**HEALTH CARE: An Important Medicare Primer for DUers. PLEASE READ! **

[mrreowwr_kittty]

Sapphire Blue asked me to create a thread about the topic of Medicare, based on a sub-thread discussion we had about it here:

http://www.democraticunderground.com/discuss/duboard.php?az=show_topic&forum=389&topic_id=535607#541674

It seems that many people, DUers included, have the impression that extending Medicare to all citizens will provide full health care coverage and will eliminate the need for insurance. This reflects a misunderstanding of how Medicare works and what it does and doesn't cover. The information in this post is not meant to be all-inclusive, nor do I consider myself to be an expert on Medicare or health care. Please feel free to correct me if I'm wrong on any details or add any clarification of your own. I just think it's very important to get the message out that this is not the panacea to the lack of health care in this country. I don't claim to know what the solution to our national health care crisis is, nor do I know how proposed Medicare extension plan will differ from, or be similar to, the current program for seniors. But here is what you need to know about Medicare now.

The Basics:

Medicare is available to persons age 65 or older who worked, or had a spouse who worked, at least 10 years under a Medicare covered employer. It is also available to people under 65 who are eligible for disability Social Security or who have end stage renal disease.

There are 3 parts to Medicare:

Part A is hospital coverage, which costs nothing to enroll in for the participant. However, anytime you are admitted into the hospital there is an automatic benefit period deductible of $992. After 30 days, that deductible goes up to $248 per day. After 90 days, it's $496 per day. That's YOUR out of pocket deductible.

Part B is doctor coverage (medical bills, outpatient services, surgery, etc.). Part B is not free. It costs $93.50 per month. That is your Part B premium and it is usually deducted directly out of the Social Security check. In addition, there is an annual deductible of $131. After that, Medicare pays for 80% of approved medical charges. So, a $50,000 knee replacement can run you $10k in out of pocket. And note the approved part - if Medicare doesn't approve it, it's not covered.

Part D is the new drug plan. It covers approved generic, and some non-generic if no substitute is available, medications after you shell out $265. Then it covers 75% of charges up to $2400. From $2400 to $5451.25, it's back on you. This is known as the "donut hole". After that, you are into catastophic area and Medicare picks up 95%. So it's $3850 out of your own pocket before there is full drug coverage from Medicare.

As you can see, this is a lot of out of pocket costs for Medicare recipients!

FAQs

So how do senior citizens afford those out of pocket costs? Answer: Insurance! They can choose between various supplement plans - those A though Js that you hear about or they can use a Medicare Advantage plan. Advantage plans are the HMOs, PPOs, and Private Fee for Services (PFFS). A supplement works by having the participant pay a set monthly premium (a typical Plan F for a new enrollee runs about $150 nationally) in exchange for having all or most of their out of pocket costs covered. Note that this is a separate premium - over and above the $93.50 that Medicare deducts from Social Security. With the HMO type plans, instead of the $93 going to Medicare, it goes to the private insurer. Some plans charge no extra premium and some charge a small one for expanded features. You will have various types of co-pays with these plans. There are pros and cons to supplements and Advantage plans but it should be clear that they are insurance and they are NOT without some cost to the participant.

How do things like pre-existing conditions factor in? Answer: If you are in your enrollment period, which for most people is 3 months prior to and 3 months post your 65th birthday, insurance companies cannot look at them. Any plan you apply for has to accept you at their stated rate, with few exceptions. But if you wait to long to enroll, or try to switch plans later, then they can be considered and you can be charged a much higher premium or denied coverage.

What about seniors living in poverty? Answer: Seniors who are below a certain income level become eligible for Medicaid. That income varies from state to state. So if you cannot afford the out of pockets, the state takes over your care. However, you often have to be pretty destitute before you can qualify for those programs.

What about convalescent and nursing care? Answer: Medicare does NOT cover the vast majority of post-hospital care. It will cover what is known as Skilled Nursing care, but there are strict parameters over what they will approve. Suffice to say that 95% of nursing home, recovery, covalescent, and long-term home and facility care will NOT be covered by Medicare. And since those supplements and HMOs work directly with Medicare, they don't cover it either. You will have to purchase - guess what? - additional private insurance if you want to be covered for that. If you don't, the government will take over your care, after you've exhausted your assets.

For more information about Medicare: www.medicare.gov wikipedia

I hope this is helpful to people and again, I'm not saying yea or nay to extending it to all citizens. I do think that people should be armed with knowledge. Please read this, comment on it, and pass it on. Thanks! :hi:

[Viva_La_Revolution]

1. Medicaid for everyone!

:)

What health services are covered by Medicaid?
In general, the following services are paid for by Medicaid, but some may not be covered for you because of your age, financial circumstances, family situation, transfer of resource requirements, or living arrangements. Some services have small co-payments. These services may be provided using your Medicaid card or through your managed care plan if you are enrolled in managed care. You will not have a co-pay if you are in a managed care plan.

smoking cessation agents
treatment and preventive health and dental care (doctors and dentists)
hospital inpatient and outpatient services
laboratory and X-ray services
care in a nursing home
care through home health agencies and personal care
treatment in psychiatric hospitals (for persons under 21 or those 65 and older), mental health facilities, and facilities for the mentally retarded or the developmentally disabled
family planning services
early periodic screening, diagnosis, and treatment for children under 21 years of age under the Child/Teen Health Program
medicine, supplies, medical equipment, and appliances (wheelchairs, etc.)
clinic services
transportation to medical appointments, including public transportation and car mileage
emergency ambulance transportation to a hospital
prenatal care
some insurance and Medicare premiums
other health services

http://www.health.state.ny.us/health_care/medicaid/

[mrreowwr_kittty]

2. Is anyone proposing that? It would be more comprehensive than Medicare. n/t

[Viva_La_Revolution]

5. just me

as far as I know. :(

[Dr.Phool]

6. H.R,676 Conyers-Kucinich, with over 60 co sponsors

It would eliminate copays and deductibles, and expand medicare to all. Single-payer, universal, govt. financed, privately administered healthcare for all.

It would be financed by a 3.5% payroll tax on employers and employees.

Check out the details at:

www.healthcare-now.org

[lonestarnot]

21. Yes that would be the one!

[mrreowwr_kittty]

40. I apologize. I should have been clearer in my post.

My post was directed more at Ted Kennedy's proposal. He wants to phase in Medicare to all Americans, starting with ages 55 to 64. From what I understand, it's the same Medicare that people over 65 get. A lot of people are under the misaprehension that it covers all your medical expenses. The Conyers bill is a complete overhaul of Medicare with a single-payer system replacing it.

[Sgent]

31. That depends on the state

in mine your limited to 12 doctor visits a year (fine for someone healthy, but an 80 yo diabetic with heart disease not so much), 5 scripts a month, and no mental health services unless your in a nursing home or hospital.

[mentalsolstice]

51. Medicaid is state controlled...

...to a large extent. If you live in a generous state, good for you. If not, too bad.

[Sapere aude]

3. As a controller of a medical clinic, I find that what people don't understand is that

Medicare does not pay enough for a clinic to cover expenses. Also most insurance reimbursements are tied to Medicare. For instance, an insurance company may pay 110% of the Medicare reimbursement amount. Some pay less than Medicare.

The main problem that I see here is that the doctors and medical suppliers are used to a certain standard of income or living. When Medicare or insurance companies decide to reduce what they will pay, the providers do not reduce what they earn. The gap gets wider and wider. At some point in time providers will have to be employees and will have to take what the clinics can pay. I don't see that coming anytime soon.


If there is ever a single payer system the providers will have to make much less than they do now. I don't know how that will ever work out. Maybe many DUers would like to be a doctor and make less than docs do now if someone would pay for their education. That is the only way I see it happening.

[pinto]

8. I favor a review of Medicare reimbursement rates, for sure.

They've been flat or decreasing for a while, iirc.

(disclaimer) I'm in favor of universal Medicare, cut out insurance companies all together, fund from employer/employee tax base, establish equitable reimbursement rates.

[salin]

9. A doctor relative hated medicare - and was scared to death

by the anti-health care reform in the early Clinton years that it flipped a dem (but only by family tradition, not really based on political awareness) to a repub. This continued for years - in part due to the lower reimbursement rate.

Then - a) the major employer started closing down plants and the rate of uninsured soared from a small amount of patients to nearly 50% of patients - and then the major insurer in the area started down negotiating contracts to not a whole lot higher than medicare reimbursements.

I have witnessed an amazing transformation after these shifts in dynamics. He does have a concern on one end that some folks with insurance have an entitlement attitude to unneeded and excessively expensive procedures (elective) because their insurance should cover it with NO controls on this end of spending that drives costs up - BUT this doc finally also recognizes that all the conservo rhetoric doesn't really deal with folks living on low incomes that an "private accounts" system would simply swell the percentage of no insurance and thus the amount of costs they would have to swallow (and contrary to your post - his practice has been forced to realize there is a downgrading in pay due to reimbursement rates - which was mitigated by partners moving to a pay for service rather than 'evenly split all profits' model -so that those who put more time in with patients... get more income.

Within the last year this relative told me that he thinks major changes are needed and that while it would probably make me faint (his warning) that he thought the only entity with enough strength to hold down costs while providing real coverage was... the federal government. You could have knocked me over with a feather.

Long way of saying that for those practices (clinics or health organizaitons) that find themselves suddenly serving a much higher percentage of uninsured and only dealing with a couple of insurers to negotiate payment rates (esp if one of those insurers has a majority of the local market) - that the recognition of lower salaries will become a reality and realization and the fear of not being able to afford to practice at all (and not due to the bogeyman of malpractice suits) that suddenly the whole idea of universal or single payer systems suddenly become tenable. Why? Because the lower reembursement rates suddenly are a lot more attractive than 50% of uninsured patient loads where much of those costs have to be absorbed internally.

[Lydia Leftcoast]

30. What if medical school loans and malpractice insurance were eliminated?

If Cuba can train doctors, why can't our government?

Oh, wait, our government is spending $250,000,000 PER DAY in Iraq.

:shrug:

[TexasBushwhacker]

4. I found out the hard way ....

while caring for my mom when she was dying of breast cancer. Once she was designated terminal, she HAD to have 24 hour care. Medicare didn't pay for that, and the hospice wouldn't take her until her death was imminent, but I could have been arrested for neglect if I didn't have someone with her 24/7. Most of the time it was me. Some of the time it was a nurse assistant that I paid for. One of my brothers would come over once a week or so. But the only thing that Medicare paid for was nurse visits 2 to 3 times a week and a nurse assistant who came twice a week to help bathe her. Fortunately I was able to move in with my mom and what I would have paid in rent and utilities went to pay for the nurse assistant until I was able to go on leave from my job.

[salin]

10. a big hurdle will be a shift in costs.

And this will be a huge hurdle to cross. Folks will have to be willing to pay more in taxes. Period. It is a trade off - pay more in taxes but suddenly have very low /little medical costs. For young folks with no families this will seem like a huge burden as their annual health costs may be very low. But for the years when medical expenses kick in - the earlier payments pay off. It is a shift in thinking that I think we, as a society, haven't been prepared for. Especially in the current regime where a 'free lunch' attitude prevails (ala ... sure we can spend huge $$ on a war and other things -but they keep cutting our taxes... we just don't have to pay for what we spend!)

Much of my family lives in Norway. Very high taxes but next to no costs for education (including higher ed) and for medical services - and in the end the cost of living is very similar - with a little more social mobility (ability to move to different social economic stratus across generations) than we have here. But the mindset is very different. A lot of work needs to be done here to talk about that trade off (pay more in taxes but receive far more in services) before we could get a really overhauled system.

[Mind_your_head]

7. Yikes! This makes me think of some questions in regard to myself

I never realized/knew this part before

Medicare is available to persons age 65 or older who worked, or had a spouse who worked, at least 10 years under a Medicare covered employer.

I'm divorced. However, my former spouse worked for a Medicare covered employer for the full time we were married. From wedding day to official divorce decree day was a few days over 11 years. I'm thinking that in my personal work life, I may have a total of only 7-9 years under a 'Medicare covered employer' (meaning full-time, big, reputable company). Many of my working years were as 'self-employed, part-time jobs b/c of the kids, etc.

Question 1) What/who is a "Medicare covered employer"?

Question 2) Would I be covered under my ex-husband re: the ten years?

and

Question 3) If the answers are unsatisfactory for me to Q's 1 & 2, will I be able to sleep tonight?

Thanks very much in advance for any answers/explanation and a BIG THANK YOU theCatburgler for bringing this up and creating this post! (and to Sapphire Blue too for the prompt to do so). :-)

edit: typo

[Mind_your_head]

15. Does anyone have any comment on my questions?

At the VERY least, 'what/who is a Medicare covered employer'?

If I'm gonna be "shit-outta-luck" at 65, at least I'd like to know NOW.

[Sgent]

32. A medicare covered employer

is any employer that pays "above board". If you got a W-2 or 1099, they will be considered a medicare covered employer -- as either they and/or you will have paid FICA.

[truedelphi]

52. I think (and please realize these thoughts may be wrong)

But your ex-spouse's Social security can only be distributed to you (as though you were still his partner) if you were married for a full seventeen years.

It could be that MediCare is the same deal - if you were together that long then his benefits apply. If not, then your work history is what will give you or not give you MediCare.

[Sapphire Blue]

11. K&R & a big THANK YOU for posting this information, thecatburgler!

:kick: People really need to understand how Medicare coverage works, what it does & doesn't cover, both medically and financially.

Implementing a Medicare-only system, w/o supplemental insurance, might easily be a death sentence for a lot of people, as they simply could not afford that 20%-plus not covered by Medicare.

And Part D? Imagine foisting that on all Americans!!!

[hashibabba]

12. Thank you thecatburglar and Sapphire Blue, too.

I am on Medicare, but I can't afford to go to the doctor. Too many deductibles, copays and things they don't cover.

On the other hand, Medicare Part B is paid for by my state.

Medicare Part D, because I qualify for extra help is good for those in my situation. They pay $5 for a medication unless its a generic in which case it costs me $2. My $438 worth of medications only costs me $16 a month. There is no donut hole for those who have the extra help, thank goodness.

As far as Medicaid goes, even though I live barely above the poverty level, I'd have to have nearly $3,000 a month in monthly medical expenses to qualify. It's been several years since I've checked, it could be higher by now.

Thanks for bringing this subject up. When I hear people say Medicare for everyone, it just means health care for the rich.

[bridgit]

13. k&r'd, the 'law of the jungle' is not sufficient in an enlightened (assuming) republic...

no less than some form of essential, or primary care needs be taken up imo

[Czolgosz]

14. K & R #5

[Cleita]

16. I think there is a misunderstanding that extending Medicare

to all would be like the Medicare seniors get right now. The reason for using Medicare as a model is because it's a system that already has the bureaucracy in place to administer it and it has been administered efficiently all these years since it was signed into law in spite of the changes and squeezing of benefits by subsequent administrations. Those of us who would want to see Medicare extended to all would want full coverage like in Canada. In this respect it's not like the present day watered down system. It would be a fully funded system that extends complete coverage to everyone. Fees would be negotiated on a yearly basis with health care professionals making sure that everyone involved is satisfied with the system.

[Sapphire Blue]

24. Well, it seems to me that calling it 'Medicare for all' is creating the misunderstanding!

If Medicare was the only health care coverage I had, I'd have to make my next appointment @ the crematorium, as I'm one of the many who could not afford the 20%-plus that medicare doesn't cover. Until this country implements socialized medicine, you'll have to tear my retiree insurance out of my cold, dead hands (edited to add: and you'd better believe I'd come back to haunt anyone who even tries to tear anything out of my cold, dead hands).

[Cleita]

25. I'm on Medicare myself with a supplement and it's getting

more expensive every year with what seems less coverage. I have a friend who is on the Medicare/Medicaid program and she is having a hard time finding doctors who will accept her coverage. So far it hasn't happened to me with my supplement but if Congress doesn't update Medicare's fee schedule there will be many of us unable to get health care even with coverage if the health care providers won't accept it. The thing that makes me mad is that this is so unecessary because of what amounts to corporate welfare that we extend to the insurance industry for their profits at our expense.

[Sapphire Blue]

29. Yes, it is getting more expensive, but it's more affordable than the 20%-plus that Medicare...

... doesn't cover.

There are physicians right now who are turning away Medicare patients because of the low reimbursement rates; those that continue to serve Medicare patients do so at a loss. You're damn right that Congress needs to update Medicare's fee schedules!

[Sweet Freedom]

50. It's going to get worse

This year (this summer, I think), Medicare will require competitive bidding, which will mean the end of many mom-and-pop type businesses that won't be able to compete. It will also mean the end of many companies that provide products to these businesses.

My mom has a business that accepts Medicare and reimbursement is getting so bad, she's examining whether or not she can continue to afford to accept Medicare.

[Cleita]

54. Yes, this is increasingly becoming a problem. We

need to get Speaker Pelosi to give priority to improving Medicare reimursement before a lot of seniors get thrown under the wheels of the GOP bus. It happened once before when Reagan was President (surprise, surprise :eyes:) when it was hard for a senior citizen to find someone who would accept Medicare. Congress went to work and updated the fee schedules but I don't believe it's been done since, so it needs to be done again.

[mrreowwr_kittty]

38. Understood

My post was directed at the plan that Ted Kennedy is proposing. He wants to extend the current Medicare to 55-64 year olds and then phase in other age groups. From what I understand, this is pretty much the same Medicare in its current form and apparently a lot of people are under the impression that it's full coverage when it's not.

[Cleita]

58. Even doing this is better than nothing. It's a start.

At least everyone who qualifies would be covered. They may have to get a supplemental insurance but that would cost less hopefully than their health plans cost today making it more affordable for employers. I personally don't want to delay getting the insurance companies out of the health business, but maybe this would be a start and people who have no coverage today would have some at least.

[truedelphi]

53. You worded that nicely. I think when the media or some

Spokesperson is using the phrase "MediCare for All" they mean that it will be single payer in the manner that MediCare is.

One great thing about MediCare is that the Administration costs (in terms of the government shuffling the paperwork) are far less than what those same costs are when handled by private insurance companies. That is probably because under MediCare you don't have hundreds of separate companies all paying out hundreds of top level executives.

But the fact taht under MediCare many services a physician provides are not given full cost credit for - that needs to change.

[Cleita]

55. Also, the government run program doesn't spend extra dollars

on promotion and advertising like the private companies do. The money goes directly to health care with only about 2% to 3% used for administration whereas private insureres use anywhere from 8% to 15% for administration. They also have to show a profit, which also eats into the premium money collected. The government doesn't have to.

[Jcrowley]

17. Thank you people

K&R

This will be passed along tomorrow. Verbally.

[nam78_two]

18. Great post and great info. Thanks for sharing. K&R

Bookmarked since I have a cold and it hurts to reda...

[Sydnie]

19. Thanks for the info n/t

[warren pease]

20. Great information. Thanks

I'm one of the delusional who thought Medicare for all was the answer. And it still could be. Would the costs you're describing and the impediments the Medicare system places in your way be all -- or mostly -- taken care of if Medicare was funded as well as, say, the pentagon?

This incessant chipping away at your bank account by imposing a copay here, a deductible there reminds me of how the Thatcher Tories dealt with the NHS in their privatization mania. They simply kept underfunding it until NHS services got so lousy and the waits got so long that people started really bitching about it. And behold, Thatcher had the solution: Just dump this archaic notion about health care for all and we'll ration by bank account instead of by service availability. Fortunately, the NHS survived, although I'm told it's still reeling from the Thatcher budgetary slashing and is still one of the lousiest single-payer systems around.

So instead of living with the limitations now imposed by Medicare, how about using it as the basis for single-payer, then demanding that it be fully funded. Of course, we've all seen how effective demands made to our employees in congress tend to be, but this is the hot-button issue for a good majority of potential voters and the candidates will have to deal with it. So far, all but Kucinich advocate some kind of system that still includes private insurance, with all the potential for abuse we currently enjoy. A nice side effect of a fully funded Medicare for all system would be the elimination of these parasites from the health care field.

So does that seem like it might work? If not, we'll have to try something else. Anything but the current impoverishing system.

wp

[goclark]

22. This is excellent and so important for Seniors(that includes me)

K and R

[goclark]

23. What happens if you have BC/B/S and Medicare

Is the deductible as high or what -- I'll reach the magic age in the summer.

[Cleita]

26. I know we all hate AARP. but their supplemental insurance is

the best IMHO. I haven't had any problems. It costs me $212 a month, but it picks up everything Medicare doesn't pay for.

[Mind_your_head]

27. Good luck on getting an answer......

Nobody's gonna 'pay' for you. Got it? Nevermind that that money has been paid (stolen) for YEARS without the HONEST intention of it ever being 'given back'. "They" earned interst on it/got to use it/exploit it for ALL THOSE YEARS. You ain't EVER gonna see it again, capish?

You (and MOST of us) have been owned! (sorry, don't know how to spell it in gamer-speak....I really CAN spell, dammit! And I'm tired of being 'owned' by "punks"!!!)

[Princess Turandot]

28. Do you mean that you will continue working after your turn 65..

and have BC/BS through an employer? When that happens, Blue Cross usually remains your primary insurance and Medicare becomes the secondary.

[Sapphire Blue]

34. I have Medicare & a retiree plan, pay monthly premiums on both...

... and nothing more, except for prescription copays. All other costs are covered in full... no doctor's copays anymore. My plan is an HMO type.

I thought I'd be able to do w/o the retiree coverage & have Medicare only, but, as I've said elsewhere in this thread, as expensive as they are, the monthly premiums are more affordable than the 20%-plus non-covered Medicare costs.

[Cleita]

56. Beware of the HMO type plan.

There are certain diseases they don't cover like renal failure as my husband and I found out the hard way, and they say they pay for emergency care if you are on vacation away from home, but there are so many strings attached to it that a person could die before getting medical care as also happened to my husband. We found out that Medicare with a tradional supplemental insurance was the best way to go even though it cost more a month than the HMO.

[Sapphire Blue]

63. I'm fortunate to have an excellent HMO plan.

It's the same coverage that I had before retirement. Prior to HMO, I had the standard 80%/20% coverage, was wary of joining a HMO plan because of the many negative things I had heard. After the first year, and ever since, I'm glad that I changed... no way would I go back!

As far as diseases covered, again, my plan is excellent & covers my various medical conditions, also hospice care @ 100%.

[WillYourVoteBCounted]

43. my Moms BCBS pays what Medicare doesn't

Not all policies are the same, Mom's policy is old, and it hasn't been
watered down.

It pays whatever medicare doesn't pay to the hospital or doctors,
and for testing.

We never get hit with a deductable or out of pocket.

It doesn't cover prescriptions (except if she is in the hospital)

We have other coverage for that.

[mntleo2]

33. And The Whole Thing Is So Confusing!

...I believe they made it that way so seniors and others will make mistakes that will cost THEM and not the companies they are being forced into for "insurance."

I really do believe insurance companies expect us to pay them their huge fees so they can hire expensive lawyers to figure out every way under the sun how NOT to inure you.

It is all we have right now but face it, the whole thing is a scam to put more money in greadheads like Bill Frist's outstretched hand saying, "Gimme, gimmee, gimmee, it's all MINE! Your house? It's MINE! Your children's inheritance? It's MINE! Your life's savings? It's MINE! Now give it to me, all of it so I can hoard it so nobody else can have it!"

As MIke Malloy says, "Have I told you today how much I hate these people????"

My 2 cents

Cat In Seattle

[calimary]

35. Definitely a thread worth bookmarking.

Kicked and recommended, too.

Thanks for posting this!

[EFerrari]

36. K&R

[vanlassie]

37. Correction

The OP stated: "So, a $50,000 knee replacement can run you $10k in out of pocket."

This is not correct. If you are over 65 and you get a knee replacement, you will be an inpatient for a couple days at most, and for your entire hospital stay, you will have a Part A coinsurance of $992.00 Nothing near 10K!!!! Your surgeon's bill of 5k will be reduced by Medicare down to, say $1200.00 and you will owe 20%. That's it.



vanlassie.

[mrreowwr_kittty]

39. I'm talking Part B here, not Part A

Part A covers the hospital charges only. Part B is your doctor's charges. That's surgery, lab work, doctor's visits, etc. If you have a $50k doctor bill for a knee surgery, you are responsible for 20%.

[bleedingheart]

60. no you have it wrong

You are responsible for the 20% of the approved amount.

I worked in the medical billing industry...I provided the information in my post below.

[mrreowwr_kittty]

64. Hey, I'm not disputing that

But if the approved amount is 50K, you (or your insurer if that's the case) are responsible for 20%. I worked in the insurance industy and I've seen the claims. The surgery itself may not run that much, but when you add in all the other medical expenses such as anesthesia, lab work, and specialists, the overall bill can be exhorbitant.

[bleedingheart]

66. the key is to ask for an itemized bill....

if you get an itemization it will make a big difference.

Many folks get huge discounts just because no one wants them to see the overcharges on medication and other incidentals.

For example you may see a charge for Tylenol that is $15.75...that can be argued quite effectively.

I have known people to get the amount owed cut by as much as 40% just by doing that...
granted it is a giant pain in the ass but it can help.

[Nutmegger]

41. We desperately need to rid ourselves of the blood sucking in$urance corps.

If Medicare can't be extended to everyone, the whole system needs to be retooled.

Thanks for this post. It does clear up some misconceptions on my part.

[WillYourVoteBCounted]

42. Medicare Part D information for folks who need lots of meds

thanks for pointing that out.

Here are my mother's monthly medicare costs:

Medicare Part A free
Medicare Part B $93.50
Medigap Insurance $200.00
Medicare Part D $70.00
CoPay for Meds $125.00

Total Monthly cost $488.50

My mother is on medicare, and we have a suppliment or
Medigap (obvious name/purpose) that costs $200 a month.

Then there's her medicare part D.
My mom takes lots of meds, so we get Humana's premium type of
Medicare part D, which DOES NOT HAVE A DONUT HOLE OR A DEDUCTABLE.

Anyone who regularly spends $100 a month or more will benefit from one
of the higher end medicare part D plans. Humana's was the best for my
Mom. (I don't work for Humana or any ins co).

It costs about $70 a month, then her meds with co pay $5.00 for most, $30
each for the really expensive meds (like the $200 a mo kind).

We end up spending $75 for Medicare D and $125 co pay for meds each month.

[mrreowwr_kittty]

44. Humana is one ot the best drug plans

Thanks for bringing that up. One saving grace of these drug plans is that you can get a stand alone plan without enrolling in the full HMO. That's good for people who want to stay in their supplements and still get the drug coverage.

[ClayZ]

45. K and R

[Solly Mack]

46. Excellent!

K&R

Thank you for putting this together!!!

[papau]

47. We do not have even one of the big 3 w/ a single payer "Medicare for all" proposal so

what are we talking about?

Until we get them to stop kissing insurance company ass and jumping up and endorsing employment based health care delivery, despite AFL-CIO endorsing Medicare for all, discussions like this one are counter-productive.

As to get bells and whistles (better co-pay, better M.D. reimbursement, one purchaser "wholesale" pricing of drugs and equipment and room rates, and anything else that anyone wants to improve), that can all be done AFTER we get over the mountain of just getting a single payer universal proposal out of any of the big three - currently only DK, bless him, has one on the table - and DK's single digit polling has not put much weight behind any of his ideas in terms of national press and Democratic Party acceptance.

WE START THE WALK OVER THE MOUNTAIN BY GETTING JUST ONE OF THE BIG 3 TO ENDORSE SINGLE PAYER UNIVERSAL HEALTH.

As an aside, the Medicare supplemental is indeed a "necessary" if you can afford it - and current pricing is not $150 per person as mentioned above in this thread, but is instead $180 per month, $360 per couple, in Urban areas, this year.

[truedelphi]

57. U folks who want me to quit raggin' on Hillary - well, get her

To understand and follow up on what papau is talking about and I would be much more willing to vote for her.

[trof]

48. You explain in a few short paragraphs what the Medicare Handbook

takes 140 pages to say. And you do it better.
Very good.

I'm not bragging, but I think I'm a pretty smart guy.
Wading through and trying to compare and understand the pros and cons of various medigap plans is one of the most daunting and confusing tasks I've ever been faced with.

At one point I felt like just flipping a coin to get it over with.
BTW, I went with an AARP plan. They were very helpful.

[Karenina]

49. K&R!!!

[bleedingheart]

59. Let me clear something up about the 80% issue - You have something a bit wrong in that information..

I worked in the medical billing industry..


Let us say that an operation costs $50,000

If the Medicare Approved amount is $25,000

Then Medicare pays...80% of the $25,000...which is $20,000

You are ONLY responsible for the $5000 that is left after 80% of the approved amount is paid.

It is AGAINST THE LAW to bill the patient for the remaining 25,000 that was not approved.

So the Insurance covers the 20% of Approved amount.

Additional information...

Depending upon what section of the country you live in...the Approved Amounts Vary...

So...in California...the Approved amount may be $35,000....but in Arkansas it might be $15,000

and no...I am not joking.

[bleedingheart]

61. I also want to state that approved charges are what medicare finds

acceptable payment for a service.

It doesn't mean they approve the bill...it means they will pay what they find appropriate for the service rendered and there are big lists of what they will pay for procedures as well as equipment...

As a result...the medical providers ALWAYS CHARGE MORE than the approved amount hoping that they can get Medicare to push the "approved" value higher...

It is a game they play...and there are medical lobbyists that are always looking to get more money.

If you want more information about this process let me know.

[mrreowwr_kittty]

65. Mea culpa. I should have clarified that issue better in my post.

Or perhaps even left it out entirely since it may cause confusion.

You are correct. If a provider accepts Medicare assignment, then they accept the Medicare approved amount and will not charge the patient more. If the provider doesn't accept assignment, then they can charge up to 15% more and Medicare will approve 5% less than the approved amount of accepting providers. The excess is paid by the patient. When I wrote that I was thinking more in terms of some elective procedures and things like that. My own insurance at work will partially cover things like lasik eye surgery and sometimes people will think that Medicare will cover those things too.

For anyone else reading this here is an explanation of accepting and non-accepting:

http://www.aarp.org/health/medicare/traditional/a2003-04-28-doctorscharge.html

[midnight]

62. Catburglar this is an extremly important issue and like you ,I

do not understand medicare. That said, I started reading through the information that you thoughtfully compiled for us. It seems like a shell of a system. I have always felt that the servents to the people-congress,president, and other's entitiled to full coverage insurance via the tax payer should extent this wonderful service to the beautiful people of this country. And for those who say we can't afford it-bullshit.

[IronLionZion]

67. Thank you so much for posting this!

The situation is never quite as simple as some would have us believe.

[bliss_eternal]

68. Kicking...

...in hopes that more will see this important information!

:hi:

:kick::kick::kick: