In my new business of selling insurance, I have learned an incredible amount of information in an amazingly brief period of time. I have learned about selling group products, and have talked to a lot of interesting and diverse people. It's mostly been a lot of fun, and I have honestly enjoyed the opportunity to dialog with people and find out what is on their minds.
While I have gotten my feet on the ground, one of the things I have looked into is selling medicare related health insurance; basically supplemental and advantage policies, for those in the know. I love the over 70 crowd, and I would love to spend my time talking with them and helping them find the right product for their lifestyle. So it seemed like a logical match, and a good fit for me.
I am here to tell you, it's a whole different health care universe out there in medicare-land. It is a world primarily designed and run by government agencies, who are in charge of everything from when the elder can buy it, to what an agent can say to them about buying it, to how and when an agent can say it. Or not, as the case may be. And it is the case more often than you would imagine.
I have always been one who believed, and I still do, that it is immoral for us as a wealthy nation to fail our citizens by not providing universal health care. Medical crises are the leading cause of bankruptcies in this country, and it shouldn't be that way. This is one of the richest nations on earth. There should not be a single citizen who does not have reasonable access to a decent doctor. People like me, who are poor but trying, shouldn't be locked out of the system, or forced to pay such high premiums, or to carry such high deductibles, it amounts to the same thing.
For all who believe that hospitals are required to provide care to all, including the working, uninsured poor, you should probably check with your local hospital on that one. While it is true they are required to stabilize you, and the key word here is STABILIZE, they are not required to provide ongoing care, and they are not required to forgive the debt, either. So if that is your plan for providing health care to all Americans, think again.
My daughter had cause to use the emergency room last spring. After a CT scan and a few blood tests, I was thousands of dollars lighter in the pocketbook, and that was with the negotiated rates imposed by my insurance company. We didn't quite reach the $5000 deductible, of course, so it was entirely out of my pocket. Or it will be for the next 25 months, because I can't afford to pay for it all at once.
Of course, rumor has it that hospitals, and even doctors, will simply write the debt off if you explain to them your circumstances. So I called the hospital to tell them of my plight, and they could not have cared less if I am poor, broke, and newly employed in a 100% commission position. They wanted their money, even if it meant it would take them 25 months to get it. Because they have their own bills to pay, and they can't do it if they are writing off every ER visit from someone like me.
And while we're on the subject, the insured are not subsidizing the uninsured. That is a myth, spread by those who have never been uninsured, I would guess. The reality is that if you go to the doctor's office without insurance, you will pay probably $50-$100 for the same visit where an insured person will pay $30. If you think the insurance companies are floating the difference, you are hallucinating, and really need to go out and get some fresh air. It's the uninsured who are making up the difference out of their pockets, and it's harder on them than on anyone.
[And just to be clear here, I am not dogging the doctors or the facilities involved. The insurance companies are big business, and they are exercising their free market rights to negotiate a contract that is in their best interests, and that of the shareholders to whom they answer. The reality is that the medical profession has to cover their own costs, as well, and if they can't do it with the revenue from the negotiated rates, they have to find it somewhere. And a lot of doctors do, in fact, give their uninsured patients a break, of course. But they set their base rates for services based on their costs - it is not an effort to screw the poor, and that is not the point I am trying to make.]
The uninsured are, for the most part, people who are working, and who make too much money to qualify for medicaid, but don't have group health available. How important is group health? Well, with a group plan, no group can be outright denied. You can raise the rates on the group, to some extent, to cover the critically unhealthy, but the insurance companies are required to issue some plan, if you agree to the rates.
Individuals have no such protection. I have talked to many people already, in just a few weeks of working, whom the insurance companies declined to insure. Even people who are managing their illnesses are locked out, eligible only for the high risk pool insurance for those who have been declined by two or more major insurers. I have heard that pool insurance is pretty high quality in some states, and reasonably priced, although I haven't looked into it, personally. So perhaps in those states it's not a disadvantage, I don't know.
However, I know from having looked at it for myself, that is not the case in Kansas. It is extremely expensive, and has poorer benefits than most of the individual policies that are available, which generally have lower benefits than the group policies available to most Americans on the job. By the time you pay the premiums, most people can't afford the high deductibles, leaving you almost no better off than if you were uninsured.
So the long and the short of it is that I definitely do believe some kind of insurance should be available to all Americans as a birthright, affording people the freedom to not be tied to a job for the health care, and to make affordable health care available to everyone, rich or poor. However, and this is a huge proviso, having seen the medicare situation up close, I have to be honest, the government should not be left in charge of our health care. I have seen the dark side of government administered health care, and it is genuinely frightening.
My fears are less along the lines of waiting periods or lack of availability - that hasn't happened now, there is no reason to imagine that if government sponsored care is the only type available, that it would significantly change the availability landscape - than they are on the administration of it all.
For those who don't know, medicare recipients are required to make choices during a six week time frame each year, November 15-December 31. Never mind that is the busiest and most compressed time frame in the year. Never mind that every single person over the age of 65 is now making a choice and submitting forms to a government agency at the same time. [Think IRS, another subject I will address some day in the future when I don't have an audit that will apparently never end hanging over my life.]
The worst of it, in my opinion, is that the people caught in this web are required to live with the choice they make for a whole year, no matter how unhappy they are, because that is the only time of the year that they are allowed to make the choice. I had one person describe it to me as sort of terrifying, because you know, whatever you choose, you are stuck with it for a whole year. And if you make the wrong choice, you are toast. I don't like toast, and I always burn it, anyway.
But the very worst part of all is that the government has made up all these goofy rules about what you can say and do while you are selling the insurance to the elder person. I certainly do understand that some of our elders need protection from the unscrupulous who are out there, waiting to swoop like vultures on the vulnerable.
But turning 65 does not signify sudden mental incapacity. I think it's insulting to treat all of them as if they were five, in an effort to protect those that have lost ground. Frankly, my 81 year old mother has more on the ball than some 20 somethings I know, so I don't know why the government thinks it needs to protect her from information that may help her make a better choice.
The very rules which are designed to protect, in fact, in some cases, will actually serve to disadvantage the elder, because they restrict the information that the person can acquire at any one time. I told my mom to check into a certain type of policy with her own agent (no, I am not such a bad agent she can't trust me, she lives in another state and I am not licensed there.)
But I told her to go to his office and meet him there, because he has more freedom if she goes to him than if he comes out to her, or to call him ahead of time and tell him she wants to talk about ALL the options that are available to her, because she doesn't even know about some of the options that are out there.
I'm guessing it's because either they aren't available to her, [Medicare policies are designed not by state, like most insurance, but by county. No doubt it's related to government reimbursement rates, but what on earth kind of system is that, I would like to know?] Or possibly it's because her agent was prevented by the rules from telling her about all her options, and he couldn't even tell her what he couldn't tell her.
And before you go off on the insurance companies, while they are clearly making a handsome profit these days, that has certainly been in the news, they are also spending a fortune on compliance. One seminar I attended included a three inch, three ring binder, one for every single agent in attendance, completely full of two sided pages almost entirely devoted to compliance issues, with only a few pages dedicated to the actual policies available to sell. The penalty for screwing up and violating the rules is an astounding $25,000 per violation, I was told at one point, so there is no margin for error for anyone involved in the process.
The most ridiculous rules have to do with documentation, of course. What would the government be without documents to file and keep for the rest of your natural life? So now an agent is required to send out a form to the elder person to sign and return before they are allowed to go out on the appointment that the elder person had to call them for in the first place, since you are not allowed to call them first, unless they are an existing customer to begin with.
I just know how well that will work out. You will mail out the form, the elder person puts it aside, because they are busy getting ready to go golf or go bowl or it's a form and they don't feel like dealing with it. I don't know about your mom, but mine hates forms. I don't see her jumping on it with much enthusiasm. Then, they have to come up with a stamp and get it into the mail. Personally, I've had some mail sitting for the last three days that I keep forgetting to get out to the box. This does not bode well for anyone actually getting information they need.
For those who are visually challenged these days, however, rest assured, the government is on it. Among the many things they require is that the font size is at least twelve point, so it's legible, on each form. They have also approved the snack list of things you can offer to the elder while they sit through the boring meeting about what their options might be for the coming year. No stone has been left unturned in the quest to control the entire process from start to finish.
The agent is required to have the form before the meeting can occur, so when they don't get it back to you in time, then you have to reschedule. But the time frame is very short, only a few weeks, and most agents are frantically busy during that period of time, because it's so compressed. I wonder how many policies will simply renew without the agent ever even talking to the person? And how is that going to protect anyone, except possibly the insurance company who holds the policy that is already in place?
So while the national discussion on universal health care rages, I would STRONGLY urge everyone to become informed, and to write your Congress-person about what you want, and especially what you don't want, with regard to health care. Don't kid yourself, the president can propose, but the Congress controls the purse strings - always has, always will. If you want to ensure your access to information, and you want to guard the flow of the dollars, Congress is where you need to point your eyes, and keep them focused.
To my elder readers, good luck on your health care decisions for the coming year. There are some terrific options out there for you, so ASK your agent what the full range of choices are, and make a truly informed decision, even if you have to wait 48 hours before you have all the answers. That way you can feel confident for the next year that you have the best plan for you, and not the one with which you got stuck.
And to everyone else, inform yourself. This is the most personal of decisions, how to manage your own health care. Be informed, be in charge, and make sure that your best interests are the ones that the Congress is watching out for. Because if you aren't willing to do it, who else is there?
