In the final hours before his release from the hospital, the doctor of my best friend’s husband convinced Medicare that her husband needed continued professional care at a rehabilitation facility and should not be sent home again. Weeks before, they sent him home without professional homecare, only for him to deteriorate into an excruciating rebound of his infection. My friend is a nurturing person, but she not a nurse. She is a petite 80-year-old who has serious medical issues of her own. Despite this, she was willing to again try to care for her husband who has chronic pain, no longer walks, requires diaper changes, and has signs of dementia because there was no alternative. Insurance was refusing to pay for his continued hospitalization and a home nurse was going to cost about $200 per day. She was stuck and beside herself with anxiety. I was helping as much as her pride would allow. Her sons preferred not to be bothered as they wanted to continue their lives burden-free. Thankfully, the doctor was more convincing this time and her husband was not coming home yet. My point is that accessing insurance has become a nightmare. It is no longer the safety net that we have relied on for so long. While not condoning the brutal murder of the United Health Care CEO, I understand the growing frustration towards ruthless profiteers like him who deny legitimate medical claims. And yes, my friend has her Medicare Advantage policy through United Health Care. Personally, we opted for Medi-gap coverage because there are fewer denials and fewer restrictions. It does cost more, but we receive premium reimbursement through my husband’s retirement benefits.
These days, it’s not just medical insurers that are making access difficult. At the beginning of the year, I switched my personal dental insurance policy to one sponsored by my husband’s retirement benefit. It provides higher coverage than my previous dental insurance and the premiums are reimbursed as part of his retirement benefit. However, I soon discovered that accessing the additional benefits was going to take hours on the phone. Last week, I went to my scheduled cleaning and x-ray appointment. The dentist recommended replacing an old silver filling and filling a small cavity. At the front desk, the insurance guru informed me that my new insurance policy only covered two cleanings and x-rays. She printed out the list of benefits that clearly showed that their practice was “in network” but that no dental work beyond cleanings and x-rays was covered. I knew this didn’t make any sense since the premiums alone cost more than teeth cleanings and x-rays. It took three days searching the website personal portal, two phone calls cleverly navigating AI to reach a human, and finally the completion of a “Waiting Period Waiver Form” that no one previously mentioned, to access the $2000 in dental benefits. I was nearly persuaded to forego the insurance benefit and just pay for the work out of pocket. But my need to fix that which is obviously wrong, stopped me.
Apparently, the insurance company automatically places a waiting period on new policy holders until the customer shows evidence of prior dental coverage for the previous 12 months to obtain a waiver. The problem is that they neglect to inform new policy holders, like me, of this process. I only learned of it by calling them directly after being denied coverage. Even the dental office insurance guru was unaware of a possible hold on my insurance coverage. Perhaps more disappointing is the fact that I had to call a second day because the first representative who told me about the waiver form then failed to email it to me as promised. I spent an entire day waiting for it to arrive in my inbox. I even checked my spam folder. No waiver form!
The problem with insurance these days extends well beyond medical and dental insurance. I live in California where we have wildfires and earthquakes. I know of a few friends who have been kicked off of their homeowner’s insurance because of the fire danger. Few companies will cover homes at wildfire risk for a reasonable premium, if at all. In some cases, the insurance is higher than the mortgage payment. When we were looking for houses, I purposefully steered clear of hillsides and open fields, recalling the traumatic experience of a wildfire evacuation situation in my early teens when our family home was in danger.
I’ve also experienced earthquakes, both big and small. However, earthquake insurance is not only unaffordable, but it isn’t even practical. Prior to the big 1994 earthquake, homeowner’s insurance covered earthquake damage. But after the huge damage claims insurance companies paid in 1994, earthquake insurance became a separate policy. We recently researched earthquake insurance only to learn that it would cost an additional $9000 to 12,000 per year and that the deductible is at least 15% of the replacement value of the home. That would come to anywhere from $100,000 to $150,000 before insurance ever kicked in. Most homes will not be a total loss in the event of an earthquake, so it makes little sense to purchase that costly insurance. Although terrifying, most of the damage caused by earthquakes (even in 1994) isn’t catastrophic because of strong building codes. One of my friends mentioned that she was planning to rely on FEMA if disaster struck. I had to inform her that President Trump is trying to get rid of FEMA and that the big, beautiful budget bill eliminates FEMA funding. There are several states who have already been denied federal disaster relief and others still waiting for an answer. We may already be on our own if and when a natural disaster destroys our homes.
Although a real pain, I’m still a believer in having insurance because unforeseen circumstances can ruin family finances. Unless young families are independently wealthy, they should definitely have life insurance to protect the ongoing livelihood of surviving family members. Both parents should be covered, even homemakers, because the out-of-pocket cost of childcare, cooking, and housekeeping are enormous. Even for the ten years I was a stay-at-home mom, I had a life insurance policy. As an elderly person, with independent adult children, I don’t have nearly as much life insurance as I once did. But I have enough to take care of my remains and any remaining obligations.
Of course, auto insurance for drivers is a must. We recently learned that auto insurance rates for the elderly are just as high as for new drivers. Despite not having any accidents nor traffic tickets, our premiums jumped way up when my husband turned 70 several years ago. And they just keep rising. We have two cars and neither of us drives much in our retirement and so I often question the necessity of two vehicles. But my husband prefers that we maintain our independence, so we keep paying to maintain two vehicles in addition to paying the rising premiums. My husband took a senior driving course to lower our premium and I sign a low mileage waiver every year, but our premiums remain as high as for young drivers. This wasn’t something we anticipated, but it is something we bear so we can come and go as we please. My best friend with the hospitalized husband finally realized a few days ago that her husband has been unable to drive for the past six months and she finally took him off the insurance, receiving a $500 refund in the process. I realized when helping my elderly next-door neighbors two nights ago that they no longer drive either. They are both using walkers and pay for a home care worker to assist them. I thought about the two unused cars in their garage and wondered whether they are still paying for auto insurance on them.
The point is that insurance has an important role to play in our lives. Having emergency savings set aside is just as important. So, when it comes to insurance, we need to make sure we have the appropriate amount when possible and realize that we might need both energy, patience, and a bit of persistent determination to insist on the benefits we are paying for.