General Discussion
Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region ForumsI have Medicare it is not free health insurance.
I have part A which we all pay for through payroll deductions. Part A covers hospital bed day costs. There is a deductable and Medicare does not pay 100% of the bill. Payments for bed days are detemined buy a formula and is different depending on a bunch of your circumstances. You can look up the formula on line in the federal register.
I have part B which pays for doctors fees. Reimbursement is determined by procedure codes and also does not pay 100% of the bill. I pay for part B through deductions from my social security check. It costs about $120 per month.
I have part D which is perscription coverage. I have one monthly perscription at this time and it is free but I pay for the coverage out of my social security check also. I am not sure what it costs but I don't get much of a savings because I have only one perscription.
Then I have a suplimental insurance plan through AARP. It costs $180 per month and goes up every year. It pays for what Medicare does not pay.
I only see my doctor every six months so I don't get much of a savings there either. I am lucky I guess at 71 years old I am rarely sick.
So I pay around $400 per month so I don't have to pay for my perscription and doctor visits.
I think Medicare for all would be similar for everyone if it were enacted, it is not going to be like going to the doctor and the government pays for it as I read in another thread here.
Also Medicare is not goverment operated. The goverment contracts with the Center for Medicare Services a corporation. Called CMS.
When I worked I was an accountant in the medical industry so I always have to shake my head when I read someone who says we will get free goverment health care. Nothing is free!
femmocrat
(28,394 posts)Thanks for the informative post. I'm also on Medicare, but I could not explain it as clearly as you did!
wasupaloopa
(4,516 posts)address that I signed up for was no longer active after I retired.
Wounded Bear
(60,233 posts)we just do the work to find ways to fund things that we consider necessary.
wasupaloopa
(4,516 posts)for all as government paid health care. If that were the case then those progressives would agree to pay for in taxes what they would not pay for out of pocket. The advantage I see is that government could make rules that would make the playing field more fair by replacing the insurance industry.
But then those rules are subject to the whims of what ever party is in power. Like today the repubs could yank the health care coverage out from under 10's of thousands of people.
Seems to me we would need a Constitutional Amendment making health care a right similar to public education which is also not indestructible.
My main point is that none of us has much understanding of health care payment issues in this country or any other. We vote for an ideal that we have in out minds which to may progressives is "free healthcare like other countries have" which does not exist either since thy pay more taxes than we do.
Wounded Bear
(60,233 posts)We all pay payroll taxes throughout our careers/lifetimes to support the initial parts of the plan, and then almost everybody pays at the back end, too, when you reach 65. It gets taken out of one's SS payments, or if you're still working through continuing payroll taxes.
Its coverage is minimal, at best, requiring many seniors to buy supplemental plans from private insurers.
Progressives tend to know these things much better than conservatives, and like I said, try to work to find ways to fund the program that minimizes the burden on the elderly. They generally succeed to the extent that Repub objections and obstruction can be overcome.
wasupaloopa
(4,516 posts)nothing else. and there is a deductible.
MichMan
(12,882 posts)I think the point to be made is that even if the 'Medicare for All" proposals were to pass, under the current Medicare system, there would still be monthly premiums, deductibles and co pays.
I have seen other posts here on DU which seem to allude many posters who don't seem to understand that it isn't gong to be "free" to the recipient by making rich people and corporations pay. Doesn't Canada finance their health care with a 15% GST?
The Velveteen Ocelot
(119,607 posts)My situation is similar. I have Medicare plus a supplemental policy; like you, so far I've been fortunate enough that I haven't had to use it very much - but I paid into it for over 40 years and I still pay for the small Part B premium and the supplemental policy premium. I'm sure a single-payer system would operate in much the same way. As I understand it, in other countries that have such a system you can still buy additional insurance for extra services.
womanofthehills
(9,146 posts)If hospitalized, I pay for first three days for room and any additional days are no cost. Everything else is free. I was hospitalized overnight for a rattlesnake bite and was flown to hospital on a helicopter, got $80,000 worth of antivenin and my total bill was $100.00. My post hospital therapy was $10 a visit.
A few yrs ago (I sound accident prone here) I tripped and fell backwards down a flight of stairs - tumbling over and over and shredded my shoulder - had reverse shoulder replacement surgery. I paid $450 up front for hospital room for 3 days -- surgery, meds, everything else free.
Visiting my regular doctor is cheap - but visiting a specialist is $45.
I don't take any medications so I don't pay any extra for med insurance.
wasupaloopa
(4,516 posts)womanofthehills
(9,146 posts)Before my mom died, when she came out to NM to live, she had Medicare and a supplemental but her bills were way higher because she was not getting her Medicare through one of the Albuquerque hospitals.
It limits your choice of doctors, but the specialists I have seen were top notch. The primary care docs I'm not too crazy about because they just want to push drugs and tests that I really don't want.
dpibel
(3,152 posts)OK. It's not free. Not much is.
But that's some pretty comprehensive coverage you've got there.
I defy you to find a commercial policy that gives you that coverage for $400 a month. Especially in your age group. Of course, no such exists, since people in your age group are covered by Medicare.
But the unsubsidized premium for a $6K deductible policy for me, a bit younger than you, is about $700 a month. So I'd say you're doing pretty well.
The fact that it doesn't net out for you, because you're healthy, is kind of the way insurance works.
And you're only one hospitalization away from being in the black. Again, how insurance works: It doesn't pay off until it saves your skin. If you're a careful driver, you're always in the red, paying more than you get out. Until you have an inattentive moment and are looking at a big injury judgment. Health care insurance works the same way.
Obviously, anyone who talks about free health coverage is making an analytical error. Even in, for instance, the United Kingdom, where you pay not a penny at the time of treatment, you're paying all along in taxes.
But to complain about the high price of Medicare is to ignore the much higher price of private insurance.
wasupaloopa
(4,516 posts)deductible Health Saving Account policy. My employer paid into my HSA $900 a year which covered all my medical bills which was one prescription a month and two doctor visits a year. I still had to pay my share of the policy.
So then and now I have it pretty good I know. I was making the point that Medicare is not government paid health insurance like some here think.
The Velveteen Ocelot
(119,607 posts)but simply pointing out that it isn't free; the government doesn't pick up the tab for everything. I think the OP and everyone else knows that private insurance would be vastly more expensive - if you could buy it at all.
BlackCherokee
(31 posts)In Maryland and Texas, I was a federal employee. CMS is a federal government agency operating under the DEPT. OF Health and Human services.
cms.gov
wasupaloopa
(4,516 posts)H&HS to operate CMS.
Several years ago there was a change in some area of the country as to who was operating CMS IIRC but I am very fuzzy now about what it was.
dpibel
(3,152 posts)You'd better let CMS know that the government is besmirching its private corporate name!
https://www.cms.gov/About-CMS/About-CMS.html
"The Centers for Medicare & Medicaid Services, CMS, is part of the Department of Health and Human Services (HHS). ...get to know the programs we administer including: Medicare, Medicaid, the Childrens Health Insurance Program (CHIP), and the Health Insurance Marketplace. "
Kind of makes a person wonder about the balance of your factual assertions.
wasupaloopa
(4,516 posts)changing venders.
At 71 my memory gets fuzzy
BumRushDaShow
(139,324 posts)"Health Care Finance Administration" until the name was changed to CMS ("Centers for Medicare and Medicaid Services" under Shrub.
charlyvi
(6,537 posts)Although CMS is, indeed, a government entity, it contracts out the processing of Medicare claims to private insurers in each state. It can be confusing. Here is the part of the Social Security Act that provides for these private contracts and outlines their responsibilities.
CONTRACTS WITH MEDICARE ADMINISTRATIVE CONTRACTORS[358]
Sec. 1874A. [42 U.S.C. 1395kk-1] (a) Authority.
(1) Authority to enter into contracts.The Secretary may enter into contracts with any eligible entity to serve as a medicare administrative contractor with respect to the performance of any or all of the functions described in paragraph (4) or parts of those functions (or, to the extent provided in a contract, to secure performance thereof by other entities).
(2) Eligibility of entities.An entity is eligible to enter into a contract with respect to the performance of a particular function described in paragraph (4) only if
(A) the entity has demonstrated capability to carry out such function;
(B) the entity complies with such conflict of interest standards as are generally applicable to Federal acquisition and procurement;
(C) the entity has sufficient assets to financially support the performance of such function; and
(D) the entity meets such other requirements as the Secretary may impose.
(3) Medicare administrative contractor defined.For purposes of this title and title XI
(A) In general.The term medicare administrative contractor means an agency, organization, or other person with a contract under this section.
(B) Appropriate medicare administrative contractor.With respect to the performance of a particular function in relation to an individual entitled to benefits under part A or enrolled under part B, or both, a specific provider of services or supplier (or class of such providers of services or suppliers), the appropriate medicare administrative contractor is the medicare administrative contractor that has a contract under this section with respect to the performance of that function in relation to that individual, provider of services or supplier or class of provider of services or supplier.
(4) Functions described.The functions referred to in paragraphs (1) and (2) are payment functions (including the function of developing local coverage determinations, as defined in section 1869(f)(2)(B)), provider services functions, and functions relating to services furnished to individuals entitled to benefits under part A or enrolled under part B, or both, as follows:
(A) Determination of payment amounts.Determining (subject to the provisions of section 1878 and to such review by the Secretary as may be provided for by the contracts) the amount of the payments required pursuant to this title to be made to providers of services, suppliers and individuals.
(B) Making payments.Making payments described in subparagraph (A) (including receipt, disbursement, and accounting for funds in making such payments).
(C) Beneficiary education and assistance.Providing education and outreach to individuals entitled to benefits under part A or enrolled under part B, or both, and providing assistance to those individuals with specific issues, concerns, or problems.
(D) Provider consultative services.Providing consultative services to institutions, agencies, and other persons to enable them to establish and maintain fiscal records necessary for purposes of this title and otherwise to qualify as providers of services or suppliers.
(E) Communication with providers.Communicating to providers of services and suppliers any information or instructions furnished to the medicare administrative contractor by the Secretary, and facilitating communication between such providers and suppliers and the Secretary.
(F) Provider education and technical assistance.Performing the functions relating to provider education, training, and technical assistance.
(G) Additional functions.Performing such other functions, including (subject to paragraph (5)) functions under the Medicare Integrity Program under section 1893, as are necessary to carry out the purposes of this title.
https://www.ssa.gov/OP_Home/ssact/title18/1874A.htm
wasupaloopa
(4,516 posts)beaglelover
(3,923 posts)Educate yourself and you'll see that everything the OP said about the cost of Medicare is true.
Hoyt
(54,770 posts)By the time you pay $130 or so a month just to qualify for Part B, $45 or so for pretty limited drug coverage, and another $125 plus for decent supplemental, you are paying a bunch out of your Social Security and any other retirement income. And that doesn't count what you paid in taxes while working and payments for non-covered Medicare services including dental, hearing aids, lenses for astigmatism with cataract surgery, drugs, etc. You can save some by going with a Medicare Advantage plan (as about 30% of beneficiaries do), but a lot of people aren't willing to make the sacrifices with smaller networks of providers, etc.
killbotfactory
(13,566 posts)One way to do this is offer Medicare as an alternative to private health insurance that people can opt into. It's basically the public option.
wasupaloopa
(4,516 posts)Yavin4
(35,864 posts)It should be funded through a combination of income and sales taxes.
wasupaloopa
(4,516 posts)Services Dept.
We could not turn away clients so we had many indigent patients. State of CA pays money to the counties called realignment funds.
The funds cover indigent care and other programs that are not 100% funded.
Realignment money comes from state sales taxes and vehicle license fees.
The term realignment refers to the services that previously were provided by the State but were realigned so that Counties now provide the service that the State pays for.
MichMan
(12,882 posts)wasupaloopa
(4,516 posts)shockey80
(4,379 posts)if everyone was on it. You will never have to worry about losing your coverage because you get laid off, fired, disabled. Medicare for all is a no brainer. The cost will depend on how its set up. If we do go to medicare for all, The republicans will do everything they can to fuck it up and pass more of the cost to us.
wasupaloopa
(4,516 posts)right as public education is.
I wish we could put an end to conservative ideology. We have too much greed, hate and ignorance in this country. maybe those who come after us will have more generosity, empathy and wisdom.
Hoyt
(54,770 posts)so, if that much. It's going to take some changes in how health care is delivered, how we as patients use it, how providers get paid, etc., to get any significant reduction. Unfortunately, I don't see that happening anytime soon.
PoindexterOglethorpe
(26,274 posts)so the $104/month I pay for Part B also includes Part D. No copay for a regular doctor visit. $50 for a specialist, but I haven't needed one so far. I am likewise extremely healthy, and a couple of years ago was taking a couple of meds. I mail ordered them and had zero copay. Of course they were generic versions of extremely common meds, which helped.
What is good about Medicare is that it covers a lot of basics, which is what a Medicare for All should be.
Wounded Bear
(60,233 posts)it only exists because private insurers would not cover the elderly at anything resembling an affordable cost.
Bottom line, if we go back to the old system, we go back to the elderly dying in poverty from a lack of access to medical care.
RyanCare:
ginnyinWI
(17,276 posts)It is an HMO, so there are some co-pays, but only a low monthly fee of $22.50. It would be free if I didn't want a plan with some dental insurance included (only checkups and xrays). I'm actually going to be shopping around for different dental coverage, something that includes more, or else some kind of discount dental plan.
There is no copay for a primary physician visit, very low lab fees, and $45 for a specialist. My meds are generic and therefore free under the plan, which includes drug coverage (Part D).
My Medicare cost is $135 a month and we are paying it for now out of pocket, because we aren't taking Social Security for a few more years. I just turned 65. If you can hold off until you are older, you get a bigger payment--a lot of people do not know that.
I think Part C is the way to go. I looked up the five top plans in my area and picked one that my doctor participates in.
The only way they can throw you off the insurance is from non-payment.
Hoyt
(54,770 posts)of physicians, etc. That was fine by me, but a lot of folks aren't going to accept it.
In fact, a lot of folks here have posted how they think Medicare Advantage is a ripoff and should be abolished. Me, I think it is the only way to go unless you have plenty of money and/or have to go to any doctor, as often as you want.
procon
(15,805 posts)It's been no fuss, no problems, and the program works seamlessly; I'm very satisfied. I have some modest copays, but my prescriptions are cheap, and I also get more free screenings, tests, classes, information seminars, and vaccinations than I can count. I don't get any surprize charges or bills, I don't have any paperwork to deal with, the clinic staff is pleasant and professional, and most specialty services are available on site or contracted through local providers.
I'm a bit anxious that Trump will try to kill off Medicare Advantage and dump me into the more costly straight Medicare coverage that would force me to pay for an additional supplemental insurance plan and spend my time shopping for the cheapest doctor, lab, pharmacy, etc.
Hoyt
(54,770 posts)With traditional Medicare, you are going to have to buy a decent supplemental policy at $130/month on up, to limit your loss if you get really sick and aren't quite poor enough to go on Medicaid, but can't afford 20% of a $100,000 stay in a hospital.
And, people keep forgetting, Medicare does not cover dental, hearing aids, long-term nursing homes, 20% coinsurance on most services including expensive hospital, etc.
It is good for what it is -- and I am grateful to have it available -- but people who think they'll end up with extra money in their pockets under Medicare are going to be very disappointed.
procon
(15,805 posts)I think most people just want a no hassle insurance (like Medicare for all) that works without any huge effort, surprises or gotchas. I laugh in disgust when I hear those Republicans touting "choose any insurance company", as if I want to spend days trying to figure out which company offers the services I might need, and which providers (from MDs, labs, hospitals, pharmacies, etc., are in that plan) No thanks!
Most people don't even know the right questions to ask. They don't know that some providers expect the patient to pay them in full, and it's up to them to submit the supporting paperwork to Medicare for reimbursement. Some providers do not accept what Medicare pays, they demand the full 100%, but the supplemental insurance plans only cover the difference between the amount allowed by Medicare and the amount paid by Medicare, so guess who gets that bill?
northoftheborder
(7,594 posts)a person paying into the Social Security system through their work, then when retired at 65, they become eligible for Medicare. A lot of people are never in the system in their work, or never have enough days working for someone who has deducted for Social Security, so they are not eligible for Social Security or Medicare. Is that correct? Myself, I am eligible for S.S. and Medicare only through my husband's employment since I stayed at home most of my working lifetime.
My point is, there would have to be some way to pay for it; what would be a good way to do that? As someone above illustrated, I have Medicare Insurance taken out of my Social Security benefits monthly.
WinkyDink
(51,311 posts)WinkyDink
(51,311 posts)radical noodle
(8,149 posts)and people often start their Social Security before or after age 65. They are not totally intertwined. The deduction from one's payroll check for Social Security is separate than the deduction for Medicare.
It's true. If people are added to it on a voluntary basis, it must be paid for... and if only voluntary, then there must be a way to determine what the costs are likely to be. Adding only those who have pre-existing conditions will raise the costs a great deal and it's better to add younger, healthier people to the coverage to lower them. I really think it has to be all or none unless someone has figured out a way not to be mandatory. I can't see how.
MichMan
(12,882 posts)I wasn't aware that people that worked under the table in a cash basis to evade income and payroll taxes were still eligible for Medicare benefits. Doesn't seem fair
The Velveteen Ocelot
(119,607 posts)you have worked (paid in) for at least ten years and are at least 62. Everybody qualifies for Medicare at age 65, but you'll have to pay a premium for Part A if you or your spouse didn't work for at least 10 years.
wasupaloopa
(4,516 posts)deductible
You still have to have Part B for doctor's charges and part D for prescriptions and a supplemental to pay for what Medicare does not pay for or get an advantage plan like some here have.
George II
(67,782 posts)...per month. We have ours through United Healthcare (the same insurance company that AARP endorses)
Our costs are about $120/month for Part B and only $25 per month for the supplemental, which covers our prescriptions with a tiny ($2 per month) copays for them.
You may want to look into that supplemental insurance.
The Velveteen Ocelot
(119,607 posts)Your $25/month covers prescriptions, but some supplemental policies cover almost everything that Medicare doesn't - and that can be quite a bit, like copays for doctors' visits, etc. - and those policies will be more expensive.
DURHAM D
(32,816 posts)Plan you purchase but your age. It takes a jump every two years. Also, smokers are rated up.
I pay about $175 a month for my supplemental Plan. If I stop traveling I will pick another plan that is lower in cost.
George II
(67,782 posts)For reference, we're in Connecticut, not sure it that affects the price.
We have $2 monthly co-pays each for our four prescriptions, and $20 co-pays for doctor visits.
DURHAM D
(32,816 posts)AllaN01Bear
(22,634 posts)i luv it when the other side calls it the giveaway program or the free this and that . we all pay into it and it is payed for.
again spot on. also in my county tuolumne ca ; medicare is administered localy by the county .
radical noodle
(8,149 posts)I would only add that the supplemental insurance one chooses can be different, but each plan is consistent throughout the insurance companies. In other words, Plan F pays everything Medicare does not. The "Plans" are always the same no matter from which company you buy. There are other plans that pay lesser amounts and which cost less. It's a crapshoot, but I've always taken the best protection I can afford. I will be 70 this month and pay $200.98 cents per month for Plan F. In addition, there is Part D to buy, which is another cost depending on what meds you take and probably your age factors in as well. It is wise to revisit your coverage yearly to look for the best coverage at the least expensive price.
mwooldri
(10,359 posts)Though I never saw a single doctors bill or hospital bill until I came to the US, I did see "National Insurance" deducted from my pay once I got my first real job.
The UK system is simpler, and more cost effective. Though it's not the system that America can have - too much is nationalized. Plus "Who's your GP (General Practitioner aka Primary Care Physician)" is important. Urban areas may have some choice. Rural areas not so much. If the GP takes you, you can choose. Choice is more restricted as hospitals will specialize - some very rare conditions might have only one clinic (maybe two) in the country to deal with it. Plus since the Scottish, Welsh and Northern Irish National Health Services are much smaller than NHS England, they have to send some patients to England. I know of one family who lived in Glasgow and the surgeon that treats their child was at Great Ormond Street Children's Hospital in London. I think they got intimate with Virgin Trains... but I digress.
Of course Medicare and Medicaid are not free. But there is so much waste and duplication in the hodge podge of private systems that is the US health care system no wonder it is the most expensive in the world. Medicare for All would make things simpler, and still leave lots of room for the private insurers to make money. Even then this basic idea can be tinkered around with to allow a lot of private involvement, yet achieve 100% coverage.
WinkyDink
(51,311 posts)Trump, they can pay for UHI.
chillfactor
(7,675 posts)pay out-of-pocket expenses.....just $100/month premium.
chillfactor
(7,675 posts)I do not pay them a premium either...and my prescriptions are $1.50 per prescription.
DURHAM D
(32,816 posts)Mickju
(1,811 posts)I pay $26 per month for the Advantage plan plus just over $100 they take out of my Social Security for Medicare. I incurred over $250,000 in medical costs last year and paid about $2500 out of pocket. I take 5 prescriptions which are now free since I switched to a mail order prescription service. I think that is a pretty good deal, but you are right that it isn't free medical care. I'm lucky that I could afford the $2500 and I realize many people are not so fortunate unfortunately. I had Kaiser when I was working and it was great, but I moved to another state after I retired at 70 where it isn't available.
OldHippieChick
(2,434 posts)something different depending on how old we are, where we live and when we retire.
Just after I started taking Medicare I moved from a state w/ Kaiser to one that didn't have Kaiser so thought I'd decide on gap plans later. Oops, landed in the hospital w/ no gap plan. I pay $140 per month for standard Medicare (A&B) but found that Medicare does some great negotiating and I didn't pay nearly as much as I expected after 8 days in the hospital. All total is was less than I would have paid had I had a gap plan.
Also, I got these wonderful discount cards in the mail that give me reduced prices for prescriptions even though I do not have that Medicare coverage.
I do not understand why this has to be so confusing, but I guess that is part of the insurance co plan. We just need to keep communicating w/ one another to be sure we don't get any more screwed than we already are.
Vinca
(50,823 posts)A couple of months back I had an ER visit that included many tests including a CT scan, EKG, etc. I was there for about 5 hours to get the problem under control. I was scared to death I would get a giant bill in the mail, but when it arrived it was only about $300. So far I'm finding paying the difference for my doctor's appointments, lab tests, etc. is cheaper than what a supplemental policy would cost me.
OldHippieChick
(2,434 posts)Blue Cross, United HealthCare, etc., supplements as you will pay less if you don't. That's part of why it is so complicated. Kinda makes me sick, but not surprised.
erinlough
(2,176 posts)At least in Michigan it does.
El Supremo
(20,371 posts)I'm paying for Medicare (and supplementals) only about 28% of what my group insurance cost when I was employed.
It's about time I started to see something for all the years I and my employers paid into it.
Ilsa
(62,139 posts)I think there should be some sort of alternative minimum tax so they can't avoid participating in this type of "commons" expense.
MichMan
(12,882 posts)Depends on who would be paying for it. No one knows yet what the cost would be