How What County You Live in Could Affect Your Healthcare Coverage – A Healthcare Story from Benton County WA

In 2010 I suffered a hemorrhagic stroke at the age of 40, due to an incredibly rare type of benign brain tumor that the neurosurgeon said had probably been there since birth (they could tell it had been there a very long time because of the way blood vessels had grown around it). I was incredibly fortunate that when this completely unexpected major health emergency occurred, I was covered by my then-husband’s health insurance through PSEW (Puget Sound Electrical Workers).

Unfortunately, the marriage was not destined to last, and we separated. However, I asked my now-ex if he would be willing to technically stay married until I hit the lifetime maximum on his work insurance policy that had covered my 11-week hospitalization. Many, many people during that time assumed that because Obama was president and had enacted the ACA, that lifetime maximums had been eliminated, but that was not the case. The policy I was under had a $1 million lifetime maximum (it may be that some companies were able to get grandfather clauses allowing them to keep lifetime maximums).

As Explanation of Benefits (EOB) statements began arriving in bundles in the mail, we started referring to me as “Million Dollar Baby.” The amount that is shown as what was paid for any service or provider on an EOB statement is the highest amount a provider could receive. However, the insurance companies always negotiate that price down. So what shows on an EOB statement is not usually what the insurance company actually paid. Most likely, they paid less, but the health consumer is not privy to that information! The only information we had were the numbers showing on the EOBs, and I was inching my way up to that $1 million. At that point I had weekly check-in calls with the woman who was the insurance case manager, to ask how close to the cap I was.

My then-husband did agree to technically stay married so I could keep that insurance coverage until I hit the million dollar limit. However, being an electrician is feast or famine, and he got laid off with no new work – a routine we had sadly become incredibly familiar with. He needs a certain number of work hours accumulated to keep his benefits instated, and with no work, he lost his benefits. The last time I checked in with the insurance case manager, I was up in the $600 thousands somewhere.

I was then forced to find a private health insurance policy until I qualified for Medicare. Anyone under 65 who becomes disabled has a two year waiting period before eligibility for Medicare kicks in. During that interim two year period, after my husband’s benefits ended, I was lucky to find a non-profit org that helped me navigate the process of finding a private policy without getting booted to the high-risk pool, which would have been insanely expensive. They helped me answer questions truthfully on applications. I believe that organization was called the Washington Health Foundation. At the time in 2011, they actually had an office space (somewhere in Seattle I think – no idea exactly where) and like three employees. I don’t think they exist anymore, but with their help, I secured a policy with Assurant until I finally got Medicare in 2012. I also learned that the key is to never have a lag period in which you are not covered. If you do, THAT is when insurance companies can pounce and charge you outrageous premium prices.

Disability does not make you rich (cue bitter laughter), and after getting divorced I was forced to do a short sale of my house because of the housing crash. I moved my young daughter and myself into an apartment in Bothell, WA. Rent prices skyrocketed, and I was then forced to move to a more affordable area. I chose the Tri-Cities (West Richland) because I have family and friends here and it is close enough to the west side that my daughter can see her father and his family on a regular basis.

When we lived in Snohomish County I had a Medicare Advantage plan (part C) for my supplemental policy. What Medicare does and does not cover can be lengthy and convoluted. However, as a general rule of thumb, Medicare part A covers hospital stays (although people need to be sure their stay qualifies – there are minute details that are best read in an article I’ll post at the bottom, if you’re interested), and Medicare Part B is the part that covers outpatient services. However, Medicare only covers 80% of outpatient visits. So most people pay for a private, supplemental policy, in addition to their Medicare coverage (which each person also pays for). Medicare Part C refers to Medicare Advantage plans, which are supplemental policies offered by private insurance companies. While we lived in Snohomish County, I had a Medicare Advantage plan (Part C) through Regence.

When we moved to West Richland, which is in Benton County, I just assumed I would be able to stay on my Medicare Advantage plan since we were moving within the same state. I assumed it all went by state; but it does not. It goes by county. After the move was complete and my daughter had already started 4th grade, I discovered that I was NOT eligible to stay on the Regence plan.

My only choice in Benton County, as a person on Medicare who is under 65, is a Medicare Supplement Plan F, offered by Premera. If I was 65 or older, I would have plenty of different Medicare Advantage plans to choose from in Benton County. However, because I am under 65, it is either the Supplement F plan or nothing. I assume this is because Benton County is much less populated than Snohomish, and there may be too few people under 65 to make it worth the insurance companies’ while to offer Medicare Advantage plans to the disabled here. Apparently I am lucky that there is a supplemental plan available to me at all in Benton County!

Trust me, I have thought many times about risking it and going without the supplemental. My monthly premium doubled, compared to what I had been paying for the Advantage plan, but I now have zero copays. So instead of paying $175 a month, which was what I paid for the supplemental in Snohomish County (Part C), I now pay $356 a month for the Supplement F plan, which covers the 20% gap that Medicare Part B does not – but I never have a copay.

I also pay approximately $130 per month for Medicare (it is deducted from my SSDI before it hits my account, which is why I am never exactly sure how much it costs me). I have also opted to pay for Medicare Part D, which is the prescription drug coverage. That also comes out of the SSDI before it hits my account, so I am not exactly sure how much I pay on that each month.

After the dust had settled and I figured out my only supplemental plan option in Benton County, I begrudgingly purchased the Supplement F plan. I then decided I would have to MAKE it worth it. As mentioned, I had only paid $175 per month for the supplemental on the west side, but over there I had co-pays. As a stroke survivor, PT and OT are now part of my regular routine. Since both PTs and OTs are considered specialists (as opposed to someone like a primary care provider), there was a $45 copay for each appointment. As rent prices increased on the west side, I was only able to go to PT and OT once a month each. I used to go to a place in Seattle one Saturday per month. If I had both PT and OT that day, the combined copays were $90. Factoring in gas to get me there and back, I started referring to those Saturdays as my “hundred dollar days.” Eventually, I stopped going to PT and OT altogether because I had to make rent. However, now that I don’t have copays (although double the monthly premium), I have been going to PT and OT regularly here on the east side.

Finally, Medicare does not cover vision or dental, so I have two separate policies for each of those, as well. All told, I have six insurance policies (Medicare A, Medicare B, Medicare D, the supplement F Premera plan, VSP for vision and Cigna for dental) for a total of approximately $520 a month, just for me. My daughter is currently covered by her father’s health insurance through PSEW, however, there have been times throughout the past 10 years when she had to be transitioned to Apple Health (WA state Medicaid) because my ex lost his benefits. Because of the current shutdown, he has been laid off again. So I do not know how long his benefits will cover him and our daughter. She will just go back to Apple Health, if necessary.

Does your brain hurt yet??? Is it complicated enough? Sometimes I envision how someone from a different country would react to this tale. I’m sure it would blow people’s minds, and I know that it is only ONE story. There are millions of similarly messed up narratives out there!

This is a website that spells out the details of what Medicare covers for hospital stays (Medicare Part A): https://www.healthline.com/health/what-medicare-covers

This one talks about what Medicare Part B covers (outpatient): https://www.healthline.com/health/what-medicare-covers

LET’S STOP THIS MADNESS!!!!! Go Whole Washington!!!!

-Kim H., Benton County WA

How COVID-19 has affected my life, Vicki Rhoades, ND

Hello.  My life is affected in so many ways.  Here are a few.
1.  As a PCP in private practice, the clinic where I rent has been open to one provider at a time, with patients scheduled such that there is no waiting in the waiting area.  This has vastly reduced the number of patients I see with a corresponding reduction in income.  I also introduced telemedicine, and may also introduce house calls shortly.  These are cash visits, but I really don’t make much money from them.  Still a vast reduction in income.  I do these things to reduce risk, both to myself and my patients.
2.  As someone very close to the “increased risk” age range, I have vastly reduced my social conversations in real life.  While I tend to be an introvert, this definitely changes my ability to see friends.  Zoom is good, phone calls are okay, but the true face to face conversations have a depth to them that virtual reality does not convey.  Still, I do these things too.
3.  Perhaps the most disturbing to me is the inability to visit my mother, who is in her late 80s.  I call her twice daily to “check in.”  She asks me repeatedly, “how much longer will this go on.”  I answer repeatedly, “I don’t know, mom.”  Because, really, I do NOT know how much longer.  It depends on so many things, both known and unknown: will people behave as I do?  will the government rules change yet again?  how does this virus behave, REALLY?  (etc etc)In the face of uncertainty, and a desire to continue to serve all while still protecting myself and others, I carry on.  I have no idea of how much longer this is practical.  Still.

Sincerely, and thanks to Whole Washington for asking.
Vicki Rhoades, ND
Tracey’s Parents Bob and Bano

Whole WA Volunteer Tracey’s COVID-19 Story

My parents told me they had fevers on March 18th.  Until then they had continued acting like the world was normal.  They live in Florida and COVID was in Washington State, not Florida, they thought.  My brother convinced them to go to get tested and on March 25 they gave in and did.  By then they both had pneumonia.  They texted my brother and I to let us know they were going in to the ER to get tested.  That was at 12:15 EST.  14 minutes later they told me they were being admitted into the hospital.
At around 6:30 EST the hospital called me on my Dad’s cell phone to let me know that my mom had been intubated and taken up to the ER and my dad insisted they call me before sedating and intubating him so he knew we knew what was happening.  I didn’t get to talk to him because he didn’t have enough breath.
Tracey's Parents

Tracey’s Parents Bob and Bano

I called my family to let them all know what was going on and that is when I found out that there might be an insurance problem.  Dad wasn’t technically admitted into the hospital yet.  He was still in the ER waiting for an ICU bed.  If he wasn’t sent up to the ICU then Medicare would not cover the ER visit according to my aunt.  She insisted I call the hospital and make sure he was in the ICU before midnight.

To this day I do not know if this is true. He got his ICU bed at 9:45 EST.  But, that isn’t really the point.  I had to call the hospital concerned about money while really all I care about is my parent’s lives.  Because, whether they would be charged or not, someone in the same situation as them in America will be charged.  It should not have been part of what I was stressing about.

My mother passed on March 30th.  Dad is still fighting after 20 days on a ventilator.  I have never gotten the chance to speak to either of them again.  20 days for Dad so far in ICU and 5 for Mom.  Without their Medicare and Medicare Advantage he would come out of the hospital destitute. In that we are lucky but I think of the thousands of people in this country with no insurance during this pandemic and have just one more reason to cry.

Tracey C., Olympia WA, She/Her

Campaign Update!

After working closely with outgoing Washington State Senator Maralyn Chase, the Department of Revenue (DOR), and the Employment Security Department (ESD), Whole Washington is proud to announce SB 5222 the Whole Washington Health Trust, sponsored by Senator Bob Hasegawa. This bill is based on Initiative 1600 and has been introduced in the state senate. With the help of Senator Chase, our Initiative Writing Committee, the DOR, and ESD revised I-1600 so that the funding provisions could be more easily implemented within existing state administrative frameworks; however, the essential substance of I-1600 remains.

It was announced by the Office of the Insurance Commissioner earlier this year that Health insurers will “propose 19 percent average rate increase for Washington’s individual market.” The volunteers and supporters of Whole Washington knew that we couldn’t wait another year to act, even before this information was released.

We still feel that urgency. Every day we hear about people declining ambulance rides because they can’t afford to pay for them, seniors cutting pills in half, and patients dying because treatment is too expensive. The time to act is now.

Please call your state senators at 360.786.7573 and request they become a cosponsor of SB 5222 and/or commit to vote for SB 5222.

Whole Washington announces the close of the signature drive for I-1600

The initiative did not reach the threshold of verified signatures necessary to appear on the November ballot, but over 100,000 voters signed that they want universal healthcare which sends a clear and urgent message to our legislators.

Highs and lows marked the months long I-1600 campaign. Highs included working with Progressive Coders to create a Savings Estimator to calculate personalized yearly costs/savings, garnering endorsements from key organizations like the Washington State Democratic Party and the League of Women Voters Washington, and collecting signatures at energized events like the March for Our Lives, Keep Families Together rallies, and Pride events across the state. Lows included the loss of a founder and beloved Chair Kathy Angel to cancer in the last few weeks of the campaign.

The campaign did not use paid-signature gatherers and had no paid staff. Even the volunteer campaign director collected signatures, easily 1000 alone.

Whole Washington wants to hear your ideas for moving forward and pushing further. We will be planning an event shortly. Stay tuned!