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But it doesnt insure everyone.. ACA is nation wide as well.. Tax credits from the federal government..
ACA, Medicare, and Medicaid, all contract out to the private sector, often times to the very same insurance companies.. Why people would object to merging them is a mystery.
Not to mention we already are doing a version of this via the Medicare Advantage program where the govt pays a private company to be your medicare. Many people prefer it because of the better benefits despite the more narrow networks. In the future us younguns raised on HMOs will be going into the advantage programs without batting an eye.
Yes and from my mother's experience it is pure garbage. They denied coverage all the time and sent her the bill. The copays were just as high as Medicare's. They tried to deny coverage and kick her out of a nursing home on day 20 of her 100 days benefit period when she needed around the clock nursing care and physical therapy. Every couple weeks they tried to deny coverage. I was hassled to death by the private Medicare Advantage plan, and was fighting with them almost weekly. I was able to fight for 90 days of her 100 day benefit period. She was brought to a relative's home on a stretcher, that we paid up front for since the Medicare Advantage plan denies coverage. Put her back on original fee-for-service Medicare and it's been better and cost the Treasury less to boot.
I'm a conservative but to hell with neocons and their public money kick backs to the wealthy.
In fairness to the privately run Medicare Advantage plan they did have a lower copay for nursing home days 20-100 (although higher for days 0-20) and a maximum out of pocket. What they don't tell you is, they will try to constantly cut your coverage if you need more than 20 days. Funny thing is, that same Medicare Advantage plan instituted the same copay as original Medicare for days 20-100 the following coverage year, just before I switched my mom back to original Medicare. So they are a worse deal even on paper. As far as I know all the Medicare Advantage plans have raised their copays the last couple years, not to mention they deny coverage and hassle you.
Which, if you are old enough to remember, made health CARE costs reasonable.
One only needed insurance for hospital stays or chronic illness.
You didn't use insurance for normal doctor visits, tests or medications as they were affordable.
Look at the cosmetic surgery industry today. That is not covered by insurance.
They have to keep costs reasonable for people to pay out of pocket or they would all go out of business.
The USG has the "midas touch" when it comes to meddling in programs.
Look at healthcare, look at student loans, look at mortgages.
All have gotten out of reach for most Americans because the USG came in to "fix it".
While not old enough to personally recall, I do know the 5 year survival rate for most Cancer diagnosis has nearly doubled, comparing pre Medicare times and now. Back then, no one could imagine a geezer getting a heart transplant.
Medicare premiums ( taxes) have not changed in almost 30 years and did not keep pace with inflation and advances in medical technology and pharmacology.
Your plan B is Ireland. Mine is prison where I can get 3 hots and a cot and all the medical care I may need.
No two countries do universial healthcare the same. What they all have in common is substantially more government meddling in the cost than happens in the U.S. And as a result, healthcare costs less and insurance premiums or government sickness fund taxes are reasonable.
What one won't find in these other systems include but are not limited to:
Big pharm advertising and encouraging viewers/ listeners to ask their MD for drug ABC, by name
A Congress that repeatedly refuses to allow Medicare to negotiate the price of prescription meds
Valet parking and lattes at the hospital
Hospitals with $ multi- million art collections
Senior non MD hospital / healthcare system management making 7 figure salaries and incentive comp
As many admin people as front line healthcare providers
A $39 walker at Walmart priced at $390 at a medical supplier who bills Medicare
For profit hospitals owned by public shareholders
Not for profit hospitals making $ hundreds of millions in annual profits, each year.
Hospitals expanding their brands and either destroying or acquiring the competition.
Last edited by middle-aged mom; 07-23-2015 at 09:21 PM..
Yes and from my mother's experience it is pure garbage. They denied coverage all the time and sent her the bill. The copays were just as high as Medicare's. They tried to deny coverage and kick her out of a nursing home on day 20 of her 100 days benefit period when she need around the clock nursing care and physical therapy. Ever couple weeks they tried to deny coverage. I was hassled to death by the private Medicare advantage plan, and was fighting with them almost weekly.
Then file a complaint with IPRO. The co pays were 20% of the entire bill? Because that what they are under Medicare, hence the need for a medicare supplement plan when you have traditional medicare.
I have worked in nursing homes and seen problems with medicare payments as well, particularly if the patient wasn't progressing fast enough in PT. The main difference I found was the advantage programs told you upfront that the service would not be covered and you could decide what to do. Medicare didn't do that and you just got stuck with the bill. We would always have to tell patients/family there is a possibility that medicare won't pay for this and the families had to sign attestation of that fact with an agreement to pay for the facility's rate should medicare deny payment. Of course Medicare would claim that things would be covered if "medically necessary" but would never objectively define that statement. Unjfortunately many people got stuck with a large bill even under medicare.
But it doesnt insure everyone.. ACA is nation wide as well.. Tax credits from the federal government..
ACA, Medicare, and Medicaid, all contract out to the private sector, often times to the very same insurance companies.. Why people would object to merging them is a mystery.
Medicare contracts out record-keeping. But Medicare itself has 3 options.
Should you sign up for Original Medicare only, it pays 80% of approved amounts and you pay the remaining 20% (plus deductibles). No insurance company is involved. Obviously that can get expensive tor severe medical problems.
The 2nd option is supplemental insurance that pays the 20% that Medicare does not pay. Some employers offer supplemental insurance for their retirees, it (Medigap) also can be purchased thru private health insurance companies and is highly regulated by Medicare.
The 3rd option are the Advantage plans offered by private health insurance companies. Although regulated by Medicare, some of the plans are nothing more than scams and are essentially worthless (thinking of those plans pushed by AARP). But there are good Advantage plans around, you just have to do careful research re them.
While not old enough to personally recall, I do know the 5 year survival rate for most Cancer diagnosis has nearly doubled, comparing pre Medicare times and now. Back then, no one could imagine a geezer getting a heart transplant.
Medicare premiums ( taxes) have not changed in almost 30 years and did not keep pace with inflation and advances in medical technology and pharmacology.
Your plan B is Ireland. Mine is prison where I can get 3 hots and a cot and all the medical care I may need.
It seems I'm not alone with that "plan B".
My brother used the paperwork to apply for his Irish passport.
Submitted the paperwork last December.
Just got notified this week that he's in "stage 2" of 6 stages to get his Irish passport because the backlog is so great.
But stage 2 means that everything he submitted met muster. I had to get the long form of various birth/death/marriage certs from several states and Ireland.
Here we go again. Jeb! is pushing Paul Ryan's idea of phasing out Medicare and instituting a voucher program which seniors would use to purchase private healthcare, citing his belief that without vouchers seniors in the future would "have nothing."
But his gloom and doom view of the health of Medicare is not reflected by program's trustees, who yesterday issued a report that the program was solvent at least through 2030, citing the passage of the ACA as one of the factors in strengthening the the program. Before the ACA, Medicare was projected to face a serious fiscal shortfall in 2017.
"Ten years ago, Medicare was a runaway freight train. Spending was projected to increase indefinitely, rising to 13 percent of GDP by 2080. This year, spending is projected to slow down around 2040, and reaches only 6 percent of GDP by 2090. Six percent. That's half what we thought a mere decade ago."
Medicare contracts out record-keeping. But Medicare itself has 3 options.
Should you sign up for Original Medicare only, it pays 80% of approved amounts and you pay the remaining 20% (plus deductibles). No insurance company is involved. Obviously that can get expensive tor severe medical problems.
The 2nd option is supplemental insurance that pays the 20% that Medicare does not pay. Some employers offer supplemental insurance for their retirees, it (Medigap) also can be purchased thru private health insurance companies and is highly regulated by Medicare.
The 3rd option are the Advantage plans offered by private health insurance companies. Although regulated by Medicare, some of the plans are nothing more than scams and are essentially worthless (thinking of those plans pushed by AARP). But there are good Advantage plans around, you just have to do careful research re them.
Actually insurance companies are completely involved. Medicare pays insurance companies a flat rate, and then the insurance companies process the claims. They hope after all the claims are paid there is a profit left, and it allows Medicare to budget because they get a flat rate billed.
Medicare sends out RFP's every few years, broken out by regions, and they contract out everything from claims, to even the call centers to the private sector.
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