“Megagap” Insurance -The False Promise Of Affordable Healthcare

Obamacare aka the Affordable Healthcare Act, has hit us squarely in the pocket book in 2015. Our health insurance provided as a benefit from GE for all retirees changed overnight, without explanation or much education for it’s 65,000 retired employees. Several are fighting the good fight and suing, interestingly the suit is being led by former HR execs who state they now feel like they have spent decades lying to GE employees after the change pulled the rug out from under them. But I am not inclined to sue a global behemoth like GE as they are still providing a pension and a cash stipend called a Retirement Reimbursement Account (RRA). The net annual premium increase to us this year is 25%. After all the pension and RRA, the net premium increase is 25% before we have any use of it.

Since we have medicare covering 80% of our medical expense what we are dealing with is the remaining 20% and prescription costs not covered by medicare. These are called Medigap and prescription supplemental coverage’s. (to Medicare)
We could have scaled down our coverage to higher deductibles and co-payments and HMOs but chances are strong that would have cost more in the long run as we both have medical conditions best managed with close care and a variety of specialists. So after much analysis in November and December we prepared to enter the wonderful world of navigating through insurance exchanges. There were over 60 combinations of plans to delve through. There were hours of inane and duplicative phone conversations looking at the fine print coverage of doctor usage and possible hospital stays, prescription and durable medical equipment equipment, and extended care situations. It was a daunting experience. And we are both adept at wading through the bureaucracy of healthcare.

So we replaced our coverage previously administered by GE and a mail order prescription service which we both used with 7 different elements of service providers, a jump from 2 elements to 7. All have different websites to master and different levels of competence in customer service to manage. The prescription coverage is a maze of pricing variables to grasp, 4 different stages (determined by cumulative spending) and 5 different tiers of pricing. The tiers are beyond standard accounting principles explanation, I suspect the costs determination are more convoluted than a moon shot. So I just try and manage the lowest possible cost for satisfactory meds.

I wondered why AARP endorsed Obamacare and lobbied hard for its passage. The preferred plan we opted for, the one most like the good coverage we had before, is under the AARP umbrella, although it is administered by Towers Watson, so I’m a little fuzzy on what AARP actually does to collect their 4.95% royalty on the premium in addition to the annual membership which we now have to have in order to participate in the coverage. They make a ton of new profit off of this coverage even though AARP membership polled 50 to 1 against passing the legislation.

All thanks to Barack Obama, and the false promise of the AHCA.


3 Responses

  1. I feel for you. The fact that AARP and the insurance industry endorsed the ACA should have been everyone’s first clue that there was a problem…it didn’t escape my notice. The insurance companies got millions of new customers, no wonder they’re for it. The bottom line reality is that nothing has essentially changed. Insurance companies are reaping record profits, and health care is no less expensive than it ever was.
    I am, in principle, in favor of extending health care benefits to everyone. And had the AARP and the insurance companies not endorsed the plan, it would never have passed. It’s just that this isn’t the way to fix the problem. Everyone should have understood that going in.
    I’m now in my second month of Medicare Advantage. I decided against Medigap. I’m seeing the differences in this and my employer-sponsored plan, and they are not all favorable, but they aren’t that much worse either. I expected to save money. In reality, it’s about the same.
    But in my opinion, you’re placing the blame in the wrong place. President Obama did not make this happen. If you want to place blame, you should be looking at the insurance companies–they made it happen. I expect better of you than to demonize the President, even if you don’t like him, which clearly you don’t.

  2. FN Perhaps you missed this.

  3. And this.

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