Assuring Your Insuring


By Neil Offen

It’s getting to be that time of year again, when our inboxes and mailboxes are flooded with solicitations from health insurance companies. These are important documents because choosing the correct health insurance is a complicated process requiring a deep understanding of how we are likely to be fleeced at any moment.

To help you decide in which health insurance plan to enroll, let us then review our coverage options:

You can choose a health maintenance organization (an HMO), a preferred provider organization (a PPO) or a direct underwritten medical brotherhood organization (a DUMBO).

There’s also a D-SNP plan (absolutely no idea what that stands for), which could be an HMO plan, although it’s possible it could also be a PPO plan. And there are, as we all know, five types of D-SNPs: All-Dual, Full-Benefit, Medicare Zero Cost-Sharing, Dual Eligible Subset and Dual Eligible Subset Medicare Zero Cost-Sharing. (Yes, at the end of the open-enrollment period there will be a test and you will have to repeat them all, in order. Winners will receive a Visa card for zero cost-sharing of any illness of their choice.)

Once you decide on your overall plan, you will need to determine which tier of the plan to choose:

Your insurer’s Pewter Plan offers a smaller deductible and a larger co-pay, depending on whether you want to see just a regular doctor or a specialist who will ask if you remember the last time you had a fungal infection.

The Brass Plan covers more services but offers a higher out-of-pocket cost and a more restrictive limit on how much you will pay for those covered services, which are services that take place under a cover, such as an umbrella.

The Silver Plan has lower co-pays but higher co-insurance and no one in customer service who is able to lucidly explain the difference between the two.

Then there’s the Gold Plan, which has no deductible, no co-pays, no co-insurance, but requires that you pay in gold.

Under these plans, the cost of services will change if you are in-network, out-of-network or prefer Fox to the more progressive networks.

If you are out of sorts but in-network, there will be an annual medical deductible that will only begin after you have exhausted all your patience and several other patients. There will be a separate deductible for your medications, because they can.

Reimbursement for your medications will work like this:

If your drugs fall into the Tier 1 grouping, the cost will be minimal because you are really getting only a placebo and all pharmacy employees have been sworn to secrecy about it.

If your drugs fall into Tier 2, generally generic medications, the cost will be more or less generic as these medications may help you somewhat more than feeding a cold and/or starving a fever would.

If your drugs fall into Tier 3, you will pay 12 percent of the actual cash price of the medication, which is the price you paid for your house. That means the medications should be taken with food but you are forbidden to attempt to refinance while chewing.

If your drugs fall into Tier 4, you will pay what is called the full Rx price, which is 23 percent of the research and development cost of the drug, multiplied by the LIBOR, or London Interbank Offered Rate, on the first day of the preceding month. Also, you may have to explain to the pharmacist why you have not been put into immediate quarantine.

If your drugs fall into Tier 5, don’t worry about paying for the drugs. You have more important things to worry about.

Carrboro resident Neil Offen has written humor pieces for a number of different publications, in a number of different countries. His column appears twice monthly in The Local Reporter.

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1 Comment on "Assuring Your Insuring"

  1. Simply brilliant.

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