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In any case, comparing the medigap coverage for doctors' office visits- seems that many of the docs here ( including my mothers' primary doc) will accept the BC medigap Plans B and D, which put the patient payment responsibility at paying the difference between the 80%(Medicare) plus 20%(medigap) payment to total the Medicare allowed amount, and the actual amount charged for the visit or service. ......and if it is, I can see why docs might accept Medicare patients with these medigap plans, but maybe not patients with medigap plans F and G, in which patients aren't responsible for the difference in the total charges to Medicare and the amounts reimbursed.
No, that isn't the way it works.
Physicians can charge and collect more than the Medicare-approved amount depending on their Medicare provider status. Provider status is not determined by patient's Medigap plan.
What these docs can charge and get paid depends on whether or not they:
Accept Medicare assignment (patient/Medigap pays only 20% of Medicare-approved charge), or are
Non-Participating Providers (patient/Medigap pays only 20% of Medicare-approved charge, plus 15% excess charge), or have
Opted out of Medicare (Medicare/Medigap reimburse patient their allowed charges, patient responsible to doctor for difference, including excess charges, without limit).
All Medigaps pay only the 20% of Medicare-approved charge or, where applicable, the 15% excess charge over and above the Medicare approved charge.
Plans A-D and K-N do NOT cover the 15% excess charge, which means if you are on one of those plans, and you see a physician who accepts Medicare reimbursement but not assignment, you are not responsible for the 20% (the Medigap pays that 20%), but you are responsible for the excess charge. - and possibly more.
No Medigap will pay more than the 20% of the allowed Medicare charge, plus the 15% excess (limiting) charge where allowed. Anything over and above those amounts is all on the patient. - unless your state has specific rules forcing Medigaps to pay over the 15% limiting charge. (I think not.)
You best put your Mom on a Plan G - community-rated. If she's not traveling overseas, she doesn't need Plan F.
Quote:
Originally Posted by Larry Caldwell
The economics of Medicare are not universal. For instance, I live in Oregon, and Medicare only pays the docs 70% of what Medicare pays to docs in Florida. Chalk one up for lobbyists. Reimbursement for an office visit is only $35, out of which the doc has to pay for the office, bookkeeping and nurses. Patients with no supplemental insurance can't afford it, which means he won't get paid for the patient portion either. The same applies to any treatments he provides. The bottom line is that, if the patient doesn't have supplemental insurance, the doc has to pay for their care out of his own pocket. Some docs do that, and none of them will refuse to treat long term patients, but quite a few just refuse to take new Medicare patients unless they also have supplemental insurance. He can't even send it to collections, because it's illegal to attach SS, pensions or IRA/401k accounts.
Is the 20% that unaffordable?? Usually those amounts are minuscule.
Quote:
Originally Posted by Ghostly1
It certainly helps that there are limits to what you can be charged for physician services - 20% of the Medicare approved amount if the doctor accepts assignment, 40% if they don't.
The Medicare limiting charge is 15% over and above the Medicare-approved rate. So, patient conceivably could be responsible for the 20%, plus the 15% excess - assuming the doctor has not opted out of Medicare completely, in which case he can charge anything.
Last edited by Ariadne22; 12-01-2013 at 10:48 PM..
And of course, none of those private sector employees had the option to go to work for any of the government entities they're now complaining about, did they? But they do seem to reserve the right to engage in pension envy when they suddenly find that they can't retire comfortably.
Talk about turning one group against the other.
PS. Not all government employees/retirees are federal.
Its a mythology to argue that everyone had the same opportunity that a 60 to 65 year old person had to go to work for the government.
There were abundant opportunities available to take one of these positions in the 1960's and early 1970's. Since that time government employment has become incredibly scarce and competitive. I remember in 1980, taking a civil service examination and scoring in the 95th percentile. Than I learned that even with a score like this and considerable work experience there were simply no opportunities for someone like myself who was young and had not served in the military.
As it turned out, I think working for myself ultimately was a much better deal. I doubt that DW and I would own two homes and other assets if I had worked for the government. However, I do see many people around me in my age group and younger that are suffering precisely because the kind of opportunities that were available in the 1960's and 1970's are not available today. It is wrong to insist that everyone had an equal shot.
Pension envy? Yes, it does exist. Its ok to ignore it from people like me, who had other choices and simply chose to make them. However, t is the equivalent of "let them eat cake" when you voice these attitudes towards those who have far more qualifications than you had and can't land a government job at any rating or level. Yes, those people exist and they exist today in droves.
I analogize many of you federal workers and retirees to a wealthy group living on a little island out in the middle of a lagoon. Surrounding you on all sides are not the lazy and selfish, but millions of those who largely due to timing didn't get the opportunity to hold a government job. They increasingly have less and less and many of them still have to pay taxes to contribute to your pensions and medical care. The more they observe the more restless they become. Ultimately, the price will be paid by younger employees who will be denied the benefits you have because those without those benefits are unwilling to fund them anymore. The whole thing will likely come crashing down at some point. Maybe it will be after you have died, maybe it will be before.
What could you do if you wanted to be responsible? First of all, agree to take on the entire burden of paying for your pension and your medical care. Let that be paid from your salaries instead of claiming any portion of general tax revenues. Second, accept the fact that at least part of the reason you are where you are has to do with timing and luck--in addition to any skills you may possess. Third, all of you don't gloat over your situation. However, many do and I see them on this forum and elsewhere. One example would be boasting about being able to retire by age 55. Virtually, no one is not a government employee can do that. Stop the gloating and use a little humility and discretion.
Location: We_tside PNW (Columbia Gorge) / CO / SA TX / Thailand
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ACA will have a profound effect on the USA healthcare availability and access (Probably LESS can afford and will have access in the long run). Retirees included.
I have gone through 3 primary care providers this yr, and I am with a very stable HMO. The DR's are just quitting due to additional regs and requirements. No longer able to be 'care-providing Dr's with a conscience, but now driven by statistically measureable 'deliverables' just as many of us have been our entire career.
The allotted 'face' time per patient is below 10 minutes, with similar for paperwork / insurance reporting. The GOV will compound that requirement.
re: OT 'pension envy'... is more like "Pension ROBBERY", There are more than a few of us (millions) who worked 30+ yr careers at excellent private employers who had superb benefit and pension and healthcare. Yet corporate raiders, sleezy CEO's and board of directors, Yr 2000 tech crash, yr 2008 financial crisis and MANY pension plans got axed or sent to PBGC (who is running a few billion in deficits...Pension Benefit Guaranty Corp. running $34 billion deficit - Washington Post
This all happened very fast for the most part and sent many into 're-planning' at retirement age.
Should be interesting scenarios for all, but not the posh double income FED, STATE, & Teachers Pensions.
thus we have a new class (75%) 'Working THROUGH retirement'. Not new to all. ALL my predecessors were farmers or self employed and worked well into their 80's and 90's, then they croaked, or were injured on the job and went into a Care center to spend their savings till broke and put spouse on the street, then onto state aid.
I believe corporate America needs to give up its outrageous compensation packages and off-shoring, bring work back to America, pay a living wage, not break its pension promises, and lie and cheat its way through its employees.
In other words - be capitalists with a conscience. An oxymoron, these days, for sure.
When I began work in the late 50's, I could have had a government job - city, county, state, federal - I could have had one. No problem. I could have even had one - a good one - in the mid-80's. Was offered and refused. Biggest mistake I ever made.
Why didn't I do it??? Because the private sector paid waaay better - at the time - and I was all about money now - not later. So, that's where I stayed. Never dreamed my rich, prestigious employer would even consider reneging on its pension promise. They had NO financial reason for this - and a complete disinterest in the effect on its older employees.
It was only in the last fifteen years of my working life - beginning in the 90s- that the private sector was no longer a better place to work. I was, at the age of 51, the victim of corporate greed - employer froze its defined benefit plan, didn't grandfather in the older employees. Essentially my retirement benefit was permanently reduced 75%. My retirement benefit today (without a COLA) - after 26 years of work - and not in a flunky job, either - barely pays for groceries and utilities.
Nope - I believe the outrage and demand for change needs to be addressed to the private sector - which, as far as I can see, does NOT do things better than the government. One of many cases in point - Medicare Advantage plans - refusing to pay mandated Medicare benefits any chance they get. I've been a minor recipient of that disregard, thanks to UnitedHealthcare, along with:
Our county tried outsourcing to the private sector various county jobs. Workers were so poorly paid, so was the work, and the county took those jobs back.
Most government workers are not overpaid. The early retirements - back in the day when my dad and uncle - federal and city employees - were offered this - the pensions were so teeny, they couldn't consider it. Although my dad's widow did have health insurance for life after his death.
No. The problem is with corporate America. Period.
Last edited by Ariadne22; 12-01-2013 at 11:54 PM..
<snip> No. The problem is with corporate America. Period.
There is no doubt there is a problem with corporate America. But there is also a huge problem with federal salaries and benefits. Mark's analogy is spot on, more so than he probably imagined.
I have worked in the federal, state and private sectors. The federal workforce is so out of touch with the "real world" that it is impossible to adequately describe the federal employees' sense of entitlement. I found the disconnect between the federal workplace and the private workplace to be breathtaking. For example, as a salaried employee in the private sector, I was expected to put in 40+ hours, as needed, without overtime pay, bonuses or even compensatory time. Not so when I was employed by the feds. I had to sneak into the building during the weekends to work on cases because by law, federal employees must be compensated for any time worked beyond the usual work week hours.
I also had the "pleasure" of editing legal documents submitted by paralegals and secretaries that included incomplete sentences. I can deal with typos, but incomplete sentences in a legal document? The best and/or brightest? Hardly. Grossly overcompensated? You betcha. See,
Ah, I don't want to forget the mandatory meeting with the Asst. Commissioner. Imagine my surprise when we were treated to a video portraying federal government employees as "exceptional". The clip ended with with a federal employee singing a rousing Star Spangled Banner. After the "meeting", I confirmed that these types of meetings were not unusual. It was then that I realized that lifetime federal employees had this "exceptional" nonsense drilled into their heads throughout their entire career. (This is why I do not normally respond to the government/private sector discussions. You can't change the mind of someone who has been brainwashed for umpteen years.)
I could go on... but I think you catch my drift.
At the end of the day, government employees are in the same boat as private sector employees. When the employer can no longer afford to pay the promised wages or benefits, the axe falls.
Its a mythology to argue that everyone had the same opportunity that a 60 to 65 year old person had to go to work for the government.
There were abundant opportunities available to take one of these positions in the 1960's and early 1970's. Since that time government employment has become incredibly scarce and competitive. I remember in 1980, taking a civil service examination and scoring in the 95th percentile. Than I learned that even with a score like this and considerable work experience there were simply no opportunities for someone like myself who was young and had not served in the military.
As it turned out, I think working for myself ultimately was a much better deal. I doubt that DW and I would own two homes and other assets if I had worked for the government. However, I do see many people around me in my age group and younger that are suffering precisely because the kind of opportunities that were available in the 1960's and 1970's are not available today. It is wrong to insist that everyone had an equal shot.
Pension envy? Yes, it does exist. Its ok to ignore it from people like me, who had other choices and simply chose to make them. However, t is the equivalent of "let them eat cake" when you voice these attitudes towards those who have far more qualifications than you had and can't land a government job at any rating or level. Yes, those people exist and they exist today in droves.
I analogize many of you federal workers and retirees to a wealthy group living on a little island out in the middle of a lagoon. Surrounding you on all sides are not the lazy and selfish, but millions of those who largely due to timing didn't get the opportunity to hold a government job. They increasingly have less and less and many of them still have to pay taxes to contribute to your pensions and medical care. The more they observe the more restless they become. Ultimately, the price will be paid by younger employees who will be denied the benefits you have because those without those benefits are unwilling to fund them anymore. The whole thing will likely come crashing down at some point. Maybe it will be after you have died, maybe it will be before.
What could you do if you wanted to be responsible? First of all, agree to take on the entire burden of paying for your pension and your medical care. Let that be paid from your salaries instead of claiming any portion of general tax revenues. Second, accept the fact that at least part of the reason you are where you are has to do with timing and luck--in addition to any skills you may possess. Third, all of you don't gloat over your situation. However, many do and I see them on this forum and elsewhere. One example would be boasting about being able to retire by age 55. Virtually, no one is not a government employee can do that. Stop the gloating and use a little humility and discretion.
One of our sons-in-law managed to go to work two years ago for the same state from which my wife and I retired so I'd say that with the necessary education and certification (he's an engineer) it's still possible. You might have to get some tickets punched in the process, however. And for the record, I didn't start work for the state until 1981 and my wife until 1985; a far cry from the 60s or 70s.
Since we're not federal retirees we don't live on your analogous island. We do, however, live next to water. I only know one other retired neighbor who worked for government. All the rest retired from the private sector.
Timing? Perhaps. Luck? Maybe a little. Whether you think so or not, and you really don't know, the rest of it just might have been education, experience and skill. And being "selfish," we accepted lower wages than available elsewhere in exchange for good benefits both while working and in retirement. We also paid taxes to help support them as well as significant amounts every month in premiums and pension costs. It would not be at all responsible for us to turn back the clock and pay every penny on our lower civil service salaries, anymore than it would be for us to undo those thing we did to benefit the citizens of our former state. It's call civil service for a reason. And by the way, I didn't retire until age 62, not 55. My wife had to retire earlier for medical reasons.
As for the rest, you're simply wrong. As with any occupation, profession or career, if you have goals and you work hard enough to achieve them, you stand a good chance of being successful, even in this day-and-age. But as my wife had to do, you just might have to start at the bottom and work your way up.
Speaking of benefits and getting back on topic, thankfully we retired with medical benefits years before the ACA. While we're theoretically "protected" from the Act's vicissitudes, there's no guarantee that this won't change some time in the future. While it wasn't around to have any impact on our retirement decisions at the time, it's entirely possible that it could negatively affect us later when the "Cadillac" benefit provision hits our former employer in 2018. Only time will tell.
One of our sons-in-law managed to go to work two years ago for the same state from which my wife and I retired so I'd say that with the necessary education and certification (he's an engineer) it's still possible. You might have to get some tickets punched in the process, however. And for the record, I didn't start work for the state until 1981 and my wife until 1985; a far cry from the 60s or 70s.
Since we're not federal retirees we don't live on your analogous island. We do, however, live next to water. I only know one other retired neighbor who worked for government. All the rest retired from the private sector.
Timing? Perhaps. Luck? Maybe a little. Whether you think so or not, and you really don't know, the rest of it just might have been education, experience and skill. And being "selfish," we accepted lower wages than available elsewhere in exchange for good benefits both while working and in retirement. We also paid taxes to help support them as well as significant amounts every month in premiums and pension costs. It would not be at all responsible for us to turn back the clock and pay every penny on our lower civil service salaries, anymore than it would be for us to undo those thing we did to benefit the citizens of our former state. It's call civil service for a reason. And by the way, I didn't retire until age 62, not 55. My wife had to retire earlier for medical reasons.
As for the rest, you're simply wrong. As with any occupation, profession or career, if you have goals and you work hard enough to achieve them, you stand a good chance of being successful, even in this day-and-age. But as my wife had to do, you just might have to start at the bottom and work your way up.
Speaking of benefits and getting back on topic, thankfully we retired with medical benefits years before the ACA. While we're theoretically "protected" from the Act's vicissitudes, there's no guarantee that this won't change some time in the future. While it wasn't around to have any impact on our retirement decisions at the time, it's entirely possible that it could negatively affect us later when the "Cadillac" benefit provision hits our former employer in 2018. Only time will tell.
I appreciate your reply and I'm sure you believe everything you say.
However, the first part is what caught my attention. Your son-in-law who is an engineer managed to find federal employment. Obtaining a degree in engineering requires an ability in math that is simply beyond at least 90% of the population. I learned that the hard way when my son was forced to drop out of engineering because of difficulties with the calculus classes. Prior to that, he had been an A student in Math in High School and even completed college Algebra there.
I mentioned my 95th percentile score on the civil service exam simply to make the point that if I couldn't find a job than that meant at least 19 out of every 20 people who applied for employment with the federal government were denied employment.
Everyone can't do it. In fact, half the people can't do it. Realistically, maybe one in every 20 people can do it. That creates a system of salaries and benefits that the vast majority of the country is locked out of but still has to subsidize through tax revenues.
There was a huge amount of luck and timing involved for those who secured federal employment back in the 60's and the 70's. Admitting that that is a key factor in one's success in life is a critical starting point in a reasonable discussion about what benefits federal employees should expect the tax paying public to give them.
Not so when I was employed by the feds. I had to sneak into the building during the weekends to work on cases because by law, federal employees must be compensated for any time worked beyond the usual work week hours.
At the end of the day, government employees are in the same boat as private sector employees. When the employer can no longer afford to pay the promised wages or benefits, the axe falls.
You've made my points better than I could.
Think Walmart on labor exploitation and forcing people to work off the clock. It's against labor laws.
Employer (all of us) can no longer afford to pay promised wages and benefits primarily BECAUSE our employers' (US capitalism) have off-shored our jobs, cheated people out of their jobs and pensions. and are paying 1970s wages.
It all begins with corporate America - and good ol' Ronnie Reagan and accelerated under Bill Clinton and NAFTA. Ross Perot had it right - "that giant sucking sound." The 80's were the worst decade of my life, 90's and thereafter only treading water. 70's were the best. I'm still waaaay better off than most - because of when I was born.
Nonetheless...it all boils down to corporate greed.
Last edited by Ariadne22; 12-02-2013 at 12:38 PM..
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