Blue Cross clarifies NC cost tool

When Blue Cross and Blue Shield of North Carolina unveiled a new online cost tool last week, the immediate concern raised by national experts and Charlotte health executives was that it wasn't clear what the numbers mean.

Blue Cross spokeswoman Michelle Douglas said Monday the company has added an explanation:  Cost estimates are averages based on historical BCBSNC claims data. Amounts listed typically include physician fees, facility fees and costs for things like anesthesia, drugs, medical supplies – as well as customer responsibility (deductible, co-pay and co-insurance). Your actual costs may be different based on variations in these factors as well as your health plan design, deductibles/co-insurance and out-of-pocket limits.

"The fact that hospitals say the numbers are Greek to them is indicative of why the tool was necessary,"  Douglas said in an email.  "Before, customers had no place to go and ask how much the total cost (physician fee, hospital fee, labs, anesthesia, etc.) of a health care procedure might be."

Meanwhile,  John Murawski with the News & Observer forwarded a message noting that UnitedHealthcare offers cost estimates to the public on its Health4Me mobile app  (it's free on for Apple or Android devices,  or see an online demonstration).

The UnitedHealthcare guest function lists estimates  "based on local market average costs,"  rather than breakdowns by provider,  as the Blue Cross tool does.  (UnitedHealthcare, Blue Cross and many other insurance companies offer more detailed members-only data,  including what patients can expect to payout of pocket based on their plan.)   I looked up knee replacement,  which the Blue Cross tool listed as ranging from $20,154 to $40,148 in the Charlotte area.  On Health4Me I got a Charlotte average of $60,185  ($59,125 for the procedure itself,  with the rest for pre- and post-surgical office visits and physical therapy).

So we're all starting to get a peek behind the curtain of health care costs.  But making sense of it is going to take a lot more work.

Can you swap Medicare for Obamacare?

After reading about turmoil in North Carolina's Medicare Advantage program,  85-year-old Marion Meili called with a question: Can I drop my policy and try to find a better deal on the Affordable Care Act exchange?

Short answer:  No.  The exchange,  which offers subsidies for low- and moderate-income people,  was designed to provide new options for people who don't have access to health insurance.  It's not available to those who already have government coverage,  including Medicare and Medicaid, or those who have qualified group plans offered by their employer.

"It's against the law for anyone who knows you have Medicare to sell you a Marketplace plan,"  says HealthCare.gov,  the official ACA exchange site.

Glenn McCoy/Slate.com

Of course,  there's never a simple answer for anything related to health coverage,  so the site follows up with exceptions:  If you're paying a premium for Medicare Part A or if you're eligible for Medicare but haven't signed up you might be able to shop on the exchange  (read details here).

Medicare Advantage is an option that lets senior citizens enroll in a private insurance plan  (get a primer on how the system works here).  Meili's policy is with UnitedHealthcare;  she tells me she got a notice of a rate hike but called the insurance company and "got it a bit cheaper."  That's a good reminder that it's always smart to shop around and ask for a better deal.

It's also smart to get help.  Medicare options and costs change every year.  In North Carolina,  call 1-855-408-1212 or visit the Seniors Health Insurance Information Program website to get advice.

A note if you live in Mecklenburg County:  Shepherd's Center does face-to-face counseling on Medicare enrollment and I have it on good authority  (my 80-year-old mom)  that they do excellent work.  Unfortunately,  they're also booked for the rest of this enrollment period,  which ends Dec. 7.  So if you call the state SHIIP line,  tell them you want your question answered on the phone or you may get referred to Shepherd's Center,  which will just send you back to the phone line.