Here's one of several articles that my wife wrote for and was published by our local paper:
I am 67 years old. I have had quite a bit of experience dealing with health insurance plans. While my husband and I taught, we were covered by our school systems through private insurance companies. We had good coverage, but I have spent many hours on the telephone straightening out claims payments, as have all my friends, and, I would bet, many of you.
My husband and I now have Medicare coverage. Medicare Part A is for catastrophic coverage and is free to us and every other senior citizen, although paid for by our own taxes as well as everyone elses. Part B is for doctors visits and procedures; it costs each of us $96.40 a month. The amount is deducted from our Social Security checks, so we do not have to deal with payments. We decided to purchase a Medicare supplement to pick up the deductible and the relatively small amounts left over after Medicare payments. Our fairly inexpensive group plan through a teachers organization costs $280.08 per month for both of us together.
In contrast to my experience with private insurance companies over the years, dealing with Medicare has been wonderful. For several years I helped my mother with her claims, and my husband and I have had Medicare for a combined total of eight years. Only once in all those years have I had to straighten out a claim, and that was because the doctor used the wrong code in filing. In other words, the Medicare staff has not made one single mistake in processing a claim. Each year we receive a booklet that explains very clearly what will be covered. Medicare saves paper and postage by mailing out one Explanation of Benefits each month, rather than one for each date of service. After paying their part, they send the information directly to our Medicare supplement company, which pays the rest and sends us an EOB. It is an efficient and almost error-free system. Medicares administrative costs are only 5%, much lower than for the private insurance companies.
In fact, my only concerns with Medicare are on the part of the providers. I understand that payments are slow to come, and the amounts paid seem unbelievably low.
Now, Medicare Part D, the prescription drug part of Medicare, is a completely different story. In order to get it passed, Congress lessened the amount of opposition from insurance and drug companies by setting it up to involve private insurance companies. The Medicare booklet lists three pages of plans for Indiana. This is choice. It is a nightmare trying to understand what each plan covers and how it works. Each January the terms change, the prices change, and, if you want to stay on top of your choice, you have to go through the selection process all over again. This might mean looking at insurance company websites or calling to find out exactly which drugs are covered, and at which level (generic, preferred brand, non-preferred brand). After you decide and choose you may find out that the drugs you thought were covered, are not, or that they are covered at a different level than you expected so that you have to get prior approval or try cheaper alternatives. This, again, is a huge hassle for the doctors and their staffs, taking time that they would like to spend with their patients.
Medicare Parts A and B is a single-payer plan, with the federal government as the payer. Billing clerks for the doctors and hospitals deal with only one entity. It is easy for them to remember what is covered because so many people are covered by one plan. We once tried an advantage plan. A private insurance company administered our Medicare A, B and D plans. We paid the government as usual for Part B, but we paid the insurance company for the prescription drug portion plus the Medicare supplement. The plan was cheap, but the headaches were many. There was a provider network. Each billing office had contracts with so many providers (changing every year, of course) that they could not keep track of the terms. Sometimes they forgot to renew their contract with our insurance company, which meant the contract was no longer valid. The insurance claims agents were not well-trained, so I got various answers, depending on which person I talked to. I think I spent more hours on the phone that year than all the other years combined, and I wound up filing a grievance over payment of claims.
As Congress takes up the issue of health coverage for all of us, not just those who have employer-provided health insurance or enough money to buy it privately, I am very concerned that they will make the same mistake they made with the prescription drug part of Medicare. I am afraid they will involve the private insurance companies and create a system that is confusing and, yes, more expensive, because there will be the expenses of profit for the insurance companies, salespeople, extra staff in doctors offices to deal with the variety of plans.
Do I want choice? Yes, I want choice of doctor and medical facility. I have that with Medicare, which I like. It is a single-payer plan.
I do not want choice of plan. My experience with Medicare Part D tells me it will be confusing for patients and providers alike, and it will be more expensive in the end. Private insurance companies compete for the healthiest patients and the highest profits for themselves and their stockholders. This kind of choice is not in the publics best interest.
