We Regret to Inform You

Laddie_Head SquareMy health insurance life is imploding and exploding. I can’t tell the difference between what I know and what I don’t know. What I heard last week isn’t true this week and might change again next week. In January I wrote about dreading Medicare. Today I think it might be the best thing that could happen to me.

On June 23 Blue Cross Blue Shield of Minnesota (BCBS) announced that it will discontinue full-service plans in the individual health insurance market beginning in 2017. This follows the exit or reduction in offerings by other companies in previous years. Minnesota was one of the states that created its own insurance exchange in 2014 after the implementation of the Affordable Care Act (ACA) and the results have been devastating for many of the 6% of citizens seeking individual insurance in the state. (The individual market covers people who do not have access to employer-based coverage and are not eligible for Medicaid or other publicBCBS Blexit programs.)

BCBS of MN is the only company so far to announce its exit from the 2017 individual market. Unfortunately it is the largest insurer in the market and its departure will affect 103,000 of the approximately 300,000 Minnesotans who purchase individual insurance. The recent announcement by BCBS follows a premium hike of over 50% in 2016. This increase was justified by the carrier’s reported loss of $265 million dollars in the 2015 individual market.

My 2016 monthly premium was 61% higher than in 2015 and was accompanied by a slightly higher deductible. If BCBS is continuing to experience unsustainable losses with the huge premiums that I am paying, my fear is that no company will be able to survive longterm in this market. Unfortunately as rates soar, many young and/or healthy individuals are choosing or being forced to go without insurance. The downward spiral of an unsustainable market is intensified as the insured population gets older and sicker and costs skyrocket.

I have no idea what the landscape for the individual insurance market in Minnesota will look like next year. It seems questionable that the remaining players can absorb the 103,000 people stranded by BCBS. Will other insurers pull out? Will exorbitant premiums, high deductibles, limited networks, and poor coverage be the norm? What will be the effects of the presidential election with one candidate vowing to repeal the ACA?

All I know is that I received a letter that says:

“We regret to inform you that at the end of this year, Blue Cross and Blue Shield of Minnesota will be discontinuing all individual and family insurance plans sold to members in Minnesota directly, through an agent or broker, or on MNsure. As a result, you will not be able to renew your current plan or select another Blue Cross plan for coverage in 2017.”

I personally only have to deal with this for three months in 2017 and will transition to Medicare on April 1. I know others who do not have this option. Some of them have Type 1 diabetes and the outlook is bleak.

Yes, Medicare is definitely starting to look pretty good.

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9 thoughts on “We Regret to Inform You

  1. All of this is a result of the Affordable Care Act and millions of dollars were taken from Medicare to help pay for the ACA. Perhaps Medicare will be better for you but I think you will find that it is not. I will have some health care changes in 2017 as well. I am retired and my employer has provides secondary insurance to the retirees for many years. As of January, 2017, they are lumping all of their Medicare eligible retirees into a Medicare Advantage Plan. Medicare does not cover CGM, Medtronic 530g, or any modern diabetic technology. I was receiving help from my secondary to pay for these things., That will end in January and I will have to consider purchasing secondary insurance.

    • Susan, hopefully the Advantage Plan will end up being a good option or at least not horrible for you. I think in some states they are OK and in other states they are dismal. Unfortunately I think things everywhere are just getting worse….

  2. Laddie,

    What’s going on in the private health insurance market is tragic, but don’t think that Medicare will solve your problems.

    I’ve been on Medicare Part B (this is not a Medicare Advantage Plan) for 4 1/2 years. They are paying for my pump supplies, but the hoops one needs to jump through to get them pay are unbelievable. 3 months prior to going on Medicare, I contacted a Medicare approved supplier. They got everything they needed from me, and from my doctor. Medicare, though, kept rejecting anything to do with the pump, claiming that there was no proof that I was on a pump. This went on for months. After they approved a supply of insets and cartridges, I thought that everything would be okay. I was dreaming. They continued to reject every order for pump supplies with the reason given “The claim does not show that you own or are purchasing the equipment requiring these parts or supplies.” The fact that they paid for the supplies 3 months earlier didn’t matter. This went on for 15 months. Appeal, rejection, appeal, rejection, appeal, payment, repeat …

    To make things worse, there is no one to talk to . They have friendly people who answer the phone, but all they’ll tell you to do is to submit a written appeal.

    Medicare’s rules are crazy. They will allow shipment of 90 days of pump supplies every 90 days. If the 90th day falls out on a Saturday, the providers won’t ship the supplies until Monday, or when Monday is a holiday, Tuesday. The 90 day countdown starts from the day the supplies are shipped. Medicare requires that you see your doctor within the previous 90 days, prior to a scheduled shipping date. I saw my doctor about 100 days ago and am scheduled to see him again next Monday. The Medicare supplier won’t ship out my pump supplies until then. These were supplies I was counting on getting on Friday. I am being forced to use insets for 4 1/2 days and hope that the supplies get delivered on time.

    Getting your test strips by mail is even crazier. Last January there were 24, Medicare approved, mail order suppliers. By June, the number of suppliers shrunk to 9. Of those 9, 3 don’t answer their phones. One that does, no longer has the test strips that the Medicare webpage shows that they carry. I’ll be going to my local Walgreens when I need strips in October. This will only be a temporary solution as I expect that Medicare will require everyone to use one of their mail order suppliers by next year.

    I am already paying out of pocket for my Dexcom. I anticipate that I will be doing the same next year for test strips.

    Private insurance isn’t the answer. Neither is government insurance. The future has never looked brighter for Type 1 diabetics. Don’t count on insurance to help you get access to the advances that are just down the road.

    • I have gone through every thing that Dave has gone through. I had to produce finger stick logs from before I was Medicare eligible to finally resove pump supplies at the Third Step of Medicare Appeals process, which is the Administrative Law Judge level. I have at least six fully favorable ALJJ decisions to cover CGM but they are all reversed at the Fourth Level which is the Medicare Appeals Council. The only option left is to take Medicare to Federal Court at a cost of $30,000. plus. That pays for a lot of supplies. They know that. As far as test strips, Dave, the first hurdle is the amount they allow. They still don’t cover all of my test strips. The mail order company I have to use, has an office in Florida and most of their work is done out of the Phillipines. They do not have any testing machines that send blood sugar test results to the pump automatically. I could gone on and on. I have been on Medicare for the same amount of time as you have Dave. Its very disheartening.

    • Dave, I hope things go more smoothly for me than what you have dealt with, but I am probably being very naive…. Probably the hardest part will be how illogical it all is and how difficult it is to speak to someone to get things straightened out. Thanks for your thoughtful albeit discouraging comment.

      • You can’t speak to someone to resolve the problem. You have to go through the Medicare Appeals process and the first chance you actually get to speak with someone who may be able to resolve problems is the Administrative Law Judge. Getting to that step takes a long time.

      • I don’t think you’ve ever been naive about any of this, Laddie. You have voiced valid concern about this stuff from the get-go, and thankfully, we have someone as passionate as you voicing it! You are right that this system is convoluted and bonkers. It is hard to keep up with it. I hope that somehow things go as smoothly as possible for you in the coming months, and years.

  3. Insurance is clearly a complicated issue. I hope you have many supplement and advantage plan options.

    I referred your blog to the TUDiabetes.org blog page for the week of July 11, 2016.

  4. I hope it gets easier. Our country is lucky to have you as an advocate! Always articulate and strong. And connected!

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