurance is a giant waste that I could use elsewhere."

I've paid for house insurance for 42 years and never filed a claim, so I now wish that I had self-insured by having a dedicated savings account. Yet, it would only cost $300,000 to replace my house and furnishings, an amount that is minuscule compared to what medical bills can amount to. I've had tens of thousands of dollars in medical expenses every year for a least eight years, and I might have to have a major surgery next year, so I don't just want insurance, I want damn good insurance, insurance that is so good that I won't to spend hours upon hours on the phone trying to get bills settled.

Snowbrush said...


"My husband has to have Medicare but can't also get supplemental insurance so has to have double coverage."

It sounds horrible, but I wish you would give more detail.

"it just shouldn't be this hard"

Ain't that the truth? My old Water Pik finally died, and when I went to buy a new one, I found that the different brands offered up to 16 settings. Who in the hell needs or wants 16 settings? It's like that with Medicare times a thousand.

"One question, though, regarding Elephant Child's comment. How can we expect to pay 1.5% of our income for medical care when we actually spend more than 10 times that amount?"

She's an Aussie . Foreigners keep sneaking into my blog, and Homeland Security can't seem to get rid of them.

"my monthly premium went down from $800+ a month on private insurance to $400+ a month on Medicare "

You have an Advantage Plan. I have a Plan F Supplement (Medigap). For $128 a month, it picks up every expense that Medicare covers but doesn't pay in full. My only medical expenses this year were for drugs, and they came to about $800. Even generic drugs are now becoming expensive.

Elephant's Child said...

'The conservatives here would like to turn Medicare over entirely to private insurers. As they see it, whatever benefits the wealthy is good, and the rest of us don't matter.'
Which sums up our current government's attitudes exactly.

Snowbrush said...

"Which sums up our current government's attitudes exactly."

Expressing it like that wouldn't go over well, so what they claim is that the richer the rich get, the more they can help the rest of us by hiring us to do things for them. I first heard of the idea back in the late seventies or early eighties when Reagan was president. At the time, it was widely called "Trickle Down Economics," although I don't know if Reagan himself used the term. A surprising number of poor people seem to accept the argument, especially in the American South, which has the highest % of the impoverished. The South has ever been a region that was prone to adamantly supporting propositions that were opposed to their interest. For example, if only slaveholders had fought in the Civil War, there wouldn't been enough of them to carry on the war because they were a tiny minority of all Southerners, and by using slave labor, they actually kept their fellow white Southerners in poverty, yet those same poor Southerners had no objection to killing and dying under the guise of states' rights. So it is today. My own state of Mississippi takes far more from the federal government in social welfare benefits than it pays in taxes, yet in no place does a higher % of white people (although they're scarcely better off than their black neighbors) oppose such benefits, preferring, it would appear, to taking their chances on the benevolence of the wealthy.

Elephant's Child said...

The term 'trickle down economics' has been used. Along with quite a few other weasel words and expressions which essentially boil down to 'we are going to look after ourselves and our friends'. 'And you can't stop us.' However, while it is very, very rare the early signs suggest that this could be a one-term government. And I hope so. I really hope so.

Strayer said...

I go about once a year to the doctor, who is actually a nurse. I got blood drawn this year, be two weeks this Friday and I have yet to hear any results. My cat got blood drawn and I got the results the same day. What's up with that?

I suppose I could call the office to try to get results, but I just really cringe at the thought of going through their two lengthy phone trees, with two reception areas, to probably be told the nurse will call me, at some point.

Snowbrush said...

"expressions which essentially boil down to 'we are going to look after ourselves and our friends'."

Same here, and the people who support this selfishness are mostly Christians. They favor putting social services under the management of the private sector or else ending them altogether in favor of private charity. They point out that the Constitution says nothing about such things, but then the Constitution says nothing about women's rights or child labor either.

"I suppose I could call the office to try to get results, but I just really cringe at the thought of going through their two lengthy phone trees, with two reception areas, to probably be told the nurse will call me, at some point."

This is why I do almost everything that I possibly can do on the computer, and I'm very glad that most medical offices now allow online queries. As for blood work, the results are usually sent to me by both the doctor's office and the lab.

Snowbrush said...

Child, I think the conservatives have a point about how many people milk the system, and I resent these people as much as anyone, but at the same time, many Republicans want to end programs that people earn. Social Security and Medicare aren't freebies, but when the conservatives call them "entitlements," they do so with a sneer which implies that they have no idea what the word means.

Paula Kaye said...

Yes Express Scripts worked very well for us. I only discontinued when he went on Hospice. We never had a single problem with them. As for my 8 years of never having been to a doctor: Nope, I don't do mammograms, never had a shingles shot, pneumonia shot, flu shot in my lifetime, I have kept my tetanus up to date but it too will be needed in another couple of years should I so desire. Never had a colonoscopy. And you are right, if I die from something that I could have known about ahead of time, I really won't care. I have lived well. And I truly believe that sometimes the more often you are in a doctor's office, the sicker you get. The more they look, the more they find. Now, with that being said, I might find myself a doctor in the future. But right now I am happy where I am on the health and wellness spectrum.

Snowbrush said...

"sometimes the more often you are in a doctor's office, the sicker you get. The more they look, the more they find."

That's all true, and it's why yearly physicals are no longer being recommended. When the feds recommended against PSAs and prostate biopsies based upon PSAs, I wanted to quit having PSAs. Peggy insisted, so when mine came back high (which it has now done for two years in a row), I refused a biopsy. Since the government recommendation, the urologists have been advertising almost daily on the local news, and the local news runs frequent stories about the importance of regular PSAs. No mention is EVER made in these stories about the government recommendation. Clearly, money is the motive.

Shingles has led people to suicide, and it has left more--including Peggy's father--in burning pain for years, so not going to the doctor isn't necessarily a choice between life and death. I've had shingles, and Peggy has had it, in both instances, we had it before insurance would pay for the vaccine. Mine was around my eye, a location that leads to blindness if not quickly treated. Luckily, Peggy recognized what it was, so I did get quick treatment. Even so, it was a horrible experience, and a third of people get it, so if you do nothing else, I plead with you to at least get a shingles vaccine. As for mammograms, colonoscopies, and PAP smears, they're more than money-makers for doctors; they really do save lives, and not only lives but misery. Your statement that you won't care if you die from a preventable disease implies that if you get one, you won't pursue treatment because, after all, if you won't take easy steps to save your life, why should you take hard ones. I hope you will change your mind. Just because you get on the medical treadmill, so to speak, by being tested, you still have the power to get off it, as I did when I said no to the prostate biopsy. It's also true that the day will come when you will value your life more than you do now. I'm reading "Last Wish" by Betty Rollin, a book about her helping her mother to die. Many years before, the mother's husband (Betty's father) had died, and for two years, she wanted to die too, but she did get the wind back in her sails, and she even found new love. I want more than anything for you to take care of yourself because I care about you. If begging will make a difference, then I am begging. I know you'll read this, so I want you to know that I have more thoughts about what you wrote about being glad you don't bore me, and I'll write them when I'm through with this.

CreekHiker / HollysFolly said...

I've had kinda good luck with covered ca...Once I finally got to choose a plan. I applied in 10/13 and got insurance in 08/14!

And still every time I visit the site (my plan is no longer offered in 2015), it will not accept my password from my previous session. It makes me choose another and answer three of several pre-selected questions. And choose a new password. When I try to use my previous password (which have all become some version of CoveredCASUX) I get a message that reads: You may not use any of your previous 24 passwords! 24!!! Yet it won't let me in with one I used yesterday!

Now I just know the drill... always click forgot password, answer questions...choose new password that you won't need to remember and do your business.