Baby Tulip Popular in the flower bed, 2014

Baby Tulip Popular in the flower bed, 2014

Yesterday, a message (a reply) to something I wrote in response to GigiHawaii’s post on Future Plans popped up on my iPad.  Because it was so rude, at first I thought it was spam. The issue under discussion in Gigi’s post involved Medicare. The topic was Medicare Advantage plans and their availability.  The responder accused me of being old and confused, both of which may be true at times.  She ended by saying I was spreading lies.  I may be older and confused at times, but I cannot be lying if I am confused…I think. I am sitting here with Medicare and You, 2015, the latest volume  (“brochure”?) from the Center for Medicare and Medicaid Services distributed to help us old and confused people understand what our medical coverage will be like in 2015.

Because the current administration keeps delaying the full implementation of the ACA, many of us are more confused than ever. The Pharmacos and insurance companies try to stay ahead of the situation, and in our case send us much anticipatory printed material. Last year, they sent David a message informing him that owing to changes in the law, they would be making changes in his coverage.

This year these changes have materialized as larger co-pays.  For example, although I take twice as much of a certain drug as David over a 90 day period (2 pills per day), my total co-pay for a 90-day supply is the same as his co-pay for a 30-day supply of one pill per day.  I have other examples, regarding visits to doctors where he always has an out-of-pocket co-pay, and my insurance fully covers my co-pay.

I retained the insurance policy I carried while I was working for the federal government, but David has a United Health insurance policy he earned through his thirty years with AT&T.  I pay a monthly premium for my health care insurance, he pays nothing but a premium for dental care.  I have minimal dental coverage.

In addition, I have traditional Medicare, Part B, and he has a Medicare Advantage plan.  We both pay the Part B premium.

 I had David on my plan until I retired and I was on his plan until I retired.

When I went on Medicare Part B, I decided after hours spent speaking with a representative or two or three at CMS, his plan representative (United Health), and my plan representative (BC/BS), to remove myself from his medical plan and drop him from my medical plan…mostly because the former confused me about my medical expenses and the latter doubled my insurance premium.

I could go on and on with this, but suffice it today, that the only thing I can deduce is that although I made careful plans for our future health care expenses, external forces are at work. In David’s case at least, the changes his insurers are making are attributed to changes in the federal law.  I deduce that to preserve their bottom line, companies are making changes anticipating what is yet to come when the ACA is fully implemented.

I won’t expound on this here, but my SIL, who runs a small business and who tries to retain health care for his workers and their families, has seen insurance company after insurance company drop out of the market in response to the ACA.  He predicts that eventually, two mega-corporations will own the insurance market.  Those companies will be United Health Care and Blue Cross.  So fasten your seat belts, you may be in for a bumpy ride.


Regarding yesterday’s puzzle.  The tree is a Tulip Popular, so-called because its leaf and flower are reminiscent of the bulb flower.  At 60+ feet it is the tallest and straightest tree in Eastern U.S. climax forests. It is also a native tree.  Look for the leaf near the center of the photo.

18 thoughts on “Nightmare?

  1. Well, I am sorry you had a bad experience with a comment on my blog. But, I don’t censor people with opinions, as long as they are not foul mouth.
    Anyway, Medicare Advantage is alive and well in Hawaii. I have looked into HMSA, United Healthcare, Kaiser, and Humana. I will be seeing a sales rep from Humana in my home today. Of all the plans offered, it seems to be the most affordable.


  2. I’m impressed that you’re trying to understand the whole thing. I received one 150-page book, and another ten-chapter book … and decided life is too short to try to puzzle my way through those things.


    • Not tying to understand the whole thing….nobody does, which is why it is so worrisome. I am mainly trying to understand exactly what a Medicare Advantage Plan is because of David. The new volume from CMS is also very nebulous. PPOs are listed as Advantage plans, but the only advantage seems to be to the insurer.

      PS I worked with various aspects of the U. S. immigration law for years (second longest law on the books)…mind blowing.. The US Tax Code is the longest…and it needs repair. But the current Congress and its staff are not up to the job. No one is because of partisan politics.

      Regarding the ACA, I am with Bill Clinton…mend it don’t end it. It is far to complex and affects too many people at this time to simply repeal it. Probably the dumbest thing the Dems ever passed, and they did it to score points with voters.


  3. I wish people wouldn’t lash out and be rude. Sorry you had that experience.

    Owning your own business is a nightmare regarding health insurance. We refuse to pay the equivalent of a mortgage for “good” coverage, so we’re stuck with a $10k deductible and no co-pays or prescription coverage. And still the payments are over $600 a month. Ridiculous. It will only get worse. *sigh*


    • I sure hope not. A number of ‘thinkers’ like the author of Fractured Society (Eric Hobsbawm, a Marxist scholar and historian) say we cannot know the future. On the other hand, the author (whose name escapes me…but he is a so-called conservative) of ‘Limits of Power’ believes it is. I find that some Conservatives can be very negative.

      I tend to think that we need to scale back on being so dependent on large government, multinational corporations, and stuff. And we need to scale back on inundating kids with everything they want instead of spending time with them. Let’s move away from instant gratification. Kids need to learn about delayed gratification. And as your sons demonstrate they need dad.


  4. The only thing I know for sure is that our insurance is very confusing and every year our out of pocket expenses increase (regardless of the extent of medical care required). I doubt any non-health-care-professional actually reads the book-length informational material sent yearly by our insurance company, printed in small font. I thought things might get simpler with Medicare (hub went on this year), but it hasn’t happened.


  5. I have all my medicare advantage info right here. 40 buck copays for all but my GP. I’m sure they will go up. G has Blue cross…the worst insurance in CA according to consumers report. Pisses me off. I’d go to the VA, but I don’t think now is the time.


    • Sorry to hear that BC in CA is so bad. My BC plan is for federal retirees, and very good. Under the federal plan I could switch to any insurance part of the pool, but stick with BC because it works for me. We had flu and shingles shots earlier today. My co-pay was zero, David’s $67 and $98. That’s how it goes. Too bad about the VA…for everyone.


  6. As a fellow “old and confused” citizen, I’m against Obamacare, so I’m told I want to see people die. I’m also against me paying for women’s contraception, so I’m told I hate women too. I’m also a supporter of the 2nd Amendment, so I’m told I want to see children killed. Other than that, I’m a pretty decent guy.


    • Very clever Al. I tried to come up with a smart retort, but had a flu shot and it killed my funny bone. However, I’m with you on these points.

      The biggest problem with the first is no one knows what’s in the law and regs, and if Obama can he will postpone its implementation until after the 2016 elections. Many of the fools who voted for the original bills will be long gone by then and the public will blame whomever is still around.

      The problem with the second is contraception can be obtained so easily it’s more expensive to buy aspirin.

      The problem with the third is someone who wants to commit mayhem won’t be bothered if there is a law against it.


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