I have been interested in the cost of healthcare for many years. When I obtained my first job after college, it was the late 1970s and my company provided medical insurance to all full-time employees at a relatively low cost. In the early 1980s, I was out of town at a client and needed to see a physician. The client recommended that I visit the clinic operated by the local HMO (health maintenance organization). The service was excellent, the cost was minimal, and I wondered why more communities didn’t operate them.
A few years later, I accepted a job as the CFO (Chief Financial Officer) of a healthcare provider whose employer-sponsored health insurance program was self-insured. It was a rapid learning experience to understand the reasons why we offered different options to our employees like an HMO, a PPO (preferred provider organization), a high premium, a low out-of-pocket cost program, a low premium, a high out-of-pocket cost program, and how those options ideally directed employee choice in order to manage overall program costs and risk. Our plan also allowed us to purchase a separate policy that insured our plan risk for costly medical care situations (e.g., high-risk pregnancy with a premature birth, heart and other organ transplants, certain cancers, etc.). With more than 40,000 employees, the overall costs were significant, but the cost per employee could be managed with the appropriate data and guidance from insurers and benefit plan administrators.
At the same time, I learned about self-insured health plans I was responsible for directing the company’s finance department that billed third parties for patient care. HMOs, PPOs, Medicare (Part A, Part B, and Part D), Medicaid, and other insurers all operated under their own sets of contracts with reimbursement guidelines. Finding out that we rarely charged anyone the “list price” for a procedure, patient bed, medical supply, prescription, or durable medical equipment was eye-opening.
After 17 years as a healthcare provider executive, I joined American Public University System in 2002. For the last 17 years, I’ve participated in the annual review of our healthcare plan offerings and because of my previous background, have been able to understand the reasons why plan costs increased more than an executive without a healthcare background. I experienced the plan changes and challenges created by the Affordable Care Act, as well as the changes in enrollment preferences of our employees. As I approach my retirement, I have had to reacquaint myself with the current rules and options for Medicare Parts A, B, and D as well as Medicare supplement insurance plans. As the head of a family with dependents and employee at an institution that does not provide health insurance for its retirees, I will have to purchase a family plan for them regardless of my choices with Medicare plan options. Based on my education and work experiences, my ability to evaluate my options should theoretically be easier.
However, as most people know, how we pay for our medical care in the United States is one of the most personal choices that we have or don’t have, and it’s most often influenced by our ability to pay for medical services. This blog piece is intended to be the first of several about the cost of healthcare for people in this country. My purpose in writing about it is to inform those interested in the topic from my perspective and the perspective of others. If I’m lucky, I’ll persuade a few of my former colleagues to pen an article or two. If I’m even luckier, I’ll gain a complete understanding of the insurance options available to Medicare-eligible retirees with dependents and select the perfect plan and coverage options effective whenever my retirement date is finalized. And, if I’m even luckier, all of us will remain relatively healthy during this period to reduce the complexity of one of the most personal decisions we make.