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View Diary: What I Keep Not Hearing About Medicare (182 comments)

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  •  we've been down this road before (39+ / 0-)

    It's called Medicare Advantage, an insurance program subsidized by taxpayers, concocted by Bush & Republicans to "compete" with Medicare.
    Major FAIL, since Med. Adv. provides no better outcomes than traditional Medicare and costs MORE, as anything privatized usually does.
    The Insurance companies kept seeking MORE government funding so Obamacare gradually ends funding Med. Adv. held by 20% of Seniors.
    If those wealthy Seniors want more coverage than traditional Medicare, they should pay for it themselves.

    "Tax cuts for the 1% create jobs." -- Republicans, HAHAHA - in China

    by MartyM on Fri Oct 12, 2012 at 07:49:56 AM PDT

    •  Just what I was about to say (20+ / 0-)

      And with "Medicare part D" - Which had about a bazillion possible prescription plans.  

      I had an elderly relative meet a very charming saleswoman for a Medicare Advantage company.. And sign all of his health care away...

      He woke up about 6 months later after the company was going bankrupt, and wondered what he had done... But she was so nice, she said that all kinds of things would be covered that medicare didnt...

      What happens when these private companies which people have put their vouchers into go bankrupt?

      Are they just out of luck?

      "We have always known that heedless self-interest was bad morals; we know now that it is bad economics" - F.D.R.

      by biscobosco on Fri Oct 12, 2012 at 09:15:25 AM PDT

      [ Parent ]

    •  Everyone I know here in Florida has a Medicare (1+ / 0-)
      Recommended by:
      ladybug53

      Advantage plan and no one has traditional Medicare which as I understand only pays 80%.

      So if Obama plans to do away with Medicare Advantage, that will be a big problem for them.

      Obamacare gradually ends funding Med. Adv. held by 20% of Seniors.

      "Who are these men who really run this land? And why do they run it with such a thoughtless hand? David Crosby.

      by allenjo on Fri Oct 12, 2012 at 09:19:46 AM PDT

      [ Parent ]

      •  Ending funding (20+ / 0-)
        So if Obama plans to do away with Medicare Advantage, that will be a big problem for them.
        Obamacare ends funding of Medicare Advantage. It does not end Medicare Advantage. It getting out of the business of subsidizing it just like it got out of the business of subsidizing banks that provided student loans in favor of offering the loans directly to students at a lower rate.

        The choice of our lifetime: Mitt Romney, It Takes A Pillage or President Barack Obama, Forward Together.

        by FiredUpInCA on Fri Oct 12, 2012 at 09:33:39 AM PDT

        [ Parent ]

      •  Remember "midnight basketball?" (1+ / 0-)
        Recommended by:
        RJDixon74135

        The catch-phrase of the right that supposedly showed the waste of any social spending?

        Well, the rights' equivalent is "Silver Sneakers," the Medicare Advantage Program that covers gyms for seniors.  That apparently has been subsidized under Medicare Advantage.

        The GOP: "You can always go to the Emergency Room."

        by Upper West on Fri Oct 12, 2012 at 10:10:05 AM PDT

        [ Parent ]

        •  Hey, Midnight Basketball WORKED. (2+ / 0-)
          Recommended by:
          ladybug53, susanala

          That stimulus bill was just the thing to jump-start us in the early 1990s.

          I've always thought it strange that people forgot this recent, well-documented example of a successful stimulus.

          •  Not only did it work (0+ / 0-)

            but before Clinton it was part of Bush's "Thousand Points of Light."

            But the phrase was pounded by Rush et al. for years so, in the make-believe world of wingnut unsubtle racism (after, who plays midnight basketball?) it is an unassailable example of welfare-queenism run amok.

            That it worked is not even a footnote in that world.

            The GOP: "You can always go to the Emergency Room."

            by Upper West on Fri Oct 12, 2012 at 12:26:07 PM PDT

            [ Parent ]

      •  Actually, allenjo, traditional Medicare has two (24+ / 0-)

        main parts. Part A pays for hospitalization expense less a deductible of a little more than $1,000. Part B pays for 80% of the  cost of doctor visits, lab work, imaging, etc., outside a hospital stay. Part A is available at no cost to Medicare eligible people, Part B costs $99/mo. For this reason, most people get a "supplemental" policy from a for-profit health insurance company to pay deductibles and what Part B doesn't cover. Mine costs $27/per month.

        Also, I have Part D that pays for drugs. The drug plan I have costs $27/month and has a $140 annual deductible and then, most of my prescriptions cost $0, no co-pay. I save about $100/month. But, there are literally hundreds of plans to choose from and they vary from state to state. Each plan has its own "formulary" that says what drugs are covered and in which "tier" with older generics being in tier 1 and newer, more expensive, more exotic stuff being in tier 3 or 4 with higher co-pays. OR, you can choose a plan like my husband's which costs more than $100 per month but includes more of the expensive drugs in their tier 1. His plan costs a lot more than mine per month but saves him about $400 per month.

        So, it's really complicated which is one reason many people choose an Advantage plan sold by a for-profit insurance company which incorporates everything.

        However, many of the Advantage plans are HMOs and participants can't choose when to see a specialist or which one to see. Their primary care physician, aka "gatekeeper," makes all those choices. Usually, for acting in the gatekeeper role, a physician gets a monthly payment from the Advantage plan rather than a "fee for service." Supposedly, this would cost less to the government because of the "superior" management the private sector would offer, but it didn't work out that way. The for-profit insurance companies have so much more administrative costs to cover (executives, sales and marketing, profits to shareholders, etc.), these plans turned out to cost about 20% more than tradititonal medicare with no better health outcomes for the participants. Shaving down that 20% is a big factor in the cost savings the Obama administration plans to achieve. Yes, some companies may leave the business if they can't make as much as tthey want, but it'll be up to them.

        Eliminate tax breaks that stimulate the offshoring of jobs.

        by RJDixon74135 on Fri Oct 12, 2012 at 10:24:11 AM PDT

        [ Parent ]

        •  Thanks for explaining how things work for you (6+ / 0-)

          and your husband on Medicare. I'll qualify for it in just under a year from my medical disability, and already I feel overwhelmed by the looming decisions about what options to choose to minimize my out-of-pocket costs (which are already sinking us).
          I have a lot of work to do to suss it all out.

          •  Medicare has a site online that's pretty good (6+ / 0-)

            I suggest you visit there soon and start familiarizing yourself with how the site works. Also, the people at Medicare are good on phone calls, although you may have to wait 10 minutes or longer to get through to someone when you call, but I've never talked to anyone there who wasn't happy to explain something or acted like I was a bother. But, you can also feel free to KOSmail me if you think there's something I can do to help.

            You want to get an early start because there are some penalties for missing critical deadlines.

            It may not work this way for you, but I got the feeling that somehow every insurance company in my state knew when I was about to turn 65 and had something to sell me -- something that required about 2 lbs of papers to explain. One of my happiest days was when I had finally made all my decisions, signed everything I needed to sign, and could toss all that extra paper into the recycle bin!

            Eliminate tax breaks that stimulate the offshoring of jobs.

            by RJDixon74135 on Fri Oct 12, 2012 at 11:39:18 AM PDT

            [ Parent ]

            •  Thanks for the tip and the offer; I may take you (0+ / 0-)

              up on it sooner than later.
              Since my eligibility isn't age-related, I might not get as much "helpful" material. But there are also some good non-profit senior centers in town that I think will be of some help.

              •  Just had this discussion this week with my (1+ / 0-)
                Recommended by:
                peregrine kate

                benefits center.  I'm retired and collecting SS.  Will turn 65 in 2013.  Our age info is tied to our SSN, so the government knows when we are turning 65.   About 6 months prior to turning 65 you will receive information on medicare eligability.  I have a HMO thru my employer.  Medicare will become my first coverage and my employer provided coverage will cover what Medicare does not.  

                I feel very lucky that my employer has not only a benefits hotline to help with questions, but medicare specialists to help walk me thru all the in's and out's of Medicare enrollment.  

                I like that this diary has been a Medicare primer for many of us.

                We are better informed and smarter together!

                "Liberals feel unworthy of their possessions. Conservatives feel they deserve everything they've stolen." Mort Sahl

                by maggiemae on Fri Oct 12, 2012 at 04:45:23 PM PDT

                [ Parent ]

                •  Thanks, but I'm 54 and will be Medicare-eligible (0+ / 0-)

                  next year at 55 because I have advanced cancer. (I am, fortunately, now in remission.) It's possible that I'll get some info from the feds since my SSDI qualification is what will get me into Medicare, but I haven't yet started getting any indications of how that will work. I will start asking around about the process soon.
                  It might also be possible to get some information out of my husband's insurer--but they're not providing very comprehensive coverage, so I am not sure about that, either. We hope that our premiums will decline once I'm on Medicare, since now we pay 80% of our family coverage out of pocket (or $1250/month for a family of three).

                  •  Ouch! That is draconian in it's impact on (0+ / 0-)

                    your life.  I'm so sorry to hear about your cancer, but so glad to know you're in remission.  My dearest friend is starting chemo/radiation for her uterine cancer.

                    I hope this turns out well for you re: SSDI.  I'd certainly call and ask for assitance in understanding your options.

                    I've always enjoyed your posts on dkos, and look forward to getting more involved again as the election nears.  Went dark for about a year due to the loss of my only child last year.

                    Take care of yourself!

                    "Liberals feel unworthy of their possessions. Conservatives feel they deserve everything they've stolen." Mort Sahl

                    by maggiemae on Wed Oct 17, 2012 at 11:22:53 AM PDT

                    [ Parent ]

        •  Although it's complicated, Medicare.gov (6+ / 0-)

          has a very good -- and not difficult to understand -- "Plan Finder" that allows you to compare the plans available in your area.

          You enter the drugs you take, including the dosages, and the software displays your options.

          You can select to compare just Rx plans (in combination with "original" Medicare), or Medicare Health Plans (definition below) with or without Rx coverage.

          For example, for my zip code, I get 30 Rx plans, 14 Medicare Advantage plans with Rx coverage, and 2 Medicare Advantage plans without Rx.

          A Medicare health plan is offered by a private company that contracts with Medicare to provide Part A and Part B benefits to people with Medicare who enroll in the plan. This term is used throughout this handbook to include all Medicare Advantage Plans, Medicare Cost Plans, Demonstration/Pilot Programs, and Programs of All-inclusive Care for the Elderly (PACE).  

          .... Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.

          We must drive the special interests out of politics.… There can be no effective control of corporations while their political activity remains. To put an end to it will neither be a short not an easy task, but it can be done. -- Teddy Roosevelt

          by NoMoJoe on Fri Oct 12, 2012 at 11:28:49 AM PDT

          [ Parent ]

          •  There's also a "medigap" plan finder (4+ / 0-)

            here.

            Medigap insurance is used in conjunction with "original" Medicare to pay the 20% co-pays and deductibles.  There are a number of standard policies defined by Medicare (currently 11).

            First you have to decide what benefits and coverages you want and then the software shows what plans are available in your area, which companies offer them, and how much they charge.

            As Medicare says dryly,

            The cost of Medigap policies can vary widely. There can be big differences in premiums that insurance companies charge for exactly the same coverage. As you shop for a Medigap policy, be sure you are comparing the same Medigap policy (for example, compare a Plan A from one company with Plan A from another company).

            We must drive the special interests out of politics.… There can be no effective control of corporations while their political activity remains. To put an end to it will neither be a short not an easy task, but it can be done. -- Teddy Roosevelt

            by NoMoJoe on Fri Oct 12, 2012 at 11:39:56 AM PDT

            [ Parent ]

          •  Yes, NoMoJoe, I agree about the Medicare sites (3+ / 0-)
            Recommended by:
            ladybug53, NWTerriD, NoMoJoe

            Plus, when I was almost ready to make my decision on a drug plan, I had one small question left and since I hadn't picked an agent, I phoned Medicare to ask. Not only did the Medicare person answer my question, but he then signed me up for the plan I'd chosen, so I didn't have to contact another insurance agent, make any appointment, etc. It saved me both time and aggravation.

            Eliminate tax breaks that stimulate the offshoring of jobs.

            by RJDixon74135 on Fri Oct 12, 2012 at 11:45:23 AM PDT

            [ Parent ]

            •  I have found both the Medicare and Social (0+ / 0-)

              Security people to be extremely helpful and about as far from the caricature of a government agency as it's possible to be.

              We must drive the special interests out of politics.… There can be no effective control of corporations while their political activity remains. To put an end to it will neither be a short not an easy task, but it can be done. -- Teddy Roosevelt

              by NoMoJoe on Fri Oct 12, 2012 at 10:48:32 PM PDT

              [ Parent ]

          •  Not comprehensive listings (3+ / 0-)
            Recommended by:
            ladybug53, revsue, NWTerriD

            I've been looking at the medicare site. The Plan finder is by no means comprehensive. It didn't show Cigna or Aetna or several other companies which offer plans in Scottsdale.

            Also, my retirement plan has cooked up something entirely different -- and it seems to be similiar but not exactly and you can't have it and a Medicare Advantage plan, too.

            I can't wrap my mind around any of it so my PhD son and master's of Accounting daughter are going to decide for me.

    •  Heavy HMO'S (9+ / 0-)

      In areas like mine, Sacramento, with state government, we have large HMO's and few "fee for service" doctors who can not compete well with HMO's.  Medicare Advantage is obtained through HMO's.  It is slightly more expensive for me than medicare my friends have been able to maintain with a family doctor they had for many years.  But the HMO's usually offer more broad coverage.  Also there are co-pays.  I have $100 deducted from my social security for medicare.  I pay another $100/mo to the HMO.  Every thing I do there cost $30/each for a basically healthy person.  The difference is that before 65 I was paying over $400/mo for the same plan.  If Romney returns us to the health care cartel who do not want us and allows them to do what is best for their Wall Street bottom line, I die early.  It is as simple as that.

      •  That's quite a bit more than I pay for (3+ / 0-)
        Recommended by:
        divineorder, ladybug53, NWTerriD

        traditional Medicare plus a supplemental policy from a for-profit insurance company, LillithMc. See above.

        Eliminate tax breaks that stimulate the offshoring of jobs.

        by RJDixon74135 on Fri Oct 12, 2012 at 10:29:46 AM PDT

        [ Parent ]

        •  The 1st $100 (1+ / 0-)
          Recommended by:
          NWTerriD

          comes out of your social security check for everyone.  You may not be counting that.

          •  Also (1+ / 0-)
            Recommended by:
            NWTerriD

            I do pay more than some of my friends on traditional medicare, but it is hard to find a doctor who accepts traditional medicare where I live.  They have long time Doctors, but when those Doctors retire they have a problem.

            •  Yes, I've had the same primary care physician (2+ / 0-)
              Recommended by:
              NWTerriD, LillithMc

              for about 10 years now and they didn't bat an eye when I went on Medicare. We went through a period about 10 years ago when several of our doctors retired. Now, when I get referred to someone new for anything, I want someone who's going to last as long as I am.

              I am counting the $100 that comes out of my check. What I have that's cheap are my supplemental and drug plan at $27/mo. each. But, I can pass along the advice our primary care physician gave us for my husband: get the best policy you can afford.

              Eliminate tax breaks that stimulate the offshoring of jobs.

              by RJDixon74135 on Fri Oct 12, 2012 at 02:05:46 PM PDT

              [ Parent ]

    •  MartyM - my understanding (1+ / 0-)
      Recommended by:
      NWTerriD

      is that Medicare Advantage is used more by low income seniors because they receive significant benefits, above Medicare A&B,  without having to purchase a supplemental plan.

      "let's talk about that"

      by VClib on Fri Oct 12, 2012 at 04:41:28 PM PDT

      [ Parent ]

      •  No - low income Seniors have traditional Medicare (0+ / 0-)

        Only 20% of Seniors have (or can afford) Medicare Advantage.

        "Tax cuts for the 1% create jobs." -- Republicans, HAHAHA - in China

        by MartyM on Sun Oct 14, 2012 at 03:17:02 AM PDT

        [ Parent ]

        •  MartyM - I don't think Medicare Advantage (0+ / 0-)

          has any out of pocket cost beyond any participant's regular Medicare payment. That's why it is favored by low income seniors.

          "let's talk about that"

          by VClib on Sun Oct 14, 2012 at 07:26:32 AM PDT

          [ Parent ]

          •  Seniors with Med. Adv. pay for Insurance coverage (0+ / 0-)

            and taxpayers have been paying part of it.
            But Obamacare gradually ends taxpayer subsidies for Med. Adv. - yet another reason the 1% oppose Obama.

            "Tax cuts for the 1% create jobs." -- Republicans, HAHAHA - in China

            by MartyM on Sun Oct 14, 2012 at 08:31:37 AM PDT

            [ Parent ]

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