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Old 04-15-2017, 05:48 AM
 
14,221 posts, read 6,936,764 times
Reputation: 6059

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Quote:
Originally Posted by TwoByFour View Post
Yes, we are responsible for our brother. I have no problem with Obamacare or single payer. But the fact is people have shown a tendency to overuse health care services when it is free. Like getting a cold - you can do what everyone has done for 100s if not 1000s of years - be patient, read a book, blow your nose and it'll be gone in a few days. But with all-you-can eat insurance, people run to the doctor who prescribes useless antibiotics. That is pigging out.

This is not my idea, this comes from analysts who have looked at why US health care costs so much. It is why Obamacare had built-in copays and co-insurance, so people would feel some financial responsibility for the choices they make. If people are allowed to consume as much as they want for free, they will. And someone has to pay for that and that ends up being all of us.
There is a huge difference between a $10 co-pay or similar for a doctor's appointment to discourage unnecessary visits and thousands of dollars in out of pocket costs for vision, hearing, dental etc etc. Thats just bad policy.

Ideally, no senior in America should have more than $500 a year in maximum health care costs (dental, vision, prescription drugs, cancer treatment etc etc). Its perfectly possible if we fight for it.
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Old 04-15-2017, 06:21 AM
 
Location: Greenville, SC
6,219 posts, read 5,920,243 times
Reputation: 12160
Quote:
Originally Posted by TMKSarah View Post
So if one beats the crap out of the other, does the other have to get a diagnosis of such like a personality disorder to get marital counselling paid for. Sounds like a chicken and the egg concept. But then again, if the other thinks marital counseling is going to do much good for their marriage, since the one thinks marital compromise means beating the crap out of the other to get their way.....well.
If there is domestic violence, the perpetrator will be required to go through a state-mandated psychoeducational program before the couple will be ready to work together on their relationship. This is typically a 6 month to 1 year program (I spent six years running three state-approved offender groups each week at an agency). Some of these guys finished the program then came back with their spouses to work on their relationships (to answer the question, yes, we had groups for female domestic violence offenders, too). In most cases they had diagnoses that qualified as "medically necessary" -- sometimes multiple diagnoses. In those cases they would probably qualify for insurance coverage -- and many agencies also offer income-based sliding scales for those who don't have insurance coverage.

Quote:
So how does the one actually get a diagnosis if the other chooses not to be medically diagnosed.

Just thinking out loud.
For couples work, they pay out of pocket. Many providers offer a sliding scale for non-insurance patients. Those who don't take insurance often set their rates low enough so they are competitive with the copays a patient would have to pay with insurance.
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Old 04-15-2017, 06:26 AM
 
Location: Greenville, SC
6,219 posts, read 5,920,243 times
Reputation: 12160
Quote:
Originally Posted by gentlearts View Post
Ok, here is what I have learned...you get what you pay for.

DH and I spent a few years with Advantage plans. This is free, but it is like selling your soul to the devil. I went for physical therapy once and was told it was only by mistake that they accepted my plan, " because they weren't getting paid anything."

My advise is to pay for Medicare supplements, D and F. If you don't get it now, you may not be eligible later. Just because you are healthy now, does not mean you will be later. If you try to get a supplement after you have a chronic or expensive illness, you can be rejected.
That's also my conclusion -- but people signing up for supplements (MediGap) should compare the plans; there are alternatives to Part F, which can be less expensive. For example, both G and N have a $183 yearly deductible, N also has a copay and G doesn't. Both have a lower monthly rate than F plans. It looks like whether G or N would be better for someone depends on how many average doctors' visits they have in a year. Also, out of network coverage can differ from plan to plan.
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Old 04-15-2017, 09:28 AM
 
Location: Coastal Georgia
50,178 posts, read 63,636,357 times
Reputation: 92924
Quote:
Originally Posted by Vasily View Post
That's also my conclusion -- but people signing up for supplements (MediGap) should compare the plans; there are alternatives to Part F, which can be less expensive. For example, both G and N have a $183 yearly deductible, N also has a copay and G doesn't. Both have a lower monthly rate than F plans. It looks like whether G or N would be better for someone depends on how many average doctors' visits they have in a year. Also, out of network coverage can differ from plan to plan.
Sure, it's not one size fits all. We did the math and over two years we spent more on copays and deductibles with a free Advantange plan than we do by paying for F and D, even though we pay $22.@ for D and $111.@ for F. The payoff will be if we avoid huge medical expenses in the future.
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Old 04-15-2017, 09:39 AM
 
106,244 posts, read 108,257,613 times
Reputation: 79786
with advantage plans from what i have seen , nothing is a problem until it is a problem .then it can be a big problem .

my co-worger bragged about how little his advantage plan costs . then his wife got breast cancer and needed chemo near years end . he got whacked with 2 huge 4500 dollar out of pockets back to back .

then he had trouble with rehab payments for another issue . not all advantage plans are bad , kaiser has some decent ones but not in ny , most of the others we looked in to were not that good .


we have other friends who had been fighting with their advantage plan insurer for months .

one of them has thyroid cancer . the review board at the insurer wants to pay for only removal of half the gland . the doctors are arguing that it has to totally go because the other half will likely be infected too . the insurer says they rather the patient under goes a 2nd surgery when needed .

like any private hmo , things can be a negotiation .
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Old 04-15-2017, 09:39 AM
 
Location: SoCal
20,160 posts, read 12,713,073 times
Reputation: 16993
Quote:
Originally Posted by PCALMike View Post
There is a huge difference between a $10 co-pay or similar for a doctor's appointment to discourage unnecessary visits and thousands of dollars in out of pocket costs for vision, hearing, dental etc etc. Thats just bad policy.

Ideally, no senior in America should have more than $500 a year in maximum health care costs (dental, vision, prescription drugs, cancer treatment etc etc). Its perfectly possible if we fight for it.
Hmm, no. Even in the U.K., you have to pay for dental and vision.
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Old 04-15-2017, 12:43 PM
 
Location: Wisconsin
25,591 posts, read 56,367,459 times
Reputation: 23297
Quote:
Originally Posted by mathjak107 View Post
with advantage plans from what i have seen , nothing is a problem until it is a problem .then it can be a big problem .

my co-worger bragged about how little his advantage plan costs . then his wife got breast cancer and needed chemo near years end . he got whacked with 2 huge 4500 dollar out of pockets back to back .

then he had trouble with rehab payments for another issue . not all advantage plans are bad , kaiser has some decent ones but not in ny , most of the others we looked in to were not that good .

we have other friends who had been fighting with their advantage plan insurer for months .

one of them has thyroid cancer . the review board at the insurer wants to pay for only removal of half the gland . the doctors are arguing that it has to totally go because the other half will likely be infected too . the insurer says they rather the patient under goes a 2nd surgery when needed .
Yes, the oversight and out-of-pockets can be killers with MA's.

If these people are NY'ers, have either of these people looked into buying a Medigap? Not sure they can disenroll in an Advantage plan mid-year but, in NY, Medigap insurers have to take them regardless of health condition. Any other non-GI state, they would be pretty much out of luck on getting a Medigap.
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Old 04-15-2017, 12:53 PM
 
Location: Central IL
20,726 posts, read 16,287,003 times
Reputation: 50370
Quote:
Originally Posted by TwoByFour View Post
Why do you think insurance is obligated to pay for vision and hearing? There are two schools of thought on this - medical insurance should be more like car insurance which does not pay for car maintenance, or, insurance should pay for everything in which case it is not insurance at all but free medical care.

Personally I think people should bear some responsibility for health care. Otherwise they tend to pig out and pigging out is one major reason why healthcare expense is out of control in the USA. I don't have a problem with vision and hearing being a personal responsibility. Neither one is going to be a financial catastrophe for anyone.
The concept of car maintenance is that if you spend small amounts steadily that will prevent larger issues down the road...things in healthcare are switched around - insurance pays for the cheap preventative measures and then, especially for vision and dental you pay much MORE than the "maintenance cost" for things like glasses and root canals/crowns - you pay all or at least 50%.
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Old 04-15-2017, 01:02 PM
 
106,244 posts, read 108,257,613 times
Reputation: 79786
Quote:
Originally Posted by Ariadne22 View Post
Yes, the oversight and out-of-pockets can be killers with MA's.

If these people are NY'ers, have either of these people looked into buying a Medigap? Not sure they can disenroll in an Advantage plan mid-year but, in NY, Medigap insurers have to take them regardless of health condition. Any other non-GI state, they would be pretty much out of luck on getting a Medigap.
yep , you are correct , that is what they did during open enrollment
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Old 04-16-2017, 12:13 PM
 
Location: SW Florida
14,891 posts, read 12,052,980 times
Reputation: 24682
Quote:
Originally Posted by Escort Rider View Post
Isn't dental care the wild card in all this?

Since Medicare doesn't cover dental care, most people have to either just pay their dental out of pocket or purchase some sort of dental insurance on their own which is likely to have yearly limits which will be exceeded considerably by one single implant. Plus the amount of dental work a person is going to need in a year is wildly variable. We can go several years with only the two cleanings per year and then WHAM, we need a root canal and a crown the next year, if not an implant to boot.

Of course the idea is to average the cost over time. But that is terribly difficult because how do we even know what the cost will be for say, ten years so we can divide by ten?

I am 73 and have had two implants so far. I have no idea whether that is excessive for my age, about normal, or whether a lot of people have had more than that. Perhaps that information is available somewhere, but I certainly don't have it. But even if we had that information, how does it help us if we depart considerably from the norm?
I think you've got good points there. From what I've seen when I looked for individual dental plans after retirement, my impression was that the independent plans had fairly low annual limits for coverage, and wouldn't go far if at all for covering things like bridges, implants, or even crowns. We're eleigible for the dental plans offered for federal employees (my husband is a federal retiree) and some of those are pretty good- there's one I noted with BC/BS that had a maximum coverage amount of $15,000 annually, through a high option policy for about $100 and change monthly for self plus one coverage. That's the best one I've seen. Most of the others are much lower in their annual limits. I'd figure that most retirees have access to policies that don't offer that much coverage, so even with most dental insurance, expenses beyond the annual limits come out of retirees'pockets and can add up to a pretty penny

But, with dental insurance, we've gambled that we won't need all that expensive dental work and paying premiums for coverage we assume we won't use. So we pay out of pocket for dental work, and you're right, there's no predicting what will come up.
I'm still debating with my husband about getting that dental coverage during the next open season, but it's not settled either way at this point.
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