November 3, 2013
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A few weeks ago Jean, a 64-year-old retiree from Littleton, sent along an e-mail in response to a column I had written. I had told of my friend’s ordeal trying to refill a particular cholesterol-lowering drug that a pharmacy benefit manager, known as a PBM, wanted him to exchange for a new drug. That new medication would have resulted in an out-of-pocket cost increase of more than 1,000 percent.
Once again it’s Medicare open enrollment season, the time for those on Medicare to choose how to cover the gaps in the government health program for seniors and people with disabilities. Once again beneficiaries in many parts of the country face a bewildering number of choices — far more than most of them can reasonably evaluate. It’s no wonder studies show that beneficiaries stick with the same plan year after year even though they may be able to get something cheaper.
What I like to call The Great Cost Shift in American health care marches on with the approach of this year’s insurance enrollment season. That’s when all of us who get coverage from employers, the new state exchanges, Medicare Advantage plans or from a Medicare prescription drug plan are likely to find that choosing drug coverage just became harder. Not that it was ever easy.
Evidence continues to pile up that Medicare Advantage plans are no advantage for taxpayers. MA plans, as they are called, are one alternative for seniors to receive their Medicare benefits. But in this case, the benefits come from government payments to private insurance carriers, not directly from the federal government.
Several years ago the prestigious Institute of Medicine, the health arm of the National Academy of Sciences, revealed something startling about U.S. health care. Many Americans get too much at the same time others get too little.
Tracy Hume, a freelance writer who lives in Greeley, and a reader of Thinking About Health columns, recently sent along this provocative question. “Do ER-affiliated urgent care providers ever try to escalate patients to the ER when it is not medically necessary?” she asked. “Why? How should a consumer respond?”
It’s now the silly season for insurance rates with government agencies, consulting groups and the media all speculating about next year’s premiums. Will your insurance premiums go up or down this fall? Never before have I seen such intense interest in insurance rates, which editors have usually considered a snoozer of a story.
Many Americans have begun to realize they’re paying too much for prescription drugs.
How many times have you walked away from the doctor’s office with a prescription for an antibiotic to treat a cold? Probably many. Over the decades we’ve been conditioned to believe that antibiotics are sort of an insurance policy against some malady that might be worse than a cold or that they will make the nasty symptoms magically disappear.
How many times have you heard politicians say that no bureaucrat should come between you and your doctor? You and your physician should decide when you need to go to the hospital or when you might want to wait out that cold before taking an antibiotic. At least that’s been the American ideal of the doctor-patient relationship. The reality is something very different.
When you next eat at McDonald’s, here’s an exercise in consumer choice: Would you choose a Bacon Club House burger with 750 calories, a Big Mac with 550 calories, or the premium McWrap with bacon and grilled chicken giving you 460?
If you’ve signed up for Obamacare or have begun using the coverage you already had, you’ve moved from the buyer’s stage to the owner’s stage. Like owning a car, you have to read the fine print in the owner’s manual to know what to do when things go wrong. In particular, you need to know who pays what for your care.
Pat Mallett, a self-employed businessman in Littleton, had heard a lot about Obamacare and thought a policy available in the new state shopping exchange would offer him a better deal than the coverage he had. The policy that covered him, his wife and two teenage kids cost about $400 per month and came with a $5,000 deductible, which meant they paid cash for routine office visits and annual physicals — up to a total of $5,000 per year.
The day of reckoning is coming for the Affordable Care Act, widely called Obamacare. March 31, the day nearly every American is supposed to have health insurance, is fast approaching. And judging from the government’s February enrollment numbers, many uninsured people still have not signed up.
The Obama administration official at the New York City panel missed a chance to explain an important aspect of the law that gets to the “what’s in it for us” question.
The conversation around health care and what we pay for it is beginning to change. The realization that we pay way more than other countries for the same services is beginning to sink in. Why do Americans on average pay $8,143 for hospital and physician services for cataract surgery while the Swiss pay $2,566 and the French only $1,938? By all accounts, outcomes are similar.
The median annual household income for seniors is $34,000, and it’s just under $30,000 for people living on Social Security disability benefits. Looking at the stats another way, half of all people with Medicare live on annual incomes of $23,500 or less; one-quarter have incomes below $14,400. Both reports found that even with Medicare, high health care costs are eating up a substantial portion of those incomes as Medicare beneficiaries know all too well.
At the end of last year, the Food and Drug Administration approved a drug that may cure some 3 million Americans who have hepatitis C, a disease that interferes with liver function and eventually can lead to liver cancer. It’s a serious illness; many people don’t know they have it until the first symptoms show up years later, and those who do have it undergo grueling and sometimes ineffective treatments.
Buying health insurance is tough enough for anyone. It’s hard to slog through the terminology. You have to ponder the unknowns about next year’s illnesses and make your best guess about the coverage you’ll need. Add in the hassle of navigating the new state shopping exchanges, and you’re facing one of the most complicated shopping decisions, ever.
Because so much of the national discussion lately has focused on health, the Affordable Care Act and its troubles, you might think that health insurance is all that matters when it comes to making people healthy. It isn’t. That good health is more than health care was a point I heard many times on my recent Fulbright fellowship visit to Canada, and it’s a topic we don’t talk much about in the U.S.
After recently reviewing options for next year’s Medicare coverage, it’s important to understand how Medicare fits with the Affordable Care Act, often called Obamacare. With all the media attention focused on shoppers in the individual market and their troubles navigating the government’s website, it’s no wonder seniors want to know if they have to sign up somewhere to keep getting their Medicare benefits. Do they have to shop in the exchanges? What happens to their premiums?
Before reviewing options for next year’s Medicare coverage, it’s important to understand how Medicare fits with the Affordable Care Act often called Obamcare. With all the media attention focused on shoppers in the individual market and their troubles navigating the government’s website, it’s no wonder seniors want to know if they have to sign up somewhere to keep getting their Medicare benefits. Do they have to shop in the exchanges? What happens to their premiums?
Buying health insurance is not fun. But if you make the wrong decision, it could cost you, so it pays to think carefully about the policy you buy in the state shopping exchange.