Until we truly have transparency in healthcare pricing we will all fall victim to high prices for healthcare. Without transparency, there is no competition, without competition prices will always be high. Mr. Frakt is right, we would not have our kitchen remodeled without a bid. If we did not get a bid the temptation by the contractor would be to send a high bill. Perhaps not ourt of reason but higher than he otherwise would.
We also need to remember that insurance is not healthcare. Insurance companies provide no surgeries, diagnostic testing, prescribe nothing. However, they do get a percentage of healthcare costs. The higher the costs, the more they make for doing nothing.
We also need to remember that insurance is not healthcare. Insurance companies provide no surgeries, diagnostic testing, prescribe nothing. However, they do get a percentage of healthcare costs. The higher the costs, the more they make for doing nothing.
1
Doctors and test providers are not just fragmented by specialty, but by motivation. My primary care physician takes a real concern for patient quality of care. If only this were true of the specialists she has referred me to. Three such specialists saw me as a walking talking ATM. The better my insurance, the more complex and expensive tests they ordered. Each such "medical journey" lasted a full year, and NEVER coordinated treatment with my primary care doctor (even when test results revealed illness better served by a GP). Neither did their expensive tests and treatments bring about any improvement or even diagnosis of my symptoms. I imagine that in the unlikely event they actually help someone, they are immediately recruited as "patient testimonials" so proudly featured on their web sites, while the much more common non-responders are left to decide when to give up. I just stopped going after six months to a year. No one from their offices even called to ask why. All of this leaves my GP shaking her head, and nodding in agreement when I decided to just treat my symptoms.
3
What's missing from Medicare are some major body parts, particularly teeth, eyes, and ears. The human body works as a system: unhealthy teeth can lead to infection and heart disease; unhealthy eyes can lead to life-threatening accidents (falls and the like) and blindness; unhealthy ears to accidents and deafness and social isolation. Separate insurance to cover these body parts is typically far from adequate and is useless for anything serious. What is needed is whole-body coverage such as is provided in other civilized countries.
18
Recent events demonstrate how uncivilized we have become as a country. We think other countries aren't as smart as we are.
4
I was a Virginia resident, disabled, and forced into Medicare advantage as so-called "health insurance." It was worse than being uninsured and my annual medical expenses were $15k a year. In most cases, my copays represented the market cost of the service provided, if not more. I literally sold my house and moved to a state where the disabled can purchase a Medigap plan so that I could have health insurance again. If I had been uninsured, at least I could have negotiated my own rates and obtained charity care. Medicare Advantage is a joke and should be terminated. For all of the aggressive upcoding offers, I sure did not see a penny of care or consideration.
2
You are confused about what happened to you. A Medicare Advantage participant is entitled to drop Medicare Advantage and revert to standard Medicare at any time without waiting for an open enrollment period. You are not able to purchase a Medigap supplement except during the open enrollment period or when first entering Medicare.
What is more likely is that during the two year period between becoming eligible for SSDI and becoming eligible for Medicare, you voluntarily entered a state subsidized program for those with preexisting conditions. You couldn't buy health insurance in the open market because you waited until after you were sick. You weren't poor enough to qualify for Medicaid, because that would not have had $15,000 out of pocket costs.
Your move to a new state coincided with your becoming eligible for Medicare, and you then bought a Medigap plan.
The coverage you had in Virginia was not Medicare or Medicare Advantage. It was state subsidized catastrophic coverage with a high deductible and you paid low premiums because you had enough money to pay for your $15,000 annual out of pocket costs. It wasn't very good coverage because you waited to buy insurance until after you were sick.
No one gets forced into MedicareAdvantage. There are employers who offer Medicare Advantage plans to their retirees and subsidize the premiums. But even in those cases, you can decline the employer subsidy and go to regular Medicare.
What is more likely is that during the two year period between becoming eligible for SSDI and becoming eligible for Medicare, you voluntarily entered a state subsidized program for those with preexisting conditions. You couldn't buy health insurance in the open market because you waited until after you were sick. You weren't poor enough to qualify for Medicaid, because that would not have had $15,000 out of pocket costs.
Your move to a new state coincided with your becoming eligible for Medicare, and you then bought a Medigap plan.
The coverage you had in Virginia was not Medicare or Medicare Advantage. It was state subsidized catastrophic coverage with a high deductible and you paid low premiums because you had enough money to pay for your $15,000 annual out of pocket costs. It wasn't very good coverage because you waited to buy insurance until after you were sick.
No one gets forced into MedicareAdvantage. There are employers who offer Medicare Advantage plans to their retirees and subsidize the premiums. But even in those cases, you can decline the employer subsidy and go to regular Medicare.
It's a different definition of "competition, but I should mention that (at least in my experience) there is virtually no choice of Medicare Advantage plans in my area for someone like me who is on Medicare for a disability rather than as a retiree. Sure, there's a list, but when it comes down to making a choice, there's only been one plan that even comes close to meeting my needs (but still doesn't fully meet them). So this kind of "competition" is also lacking.
2
That leaves you with the option to have regular Medicare, or to purchase a medigap plan, and there may not be any desirable medigap plans either.
I'm always astonished at the number of people who think Medicare for all is a great idea. Medicare works fine for people who live in an area where there are lots of middle class people with employer provided health insurance. The providers are willing to accept the low Medicare reimbursement rates because the Medicare population is a small proportion of the market.
I'm always astonished at the number of people who think Medicare for all is a great idea. Medicare works fine for people who live in an area where there are lots of middle class people with employer provided health insurance. The providers are willing to accept the low Medicare reimbursement rates because the Medicare population is a small proportion of the market.
I'd like to point out the intrusion of private business into my care of patients. I regularly get requests to sign for medical equipment for my patients. These requests do not provide evidence that I ever ordered this equipment. And checking the chart also does not turn up any orders.
I believe these scams work because work obligations far exceed 24 hrs/day for all primary care providers and a simple signature only takes a few seconds. And my taking time to check for scams means putting off my next patient obligation.
I will look for replies to see if anyone out there knows the state or federal agency that would find this information of interest. I work in California.
I believe these scams work because work obligations far exceed 24 hrs/day for all primary care providers and a simple signature only takes a few seconds. And my taking time to check for scams means putting off my next patient obligation.
I will look for replies to see if anyone out there knows the state or federal agency that would find this information of interest. I work in California.
9
There is doubtless an opportunity for cost savings within Medicare Part C which is covering a third of the Medicare population for a quarter of the total cost of Medicare.
However, upcoding is not unique to Medicare part C plans, it also takes place in traditional Medicare. Over 25% of costs paid by traditional Medicare are paid in error, for duplicate or unnecessary services or for services never rendered. Whatever your opinion may be about part C insurers, the are not overpaying to the tune of 25%.
A significant part of the problem with traditional Medicare is that to keep the overhead at the much touted 2%, is it pays outside contractors 2% to process the bills. If they detect a $250 bill that is a duplicate service, they can pay it and receive their $5, or they can spend $5 notifying the provider that he is not going to be paid and get paid zero by the government [potentially adding costs when the denial is contested]. Which do you think they choose?
Government resources would be better spent examining the practices of traditional Medicare which is covering two thirds of the Medicare population for 75% of the cost. That's where the real money is.
However, upcoding is not unique to Medicare part C plans, it also takes place in traditional Medicare. Over 25% of costs paid by traditional Medicare are paid in error, for duplicate or unnecessary services or for services never rendered. Whatever your opinion may be about part C insurers, the are not overpaying to the tune of 25%.
A significant part of the problem with traditional Medicare is that to keep the overhead at the much touted 2%, is it pays outside contractors 2% to process the bills. If they detect a $250 bill that is a duplicate service, they can pay it and receive their $5, or they can spend $5 notifying the provider that he is not going to be paid and get paid zero by the government [potentially adding costs when the denial is contested]. Which do you think they choose?
Government resources would be better spent examining the practices of traditional Medicare which is covering two thirds of the Medicare population for 75% of the cost. That's where the real money is.
4
I think I prefer a Medicare Advantage organization that is proactive to catch "serious conditions early". What am I missing here?
3
Obamacare requires all health insurance plans to offer a physical examination gratis that might catch "serious conditions early".
2
Read Dr Gilbert Welch's book, Overdiagnosis and (a little easier to grasp) Less Medicine, More Health. Everyone in the US should read those books. I'm reluctant to see a doctor who's not familiar with Dr Welch and his work.
Also see:
http://www.nytimes.com/2015/01/09/opinion/skip-your-annual-physical.html
Catching "serious conditions" early does not always prevent death or more intense treatment. You're much more likely to get referred for further tests based on some blip during a physical; it almost always turns out to be nothing, but you've had the inconvenience (and copays) and the insurance company gets to document that they're spending a lot of money to keep you healthy. Also the follow-up tests for these false positives and overzealous interpretations can be detrimental to your health. Read Snowball in a Blizzard by Steven Hatch.
Meanwhile if you DO have a serious or urgent condition you (a) usually can't get to see your doctor because she's booked up with routine physicals and (b) the insurance company, having spent a fortune on routine exams and follow-up testing now argues fiercely against reimbursing you.
Also see:
http://www.nytimes.com/2015/01/09/opinion/skip-your-annual-physical.html
Catching "serious conditions" early does not always prevent death or more intense treatment. You're much more likely to get referred for further tests based on some blip during a physical; it almost always turns out to be nothing, but you've had the inconvenience (and copays) and the insurance company gets to document that they're spending a lot of money to keep you healthy. Also the follow-up tests for these false positives and overzealous interpretations can be detrimental to your health. Read Snowball in a Blizzard by Steven Hatch.
Meanwhile if you DO have a serious or urgent condition you (a) usually can't get to see your doctor because she's booked up with routine physicals and (b) the insurance company, having spent a fortune on routine exams and follow-up testing now argues fiercely against reimbursing you.
5
We all know that the health system is rigged for the providers. They charge more becuse they can. They are not controlled and they make syure the lobbyits keep it this way. Non Profit hospitals (top 10) averaged 155 million profits, Imaging can cost from $500 to $5000 for the same type exam. Surgery can be 10X n more in one area then another and drugs are totally out of control, A $250 prescript. in USA is $43 in France or Germany.
Single payer system would actually save consumers trillions of dollars over 10 years. A miimum increase in taxes could save thousands in costs. the single payer system will work. The lobby guys will fight it and pay of the congress. Business as usual.
See letusbeawarefolks.blogspot.com-will single payer system work, for details.
Single payer system would actually save consumers trillions of dollars over 10 years. A miimum increase in taxes could save thousands in costs. the single payer system will work. The lobby guys will fight it and pay of the congress. Business as usual.
See letusbeawarefolks.blogspot.com-will single payer system work, for details.
5
Medicare Only Pays for Long Term Care under Limited Circumstances and for a Limited Number of Days
Many consumers incorrectly assume Medicare will always pay for the first 100 days of their long term care. According to the U.S. Department of Health and Human Services...
http://www.skloff.com/long-term-care-insurance-elimination-period-and-me...
Many consumers incorrectly assume Medicare will always pay for the first 100 days of their long term care. According to the U.S. Department of Health and Human Services...
http://www.skloff.com/long-term-care-insurance-elimination-period-and-me...
Assuming someone qualifies for skilled nursing care, the co-pay on a 100 day stay is $12,600.
Negotiating drug costs on a national level would render savings. Compare drug costs in the U.S. to Canada (with or without province variances). Asking the GOP candidates if they would move to do this would test their commitment cost containment and show their hypocrisy about "bad big government". We all pay for their failed theories.
10
Medicare "Advantage" was sold by the Republicans as a way to lower costs through competition. They argued (and voted) to include a subsidy to "get the plans started" after which they would become less expensive than traditional Medicare.
Remember that the Republicans tried to block the creation of Medicare from the start, and ever since have been trying to voucherize and privatize it. The subsidy in effect gives taxpayer funds meant for Medicare to private insurance companies.
In fact, the subsidy did not disappear, and when Democrats tried to cut extra funds for Advantage Plans, Republicans cried that Democrats were trying to "cut Medicare", while simultaneously complaining that Medicare is draining budgets. A significant part of that "drain" was from "Advantage" plans.
The article points out that it is complicated. But the answer could be simple. If Medicare Advantage Plans are not saving money, which was claimed to be their original role, then let's return to universal regular Medicare.
Remember that the Republicans tried to block the creation of Medicare from the start, and ever since have been trying to voucherize and privatize it. The subsidy in effect gives taxpayer funds meant for Medicare to private insurance companies.
In fact, the subsidy did not disappear, and when Democrats tried to cut extra funds for Advantage Plans, Republicans cried that Democrats were trying to "cut Medicare", while simultaneously complaining that Medicare is draining budgets. A significant part of that "drain" was from "Advantage" plans.
The article points out that it is complicated. But the answer could be simple. If Medicare Advantage Plans are not saving money, which was claimed to be their original role, then let's return to universal regular Medicare.
23
Many Medicare Advantage(MA) plans have learned to game the system. They form alliances with independent practice associations (IPAs) that encourage their physicians to switch "healthy" traditional medicare recipients into MA plans, upcode healthy enrollees for higher payments and transition "very high cost" enrollees (eg those with end stage renal disease, cancer, CHF, etc) into hospice care or, thru loopholes, back to traditional medicare shortly after the healthy enrollee develops a very high cost disease. Also, many MA plans create an environment that promotes the unethical rationing of care for our seniors by only offering global capitation contracts with physicians or IPAs that wish to provide services for the MA plan enrollees. Many globally capitated physicans and IPAs have learned to make fortunes through medicare advantage plans by collecting monthly payments when patients are healthy and by avoiding the use of those payments towards a newly ill enrollee by delaying diagnostic workup, transitioning to hospice when not truly indicated or by dropping very high cost patients back to traditional medicare. In many smaller markets the MA plans are well aware of these tactics but do nothing to stop it and collude with IPAs to continue fraudulent practices such as upcoding. Even STAR ratings for these MA plans can be manipulated as some MA plans guide disgruntled patients into a "competitor" MA plan which is owned by the same set of investors.
4
So this is why my corrupt United Health Care (AARP MediCare Advantage) plan calls me constantly, virtually begging me to go in for my annual wellness exam. I see my doctor regularly and monitor my health minutely; I always have. I could NOT figure out why the bum's rush for the wellness exam, which is, by the way, virtually useless. THE ANSWER IS: The wellness exam helps the insurance company charge the government more! And here I just thought it was a way to stupidly patronize the aging. My imagination about corporate corruption is entirely inadequate! Note the type of corruption: Ripping off the government. Why do Republicans talk about moochers and keep pushing to privatize everything into corporate hands??
33
Nellmezzo,
Thanks for the warning. I just got an envelope from United Health Care (AARP Medicare Advantage) with info on their Medicare Advantage plans. I always felt that AARP is just a marketing scheme for Insurers to sell insurance plans to Seniors reaching 65.
I will stick with Traditional Medicare part A & B then consider a Medigap Part F plan from BCBS..
Thanks for the warning. I just got an envelope from United Health Care (AARP Medicare Advantage) with info on their Medicare Advantage plans. I always felt that AARP is just a marketing scheme for Insurers to sell insurance plans to Seniors reaching 65.
I will stick with Traditional Medicare part A & B then consider a Medigap Part F plan from BCBS..
1
All these articles leave this reader with one conclusion: single payor universal access health care. Other countries do it. We should be able to. No one should have to worry about paying for necessary care, not if this country is as rich as we've been told. Of course the GOP would have us believe that by having this sort of system everyone will rush to the doctor and demand expensive useless treatments. The truth is that we would be healthier if we had a more unified system, one where we, the patients, wouldn't have to worry about communications between doctors, if a prescription is covered, if a provider is in network, if we can afford the deductible, the co-pay, and the coinsurance.
The problem is that our politicians, who have more and better choices than us, haven't got the backbone to do the right thing: let the healthcare industry howl about profits, etc., while seeing to it that every American can receive the health care they need.
The problem is that our politicians, who have more and better choices than us, haven't got the backbone to do the right thing: let the healthcare industry howl about profits, etc., while seeing to it that every American can receive the health care they need.
28
The only countries that have single payer universal healthcare are Canada and Britain. Every other western country has a hybrid system. And there is a reason for that. Single payer universal healthcare is a ticking time bomb, and a looming disaster.
3
You may be right. The UK NHS has been just such a ticking time bomb for 69 years now. The current government wants to privatise it and is working on it as fast as the electorate will allow. Meanwhile, Britain spent 9.1% of GDP on healthcare in 2014, down from 9.4% in 2011. That's about half of the US percentage. Most health indicators for the UK match or exceed US measures, but not all.
I don't know how risk averse you are, but perhaps the US electorate would accept the wager of saving 9% of GDP for other purposes (infrastructure?, Free state colleges?) at the risk of a potential disaster two generations on.
I would.
The US electorate is not going to be given the choice of course, just as nobody would believe that Sanders's proposals could be financed without massive tax increases, even if they remained lower than current medical insurance premiums.
I don't know how risk averse you are, but perhaps the US electorate would accept the wager of saving 9% of GDP for other purposes (infrastructure?, Free state colleges?) at the risk of a potential disaster two generations on.
I would.
The US electorate is not going to be given the choice of course, just as nobody would believe that Sanders's proposals could be financed without massive tax increases, even if they remained lower than current medical insurance premiums.
7
Richard, even if Americans were given the choice, they might not take it. Most people do not care about (or understand) health indicators. They care only about what they perceive to be access on demand (and also clearly ignore "free" lifestyle behavior changes in favor of illness treatment).
1
This article highlights the extent to which healthcare markets are weighted heavily toward the providers. Patients rely on doctors for diagnosis and treatment recommendations; insurers rely on paperwork from the provider to determine the situation.
When markets are so skewed, it takes a huge amount of regulation to try to get them to operate like free markets. The efforts to create competition are just a symptom of the problem, not a solution.
When markets are so skewed, it takes a huge amount of regulation to try to get them to operate like free markets. The efforts to create competition are just a symptom of the problem, not a solution.
5
The healthcare system in this country is a mess. Pure and simple, it's a mess. There are a myriad of perverse incentives built into every aspect of the system. That's because we keep electing people who only pay attention to the lobbyists from the industries that pay for their campaigns. Even those few lawmakers who try to be fair, are not trained in the technical details of how the system works. So, they are not venal (see above) but ignorant instead. If you have a system governed by the corrupt and the stupid, then you will get what we have in health care. There's really no way out of the trap other than a single payer system. You can have that with competition from providers but without simple mechanisms to govern prices the system will never be fair or affordable to people who aren't in the notorious top 1 percent of income.
28
President Obama was well aware that services at non-profit charity hospitals were and are overpriced because they pay people like his wife $350,000 for part time jobs that do not contribute to patient care.
This article is about how the insurers game the system to maximize their profit. A couple of pages away, the drug companies have prices too high or have shortages.
Why is it that no one ever asks the question of why non-profit charitable hospitals, that don't pay real estate taxes or sales taxes charge the same amount as for profit hospitals. Could it be seven figure salaries for CEOs and CFOs, as well as payments to the Michelle's of the world of $350,000? It's not because the nurses are getting rich, or because the illegal alien nurse's aids and janitors are.
ObamaCare was always designed to shift more money to the elite. That more money was coming from taxpayers or from premium payers and deductibles and co-pays.
The article clearly says that even with the "excess" spending, MA plans are covering a third of the population with 25% of the costs. Standard Medicare, the single payer you want, covers 67% of the population with 75% of the cost. Is that really going to save money? Or is it going to beef up Michelle's post POTUS paycheck? The cronies get billions, the poor get pennies, and the working class pays.
Anyone who objects is excoriated as wanting the poor to go without healthcare. No, conservatives want the cronies to give up their bonuses.
This article is about how the insurers game the system to maximize their profit. A couple of pages away, the drug companies have prices too high or have shortages.
Why is it that no one ever asks the question of why non-profit charitable hospitals, that don't pay real estate taxes or sales taxes charge the same amount as for profit hospitals. Could it be seven figure salaries for CEOs and CFOs, as well as payments to the Michelle's of the world of $350,000? It's not because the nurses are getting rich, or because the illegal alien nurse's aids and janitors are.
ObamaCare was always designed to shift more money to the elite. That more money was coming from taxpayers or from premium payers and deductibles and co-pays.
The article clearly says that even with the "excess" spending, MA plans are covering a third of the population with 25% of the costs. Standard Medicare, the single payer you want, covers 67% of the population with 75% of the cost. Is that really going to save money? Or is it going to beef up Michelle's post POTUS paycheck? The cronies get billions, the poor get pennies, and the working class pays.
Anyone who objects is excoriated as wanting the poor to go without healthcare. No, conservatives want the cronies to give up their bonuses.
The biggest problem with Medicare Advantage is that it caters to healthy insureds (by covering such things as eye care that regular Medicare doesn't cover); seniors with chronic health problems avoid Medicare Advantage because it tends to be relatively restrictive (relative to regular Medicare) in authorizing treatment. Thus, providers are not only gaming the system by upcoding, but upcoding with relatively healthy patients. Supporters of Medicare Advantage don't bother to mention that it caters to relatively healthy seniors, making it look good by comparison to regular Medicare that must cover the sickest patients.
18
reaylward So is it your contention that healthy people have bad eyesight? Other than that, there is not only no substance behind your statements but the research says exactly the opposite. People with chronic conditions get better treatment on a public Part C health plan. However this has nothing to do with Medicare but is true of all managed health care
2
One of the problems with Medicare Advantage plans is that although they offer comprehensive holistic services, unlike traditional Medicare, they tend to be geographically restrictive, so are unsuitable for snowbirds, and people who travel have to buy travel health insurance supplements. (ObamaCare has a similar defect, you have limited coverage if you leave your immediate neighborhood.)
Another problem is that although they function well in wealthy urban areas that have robust supplier networks (where you have multiple insurers vying for customers), they don't work so well in rural and poor areas where there aren't medical centers of excellence or sufficient providers, and so it is more costly.
If you look at the people who switch from Medicare Advantage to standard Medicare, the people who are dissatisfied are in "insurance districts" that do not have insurer competition. The overwhelming proportion of people who have MA like it.
Traditional Medicare has low deductibles and 20% co-pays. A little known fact is that it has no out of pocket maximum. Most MA plans do have a out-of-pocket maximum, which actually makes it more desirable that traditional Medicare for those who have very costly medical issues.
More than half of new participants sign up for MA, which does make the pool somewhat healthier. But older retirees tend to not want to change their plans, even if they have chronic conditions, and would be better off with a plan that provided holistic care.
Another problem is that although they function well in wealthy urban areas that have robust supplier networks (where you have multiple insurers vying for customers), they don't work so well in rural and poor areas where there aren't medical centers of excellence or sufficient providers, and so it is more costly.
If you look at the people who switch from Medicare Advantage to standard Medicare, the people who are dissatisfied are in "insurance districts" that do not have insurer competition. The overwhelming proportion of people who have MA like it.
Traditional Medicare has low deductibles and 20% co-pays. A little known fact is that it has no out of pocket maximum. Most MA plans do have a out-of-pocket maximum, which actually makes it more desirable that traditional Medicare for those who have very costly medical issues.
More than half of new participants sign up for MA, which does make the pool somewhat healthier. But older retirees tend to not want to change their plans, even if they have chronic conditions, and would be better off with a plan that provided holistic care.
Obamacare "defect" aside, many millions who were priced out of the market either due to un-affordability of premiums or preexisting conditions, now have a shot at least of having some type of coverage..
I do feel bad for the snowbirds though..maybe Michele will contribute some of her $350,000 to their cause.
I do feel bad for the snowbirds though..maybe Michele will contribute some of her $350,000 to their cause.
Of the approximately 55+ million Seniors that were enrolled in the Medicare Program in 2015, only 15.7 million of that figure paid for and participated in Medicare Advantage programs.
For an extra $ 150 - 300 a month (depending on your age and your health care provider) these programs, effectively, cover the 20% that Part A & B don't cover including a certain level of prescription drug coverage.
This means that if you are a Senior with an extra $ 3k - $4k to spend annually, 100% of your health care needs are covered and you rarely have to come out of pocket for anything.
As a son with a elderly mother with ever growing health care issues, the Medicare Advantage program has been a blessing as she now has to be hospitalized about every quarter for recurring illnesses. As one that believes in tax fairness and emphasizes with those Seniors that can not afford this extra cost, it is difficult to understand the rationale of subsidizing health insurance companies that service a small percentage of the population with the ability to pay for something others can't afford.
For an extra $ 150 - 300 a month (depending on your age and your health care provider) these programs, effectively, cover the 20% that Part A & B don't cover including a certain level of prescription drug coverage.
This means that if you are a Senior with an extra $ 3k - $4k to spend annually, 100% of your health care needs are covered and you rarely have to come out of pocket for anything.
As a son with a elderly mother with ever growing health care issues, the Medicare Advantage program has been a blessing as she now has to be hospitalized about every quarter for recurring illnesses. As one that believes in tax fairness and emphasizes with those Seniors that can not afford this extra cost, it is difficult to understand the rationale of subsidizing health insurance companies that service a small percentage of the population with the ability to pay for something others can't afford.
5
Jim. It is true that some public Part C Medicare health plans cost from $150 to $300 a month, the average price is well under $100 and many plans are available at no cost (of course, plans with no cost have high co-pays). In addition, seniors of low income can get public Part C plans that cost up to $80 a month at half price or better through a program called Social Security Extra Help even if they feel the zero-premium plans are not right for them.
(You also need to be aware that what the author of this article says in this article about insurers being "subsidized" is totally false. As is almost everything else the author says about the public Part C health plan program. starting with the claim that it is private.)
(You also need to be aware that what the author of this article says in this article about insurers being "subsidized" is totally false. As is almost everything else the author says about the public Part C health plan program. starting with the claim that it is private.)
3
Medicare Advantage plans have another , never discussed, problem. The best plans are offered in areas where the insurance company will make the most money because there is a greater population. Rural areas, such as mine, are offered plans, if offered at all, that have higher premiums and greater co-pays than the same plans offered to metropolitan areas. HealthNet, for example, may offer a 0 premium plan for someone in Pima County while the adjoining Santa Cruz County is offered a plan costing many dollars in premiums,higher co-payments, and a higher out-of-pocket limit. Many times the same plan is not offered at all in rural areas. The plan I had last year, United Health Gold Benefits, which was the best plan I could buy on my income, was discontinued in Santa Cruz County this year.
Not only do people in rural areas have to pay more for coverage and deductibles, they have to drive greater distances for health care than those living in metropolitan areas. In fact, many times, a rural patient will go to the same provider/hospital as those in the adjoining county, but pay more for the service, not to mention the expense of getting there. There is higher rate of poverty in the rural areas, also, so this population finds it a strain on their finances just because they live in an area not favorable to the profits of the insurance companies.
It is time for Human Health and Services and the government itself to address these inequities!
Not only do people in rural areas have to pay more for coverage and deductibles, they have to drive greater distances for health care than those living in metropolitan areas. In fact, many times, a rural patient will go to the same provider/hospital as those in the adjoining county, but pay more for the service, not to mention the expense of getting there. There is higher rate of poverty in the rural areas, also, so this population finds it a strain on their finances just because they live in an area not favorable to the profits of the insurance companies.
It is time for Human Health and Services and the government itself to address these inequities!
25
This problem was addressed in 2003 by the Medicare Modernization Act. Among other things that 2003 law gave insurers extra money to provide people in rural areas public Part C Medicare plans similar in value to the ones that we seniors in cities and suburbs can get (this was called the PFFS program). When control of the House of Representatives changes hands in 2007, the new Congress passed laws in 2008 and 2010 that took away those extra funds for seniors in rural areas. (Of course nothing in the Medicare law can change the fact that you live far away from most doctors and medical centers. But the 2003 Congress tried to help you out.)
14
I will have to check your facts Dennis - The democrats controlled the house and senate in 2008 and 2010 - I am sure they would never do anything to hurt medicare patients - they are all about helping the elderly.
5
If you believe that democrats are about helping the elderly or anybody but themselves, I have a bridge that I will sell at a great price. Everybody should carefully examine what politicians from both parties say and do about issues that you are concerned about.
6
It is nonsense for this senior-citizen-hating author to say competition is not involved in the public Part C health plan program. Why does the Times consistently give this platform to this author to spread such ignorant statements. The author even compares Part C with Part D and Obamacare insurance, somehow ignoring the fact that the way both the newer programs works from a competitive bidding point of view is the same as the almost 20 year old Part C program (with 20 years of demonstration projects before that).
But the real way public Part C Medicare insurance is competitive is in the sense that it is all about competition between it and private Medigap insurance, which almost always costs seniors two or three times as much for often worse insurance coverage.
(On the other hand, it is interesting to see the author inadvertently indicate how cost effective the Part C program is: the author notes in the second paragraph that the public Part C program “accounts for about a quarter of Medicare’s budget and a third of its enrollees.” Think about that.)
But the real way public Part C Medicare insurance is competitive is in the sense that it is all about competition between it and private Medigap insurance, which almost always costs seniors two or three times as much for often worse insurance coverage.
(On the other hand, it is interesting to see the author inadvertently indicate how cost effective the Part C program is: the author notes in the second paragraph that the public Part C program “accounts for about a quarter of Medicare’s budget and a third of its enrollees.” Think about that.)
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I should have noted in my initial comment that it is the author that claims that the public Part C program “accounts for about a quarter of Medicare’s budget and a third of its enrollees.” I am not sure that is accurate although it is directionally true. The most relevant data appears early in each year's Annual Report of the Medicare Trustees (usually the first table) where you can calculate that people on Parts A/B/C have consistently cost the same or less per person over the history of the Pat C program since 1997 than people on A/B/other per person
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The author is a health economist with a significant amount of expertise and history in the area. It is certainly not true that the author "hates senior citizens," that seems like an absurd overreach and not at all supported by this article.
Do you think he just googled "how much does Medicare Advantage cost?"
To get to your two main points (as far as I can tell): The Kaiser Family Foundation provides some of the most reliable and easiest to understand fact sheets on health policy and cost issues.
http://kff.org/medicare/fact-sheet/medicare-advantage/
- 31% of Medicare beneficiaries were enrolled in Medicare Advantage plans in 2015.
- The fact sheet explains how the bidding process works. Plans do not bid against each other. That's what competitive bidding would do.
- When MA plans are taking in more than 100% of the benchmark, it follows that they would account for a greater share of spending per-capita than traditional, fee-for-service Medicare. Hopefully, that disparity in spending will be reduced. Of course this must happen without a reduction in the quality of care. The star-rating system appears to be working for MA, and beneficiaries are seeking out highly-rated plans, and plans are incentivized to provide the things they want.
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Do you think he just googled "how much does Medicare Advantage cost?"
To get to your two main points (as far as I can tell): The Kaiser Family Foundation provides some of the most reliable and easiest to understand fact sheets on health policy and cost issues.
http://kff.org/medicare/fact-sheet/medicare-advantage/
- 31% of Medicare beneficiaries were enrolled in Medicare Advantage plans in 2015.
- The fact sheet explains how the bidding process works. Plans do not bid against each other. That's what competitive bidding would do.
- When MA plans are taking in more than 100% of the benchmark, it follows that they would account for a greater share of spending per-capita than traditional, fee-for-service Medicare. Hopefully, that disparity in spending will be reduced. Of course this must happen without a reduction in the quality of care. The star-rating system appears to be working for MA, and beneficiaries are seeking out highly-rated plans, and plans are incentivized to provide the things they want.
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Lisa, apparently I was not clear. I said the real competition is between public Part C health plans and private Medigap insurance and the competition is there and it is working to provide seniors great value. it is true that the author said Medicare Advantage needs a different competitive bidding scheme in the article (and I agree but strangely the author in other articles opposes the only proposal that would do that; the Wyden-Ryan reform proposal of 2011.) But the author's headline says something different that is false and and hateful to seniors because the author wants to force all seniors into private Medigap insurance and that is why his or her opinions (there is one like this about once a month) are so ignorant. There is never any acknowledgement of how Medicare works with Medigap (or group retiree insurance for that matter).
Separately you do not seem to understand the framework/bidding process given your conclusion that there is a relationship between it and per-capita costs. For what Part C costs per person compared to those not on Part C, the definitive source is the Medicare Trustees report. The necessary data to do the calculation is usually in the first table presented. For all but a few years, Part C has cost the same or less than the alternative per capita. The only year when it did not were the years that the Congress tried to help rural seniors--see another comment on this article.
Separately you do not seem to understand the framework/bidding process given your conclusion that there is a relationship between it and per-capita costs. For what Part C costs per person compared to those not on Part C, the definitive source is the Medicare Trustees report. The necessary data to do the calculation is usually in the first table presented. For all but a few years, Part C has cost the same or less than the alternative per capita. The only year when it did not were the years that the Congress tried to help rural seniors--see another comment on this article.
This article nibbles around the edge of our lousy nonsystem for disease care.
Essential disease care, as many people have noted, is not a "free" market.
Thus, this careful calculation using "market forces" to reduce costs is irrelevant.
For essential disease care, we require a basic universal system with cost controls.
People who have few resources will be able to obtain these essential services. Those with extra resources and the desire for services not provided could arrange those in addition.
That seems to work OK in many other "advanced" nations.
Essential disease care, as many people have noted, is not a "free" market.
Thus, this careful calculation using "market forces" to reduce costs is irrelevant.
For essential disease care, we require a basic universal system with cost controls.
People who have few resources will be able to obtain these essential services. Those with extra resources and the desire for services not provided could arrange those in addition.
That seems to work OK in many other "advanced" nations.
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What are you talking about? Poor Medicare beneficiaries get supplemental support from Medicaid. So there is universal care for the over 65 population.
The medicaid waiting lists, in states whose Republican legislatures have rejected the federally funded Medicaid expansion monies, are months if not years long. The poor over- 65 medicare person waits for care with everyone else in those unfortunate states.
How often do traditional Medicare providers up-code or bill for services not rendered or bill for services not recommended or needed. It spends 75% of the money on 67% of the population.
The reason I ask this question is because on three occasions my mother's explanation of benefits report from Medicare indicated Medicare had been billed for services not rendered (three unaffiliated providers). When she notified Medicare, they said, "We've already paid that bill," and took no action to recover the overpayments.
The contractors who process the bills for Medicare have no interest in verifying the bills are legitimate. They get paid 2% to pay the bill. If they go to the trouble to reclaim a $500 overpayment, they do not get additional compensation and in fact have to give back the $10 they were paid for processing the bill. You could not establish a worse set of incentives if you tried.