Posted on 03/31/2019 3:57:38 AM PDT by Kaslin
Now that the Democrats got skunked on their plan to take down Trump with Russia they have pivoted along with their teammates on cable news to health care.
The people who work on governmental health policy quite often have not experienced having the insurance they regulate. Recently single-payer insurance (i.e. government operated and controlled medical insurance) has been recast with the cutesy name “Medicare for All.” As someone who recently became a Medicare-covered individual along with the Beautiful Wife (BW), let’s talk about reality.
As you know, Medicare is a program begun in 1966 to cover people 65 years of age and older. The program is to be paid through lifelong payroll tax payments akin to social security. Unlike social security, the benefits are not related to how much you have paid into the program. An important point to understand is (for most people) the vast majority of medical expenses are incurred near the end of one’s life. When the program was established, it was not anticipated that people would be living as long as they do. This has also driven up costs; i.e., keeping older people alive.
As an aside, Medicare covers for pre-existing conditions. 180 million people who are covered by corporation health insurance also are covered for pre-existing conditions as well as those covered by Medicaid. That is over 90% of Americans, so we can dispense with that canard. Some politicians want you to believe people are threatening to take away coverage for pre-existing conditions when that is just not true.
One thing you need to know is who must go on Medicare. If you have personal insurance or are covered by group insurance where the group is 20 or fewer people, you must go on Medicare. If you have coverage by a company and there are more than 20 people on the plan, you can opt out. More seniors are working past 65 years old and are opting out of portions of Medicare to remain covered by their employers. One reason is Obamacare outlawed reimbursement to the employees of any insurance paid by employees.
When you are young – except possibly those caring for an elderly parent - you probably don’t know how Medicare works. You think that if you have Medicare that covers you because you have been making payments into the program for 40 or more years, but nothing could be further from the truth. What you need to know is your “alphabet” to understand the different components.
There are four main elements to consider:
Part A – This is the free element. It covers your medically-necessary hospitalization. That is the only thing you get at no cost, somewhat. This has a co-pay of up to $1,364 annually in 2019.
Part B – This covers doctor fees and some outpatient services. This you pay for to Medicare. If you receive Social Security, the government deducts your insurance premiums from your monthly social security payments. Also, Part B benefits are income tested. That is why 12.4% of people opt out of this benefit and remain covered by their employers. The more money you make the higher your premiums, which start at $135.50 per month currently. Monthly premiums can go as high as $460.50. Part B has a co-pay of up to $185 annually in 2019.
Part D – This is for medications and the cost is all over the place. This insurance is paid for by you, not the government.
You get this insurance by going on a Medicare website, putting in your prescriptions and whether or not they are generics. The site generates for you a few options with monthly premiums and annual co-pays. Interestingly, the premiums for the BW were more than for me despite the fact she takes fewer regular prescriptions. That is because the BW takes hormone replacement, a common medication for women over a certain age. Thus, it appears Medicare discriminates against women by charging higher premiums because they don’t want to cover a vital medication for older women.
Plan F – This is a comprehensive supplement to Medicare which covers other things not covered by A and B and the co-pays for A and B. Ear cleanings and flu shots are two examples of what Part F covers. This supplemental policy is paid for directly by you.
Here are a few of our experiences so far. Yes, there is less paperwork. There are more cards to carry around – three since one covers both A and B. There is less cost as our insurance has gone down about $400 per month per person and our annual co-pays have been eliminated which were about $4,000 each. That is supposedly a savings of about $17,500 per year if we maxed our deductibles under our private plan. But that savings comes with 50 years of paying into a fund and we are still paying in because we are still working. Otherwise, if you remain working, payroll taxes are still collected and you are charged more for your Part B insurance.
The point is Medicare is far from free. Less paperwork and figuring out what is or isn’t covered notwithstanding, decisions still have to be made under Medicare unlike what has been stated by some politicians.
Our first occurrence with Medicare came with a shoulder surgery needed by the BW. Both shoulders needed fixing but only one could be done prior to her 65th birthday so the second was scheduled for after. The surgery was planned when we found out her friendly surgeon did not take Medicare. He would perform the surgery we presumed, but we would have to pay his fee out-of-pocket. California has a lot lower acceptance rate for doctors of Medicare.
We called our doctor referral source who is a non-practicing orthopedic surgeon. He knows almost every doctor in the area because he developed surgery centers and had a lot of docs as investors. He told me he stopped accepting Medicare years ago because the reimbursement rate did not warrant the financial and insurance risks of performing the surgery. He recommended two top flight doctors and we proceeded with one.
The BW went ahead with the surgery. The new doctor recommended a specialized procedure which would not be covered by Medicare, but for which we could pay out of pocket to the tune of $7,200. We decided with -- proper medical consultation -- that in her case it was not necessary. We had to go through that analysis and make sure we were not risking her health because we did not opt for that portion and whether we were just being frugal because Medicare did not cover for the procedure. For most that amount is not an option -- $7,200 is a lot of dough.
From our experience we can deduce some things. Medicare for All is a nice saying, but very misleading. First, Medicare comes with a cost or all and that would have to be factored in - it is not free for anyone despite all you paid into the fund. Second, it does not cover everything as some politicians lead you to believe. Third, if you want to keep your doctor, you may not be able to do so.
The truth is Medicare for All is just a ploy to further move us to government controlled and administered health care. I have been writing this point for years and wrote that Obamacare was just a step along the way. The Left continues making private insurance more and more difficult to administer and then belittles the insurance companies for their operations. There is one goal here: to have complete control over the health care system and then we will be at the lowest common denominator for the health care we receive.
As you have been told before, just look at the health care administered by the VA. The Trump administration has finally freed our veterans to see private care practitioners. Thank God. Please don’t make the rest of us suffer the fate of our veterans being covered by government-run insurance.
Good article, Kaslin...thanks for posting.
Thanks
Very good article but unfortunately, nobody will explain all of this to the idiots that want it. My husband has been on medicare for 25-years but I have supplemental insurance on him from my former employer (P&G). I retired at 58 and they provided good retiree insurance with a reasonable premium and deductible. I go on Medicare in October and will have Medicare Parts A&B plus my supplemental retiree insurance. The last thing I want is for government to eliminate the good health insurance I worked 40 years to have that fills in the blanks from Medicare.
That's not correct. Once you turn 65 you are enrolled in Medicare regardless of whether you have private insurance or not. What you can do is opt out of Medicare Part B if you have private insurance. Medicare is your secondary coverage and your private insurance is primary.
The exemptocrats who voted in a healthcare mandate that did not include them should be called out ddaily for their hypocrisy. As usual, the Republicans, who are also exempt are silent.
The first rebuttal to aocialism and the new green deal should be how the US leadership already exmpted themselves from obamacare and insuder trading.
Meducare for all is for everyone else.
They have clearly shown us, they are exempt. Classic socialism is not for the socialists.
He forgot to mention that ‘Medicaid’ covers every dime of Medicare and all healthcare costs for those that have never worked a day in their life.
Many illegals will wind up in that group and get free healthcare for life!
The ones that get screwed by ‘Medicare’ for all’ are the ones that have had to pay for it their whole life!
Bookmarking
We have Medicare Advantage through Aetna Coventry, the elite plan and couldn’t be happier.
I think they actually mean Medicaid for all. No way do they plan for their folks to make Medicare copayments, or pay for supplemental coverage.
Free medical care for all!
The total allowed Medicare "Paid in Full" price was well under $200, in both cases. That's not enough to even cover equipment usage and disinfecting costs, much less the rates of reimbursement for medical doctors with years of post-MD education. Doctors will simply refuse to work if 'Medicare for all' becomes law.
No, they really are that stupid, and ignorant. Trust me.
Supplement Plan F is no longer available to new applicants as if Jan 1, 2020. If you already have Plan F, it will continue for you, but be warned because there will be no new Plan F users, the premiums will go up faster because costs in that plan will be going up as the users get older and use the plan more and more. People new to Medicare (like me) are being pushed towards supplement Plan G which is very similar to F if you are interested in the Medigap plans instead of Medicare Advantage plans.
Wife and I have been on Medicare for years. Costs about $2,500/year combined taken out of social security so you don’t really feel the hit. Tricare for Life is secondary as well as covering drugs incredibly well. Never a problem with doctors not accepting. Likewise, couldn’t be happier. The only problem I’ve noticed is that I don’t think the doctors are paid enough but if they are happy so am I. Medicaid is another story.
2) The people who want medicare for all have not experienced being on Medicare, so they are completely unqualified to speak on the subject.
3. ALL government employees should be required to obtain Medicare insurance and not retain private coverage. Universal dog food should be consumed by all dogs.
no mention of medicare advantage
Medicare recipients have paid into the program for 40-50 years. Prepaid premiums if you will. “Medicare for All” would mean millions of people would be put on the government program without prepaying anything - or little.
The math and morality don’t add up. It would bankrupt the system and ruin healthcare for our children and grandkids.
Bankrupting the existing system IS the socialist objective.
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