Banner photo of Larry Eugene Meredith, Patrick Flynn and Ronald Tipton, 2016.

The good times are memories
In the drinking of elder men...

-- Larry E.
Time II

Thursday, July 5, 2012

HMO - HO HO HO!

There is an old saying, "You get what you pay for."  This is said when someone complains about something they paid little or nothing for; something bought on the cheap, a bargain, a perceived good deal, and then it doesn't work well.

"I bought this two dollar watch off a guy in the street and it stopped keeping time two days later."

"Well, you get what you pay for," is what the fool is told.

Quite often this saying is true.  Not in the case of the Medicare Advantage Plans, at least not the one offered by the A-As-In-Hole Insurance Company. "One of the wonderful things about reaching age 65," a TV ad tells us, "is Medicare." (Not an A-As-In-Hole ad in case you are guessing.) Medicare may or may not be wonderful, but most certainly the Advantage plans aren't. But who knew? Most people I have spoken with about what happened to my mother are amazed when the medicare Advantage is explained to them. I have to admit I didn't know what they were.

I thought they were Medicare Supplement Insurance, you know, policies that cover what Medicare doesn't, like co-pays and deductibles.

By the way, this is another thing where "you get what you pay for" doesn't apply, Medicare Supplement Plans (known as Medigap). You'll see ads from Company Y pushing their supplement plan as being better than Company X, and you are only paying a little more a month. Well, then pick Company X because these supplemental plans are standardized by the government. There is a menu of 10 choices. Each choice offers some additional services, for example Choice C offer Skilled Nursing Co-Pay Coverage, while Choice B doesn't and Choice K only offers 50%; however, Choices B and K don't cover the Part B Annual Deductible while Choice C does.

You need to select the Medigap coverage you think you'll need. Perhaps you never leave the country, so you don't need Choice C because it covers out-of-country emergency care. But whatever Choice you make remember it is exactly the same coverage you will get through Insurance Company X as Company Y, so don't take the one charging a higher premium.

I noticed when we visited one nursing home and I told the Admissions Director my mom had a Medicare Supplement plan called A-As-In-Hole Medicare Super-Duper that she wrinkled her nose.

"That's not a supplement plan," was all she said.

Now remember there were all those crossed off nursing homes that wouldn't accept my mother's insurance. It did seem funny that something from one of the best known insurance companies in the country called Super-Duper Plan would not be universally accepted.

When my mother's coverage was dropped after 43 days instead of the 100 days Medicare normally covers for such therapy I found out why these places wanted nothing to do with it.

I was put in contact with an insurance specialist both by a nursing home and a friend. He explained the different animals. He said my mom would have been fine if she had traditional Medicare, in other words Plan A and B, even without supplemental. What she has is definitely not supplemental.

I had a friend ask me if my mother had the Medicare Plan B premium deducted on her Social Security. Indeed, she did. He said she had Plan B coverage then. Not exactly, what she has is a Medicare Advantage Plan that gives the same coverage as Plan B and she gets the privilege of paying the Plan B premium to the government as well as an additional $145 a month to A-As-In-Hole Insurance Company for it.

So just what is this animal? It is really Super-Duper? Not so much. The A-As-In-Hole Medicare Super-Duper Plan gives you, by law, everything Plan A and B of Medicare does. It still has all the deductibles and Co-Pays, may even have a few additional ones. It doesn't supplement anything. It does include Part D, the prescription drug portion. But you can get Plan D coverage for under $40 a month, so what is the other $105 a month she is paying get her? Remember, she is also paying Medicare her $96.50 a month, but Medicare itself is not providing any of her coverage. No-no-no, A-As-In-Hole is doing it all. No claims ever go to Medicare at all.

It works this way. Medicare collects the regular premium from Mom's Social Security every month. Medicare then pays A-As-In-Hole a portion of that amount. Thus the government makes a little money on the deal. A-As-In-Hole takes that fee and adds their own premium, the $145 a month and agrees to cover what Parts A & B do.

So why would anyone go for this, you ask? Because when you are our age and you see the ad telling you how great the Super-Duper Plan is because it not only covers your Medicare care, but your drug prescriptions and your eye exams and glasses and your hearing aids and hearing exams and for an additional $10 a month your dental, it sounds like a good deal to a lot of us Seasoned Citizens. But since you can get a separate policy for Plan D at less than $40, that $105 additional a month should easily cover those other costs for most of us with money left over in our bank accounts.

And The A-As-In-Hole Insurance company and its cohorts who offer these Medicare Advantage Plans are allowed to make their own rules in some areas.

Thus instead of the 100 days of rehabilitation my mom would have received under traditional Medicare, she was cut off at 43 days by her supposedly Super-Duper Insurance Coverage.

Now a further note concerning my dad, who has this same type policy. It is even more odorous since he already gets his prescriptions and hearing aid needs through the VA as a combat veteran of WWII. What in the world is he getting for that $145 a month?








1 comment:

Ron said...

$145.00 a month is what I pay for my supplement plan. OMG! Am I screwed. I also have the VA presceiption drug plan. $8.00 (up $1.00 from last year) for one month subscription (30 pills) and $24 for 3 month's supply (90 pills). Good luck!