Medicare

My recent experiences with health insurance. Continue reading

My company has offered an excellent health insurance plan for the last two decades. I have religiously contributed to it month after month. The total amount that I and the company have paid is just staggering. For that I have received a discount on a couple of pairs of glasses, and I did go to the doctor once when I had a urinary infection. Oh, yeah – the clinic prescribed some salve for a rash on my leg. Anthem definitely has made a lot of money on me.

All that is history. The baby-boomers are lined up to begin feeding at the public trough. I, for example, have been on Medicare since August 1. It has been a strange and enlightening experience.

Months before I became eligible I was inundated with offers from private insurance companies concerning supplemental insurance. I started throwing them away unopened, but if I had kept them all, the pile would surely be at least six inches high. Since I have only been ill a couple of times since I got the Russian flu as a sophomore in college, I was not thrilled about the prospect of spending much money on additional health insurance. I called my insurance agent, and he determined that the best plan for me would be one from Connecticare. The cost of this “supplemental insurance” was exactly $0. Don’t ask me to explain how this is possible. I later decided to add dental coverage to it. So, next year I will be paying a very modest premium to Connecticare, but my total coverage is superior in nearly every way to the private plan.

I calculated that I would be paying Medicare about $100 per month for its basic coverage. The government, however, calculated that it should be about twice that. It seems that the Social Security Administration used my 2011 income tax return instead of my 2012 return. It was therefore not cognizant of the fact that Sue and I got married in 2012. I received a letter in the mail notifying me that my additional premium, which is called IRMAA, would add another hundred.

Not that Irma!

Not that Irma!

I called Social Security. I was on hold for a little over an hour, during which time I got to listen to an insipid piece of music that was on a loop. It was not really obnoxious; it was just cloying. I do not know who chooses the music, but I have three words of advice for them: “Nobody hates Mozart.”

Eventually I talked to a nice man in the Springfield, MA, office. He asked me to mail his office a copy of my 1040 for 2012 and my marriage certificate. I did so, and on June 24 I received an envelope that contained the documents that I had mailed as well as a note confirming that they had been received.

The first quarterly bill that Social Security sent me in July was for the basic coverage, and I paid it. In August, however, I received a confusing invoice that seemed to indicate that I had not paid enough. I called Social Security again, and this time I got to listen to that selfsame tune for over ninety minutes. The lady who talked to me this time was not from Springfield. My call had been routed to the national office. She called up my record and, after talking with the “technical consultant,” she reported that my file had only been half updated. She said that she had fixed it. I asked her whether I should pay the additional bill or not. She did not venture an opinion, but she did state that if I overpaid, they would refund the excess. This was not particularly reassuring to me.

In September I got another invoice, this one for the quarterly period that began on November 1. It recognized my first payment, but it still insisted that I owed two quarters of IRMAA payments.

I girded my loins, donned my battle armor, and called Social Security again. The music-filled wait this time was nearly two hours. I talked with a different lady at the national level who apologized for the delay and explained that all calls to local offices in the afternoon were being forwarded to them so that the local agents could schedule face-to-face meetings. She said that the agency, which serves fifty million recipients, was terribly understaffed.

When she looked at my computer file she discovered that my record definitely still indicated that I was required to pay the IRMAA. She said that she could see that the local office had received my forms, but evidently no one ever updated my files. She made a “telephone appointment” for me with a representative in the Springfield office. The earliest appointment that she could schedule was on October 24, exactly one month in the future, exactly four months since the same office acknowledged receipt of my documents, and exactly one day before my next premium was due. I dutifully asked the lady how much I should pay, but I got the same nebulous response as before.

I reckoned the odds of whether I would actually get a call that day at about 50-50. In fact, it came fairly early in the morning. This time the local agent was a woman. She looked at my record and related with a sense of conviction that, unlike the 1040 for 2012, the marriage certificate was “not in their database.” She said that I could either bring it in or mail it again. I did not feel comfortable mailing it. She said that I would need an appointment to bring it in, and, to my shock, she scheduled me for 9:00 a.m. the next day!

I arrived at the Springfield office at 8:55. I was surprised to see about thirty people lined up at the door. At 9:00 sharp the security guard came out and warned us about the prohibition on the use of cell phones and the consumption of food and beverages within. He then asked for a show of hands of people with 9:00 appointments. About half of us raised our hands. One guy insisted that he had an 8:00 appointment (“and confirmed!”). The security guy was skeptical but not dismissive. He told those of us with appointments to proceed directly to one of the six windows. The other hapless creatures were ushered inside to take a seat. God only knows what became of them.

While others fought for positions at the first few windows, I calmly walked up to the last window. The lady asked me for my name. “My name?” I queried. Surely, if anyone were to use Social Security numbers, it would be here.

But no, as soon as she heard my name, she said, “Oh, you are the one with the marriage certificate. Do you have it?” I handed it to her. To my astonishment she efficiently photocopied it and then wrote on a purple post-it the name and telephone number of the lady with whom I had an appointment. She said that the lady would call me later in the morning and that I should get in touch with her if I have any more problems. The whole thing took less than two minutes.

I was only back in the office for a few minutes when Mrs. Doppmann telephoned me. She said that she was unable to meet with me because her supervisor called a meeting that morning. However, she said that she had personally updated my record, and it now looked correct. She also said that she would keep an eye on it. Evidently these files will revert to erroneous values unless they are under constant scrutiny.

If my next bill is in error, I will call Mrs. Doppmann directly and avoid listening to that music. If it is correct, I may offer a purple post-it to the highest bidder on eBay.

* * *
I have more than three decades of experience at designing computer systems, and I currently manage four websites. Nevertheless, I have no opinion on who is to blame for the problems with the website for the exchanges for the Affordable Care Act. There is one fact that has received very little emphasis, and that is that the new health care program was designed to be run by the states, not the federal government. Insurance, after all, is regulated at the state level. The federal government has previously had no role at all. It makes sense that programs that made new requirements on the insurance companies would be run by the states.

In the Nutmeg State and fourteen other states that is, indeed, the way it is. I logged in to the Connecticut website to see what insurance would be available for Sue on the exchange. The site was responsive and easy to navigate. I found a “gold” policy for her that seemed similar to what she currently has. It even had the same carrier. The most obvious difference was the price, which was about $400 less than what we currently pay. I downloaded a pamphlet that has 119 pages of details of the coverage. Sue and I will compare it with her current coverage and decide whether to enroll as of the first of the year. My understanding is that most people in the other states that have their own exchanges have had similar experiences.

7,615 people enrolled in Connecticut in October. Seven times that many have enrolled in the state of Washington. The Chief Information Officer of the Health Benefit Exchange there said it succinctly: “It is just the complexity of their scope v. ours. We focus on one state, but they are having to focus on thirty-six states. It’s just that much more complex.” When you add in the fact that each state must be notified of the details of each enrollment and they all have different computers and different software, the difficulties of doing the enrollment at the federal level are more easily understandable.

So, it seems to me that those people who are fed up with trying to use the healthcare.gov website should first ask their state governments why they have not done their job and created an easy-to-use website like Connecticut’s and Washington’s. The federal government is footing the bill, after all. What is their excuse?