Making a profit isn't enough for Wall St.: You are going to have to pay, with your money (and maybe your life!)

Wendell Potter, in his “Health Care Un-Covered” substack, recently (Aug 6, 2025) reports that ‘As Americans Struggled, Health Insurers Made a Record-Breaking $71.3 Billion in Profits. In 2024, seven big insurers posted $71.3 billion in profits and paid their CEOs more than $146 million.’ There are several things being said in that sentence. First is that health insurance companies made a lot of profit. Second is that some people, specifically health insurance CEOs, are doing very well, thank you. Third is the assumption that Americans are struggling, presumably with their health insurance and healthcare. Let’s think about each of these.

These health insurance companies, per the chart that Potter includes, made $71.3B in profits. That seems like a lot to me. For most, it’s also more than the prior year. But not for all. Note that Humana made 33% less than in 2023, a mere $2.7B. 

Fortunately, that was enough to continue to pay it’s CEO over $15M.

At least UnitedHealth, the largest health insurer, is doing fine, right? It increased its profits 6% over the year before, and its CEO Andrew Witty (head of UnitedHealth Group, not to be confused with the assassinated Brian Thompson, CEO of UnitedHealthCare, who worked for him), is the highest-paid health insurance CEO at $26.3M, so I guess he deserves it because the company is doing so well. That shows that I (and possibly you) are not expert in the ways of Wall St. investors. It wasn’t enough for them. Just two days earlier, on Aug 4, Potter posted ‘Inside the Midyear Panic at UnitedHealth’. It makes fascinating reading, although the lessons learned by an MBA student may be different from those learned by, say, a regular person needing healthcare. As far as Wall St. is concerned, it is not enough to stay profitable; corporate profits need to continually go up so that these investors can meet their expectations for their own profit. It is important to understand that, as much as health insurance companies can be seen to be greedy parasites who produce nothing but obstruction and cost for those providing and receiving healthcare which they sell as producing “value”, private investors are a meta-level worse. They don’t even pretend to produce anything; they are, as an old family friend liked to say, “in money”. They invest and expect money back, more money all the time, and don’t care much about how the companies they invest in get it.

Nearly 500 years ago, Shakespeare wrote the “Merchant of Venice”, an excellent but anti-Semitic play about a greedy Jewish moneylender named Shylock.* Shylock has been widely decried for centuries for demanding a pound of flesh as repayment for the loan (how horrible!) But, by today’s standards, particularly in health insurance, he’d be a piker. While a lot of people, including me, could afford to lose a pound (or 20) of flesh, the health insurance companies are being spurred on by their investors (along with their own lack of values), are doing much worse. The actions that they are taking to ensure Wall St. investors make what they believe to be sufficient ROI will end up killing people. Antonio should have been happy to give up his pound of flesh! 

Of course, the financial investors in health insurance companies are not gauche enough to literally demand the killing of their clients. But they did demand changes that will undoubtedly have that result. While UnitedHealth saw an 8% increase in their Medicare Advantage plans, which they generally like because these plans allow them to do what they do with regular insurance, obstruct access, they still had to pay more out in medical claims than the shareholders were happy about. As Potter says, “Those seniors figured out how to get at least some care despite the company’s high barriers to care (aggressive use of prior authorization, “narrow” networks of providers, etc.).” Sounds good if you’re a patient, but if you’re an investor, it’s horrific. Remember what the insurance industry calls the percent of the premiums that they collect which they actually have to pay for medical care? The “medical loss ratio”! They hate it when they make less profit because they are paying for your care! Yes, UnitedHealth made $14.3 billion in profits during the second quarter, but it was less than the $15.8 billion they made in the second quarter of 2024, so something had to be done!

Potter describes what UnitedHealth promised its investors they would do:

• Dump 600,000 or so enrollees who might need care next year  [after all it is much more profitable to collect premiums from people who won’t need care]

• Raise premiums “in the double digits” – way above the “medical trend” that PriceWaterhouseCoopers predicts to be 8.5% (high but not double-digit high)[ie., you, the customer, pay more for less]

• Boot more providers it doesn’t already own out of network [when they work for you, money you pay them goes back to yourself!]

• ·       Reduce benefits [of course]

Yup, these changes most definitely will kill people.

Most insurance involves has you betting against yourself; you pay premiums to protect you if something happens that you do not want (or expect) to happen, but might. You have homeowner’s insurance, but you hope your house doesn’t burn down. You have auto insurance, but you hope you are not in a car accident. Originally, health insurance followed the same idea; it was not intended to pay for routine care, but to protect you if you had to be hospitalized and or have surgery for something you didn’t expect. But then it began covering (or hopefully covering) regular medical care, visits, treatments, and drugs. It was paying for what you wanted – regular care, not unexpected and unanticipated “major medical” care. This is different from what insurance usually is. Actually, though, insurance companies preferred as it is predictable and relatively low cost. With Medicare Advantage plans, for example, they take money from Medicare to cover seniors who are happy to have coverage for prevention, doctor visits, drugs, and even gym membership without having to pay separately for a Part D plan, a Medicare Supplement plan (to cover the 20% of hospital costs Medicare Part A doesn’t pay for), etc.

When those people get sick, however, they want their bills paid, and not infrequently United and the others were denying it. But as Potter points out, not often enough to please their investors. People were sometimes, increasingly, getting their bills paid – indeed CMS, the Center for Medicare and Medicaid Services, was requiring that they be paid. That is what infuriated investors – all that money going to pay for medical care rather than profit and shareholder dividends! So, they will reduce benefits, increase premiums, further limit the doctors you can see and hospitals you can use, and make being sick more unpleasant than it already is. Tough luck.

But that’s what you get when you have a “healthcare” system that exists primarily to make profit, not to provide healthcare. When you live in the United States. Why do we put up with this?

 

 

* Jews were moneylenders because it was an area open to them; in those quaint days Christians actually thought they had to abide on the Biblical prohibition on earning interest from lending money. It’s complicated; most of the prohibitions are actually in the Old Testament, but this was often interpreted as not lending money to other Jews; Christians were OK. Of course, they were presumably lending to other Jews when New Testament describes Jesus turning over the tables of the moneylenders in the Temple, saying per Matthew 5:42 ‘Give to the one who asks you, and do not turn away from the one who wants to borrow from you’. Anyway, both Jews and Christians lend money – “invest” – now.

 

Such a deal! Insurance companies keep your money and deny you care! How can I get in on that?

How’d you like to have a business that essentially everyone had to buy from, where the price for your service went up every year, where the quantity and quality of your service decreased every year, and more and more of the cost of providing it could be passed directly (as well as indirectly) to your customers?

Sound good? Welcome to the world of health insurance and pharmacy benefit managers (PBMs), often owned by the same companies! You get insurance premiums paid to you by people or their employers (and mostly by both, since the employers rarely pay the full cost anymore), and get to raise them every year, by far more than inflation or certainly your costs, as well as directly shift costs to your end-user customers (i.e., “patients” or “people”, not the employers) through the use of deductibles and copayments! What a deal! And then, even better, your main business activity is not providing service! Yes, while people (and employers) think they are paying for medical insurance so that when they get sick or need hospitalization or surgery it will be paid for, your main activity is finding ways to not pay for it! In fact, that is what you pay your employees to do – find ways to not pay for your customers’ healthcare! You have a whole variety of techniques to utilize for this purpose, and they are kind of “nested” or sequentially algorithmic:

n  Have the initial reviewer, possibly a nurse, or possibly an AI algorithm, just deny coverage.

n  Have the next level reviewer, often a physician, not necessarily (indeed rarely) in the specialty involved, frequently with no recent practice experience, and often not even in the US, deny the claim.

n  Have the next level reviewer (again, amazingly, often AI) deny the claim.

n  Figure that most people won’t appeal the denial. You’re right.

n  If they do appeal, maybe you’ll have to pay. Or you can start the process over!

To be sure, it is not always true that all companies always deny coverage, or that the process of prior authorization is always used even when everyone including the insurance company and their employees know that it is a perfectly appropriate claim being submitted by a perfectly appropriate provider for a perfectly appropriate procedure. But a lot of them do, and do it a lot. In a recent guest post on Wendell Potter’s substack “Health Care Un-Covered”, Rachel Madley (Director of Policy and Advocacy at the Center for Health and Democracy. covers hearings led by Sen. Richard Blumenthal (D-CT) on the practice of insurance companies and PBMs regarding prior authorization, denials, and the use of AI to make these decisions:

[B]etween 2019 and 2022, the prior authorization denial rate for post-acute care in UnitedHealth’s Medicare Advantage plans doubled. The denial rate for long-term acute care hospitals in Humana’s Medicare Advantage plans increased by 54% from 2020 to 2022. During this time, UnitedHealth, CVS/Aetna, and Humana increased their use of artificial intelligence (AI) for prior authorization reviews, often resulting in increasing denial numbers and decreasing (or absent) review time by human beings.

And not just United Health.

The report noted that CVS, which owns Aetna, saved $660 million in 2018 by denying Medicare Advantage patients’ claims for treatment at inpatient facilities. Around the same time, CVS found in its testing of a model to “maximize approvals,” which would be a good thing for patients, that the model jeopardized profits because it would lead to more care being covered. In 2022, CVS “deprioritized” a plan to increase auto-approvals because of the lost “savings” from denying patient care.

 

Great! But so what does this tell us that is new? Well, really, just that it is getting even worse from the execrable, immoral, and anti-human (and anti-decent-business) practice that these enterprises were already using. By the way, if you were thinking that I have made the case that these are good businesses to own and make money from, you’re right, but it is going to be hard to get in unless you are a multi-billionaire since these things are so profitable that they are mostly owned by entities known as private equity. That phrase, “private equity”, sounds kind of bland, but it means groups of people with a lot of money who buy businesses not only for making money from them, but by making money however possible. This includes not only immoral business practice, but also completely destroying the company and selling its assets for, literally or figuratively, scrap. Plus, UnitedHealth, CVS/Aetna, and Humana own so much of the market, there is not room for you.

 

And, of course, after hearings and findings like those of Sen. Blumenthal, we might expect increased regulation of these companies and this business, which could limit the gross ripoff of people’s money that fills the pockets of their investors. Well, not so fast.

The report recommends that the Centers for Medicare and Medicaid Services (CMS) collect additional data, conduct audits of prior authorization processes, and expand regulations on the use of technology in PA reviews.

Hardly draconian penalties! For callously and in pursuit of financial gratification denying health care to millions for years and years, the report recommends that CMS ask for – more data! We really want to know how badly they’re screwing the American people!

Humbly, I would suggest more than that. I would suggest that the federal government not only stop enabling this money grab – after all, through Medicare they are the largest funder of health insurance, and through Medicare Advantage (MA) plans (and more recently through privatized Medicaid programs), directly fund much of the money made by these insurers – they might actually regulate them and make them deliver on the product that they are supposed to! They could go back to being managers of Medicare programs but not owners of MA programs.

You know, it doesn’t have to be this way. Or you should know that. And Sen.Blumenthal, and his committee, and CMS should know that. They, are you, should all be aware of it because of the program that covers most seniors, Medicare. Traditional Medicare, not Medicare “Advantage”. Medicare, what I’ll call TM for Traditional Medicare, covers virtually all medically beneficial procedures, tests, and encounters, at virtually all doctors (very few don’t take TM, although many do not take MA). There is NO need for prior authorization with TM, and there are no denials for covered services. There is no review by anyone, doctor, nurse or AI robot, to see if there is a way that they can deny you coverage. They just pay it. They pay the amount that Medicare has authorized for that service.

Admittedly, they do not pay all of the authorized amount; for in-hospital care TM pays only 80% of the authorized amount. This is bad (although not as bad as not getting the service your doctor thinks you need at all!) but it is an entirely separate issue. One is a Medicare policy issue of paying only 80% and the other is an open-ended ability for insurance companies (including MA) to deny payment for your care based on their notions of … what will make them the most money. Indeed, I’m wrong; they are completely different things but not unrelated. They are both the results of policies put in place to try to weaken Medicare and make money for insurance companies through privatization. After all, if TM only pays 80% of the approved charges, and you have to buy a Medigap policy to cover it, this may be an incentive for you to join an MA program and make money for the private insurance industry! Another important difference is how claims are paid; TM pays out money to providers for services that you receive. MA gets all of the money allocated for you in advance, and then makes efforts to hold on to it by not paying for services for you. And, through a variety of tricks, it gets more than TM would allocate for you!

This is not what the federal government should be encouraging. It should not be pushing more people to be covered by private insurance, using Medicare, Medicaid, your employer’s or your own money. It should not be pushing people into programs that make a science of denying them necessary care. What should it do? Two steps:

1.      Put everyone in Medicare. Traditional Medicare. Everyone, birth to death, regardless of age, gender, race, ethnicity, or employment status. Everyone in one program.

2.      Dispense with the limits on what TM pays for. Not just that the current 80% should be 100%, but covering all needed health care services, including mental health, dental, glasses, hearing aids, and long-term care.

Pushing more people into programs where they are the mercy of profit-hungry insurance companies to receive the healthcare they need is the WRONG way to go!

For an easy-to-digest look at how Project 2025, which has been put together by right-wing “thinkers” as a list of what a new Trump administration should do, look at this very well-done comic, https://stopproject2025comic.org/comic/health-care/  You might also want to look at how Project 2025 will address all the other issues that affect your life! Here is one panel: 

PS: I found the other two cartoons above on my Facebook feed, and the creators were not credited. I am sorry for this; creators should always be credited for their work. I would be more than happy to do so if anyone can find who to credit!

Insurers in trouble for the wrong reason: Wall St. wants them to rip you off for even MORE!

There is good news and bad news regarding health/medical insurance. Let’s start with the good:

In his Substack, “Health Care Uncovered” from August 8, 2024, Wendell Potter reports that “Wall St. is disenchanted with Medicare Advantage Plans”. This is good news in the sense that it is good when anyone is disenchanted with these plans, or any aspect of the for-profit health insurance industry. Potter notes that both CVS/Aetna and CIGNA disappointed Wall St. investors with inadequate (from their point of view) profits, compared to a year ago. I also am disenchanted, but for different reasons than Wall St. I am upset that these for-profit insurers continue to rake off such a huge amount of money that was intended, by the workers and employers who paid it, to be spend on actually delivering health care. Investors are upset that these health insurers are not raking in even more.

Potter notes that Aetna president Brian Kane resigned as a result, but appropriately writes:

I am much more concerned about the health and well-being of the 4.3 million people enrolled in CVS’s MA plans and the 6.2 million in Humana’s plans. Sadly, most will find they’re trapped in a circle of hell created by the insurance industry, unable to stay in their current Medicare Advantage plan but also unable to return to traditional Medicare because of what for them will be unaffordable Medicare supplemental policies (most of which are sold by the same big insurers that sell MA plans). Seniors have six months from the date they’re eligible for Medicare to buy a supplemental (Medigap) policy to cover out-of-pocket expenses. If they’ve been enrolled in an MA plan longer than six months, they’ll have to go through medical underwriting. That means that if they’re being treated for much of anything or, God forbid, have a “preexisting condition,” they’ll have to pay an arm and a leg for Medigap policy.

A similar piece of good news is not particularly about Medicare Advantage plans, but the overall health insurance industry/scam, in a story about data-analytics firm MultiPlan (‘Revenues Down and Stock Battered as Data Firm Faces Scrutiny’, NY Times, August 16, 2024). This one is a little harder to understand than the CVS/Aetna and CIGNA stories. They are about the fact that while they are making beaucoup bucks, it is not as much as investors would like. In the MultiPlan case, we have a company that worked for insurers to get reimbursements down (that is, to pay doctors and other healthcare providers less) and made money from it. For example, if a doctor billed $100 and MultiPlan told the insurer to only pay $50, that’s more money for the insurer (and MultiPlan), and the patient can be on the hook for the other $50. (Of course, it’s never only $100, or $50.) Since they do this mainly for “out of network” care the amount that you (the patient) can get stuck with having to pay can be – a great deal. (This can happen even when you choose an “in-network” doctor and hospital, since other doctors – like in the ER, or radiology, or even the “assistant surgeon” – can be out of network. And the ambulance almost always is).

This article was a follow-up to an earlier exposé in the NY Times ‘Insurers Reap Hidden Fees by Slashing Payments. You May Get the Bill.,’ April 24, 2024, in which the amount the patient could get stuck having to pay was as much as $100,000 – or more. The good result of this first article was a lot of opprobrium aimed at MultiPlan, resulting in some insurers being more reluctant to use them (because of the bad publicity, not because they save them money; apparently they can use other less-notorious data analytics firms to save them money), so MultiPlan is in trouble as the more recent NY Times article documents. Good. I love to see them in trouble.

The bad news is that it is likely to be you and other regular people who are screwed. There is already evidence that the pressure from investors to go back to making not just great but obscene profit margins is affecting CIGNA, CVS/Aetna, and other insurers, who are denying more claims, making it even harder to get the care that you need. Potter notes that

Humana said last week it planned to jettison “a few hundred thousand” of its Medicare Advantage enrollees that have become unprofitable. CVS says it will get rid of about 10% of its MA enrollment, which would be around 430,000 of America’s seniors and disabled people.

That’s a lot of seniors who will lose their medical coverage. I have often been critical of Medicare Advantage plans (sometimes called, more accurately, Medicare Dis-Advantage), which are NOT Medicare but are private insurance plans, usually HMOs or PPOs, paid for by Medicare funds. One of the major reasons for my criticism is that because they are private insurance, they can (and often do) deny coverage for care even when the care is approved by Medicare. Recent legislation has required these MA plans to cover Medicare-approved care, but in fact they still often deny claims. Indeed, it is often the modus operandi for these companies. They may approve the claim if you appeal, but the vast majority of clients do not appeal, and probably don’t even know that they can. If fined by the Center for Medicare and Medicaid Services (CMS) it becomes a “cost of doing business.”

But the “jettisoning” of hundreds of thousands that Potter refers to illustrates another big problem with MA. As with all insurance – not just medical – companies make money by collecting premiums and paying as few claims as possible (although medical insurance companies seem to have taken this to the extreme). One effective way to do this for healthcare is to insure healthy people. They, or their (usually former, if they’re on Medicare) employer pay the premiums but they don’t cost much money in claims. And they love getting free eyeglasses and hearing aids and gym memberships, which cost the insurance companies very little. The problem is that sometimes previously healthy people get sick, and this becomes more and more common as they age. Remember that in any given year approximately 5% of the people account for about 50% of healthcare costs, but they are not necessarily the same people the next year. Some folks get better, some folks get worse, and some really sick people die. MA plans have long “encouraged” their sickest (= most costly) patients to consider switching to traditional Medicare. Now they will be more than encouraging; they’ll drop those high-cost “losers”. Maybe you.

The MultiPlan case got good (that is, bad) coverage from the original April NY Times investigation, which resulted in it losing business as reported by that newspaper in August. But the insurers will get another data analytics firm to try to screw doctors and other providers, and the patient, you, will still be caught on the hook for many of those dollars. The system is not set up to help or protect you, and it has relatively few sanctions against companies whose business model is to find any way to screw you that will make them more money, and to use that money to hire lawyers and others to find the loopholes and to pay the politicians to ensure that they are not closed too tightly.

It’s kind of like a sport where one team able and willing to bring in ringers, violate the rules, commit all sorts of fouls and infractions, and at worst get a slap on the wrist for it. Not a fair game, but heck, that team’s owners are paying off the referees and the league.

There’s another way to do it. Absolutely strict regulation to ensure the interests of patients are the ones that are protected, and protecting the profits of the insurers is given zero weight. Penalties that are strictly enforced, and draconian and include going out of business. Even better: prohibiting profit making in any healthcare endeavor. In some countries, like Switzerland, there are private insurers, but they all have to offer the same comprehensive product, charge the same rates, and be non-profit. So how do they compete? Customer service, can you imagine!?

I like that approach!

Medicare Part D: Learn from my mistakes

Following up on my piece on Medicare Advantage programs (Medicare Advantage: OK, it's bad for the country, but what about for me?, Dec 6, 2022), I wanted to add a piece on the Medicare Part D Prescription drug program. While others may be smart enough to not make the mistakes I have, I believe that the structure of the program and the behavior of many or most of the insurance companies involved in it encourage people to make decisions which are often not to  the person’s benefit (of course, they benefit the insurance companies!), so maybe others can learn from mine.

First, some clarifications about the last post, based upon comments I have received. Not all Medicare Advantage plans are equally bad or equally predatory. The for-profit ones run by insurance companies are the worst. Several not-for-profits are descendants of the original HMOs (from the time before they were called HMOs), which were real consumer cooperatives based upon the idea that if they could cut out the middleperson (the insurance companies) they could deliver more healthcare to members for the same money or at least the same healthcare for less money (these included HIP in NY, Group Health in Seattle, Ross-Loos in LA). Kaiser was not a consumer cooperative -- it was originally begun by Henry Kaiser for employees of his steel company -- but did function in a similar way as a nonprofit. Many of these were, however, bought out by insurance companies, venture capital (private equity) companies, and other profit-making organizations, and of course most of the Medicare Advantage plans that now exist were always for profit.

It should go without saying that when the “middleperson” (insurance companies) that you were going to cut out to benefit the consumer members takes over ownership, things change.  And, while many of the non-profits are less egregious in their exploitation than the for-profits, they share many of the same characteristics. So it is still “caveat emptor”, let the purchaser beware. Consider the idea that a non-profit Medicare Advantage plan may be better for you than a for profit, but it may still be a bad choice compared to traditional Medicare (TM). And certainly compared to what we should have – an improved and expanded Medicare for All.

Which brings me to Part D. Originally, Medicare was designed primarily to cover hospital care, then the most costly part of healthcare, and this, now called Part A, is the only portion covered by the Medicare Trust Fund from the money deducted from paychecks. Part B, the portion that covers outpatient care, is funded by general revenue plus monthly premiums paid by Medicare recipients to the government, which in 2023 will begin at about $164/month (for incomes below $97,000/year) and go up with higher incomes. Medicare Part C is what is now called Medicare Advantage, the substitute for TM (Parts A, B and D). Part D is the prescription drug plan. It became apparent in the decades since Medicare was created that prescription drugs were an increasing portion of the annual medical costs for Medicare recipients and that they were not covered was a problem for many people. So, eventually, under the presidency of George W. Bush, Part D was passed to cover them. But, of course, it was a “compromise”, which, as usual in government, means a compromise between meeting the needs of the American people and making a lot of money for the private corporations that ‘lobby’ (read: give money to) Congress. So, rather than covering drugs under the Medicare program, which would have done it pretty much at cost (traditional Medicare’s overhead is approximately 2%), it was farmed out to private insurers, some non-profit but mostly for-profit companies. Their overhead is a lot more, and they make a lot of money on this, as every Medicare recipient is required to have a part D plan (unless they are still working and covered by an employer plan or have a Part C, Medicare Advantage, plan that covers prescription drugs). Private for profit drug manufacturers also won another huge concession from Congress and the administration in the form of a prohibition on Medicare negotiating the prices of the drugs. As the largest purchaser of these drugs in the country, they would have great leverage and get great prices, and as a result the pharmaceutical companies would make less money. We wouldn’t want that, after having carved in profit for the insurance companies, so we don’t have it.

So let’s talk about me. When I retired and had to get a Part D plan I also needed a Medicare Supplement plan, to cover the 20% that TM doesn’t pay and other costs. I got the latter through my insurance company, USAA, and got a good policy for a reasonable fee. One thing Medicare does regulate are Medicare Supplement plans, which are identified by letters: A, K, F, G, N, etc. All plans offered by any insurer have to meet the standards – that is, the benefits for all type F or type K plans have to be the same-- so the competition is on price and service, which is absolutely the way it should be (but rarely is). However, USAA does not offer a Part D plan; they contract with Humana to offer their plans to their customers, so I chose a Humana plan. Unfortunately, the standardization that characterizes Medicare Supplements is NOT true for Part D; the different plans have all kinds of complicating and confusing characteristics. Both Medicare and the insurers offer “calculators” where you can put in the drugs you take and it calculates what they would cost you on each of their plans, adds the premium, and voilà, tells you the best deal for you. Maybe. If you trust them. But there turn out to be some hidden factors.

I chose the Humana plan with the cheapest premium, Humana Wal-Mart, not because I expected to buy my drugs at Wal-Mart but because it was the cheapest. My drugs, you see (I take 3 prescription drugs) are all available generically. They are (relatively) cheap. And so Humana does not cover them. So I pay out of pocket. Until and unless I meet my deductible; then they pay, maybe. But what I discovered in the first year is that any drug I get that is a lower price that the supposed retail price doesn’t count toward my deductible. Humana’s justification is that they have negotiated lower prices, and I am benefiting. It sounds possibly plausible, except all  insurers have pretty much the same lower prices. And usually more than you’d pay with GoodRx®. But it means that I can never meet my deductible and thus they never pay anything. But I pay them a monthly premium. That is a good deal – for them. Sounds an awful lot like a protection racket!

Because I just kept the same plan in my second year, I thought I’d do the same in my third, and didn’t go online to choose a plan during open enrollment. I then got my bills and my premiums went up from about $17/mo to $57/mo! When I inquired (irate) they said I didn’t elect a plan, and the exact plan I had had (the cheapest) was no longer available, so they decided for me that I’d be best off in their most expensive plan! Two things to note: 1) while my premiums went up (and I had to keep this plan for a year), they still paid nothing, so I just contributed more to Humana, and 2) they did have a cheap plan, which cost even less than I had been paying ($14/mo) but of course they didn’t think I’d want that.

The next year, I took it, and have had it for a few years. The premium has crept up, from $14, to $17, to $22. Last year I paid $272 for drugs and they paid $21. That, I think, was for a vaccine. This year the premium is going up to $30, nearly a 50% increase. But I didn’t notice that until they sent the payment book. It took me two days to look, call Humana and discover from them that the increase was just, well, an increase, no reason other than they want more money and can do it, and that when I went to Medicare.gov there were companies offering plans for as little as $7.40/mo. I would probably get no benefit from them either, but a lot lower premium. Sadly, for me, I found this out December 8, and December 7 was the end of the open enrollment period.

I won’t forget next year. I have no loyalty to Humana, and think they are unscrupulous predatory profiteers. Of course, most all of them are, but Humana seems to be worse than many. Luckily, the premium difference won’t break me, but since I will get no benefit, there are about a thousand different charities I’d rather donate the money to than the Make Humana More Profit Fund.

US government programs should exist to help the American people. Some good reforms would include allowing Medicare to negotiate drug prices and standardizing Part D plans the way Medicare Supplements are. Real reform would be to have a single universal program covering all health care (inpatient, outpatient, drugs, mental health, vision, dental, etc.) and eliminate profit from healthcare.

Sorry it is too late for this year. Be careful during open enrollment next year. I will be.