Aetna's Dirty Little Secret

What is it that Aetna is hiding from me?  From us?  Clearly there must be some kind of sinister behavior they, along with all their co-conspirator buddies at Blue Shield, Humana, Kaiser, etc., are doing that I am just not aware of.

After all, the government is just protecting me from all the terrible things that will befall me in the future.  Over twenty years ago a saint by the name of Hillary Clinton tried to save us all with her own "Health Security Act".  Don't you love these Orwellian word games.  Seems like "Social Security" by its own definition should have already "secured" us a long, long time ago.  I guess sometimes things don't always go according to plan.

How have we all managed to survive the last twenty years?  If this is so dire, where have they been hiding all the bodies?  I have to admit that the cost of health care has risen at an unsustainable rate.  My insurance premiums over that period of time have gone up much more than I care to believe when I run the numbers.  

I thought to myself, maybe I am just not being very fair.  I should give the government health care option a fare shake.  I mean, when the IRS points a gun at my head and says, "You gotta buy this!"  I out to at least take a look at what I'm getting in exchange for my life.

I took the liberty of condensing the report from my prior comments and reproducing it here with my current (soon to be "withdrawn") coverage through Aetna.

  

Insurance is extremely complicated.  There are in-network and out-of-network, copays and deductibles, maximum out of pockets and a whole slew of other tricky language and complex processes utilized to "insure" you.  I do not pretend to understand them all, but for the average person out there, let me explain what you are seeing.

Under the Covered CA plan you see copays and a $2,000 (70/30) deductible with a $6,400 max out of pocket.  This means that as you use medical services throughout the year you will pay 70% of the costs until you reach $2,000.  Then you will have the copay for those services until you spend $6,400.  At that point you will have reached the maximum out of pocket for the year and everything will be covered at 100% going forward.  

Under Aetna's plan you can see there are no copays.  I just have to pay until I reach the $5,500 out of pocket max and then I too get 100% coverage going forward.

When you examine these two plans side-by-side like this, Aetna doesn't look very good.  

But here is where personal choice comes it.  I, and my family, are fairly blessed with good health.  Our genes cannot take all the credit however.  We all eat right, exercise almost every day, don't smoke or drink.  Although, I do try to get that one glass of red wine in every day.

I went back and pulled all my medical expenses for the last 10 years.  Here is what I found:

For our purposes here, we can throw out the first two lines as they represent items that are not covered by Aetna nor will they be covered under Covered CA.  As a side note, genetics were NOT kind to our kid's mouths.  Orthodontics is expensive for kids with tiny mouths and more teeth than your average shark.

The next thing to do was to make some assumptions.  Lets assume that going forward I will utilize medical services in much the same way over the next 10 years as I have over the last 10 years.  I know that is not likely since I am starting (just starting mind you) to get old.  It will give us something to compare Aetna with Covered CA however.

This is the main reason for my extreme frustration.  When you look at these numbers they are not even close.  You can see that there was some small savings for labs and MD visits.  These items are not subject to the deductible with Covered CA.  This means that you pay a small, set fee each time you use these services.  Now Aetna is looking a hell of a lot better.  After ten years I am going to save enough money to almost afford that new Porsche.

There are going to be a lot of nay-sayers that argue, "Well that is fine since you are so healthy and don't use any services.  What are you going to do if you get cancer or something like that?"

First, I will not get cancer.  I am almost superhuman.  But, lets suppose that I did have to go into the hospital for a significant injury or maybe an infection.  What would that look like?

In this case, I have an almost $40,000 hospital bill.  And it is here that Covered CA and Aetna finally (although not really) come to parity.  The Covered CA person paid a lot less for their services.  But they paid a fortune more for their premiums.  And something magical happened in the Aetna case - I met my *maximum out of pocket of $5,500 for the year so I did not have to pay anything more.  At this point, Aetna's yearly cost still came under Covered CA.  

I still have an ace up my sleeve though.  My Aetna plan is (or was) an HSA (Health Savings Account) qualified plan.  This means that I can set aside pretax dollars and pay myself back with them if I use any - I'll repeat that ANY - medical expenses.  In my example, I paid myself back for my maximum out of pocket expenses in the amount of $5,500.  

Just like that, I spend considerably less than the Covered CA person.

Disclaimer:  I realize that these scenarios are very simplistic.  I recognize that I still spent the same amount.  But an HSA is an investment vehicle with the intent to save for future medical expenses.  If you don't have any expenses, the money just accrues.  

If you like your insurance . . .

In August of 2009, our newly elected President, Barack Obama famously stated at a town hall, "If you like your health care plan, you can keep your health care plan."

He uttered this phrase multiple times in an attempt to allay the fears that many individuals and families harbored that they would be forced to abandon their current insurance coverage and provider in favor of some kind of all-encompassing and all-powerful government insurance.  There was talk of death panels and waiting months in order to have your ruptured appendix removed.  There was also talk that healthcare would now be more accessible.  People that could not afford insurance would now be able to.  Millions of uninsured would now have access to providers without clogging up the already overwhelmed emergency rooms across the nation.  People with pre-existing conditions would not be turned away.  Folks that were 45 years old but 95% of the way to a resting spot six feet under due to an existence fueled by overindulgence in food, drugs, and sun - would pay the same amount as an 18 year old high school captain of the swim team.  One cannot afford to discriminate in this country unless one is willing to be prepared for damning labels like "cold-hearted", "neocon", or "tea bagger" just to name a few.  

Much like all other erosion of personal responsibility like wearing a seatbelt and drinking Big Gulps, our government is much better at getting participation in healthy living by pointing a gun at our heads than by simply allowing each of us to decide for ourselves what is good, or not good, for us and then having to manage the consequences.

So, like a good little citizen, I have paid my taxes - in order to fund NIH studies on the sexual predilections of African forest bats.  I have always paid my mortgage on time - in order to subsidize the many individuals that have walked away from their homes and let them fall into foreclosure because the banks "tricked them" into signing those loan docs.  And, I have covered my family with health insurance - in order to lessen the financial burden thrust upon all the Occupy Wall Streeters when they consumed too many bad mushrooms.

Insurance, I am told, is a necessary evil.  As someone who invests for his future, I can agree with that description.  I bet on companies all the time.  Will Apple's next iGaget be a hit?  If I believe so, I might throw a little money their way to support their concept and growth.  If I'm wrong, I lose my investment.  No one likes to lose.  So, as a healthy individual that is part of an average but healthy family I have to protect my investment.  I want to see my children grow up.  I want them to go to college.  I want to travel to Europe.  I want to retire in comfort.  I want . . .   

There are a great many maladies that might strike us from the moment we are born (sometimes even before we are born).  Anything serious like an auto accident, cancer, or heart attack can devastate an investment portfolio.  All of those "wants" will be condensed down to just one: I want to be healthy.  

So, like I said, for over two decades I have hedged my bets by purchasing healthcare insurance.  I played ball.  I did the responsible thing.  I would have preferred to spend the money on hookers and blow but that did not fit my healthy lifestyle so I opted for wasting it on insurance.  It was a waste.  My family has never really utilized our insurance.  We pay cash when we do happen to visit the doctor since our deductible is astronomical.

Last week, in response to doing my civic duty so heroically for so many years, Aetna sent me a letter explaining some important "changes" to my coverage.

I was particularly fond of the soothing language "withdrawal of coverage".  They didn't kill or terminate my coverage.  They simply pulled it away like a hungry leech that had engorged itself on my financially sound blood.

Oopps.  So much for "If you like your insurance . . ."  Maybe the government knew better than me.  I suspect they were able to focus some of their NSA assets on my psyche and listen in on my subconscious thoughts to determine that I actually hate my insurance.  Thank you again for saving a wretch like me.

Luckily, the letter points the way to the much heralded California Exchange.  So, I connected to the site and this is what they calculated for me:

YIKES!  or ZOINKS!  as Shaggy would say.  Unfortunately this is no cartoon whose absurdity I can chuckle at with my children.  It's going to become our future in just a few more months.  At this time I am paying $565 per month to cover my family through Aetna.  The super-efficient government is going to be able to do that at the tremendous discount of an additional 72% more.  Those of you that live in California, feel free to check out their little calculator yourself at:  

http://coveredca.com/calculating_the_cost.html

Now I suspect that many of you might be thinking that I must be comparing apples to oranges.  Let's take a look at the state's breakdown on the various plans:

Currently the calculator only gives you the "Silver" plan to compare.  This is pretty good since it is very similar to what I have now.  With my next post I hope to have my current benefits next to those offered by the California Exchange.