'Our Seniors Deserve Better': Jayapal Demands End of All Medicare Privatization Schemes

[Ms. Toad]

34. There are not copays and out-of-pocket (beyond a small deductible) unless you choose them.

The best (non-grandfathered plan) is capped at $233 total out-of-pocket expenses for the entire year. No copays. No coinsurance. ($233 is this year's deductible - it is set annually)

The next cheapest plan has $233 + $20 copays for doctor's visits. That's it. No copays for hospitalization, no copays for ambulances, no copays for diagnostic tests, no copays for emergency room or urgent care, etc.

The break even point for the two premiums in the reasonably priced plans was 5-8 office visits a year. You can choose to pay a flat $8 -$13 more a year in premiums (and have no office visit copays) OR you can gamble that the number of visits would be fewer - and save the $8 - $13/month

My father chose to gamble - and so far it has paid off for him. 25 years in, he is so far ahead that even if he goes to once-a-month visits for the rest of his life he's still ahead.

My spouse and I each have chronic conditions. She's already above the cut-off point. I'm at 7 visits this year, and am guaranteed to have 6 more. So we're both paying $8-$13/month over the plan my father is on. So far, that choice is saving us money (and would have saved us even more over the $0 premium Medicare Advantage plan which charges $5 for regular office visits - but $40 for specialists)