Ah...The 'Crisis' Continues.......

[Dan40]

Originally Posted by Scott S

Ex...

If Medicare is good why does my my 75 year old mother pay $310 a month out of pocket to cover what Medicare won't?

As a small business employer I have pretty much had it with shilling insurance for anybody! Being the middleman for insurance companies sucks, I am a fantastic logger, let me do what I do best and find a way to get coverage for anybody who WANTS it.

My plan is simple, a 3% payroll deduction for everybody, no income ceiling...

A *copay for every medical procedure of 10% of your bodywieght, double if you smoke. No exceptions, if you got skin you got to put some of it in the game. To get care beyond a bandaid or Kotex for any injury you gotta double triple prove you are a legal US citizen.

*children excluded..

Any questions?

Scott S

What is the $310. per month for?
A Medicare Supplement policy?
OR
Prescription drug costs?
OR
Her co-pay?

I spent many years in the health insurance business. Had an agency with over 100 agents in a number of states. Personally made over $100K yearly from Med-Sup. sales. Only sold them because people are completely convinced they MUST have a supplement. I lead off EVERY sale with the statement, "You DO NOT need a Medicare Supplement."
Can you imagine having a Supplemental policy to cover what your major medical policy doesn't? Assume your MM policy covers you 80/20.
You visit the Doc. Office visit is $100., you pay $20, your policy pays $80.
Would you buy an extra policy at over $100 per month to cover that $20.?
If a Medicare beneficiary was in the same office on that same day, seeing the same Doc, the Medicare APPROVED amount for an office visit would be $38. to $42. Call it $42. Medicare pays 80%, the patient OR their supplement pay 20%. EIGHT DOLLARS AND FORTY CENTS. The remaining $58. of the normal office visit charge VANISHES.
IF your Mother is racking up $1550 in Medicare APPROVED Doctor calls per month, she would be paying the same $310. per month with no insurance. If she sees Docs at a rate of less than $1550 per month, the insurance is only giving her 'peace of mind' at a high cost. IF the $310. is for a supplement. I don't have a supplement, my wife doesn't have a supplement, they are a waste of money.
If the $310 is for drugs, then THAT is and has been the real GAP in Medicare. Medicare did not cover drugs [except in hospital stays at all. PART D was the Government solution for the drug GAP. It is terrible.
The insurance companies that offer it are all but unregulated. They can ONLY carry drugs THEY choose to carry. If a certain brand name drug costs them too much one year, the next year they DROP it off their formulary.
A simple fact of insurance, insurance MUST take in more money than it pays out from all but a few. You carry a major medical policy to protect you and yours from a catastrophic medical cost. Under Medicare, there are no catastrophic costs. Ref: My wife's $80,000 Plus hospital stay above. Our cost with Medicare alone, $1068. Had her hospital stay cost $750,000. or a million or two, our cost would still have been $1068. The lowest priced supplement in our area would be $130 per month EACH. $130X12=$1560 to cover $1068. Plus another $1560 to cover my $0 cost.

[427sharpe]

Originally Posted by Excaliber

Well at least it's a plan Scott!

...I have no idea why your Momma has to pay $300 a month, sounds outrageous to me. I think we should start billing 427sharpe for some of that!

Thats the problem with you socialists...you always run out of other peoples money!

[cobra de capell]

Originally Posted by Scott S

Ex...

If Medicare is good why does my my 75 year old mother pay $310 a month out of pocket to cover what Medicare won't?

As a small business employer I have pretty much had it with shilling insurance for anybody! Being the middleman for insurance companies sucks, I am a fantastic logger, let me do what I do best and find a way to get coverage for anybody who WANTS it.

My plan is simple, a 3% payroll deduction for everybody, no income ceiling...

A *copay for every medical procedure of 10% of your bodywieght, double if you smoke. No exceptions, if you got skin you got to put some of it in the game. To get care beyond a bandaid or Kotex for any injury you gotta double triple prove you are a legal US citizen.

*children excluded..

Any questions?

Scott S

I’m just curious, why does she? Does it cover prescriptions or services? Does she have a supplemental plan to cover those services that Medicare doesn’t pay for 100% and a prescription plan as well?

A supplemental plan, along with a prescription plan run about $135 per month and, with those plans, there is normally no or very little out of pocket expense.

Of course, if ObamaCare is actually passed – MediCare either will end up not being taken for payment by doctors or services will be unavailable as part of MediCare, e.g. either rationed or simply not offered period. Why? Payments to doctors/hospitals will be reduced by $500 Billion to help pay for a public option under ObamaCare.

It's important, for you and your Grandma, that ObamaCare be defeated.

[Excaliber]

And if SOME KIND of health care reform is NOT passed we ignite the fuse on a financial time bomb. Do nothing, it will blow up, thats why it's so important to get reform passed to help Scott's Mother.

[BeanCounter]

Ernie,

Please discuss in some detail this financial time bomb that you see looming. Instead of throwing around tired old cliches and fear mongering why don't you tell us the particulars of this problem. How much? And try to spell it correctly.

[Excaliber]

No need to worry about the money, just like Social Security everything will be fine. It's OK to go back to sleep now...

[cobra de capell]

Originally Posted by BeanCounter

Ernie,

Please discuss in some detail this financial time bomb that you see looming. Instead of throwing around tired old cliches and fear mongering why don't you tell us the particulars of this problem. How much? And try to spell it correctly.

Notice that Ernie avoided any details relating to the financial time bomb - he's famous for that here.

Actually, MediCare is headed for BK, so since that is a financial timebomb (as well as Freedie/Fannie/Post Office/Amtrak/Medicaid, why not fix those first. In the case of MediCare - millions of baby boomers will retire (if they can afford to and have a job to retire from) in the next few years - causing even more MediCare financial trouble - besides that, ObamaCare wants to take $500 Billion from MediCare to pay for the public option at the same time - it's insane.

[Dan40]

Originally Posted by cobra de capell

I’m just curious, why does she? Does it cover prescriptions or services? Does she have a supplemental plan to cover those services that Medicare doesn’t pay for 100% and a prescription plan as well?

A supplemental plan, along with a prescription plan run about $135 per month and, with those plans, there is normally no or very little out of pocket expense.

Of course, if ObamaCare is actually passed – MediCare either will end up not being taken for payment by doctors or services will be unavailable as part of MediCare, e.g. either rationed or simply not offered period. Why? Payments to doctors/hospitals will be reduced by $500 Billion to help pay for a public option under ObamaCare.

It's important, for you and your Grandma, that ObamaCare be defeated.

CdC,
Medicare supplement rates are by zip code. $135 might cover a med Sup and Rx plan in Bumdum, Iowa. But in the southern half of Florida you could not get a Med Sup plan B for $135. And an Rx Part D plan [cheapest] is $44. plus co-pays. My Rx plan equals $111.per month. Last year it was $63 including one more expensive drug. That drug was $33. per month and without it this year I'm up to $111. So a REAL increase from $30. pm to $111. pm in one year. That's a Government plan for you.

[Scott S]

Originally Posted by Dan40

What is the $310. per month for?
A Medicare Supplement policy?
OR
Prescription drug costs?
OR
Her co-pay?

Yes it is a supplement policy, after reading your post I think it's time for a talk with mom, good info to think about.

Thanks..

Scott S

[BeanCounter]

Ernie,

I think you need this talking to also.

http://www.youtube.com/watch?v=m4r6YCUtxfs

[cobra de capell]

Originally Posted by Dan40

CdC,
Medicare supplement rates are by zip code. $135 might cover a med Sup and Rx plan in Bumdum, Iowa. But in the southern half of Florida you could not get a Med Sup plan B for $135. And an Rx Part D plan [cheapest] is $44. plus co-pays. My Rx plan equals $111.per month. Last year it was $63 including one more expensive drug. That drug was $33. per month and without it this year I'm up to $111. So a REAL increase from $30. pm to $111. pm in one year. That's a Government plan for you.

Actually, that increase is not so bad - drugs can be expensive and if one needs the really expensive ones, one must pay.

Personally, I think that MediCare is a great plan - as long as one can afford supplemental coverage and Part D coverage - if one cannot it can be a difficult financial road in retirement.

The bottomline - maintain a healthy lifestyle from birth the grave and life will be one hell of lot better, financially speaking. If you don't, pay to play kicks in - big time - as it should.

Too many people want to do whatever they want to do through life and expect someone else to step up and pay, especially during the last few years. Only those whe take care of business should benefit fully.

[Dan40]

Originally Posted by cobra de capell

Actually, that increase is not so bad - drugs can be expensive and if one needs the really expensive ones, one must pay.

Personally, I think that MediCare is a great plan - as long as one can afford supplemental coverage and Part D coverage - if one cannot it can be a difficult financial road in retirement.

The bottomline - maintain a healthy lifestyle from birth the grave and life will be one hell of lot better, financially speaking. If you don't, pay to play kicks in - big time - as it should.

Too many people want to do whatever they want to do through life and expect someone else to step up and pay, especially during the last few years. Only those whe take care of business should benefit fully.

Perhaps I said it wrong. Last year drugs were $63 per month INCLUDING 1 drug that was $33. of the $63. This year I'm off that drug and no drugs have been added, so if prices stayed at last years level, I would be paying $30.per month, instead I'm paying $111. per month WITHOUT last years expensive drug. That is a 370% increase. How high does it have to be for you to call it bad?

And Medicare supplements are a waste of money. WORST for those that can least afford them.
A silly expenditure for those that can afford them. Insurance is to protect one from a catastrophic loss. No such loss is possible under Medicare WITHOUT a supplemental policy.
Imagine a $800,000.00 hospital bill under Medicare Part A, patients responsibility, $1068.
Coupled with $50,000 in Doctors bill under Medicare Part B. The Medicare approved amount for that $50,000 would be about $15,000. Patients responsibility 20% or $3000.
Total of $4068. of $850,000. $4068 is not a catastrophic loss at any income level. At the lowest level, it would simply be written off. Doctors ROUTINELY write off the 20% patient share. Its too small to try to collect.
How often and how many ever face that kind of expense? Medicare supplement premium at ONLY $100 per month [much lower than one can get in my area] 5 years of good health and $100 per month =$6000.
To give you a better idea, my wife had 2 torso XRays per day for 18 days. The total was in the thousands. After Medicares adjustment, out share of the XRay charges,,,,,,,,,,$9.80. That's NINE DOLLARS AND EIGHTY CENTS.

That is why I say Medicare is terrific, but it could not exist without the support of the , in place, for profit, health care system we now have. Reduce the reimbursement rates of a "public option" to what Medicare pays and the hospital would become a condo and the Doctors would have realtors licenses to sell the condos.

I have another thought for you to ponder. The Congressional Black Caucus says they insist that ANY health care reform bill absolutely MUST have the 'public option.' They are welcome to their position.
What I'm pondering and ask you to ponder as well is, why is their NO Congressional White Caucus? And how much hell would be raised if there was a White Caucus?

[Excaliber]

MediCare is headed for BK

CDC understands the delima.

I'm not going to waste my time doing research for those that don't get it, you either do, or you don't. If you don't, go back to sleep.

[BeanCounter]

I think the real dilemma is that you understand delima. Is that sort of like "you put delima in the coconut"

[Dan40]

Originally Posted by Scott S

Yes it is a supplement policy, after reading your post I think it's time for a talk with mom, good info to think about.

Thanks..

Scott S

The entire Medicare + Medicare Supplements [Medigap policies] is terribly confusing for seniors [everybody for that matter]/
There is Medicare PART A, this covers hospital IN PATIENT stays[1a]
There is Medicare PART B, this covers out patient treatments and doctor office visits. [1b]
There is Medicare PART D,this in the new one that covers prescription drugs.

[1a] Hospital RISK= $1068 this year for any hospital stay under 60 days.
[1b] one time annual deductible of $135. this year.

Then there are the Medigap PLANS, a, b, c, d, e, f, g, h, i, j. These are insurance policies purchased from private companies.
I have found Medigap plan d to have the best bang for the buck. It DOES cover [1a] above
What it DOES NOT cover
1. prescription drugs. Now with Medicare PART D above, one does not need Rx coverage in a supplement too.
2. It does nor cover the 'excess charges' that a Doctor that does not accept Medicare assignment, may charge. A money hungry insurance agent may push for this using the scare of high charges. But again there is the Medicare approved amount and the Doc that does NOT accept Medicare assignment may only charge 15% more than the Medicare approved amount. [Office visit $100. Medicare approved amount $38. The Doc may charge 15% above the $38. Not worth insuring.] Anyplace with a large senior population and virtually ALL Docs will accept Medicare assignment.
3 It does not cover the Medicare PART B deductible. Which is $135. this year. [it usually goes up very few dollars each year] That is a one time $135 deductible per year. NOT PER DOCTOR. ALL plans that do pay this $135. have a premium total well in excess of $135 more.

[cobra de capell]

Dan40 - Hmmm.....interesting input.

So, was your option to go with another Part D policy (drug insurance) not viable to lower your increased monthly cost?

Supplemental policy - the math sure works out for not having such a policy, is that why it's offered by insurance companies so relatively cheap, e.g. their bet is that outgoing payments can accurately be projected as very small over time within the covered group of people?

By the way, are you stating that you don't carry supplemental coverage?

As to the Black Caucus - that has always been a queer thing to me as well, as is the continuing existence of the NAACP. I suppose that there was a valid reason for those types of organizations back in the early to mid 20th Century, but how they can be justified now is beyond strange. If I were black, I'd want them eliminated in favor of no color designation assigned to any group, by law. As long as they exist, they will directly and indirectly support the recognition of color as some sort of 'difference' between humans - I don't see how that can be good for blacks or whites, but especially for blacks.

On the other hand, since they do exist, I’m thinking that it would be fun to start a White Caucus, along with a National Association for the Advancement of White People (NAAWP). That would at least be entertaining for a short time and may point out how silly it is the have Black and Latina organizations at this time in American. The ironic scenario in the future may be that once Latinas take over America a white organization just may be necessary to do whatever it is that the NAACP does for blacks at this time - I'm really not sure what that is other than collect dues.

[Dan40]

Originally Posted by Excaliber

CDC understands the delima.

I'm not going to waste my time doing research for those that don't get it, you either do, or you don't. If you don't, go back to sleep.

Yes, Medicare covers ONLY 45 million, it pays Doctors and hospitals CHUMP CHANGE and still costs over a TRILLION dollars per decade. And it is still broke. Yet the DC lying idiots tell us that public coverage of about 350 MILLION, 50 MILLION OF WHICH [OR MORE] WILL NOT CONTRIBUTE A DIME IN any MANNER, MONEY , WORK, LIFESTYLE, will only cost one TRILLION more per decade. At least 50 million pure parasites will be sucking up the public health. More than the total on Medicare, almost all of which have paid into it all their working lives and now pay $100 per month each out of their Social Security checks. 45 million, ALL CONTRIBUTING, costs over a TRILLION per decade. 50 million parasites ALONE will cost over 2 TRILLION per decade. And then we add in the OTHER 255 MILLION and we are supposed to believe the whole shebang will cost only an extra TRILLION.
An EXCESS $10 TRILLION is a lock, probably more! And we just do not have it and cannot borrow it or print it.
So I VERY much understand the dilemma.

Delima bes a bean.

[Dan40]

Originally Posted by cobra de capell

Dan40 - Hmmm.....interesting input.

A So, was your option to go with another Part D policy (drug insurance) not viable to lower your increased monthly cost?

B Supplemental policy - the math sure works out for not having such a policy, is that why it's offered by insurance companies so relatively cheap, e.g. their bet is that outgoing payments can accurately be projected as very small over time within the covered group of people?

C By the way, are you stating that you don't carry supplemental coverage?

As to the Black Caucus - that has always been a queer thing to me as well, as is the continuing existence of the NAACP. I suppose that there was a valid reason for those types of organizations back in the early to mid 20th Century, but how they can be justified now is beyond strange. If I were black, I'd want them eliminated in favor of no color designation assigned to any group, by law. As long as they exist, they will directly and indirectly support the recognition of color as some sort of 'difference' between humans - I don't see how that can be good for blacks or whites, but especially for blacks.

On the other hand, since they do exist, I’m thinking that it would be fun to start a White Caucus, along with a National Association for the Advancement of White People (NAAWP). That would at least be entertaining for a short time and may point out how silly it is the have Black and Latina organizations at this time in American. The ironic scenario in the future may be that once Latinas take over America a white organization just may be necessary to do whatever it is that the NAACP does for blacks at this time - I'm really not sure what that is other than collect dues.

A
The policy renews in nov. dec. and the new price is announced in jan. A new part D plan cannot be purchased in Jan. Will not happen this year.

B
A pure money maker for insurance companies. No catastrophic risk to the insured, means no such risk to the insurance company either. I sold them only because people insist on buying them and if I sold it, they got the best policy for the least premium, not the one that paid the highest commission.

C
No I do not have a supplement policy. I do not give advice that I do not follow as well.


NAAWP, Wouldn't that be welcomed with open arms! Or loaded arms.

[cobra de capell]

Hmmmmm..so you walk your talk, great!

As I understand your response under B - securing a supplemental policy under MediCare would be the same as securing a supplemental policy to compliment a private insurance policy in the workplace, e.g. it would cover the 20% gap etc if something were to happen - big time. The difference: 20% may be higher under a private plan since MediCare tends to pay less overall for services. True?

If that's true, no one in their right mind would even think about buying a supplemental policy in the private sector and should not buy a MediCare supplemental policy.

[Dan40]

Originally Posted by cobra de capell

Hmmmmm..so you walk your talk, great!

As I understand your response under B - securing a supplemental policy under MediCare would be the same as securing a supplemental policy to compliment a private insurance policy in the workplace, e.g. it would cover the 20% gap etc if something were to happen - big time. The difference: 20% may be higher under a private plan since MediCare tends to pay less overall for services. True?

If that's true, no one in their right mind would even think about buying a supplemental policy in the private sector and should not buy a MediCare supplemental policy.

I have never seen or heard of a supplemental policy for a major madical policy [the kind you'd have in the workplace.]
While 80/20 is fairly normal and there is no low price restriction like Medicare. There is almost always [any policy I sold had it] what is called a "STOP LOSS' clause. It states that you pay your 20% of whatever the charges are UNTIL you reach the 'stop loss' number. Could be $2000., $5000, $10,000, but once the insured is out of pocket that amount, the insurance covers at 100%. Neither Medicare nor Medigap polices ever had that 'stop loss' clause and that might have been the nucleus of seniors fears of huge medical bills in their old age. That fear was and is unfounded, but fears of the unknown always are.