Sunday, December 21, 2014

Health Insurance or Let's Make Your Head Explode

Now that I'm sorta almost nearly employed, it's time to deal with the Evil Empire (no, not Comcast) - health insurance. For those of you who think Obama did wonders for the uninsured, it's time to crawl back under whatever rock from which you emerged.

I objected to government-run healthcare and I caught a ton of crap for it. I objected because nothing run by the government is a good idea or works correctly: look at Medicare and Social Security. The objection from the other side was that at least people would be insured.

The long and short of it, dear readers/plodders, is that Obamacare is a gift to insurance companies. You must have an Obama-approved plan or pay a fine. After some research, a fine would actually be better in some cases.

If you have an employer-sponsored plan, do the research. You'll probably find that it's cheaper with your employer. You will also avoid the dreaded Donut Hole [more later].

My previous employer (where the yellow brick road meets the duck pond) had good coverage at ridiculous rates. My new employer offers so-so coverage at ridiculous Obamacare rates. It makes my head spin.

So off I went, to, to do my own research. Now I know insurance, from being in the field, being a consumer and being married to a Frequent Flyer. With all of my cumulative years of insurance dealings, after doing the research and going over the numbers, my head exploded. There are bits of cranium, red stuff and something that looks vaguely like cauliflour all over the ceiling. Have you ever tried to clean this stuff off a ceiling? With or without a ladder? In the dead of winter? Without so much as a pole?

The people who champion Obamacare will tell you that millions more people now have healthcare than before.  What they don't tell you is that in most cases, this is subsidized by everyone else. And they can have up to six thousand dollar deductibles. For all of you playing along at home, this means that the insured have to pay up to six thousand dollars before their insurance kicks in (twelve thousand for couples). People who have never had insurance before are getting the shock of their lives because they don't know what a deductible is. Yes, they are technically covered but most won't even make their deductible (unless they have a hospital trip in their future). So that's a monthly premium plus a deductible. You are paying for the right to pay your deductible (or pay a fine).

To be fair, one of my loyal readers is overjoyed with their plan. I must admit that it's a great deal and really helps my reader out.  There may also be a difference between states that have their own plans and states that default to the federal plan (mine).

Are you ready?  [drum roll]

I did some ridiculously complex spreadsheet projections to see what plan benefits us most. This was rather a shame, as I am completely incapable of ridiculously complex spreadsheet projections. One has to take into account the premium, deductible, copay for office visits (primary and specialist) and drug copay. Add a headache to your already-spinning head.

For a single guy about my age, the cheapest plan is about four hundred dollars per month, with a sixteen hundred dollar deductible. In the end, I will have put out an additional thirty eight hundred dollars on top of the premium and deductible (plus donut hole). I am by no means a large user of medical services. This kind of plan is good for younger, healthy folks or me.

But wait...

Now stop waiting. You can select plans with escalating monthly premiums. For a premium of four hundred thirty eight dollars and a four thousand dollar deductible, I would put out two thousand one hundred fifty six additional dollars. Plus donut hole.

There are a few other plans with cheaper monthly premiums and deductible so high that insurance would never kick in.

And if you think this is bad, try adding your spouse to the plan. It comes out over double the premium for a single person.  And if you think this is bad, I won't even mention the family plan.

And now your head has exploded, like mine, and your relatives/cohabitants/roommates are left to try to remove the stains from the ceiling.


I have a thing about being interrupted - it agitates me. The more interruptions, the more agitated I get.
So I'm starting my Grand Analysis and my wife jumps up to have a cigarette. I continue then ask for the cost of her meds. She leaps from the couch and starts watering a plant.

At this point, I'm getting the idea that she does not want to deal with this. I asked. She asked why I asked. I told her that it's important we do this and the fact that she keeps leaving the general area seems to indicate that she wants no part of this process.

Attempting to listen to my point, she sits down and her leg starts jumping around of its own accord. In her family, leg jumping indicates agitation and anger. When Dad's leg was moving, she needed to make herself scarce. I pointed at her leg, which she hadn't noticed. Even when she noticed it, it would not stop moving. I have to admit it was pretty funny watching her trying to stop it (and failing).

Further into calculating numbers, my darling picks up her phone and starts reviewing the calls. At this point, I'm quite agitated due to the constant interruptions (although neither of my legs is moving about on its own). Finally I had to pull out the Big Guns and ask if playing with the phone was more important than deciding on healthcare.  She finally admitted that she didn't want to do this.

Funny, neither did I.  And I pity folks who have little knowledge of healthcare and insurance.


Far from being a tasty treat, donut holes are poisonous entities, otherwise known as gifts to insurance companies, installed by Congress as a Screw You to the populace.  And don't forget - Congress does not have to use this wreck they created; they have their own special plan that covers what ours doesn't.

Donut holes come with drug plans that aren't from an employer, for instance, all Obamacare plans. Your drugs are covered up to a certain dollar amount, then you fall into the donut hole, when the plan pays a paltry percentage for your meds. Another few thousand dollars later, you are again covered under the catastrophic portion of the plan.  If you are prescribed a lot of medicines, especially expensive ones, you are beyond screwed. It's cat food for you (which would be just fine with my dog but not me).

My parents hit their donut hole in October. My wife hit her donut hole in forty five days. And this magic carpet ride starts all over again in January.


The Medicare set, along with the Disability set, gets Medicare insurance. This is a good insurance but it does not cover the entire medical expense. It also does not cover drugs.  For example, let's say the doctor charges you one hundred dollars for your visit. In the Olde Days<tm>, Medicare would pay eighty dollars (after deductible) and your additional Medigap policy would cover the extra twenty. But since this is most definitely not the Olde Days<tm>, it no longer works that way. Out of one hundred dollars, Medicate pays eighty (after a larger deductible) and Medigap, depending on plan, might pay ten, with the extra ten to come directly from your pocket.  So you need Medicare hospital and doctor (Plans A+B), supplemental/Medigap (Plan C) and meds (Plan D, after deductible, with possible pre-existing conditions).  There are also Medicare replacements, which encompass Plans A,B,C and D and have exclusions and weird HMO regulations.

There is also a late filing fee for people who don't get their insurance during Normal Signup Time. Normal Signup Time is a few days in December, between the hours of ten and eleven, at the Normal Registration Place, around the corner, in the sub-basement, in the secret room you must go on a trek to locate the key for.  Hint: beware of the anteaters; they're out to get you.

By the time my wife has navigated this mess, her plans cost two hundred dollars per month with a five hundred dollar deductible and an additional six thousand dollars out of pocket. This estimate does not include some meds, hidden deductibles, hidden costs, late fees, and a one thousand dollar mandatory tribute to the President and architects of this Insurance Wonder.

If you're wondering why I was unemployed so long, let me do the math for you.... I need to make approximately two hundred thousand dollars per year to pay for all of this. And this is before anyone runs into my car (with its five hundred dollar deductible).

I have to go now. My insurance only covers one cranial explosion per year, plus the ceiling cleanup is not covered by anybody but me.

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