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View Diary: What are some Progressive Solutions to the "Medicare Problem"? (70 comments)

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  •  Medicare Advantage needs to go!!! (5+ / 0-)
    Recommended by:
    jamess, Araguato, ladywithafan, Chi, Cedwyn

    About 25% of us on Medicare have signed up for Medicare Advantage programs.  Most of us pay nothing for this, and get some benefits.  The biggest is a stop lose at $5200 a year.

    To get this free benefit, the insurance companies are paid to administer Medicare instead of the government.  I still have regular Medicare A and B  which I do pay $105 a month for.

    But the profits the companies are making off of this are huge, and could be easily eliminatd

    "We borrow this Earth from our Grandchildren."

    by Arizona Mike on Sun Jan 20, 2013 at 06:39:01 PM PST

    •  Agree ^^^^^ (2+ / 0-)
      Recommended by:
      jamess, ladywithafan

      My husband is newly on Medicare and this was the first year we had to fight our way through the unbelievably complex choices every single senior has to make.

      Where one plan before 65 did everything, we wound up with four different sets of benefits (Parts A and B from Medicare, mandatory Part D (drug plan selection) and a supplemental policy (Medigap Insurance). As it happened the first year we chose the supp. from the insurer that had covered him before he turned 65, so it basically was the same insurance, only now with four, not mutually coordinated, parts.

      This fall we struggled mightily with the drug plan choice which not only requires you to estimate (in advance) what you  wish (or can even afford) to pay, but also what drugs you now take, may take, might have to take if things change, but even which pharmacy chain to choose.  The variables, though helpfully laid out in an interactive website are enough to drive one mad.

      No wonder so many people fall for the Medicare Advantage plans  - only one decision to make.  Though I know of one person who actually died because they believed that traditional Medicare was no longer possible and chose an Advantage Plan. And that plan controlled access to treatment that would have saved his life had he been "allowed" to chose another facility.

      When people say "Medicare For All" (as I once did) I now mutter to myself, "Be careful what you wish for."

      The other technical argument against raising the entry age for Medicare is that most health insurers won't offer insurance after the month you turn 65 - they are only too eager to dump customers onto the public program.  We wouldn't have made the change without their demand.  It had ramifications for me, too, as I was suddenly in limbo as the too-young- for-Medicare dependent on the policy of a person being involuntarily switched. We made some adjustjments and it worked out but it was hair-raising for a few weeks.

      From the insurers' points of view shot-gunning the newly-65 into Medicare pre-emptively saves them money as older people tend to use more services, in the aggregate.  But keeping those same older people in the under-65 insurance market only shifts those costs to younger workers' plans and their employers.

      The Part D plan also has a built-in pitfall. By keeping the drug plans separate from Medicare (and the Medigap insurers if one chooses such a plan) there is an economic dis-incentive for drug plan companies to pay for more-expensive drugs that sometimes would result in cheaper overall care, as long as the care is being paid for by someone else.  

      Case in point: My husband takes an old-fashioned blood thinner, so generic and cheap, it's practically free.  There are newer and vastly more expensive  ($600+/mo) blood thinners available.  Most Part D drug plans that we priced which covered them cost much more in premiums and still only covered a small share.

      The thing to know about this is that the newer drugs are reputed (they're new so who really knows the truth here) to do a better job, with less side effects, fewer restrictions, and with better outcomes at what you're taking them for than the old, cheap,  stand-by. Since you take blood-thinners to prevent very serious (and very expensive to treat) disease-related complications  and the old drug has a significant risk of serious (and expensive to treat) drug side-effects, one would think that everyone in the system would be clamoring for the over-all cheapest course of action: the new drugs.

      Nope. Using the old drug means Medicare will get saddled with paying for any possibly-avoidable poorer-outcome costs AND any drug-related complications, while the private Part D insurer is still making money on the newer drug by limiting access, jacking up premiums and skimping on reimbursements for it. Who negotiated this foolish state?

      I know, I know, one more thing to chalk up to Shrub.

      A

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