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Boomer Bytes #32: Are We Being Ripped Off?

Editor’s Note: Below is another column in Steve Canipe’s series called Boomer Bytes. The column, as the title suggests, will focus on a variety of topics that may be of interest to baby boomers, those born between 1946 and 1964. But Canipe also hopes to start a conversation with younger generations, too. Check out an introduction and Canipe’s (first self-titled) column here.

Are We Being Ripped Off?

By Steve Canipe

Aug. 22, 2014. This was the week for medical visits for my wife and me.  These were all part of the regular yearly checkups that we get and thankfully, nothing is out of the ordinary with either of us.  We are very lucky to be “healthy” older folks!!

Prior to having the new State Retiree insurance option, when we went to the doctor’s office we did not pay any co-pay amounts.  We did not pay for the yearly panel of lab tests that are part of our physicals. My wife and I are NC school system retirees, having worked for 30ish years as teachers/principals/etc. Well these visits all came with a $20 co-payment and a $40 lab charge…so much for having your wellness physicals covered!


We retired before we were 65 (Medicare age) and the state provided the same level of coverage as when we were working.  There was no extra cost for medicines beyond the traditional co-pays there – typically $10-$20/prescription with a $40 for a non-generic drug. Once we hit the magical age of 65 the state coverage became secondary and Medicare became primary.  You might think this was a good deal – alas not so fast…and this was before the Affordable Care Act – because I was still working for an online university and making more than a particular amount – we had to begin paying almost $200 each per month for the privilege of being in Medicare.  I know part of this cost was due to the relatively good salary I was making and I did not yell and scream over the extra $4800 per year we were paying.  Before Medicare we paid nothing.

However, even the retiree aged 65+ with no income but Social Security payments has to pay about $100/month or $1200/year. Our prescription drug plan with the state remained as it was until a couple of years ago when the state decided to charge us an extra $10/month for the privilege of letting them provide prescription coverage.  So another $120 for each of us per year – this is in addition to the medicine co-pays we were already paying.

Since the state decided to reduce taxes in the last legislative budget session, this necessitated a change in insurance yet again.  Living in Boone, we could either opt for a 70/30 traditional Medicare plan or elect an advantage plan from either United HealthCare or Humana.  Oh and by the way each of these would have an extra $75/month each for prescription coverage in addition to the normal co-pays.  And I will say from my viewpoint, before saying good deal, make sure your drugs are even covered – one of mine was not and it went from a $10 copay to $140/month with no coverage – my provider, United HealthCare did not cover it at all.  It is a generic drug, and fortunately I found that Sam’s Club in Hickory has a 42 day supply of it for about $17.  Guess where I am getting this medication now?

My wife and I each opted for the United Healthcare advantage plan benefit and the only advantage is that we now get the Silver Sneakers card. This gives us the use of our local Broyhill Wellness Center, where we had been members since we moved back to Boone nearly 8 years ago. There are other local establishments that honor it and it is a nationwide program.  It is a great way, we have found for us to stay active, and hopefully not need other expensive medicines or medical treatments.

But wait, we are not done with the nickel and dime costs of the new plan.  I had a stress test as part of my physical – last one 10 years ago.  Co-pay was $100.  My wife had a colonoscopy as part of her test – last one 10 years ago.  Co-pay also $100.   All I can say is that I am so very thankful that we are basically healthy and our salaries are good, as we are still working – me full time and my wife in an avocation (writing novels) that is breaking even.

Some might say this is because of the Affordable Care Act (ACA) that we are having to pay more.  Well that is not totally true at least.  My mom, before she died, was paying for her hospitalization insurance and had the supplemental policy that cost her about $150/month.  She had been a housewife most of her life and was really collecting from my dad’s social security account once he passed away.  But he had been a farmer and a textile worker and never made much, so Mom got less that $1000 per month, before the costs for the various insurances – all of this long before ACA was passed.

Who is it that needs to be responsible for the health care of its citizens?  Do both government and individual have some responsibility?  Or is it solely the responsibility of the individual?  These are hard questions but I am going to, in my comments, show my prejudice against a for-profit insurance company being benevolent and helping individuals.  There is no benefit to an insurance company for covering individuals that use the product. If they have to pay they do not make money – simple economics.  The only way they exist is to spread risk among all users.

This is the same principle that if you have a claim against your car insurance or home owners – your premium goes up. Has anyone other than me had this to happen?  In small losses it is far better to just “eat” the loss and keep the insurance from increasing.  Had this to happen recently with an iPhone theft.  Far cheaper to buy a new one at cost rather than pay the $500 deductible and then have your insurance go up for the next three years.

If it seems like I am a little aggrieved – I am.  I am not being a Pollyanna, and expect insurance to be free.  Someone has to pay.  But since we have been switched to the better Advantage Plan, our out of pocket costs have radically increased.  The donut-hole in prescription drugs is still there and includes not only what the insurance company pays but what you have paid in copayments as well–another sort of double-whammy. Fortunately every drug that I use is a generic so the cost for me is comparatively low.  The cost for the donut hole figure is not low –I just refilled a prescription for my atorvastatin (generic Lipitor) which controls my high cholesterol.  The insurance “paid” $414 for my 90 day supply.  My cost was $30.  But for the prescription drugs (also run and managed by a for-profit insurance company; the drugs are now part of the overall Advantage plan) is $444.  This is the same insurance lobby that prevents negotiation and seeking a lower cost in Canada where the same drug is listed as $134 total – so US drug companies are making a profit from me on this one prescription of $310!

Let me hear from you concerning your experiences with insurance companies and what they are charging you. Keep in mind that none of us “seniors” are naïve and expect something for nothing but do we have to bear an inordinate burden so insurance companies can be profitable? Send your thoughts, either via email at boomerbytes@yahoo.com or post them at the end of the column. I’ll look forward to hearing from you.