80/20 healthcare

[Freewill]

What is the problem if everyone, everyone, is covered by a program like medicare? Where their premium pays 80 percent of cost and the person pays 20? Then if so desired the person can buy "advantage" or "gap" plans to enhance their coverage?

this would require dropping the company sponsored healthcare and in exchange people would have a choice of which private insurance they would buy advantage plans, which could be provided for by the company they work for. It would make every one in the same group.

Seems to me that would be fairly simple and would maintain both sides of the argument.

I am not really sure why private healthcare insurance, which has allowed costs to skyrocket, needs protection.

 

[Penelope]

I pay close to 450 a month for medicare, Part d (400 deduct) and medigap. As long as gaps and advantage plans do not keep going up, and that is for 1 person. So a couple at this time will probably pay 1000 and still have dental , eye glasses and assessment, and hear aids to pay for out of pocket.

 

[Admiral Rockwell Tory]

What is the problem if everyone, everyone, is covered by a program like medicare? Where their premium pays 80 percent of cost and the person pays 20? Then if so desired the person can buy "advantage" or "gap" plans to enhance their coverage?

this would require dropping the company sponsored healthcare and in exchange people would have a choice of which private insurance they would buy advantage plans, which could be provided for by the company they work for. It would make every one in the same group.

Seems to me that would be fairly simple and would maintain both sides of the argument.

I am not really sure why private healthcare insurance, which has allowed costs to skyrocket, needs protection.

Because Medicare artificially sets prices for reimbursement that severely restricts the number of doctors which will accept Medicare. There is very little profit in it.

Also, the premiums are insufficient to offset the cost of the care, so we wind up passing the costs off to those with "real" insurance. Those $5.00 aspirins are paying for Grandma's bypass surgery a couple of dollars at a time.

You want healthcare costs to explode, just expand Medicare beyond its current scope.

 

[Penelope]

I have never had a DR that turned me away due to Medicare.

 

[Freewill]

I pay close to 450 a month for medicare, Part d (400 deduct) and medigap. As long as gaps and advantage plans do not keep going up, and that is for 1 person. So a couple at this time will probably pay 1000 and still have dental , eye glasses and assessment, and hear aids to pay for out of pocket.

Medicare today is 134/ month so I am not sure how you are paying 450 for medicare, unless you have an expensive advantage plan.

I pay 134/month for medicare and an advantage plan, because I don't use medical more then a few times a year it is pretty cost efficient for me. I also get free gym membership.

My wife has to buy hers and she pays 450/month for a really crappy plan. 750 dollars for an ER visit. She is getting her knee replaced soon and I have no idea how much that is going to cost. Maybe i don't really want to know.

 

[Freewill]

What is the problem if everyone, everyone, is covered by a program like medicare? Where their premium pays 80 percent of cost and the person pays 20? Then if so desired the person can buy "advantage" or "gap" plans to enhance their coverage?

this would require dropping the company sponsored healthcare and in exchange people would have a choice of which private insurance they would buy advantage plans, which could be provided for by the company they work for. It would make every one in the same group.

Seems to me that would be fairly simple and would maintain both sides of the argument.

I am not really sure why private healthcare insurance, which has allowed costs to skyrocket, needs protection.

Because Medicare artificially sets prices for reimbursement that severely restricts the number of doctors which will accept Medicare. There is very little profit in it.

Also, the premiums are insufficient to offset the cost of the care, so we wind up passing the costs off to those with "real" insurance. Those $5.00 aspirins are paying for Grandma's bypass surgery a couple of dollars at a time.

You want healthcare costs to explode, just expand Medicare beyond its current scope.

One thing I do know for sure, the current system is unsustainable, if we don't want to bankrupt everyone. Health care cost are going up much faster then inflation rate.

I have not been denied because of medicare payments.

I am thinking that passing the cost off so that the insurance companies can be more profitable just seems wrong.

 

[Mac1958]

What is the problem if everyone, everyone, is covered by a program like medicare? Where their premium pays 80 percent of cost and the person pays 20? Then if so desired the person can buy "advantage" or "gap" plans to enhance their coverage?

this would require dropping the company sponsored healthcare and in exchange people would have a choice of which private insurance they would buy advantage plans, which could be provided for by the company they work for. It would make every one in the same group.

Seems to me that would be fairly simple and would maintain both sides of the argument.

I am not really sure why private healthcare insurance, which has allowed costs to skyrocket, needs protection.

That's what I'm screaming for, and I'm beginning to think we might get there.

The Medicare / Medicare Advantage / Medicare Supplement system is already in place, it works, it takes a massive monkey off the back of American business, it's an excellent blend of public and private, let's do it.

The GOP and the Dems have fucked up, but I think our "leaders" (har har, cough) are smart enough to avoid real Single Payer. This is the obvious answer.
.

 

[Penelope]

I pay close to 450 a month for medicare, Part d (400 deduct) and medigap. As long as gaps and advantage plans do not keep going up, and that is for 1 person. So a couple at this time will probably pay 1000 and still have dental , eye glasses and assessment, and hear aids to pay for out of pocket.

Medicare today is 134/ month so I am not sure how you are paying 450 for medicare, unless you have an expensive advantage plan.

I pay 134/month for medicare and an advantage plan, because I don't use medical more then a few times a year it is pretty cost efficient for me. I also get free gym membership.

My wife has to buy hers and she pays 450/month for a really crappy plan. 750 dollars for an ER visit. She is getting her knee replaced soon and I have no idea how much that is going to cost. Maybe i don't really want to know.

Medigap and Part D. No I would never get an Advantage Plan. I pay a more for medigap as I'm not quite 65 yet, and my brothers are now paying 195 and it depends on age , the older one is the higher it goes, unless if one is under 65. Oh and Part D , with my 400 deduct, thankfully I am only on 2 generic meds , but if one is on higher cost meds, the total price goes toward the donut hole, so it does not take long to get to the donut hole.

Don't forget you pay in all your life for Medicare as well. Its not an entitlement.

 

[Admiral Rockwell Tory]

What is the problem if everyone, everyone, is covered by a program like medicare? Where their premium pays 80 percent of cost and the person pays 20? Then if so desired the person can buy "advantage" or "gap" plans to enhance their coverage?

this would require dropping the company sponsored healthcare and in exchange people would have a choice of which private insurance they would buy advantage plans, which could be provided for by the company they work for. It would make every one in the same group.

Seems to me that would be fairly simple and would maintain both sides of the argument.

I am not really sure why private healthcare insurance, which has allowed costs to skyrocket, needs protection.

Because Medicare artificially sets prices for reimbursement that severely restricts the number of doctors which will accept Medicare. There is very little profit in it.

Also, the premiums are insufficient to offset the cost of the care, so we wind up passing the costs off to those with "real" insurance. Those $5.00 aspirins are paying for Grandma's bypass surgery a couple of dollars at a time.

You want healthcare costs to explode, just expand Medicare beyond its current scope.

One thing I do know for sure, the current system is unsustainable, if we don't want to bankrupt everyone. Health care cost are going up much faster then inflation rate.

I have not been denied because of medicare payments.

I am thinking that passing the cost off so that the insurance companies can be more profitable just seems wrong.

Costs are increasing because of Medicare and Medicaid. Expand them and you will really see costs shoot through the roof!

You may not have been denied because of payments, but have you ever tried to find a new doctor that will accept Medicare? My mother, God rest her soul, needed some psychiatric care to deal with her blindness, and other health issues. I tried unsuccessfully to locate any mental health care providers in a city with over 1 million people that would take her as a Medicare patient. I spent days calling every provider I could find to try and get her help. I found one that would evaluate her and see if they could help her, but I would have to pay them out of pocket first. The next appointment available was after she had already suffered a stroke and died.

 

[Penelope]

I pay close to 450 a month for medicare, Part d (400 deduct) and medigap. As long as gaps and advantage plans do not keep going up, and that is for 1 person. So a couple at this time will probably pay 1000 and still have dental , eye glasses and assessment, and hear aids to pay for out of pocket.

Medicare today is 134/ month so I am not sure how you are paying 450 for medicare, unless you have an expensive advantage plan.

I pay 134/month for medicare and an advantage plan, because I don't use medical more then a few times a year it is pretty cost efficient for me. I also get free gym membership.

My wife has to buy hers and she pays 450/month for a really crappy plan. 750 dollars for an ER visit. She is getting her knee replaced soon and I have no idea how much that is going to cost. Maybe i don't really want to know.

How much is your advantage plan? What is your wifes OOP max, that is the most it can cost you. Best to make sure you have time for elective sx as she will probably need some rehab. You do not want to go into next years deduct.

 

[Freewill]

I pay close to 450 a month for medicare, Part d (400 deduct) and medigap. As long as gaps and advantage plans do not keep going up, and that is for 1 person. So a couple at this time will probably pay 1000 and still have dental , eye glasses and assessment, and hear aids to pay for out of pocket.

Medicare today is 134/ month so I am not sure how you are paying 450 for medicare, unless you have an expensive advantage plan.

I pay 134/month for medicare and an advantage plan, because I don't use medical more then a few times a year it is pretty cost efficient for me. I also get free gym membership.

My wife has to buy hers and she pays 450/month for a really crappy plan. 750 dollars for an ER visit. She is getting her knee replaced soon and I have no idea how much that is going to cost. Maybe i don't really want to know.

How much is your advantage plan? What is your wifes OOP max, that is the most it can cost you. Best to make sure you have time for elective sx as she will probably need some rehab. You do not want to go into next years deduct.

My advantage plan cost me zero, but it isn't that much better then just having medicare. There are some perks, like free gym membership, but I do have some problems with how they charge for things like durable medical equipment.

This will be my third knee replacement I have been the nursemaid for. Second for my wife and my father had one done at 88. I am used to the suffering. I believe her out of pocket is 7500 so that is what I am expecting to pay.

 

[BlueGin]

What is the problem if everyone, everyone, is covered by a program like medicare? Where their premium pays 80 percent of cost and the person pays 20? Then if so desired the person can buy "advantage" or "gap" plans to enhance their coverage?

this would require dropping the company sponsored healthcare and in exchange people would have a choice of which private insurance they would buy advantage plans, which could be provided for by the company they work for. It would make every one in the same group.

Seems to me that would be fairly simple and would maintain both sides of the argument.

I am not really sure why private healthcare insurance, which has allowed costs to skyrocket, needs protection.

That's what I'm screaming for, and I'm beginning to think we might get there.

The Medicare / Medicare Advantage / Medicare Supplement system is already in place, it works, it takes a massive monkey off the back of American business, it's an excellent blend of public and private, let's do it.

The GOP and the Dems have fucked up, but I think our "leaders" (har har, cough) are smart enough to avoid real Single Payer. This is the obvious answer.
.

In order for it to work as Obamacare suggests. The private insurers and hospitals have to allow off large sums of medical exenses that the government doesnt reimburse or pay for. If patients don't have duel coverage...that money comes directly out of their pocket unless they can get financial assistance and a charity write off.

 

[Freewill]

What is the problem if everyone, everyone, is covered by a program like medicare? Where their premium pays 80 percent of cost and the person pays 20? Then if so desired the person can buy "advantage" or "gap" plans to enhance their coverage?

this would require dropping the company sponsored healthcare and in exchange people would have a choice of which private insurance they would buy advantage plans, which could be provided for by the company they work for. It would make every one in the same group.

Seems to me that would be fairly simple and would maintain both sides of the argument.

I am not really sure why private healthcare insurance, which has allowed costs to skyrocket, needs protection.

Because Medicare artificially sets prices for reimbursement that severely restricts the number of doctors which will accept Medicare. There is very little profit in it.

Also, the premiums are insufficient to offset the cost of the care, so we wind up passing the costs off to those with "real" insurance. Those $5.00 aspirins are paying for Grandma's bypass surgery a couple of dollars at a time.

You want healthcare costs to explode, just expand Medicare beyond its current scope.

One thing I do know for sure, the current system is unsustainable, if we don't want to bankrupt everyone. Health care cost are going up much faster then inflation rate.

I have not been denied because of medicare payments.

I am thinking that passing the cost off so that the insurance companies can be more profitable just seems wrong.

Costs are increasing because of Medicare and Medicaid. Expand them and you will really see costs shoot through the roof!

You may not have been denied because of payments, but have you ever tried to find a new doctor that will accept Medicare? My mother, God rest her soul, needed some psychiatric care to deal with her blindness, and other health issues. I tried unsuccessfully to locate any mental health care providers in a city with over 1 million people that would take her as a Medicare patient. I spent days calling every provider I could find to try and get her help. I found one that would evaluate her and see if they could help her, but I would have to pay them out of pocket first. The next appointment available was after she had already suffered a stroke and died.

Could you provide a link to the information you are giving? It seems to me to be a canned response.

 

[Freewill]

What is the problem if everyone, everyone, is covered by a program like medicare? Where their premium pays 80 percent of cost and the person pays 20? Then if so desired the person can buy "advantage" or "gap" plans to enhance their coverage?

this would require dropping the company sponsored healthcare and in exchange people would have a choice of which private insurance they would buy advantage plans, which could be provided for by the company they work for. It would make every one in the same group.

Seems to me that would be fairly simple and would maintain both sides of the argument.

I am not really sure why private healthcare insurance, which has allowed costs to skyrocket, needs protection.

That's what I'm screaming for, and I'm beginning to think we might get there.

The Medicare / Medicare Advantage / Medicare Supplement system is already in place, it works, it takes a massive monkey off the back of American business, it's an excellent blend of public and private, let's do it.

The GOP and the Dems have fucked up, but I think our "leaders" (har har, cough) are smart enough to avoid real Single Payer. This is the obvious answer.
.

In order for it to work as Obamacare suggests. The private insurers and hospitals have to allow off large sums of medical exenses that the government doesnt reimburse or pay for. If patients don't have duel coverage...that money comes directly out of their pocket unless they can get financial assistance and a charity write off.

Yes, I agree and that isn't going to change unless we change the system. I would say that in my lifetime I have never had a hospital stay for sickness or injury. I have not used the ER since forever. I go to the doctor pretty much once a year and sometimes have some extra tests, like a stress test. So I am thinking that whatever premium that I paid or was paid for me payed for a whole lot of other people's health care.

So, it seems to me that if EVERYONE is enrolled paying into a big pot of money and that money is closely watched we could see an improvement. But by what I am seeing there is nothing telling me we will see any improvement. How can their be if we keep the same system? 80 percent of the people have company sponsored healthcare. If they were to be put into a system like I suggest then that would free the companies from the burden of administrating the system. It would cut out the insurance companies from gouging consumers and it might put an end or slow down the escalating costs passed on.

What is going on today isn't working and just saying to hell with people cut them off doesn't seem to be productive.

As always though, everyone should have a stake in the system, whatever it is.

 

[Freewill]

Why is Health Care so expensive? - Consumer Reports

 

[Penelope]

I pay close to 450 a month for medicare, Part d (400 deduct) and medigap. As long as gaps and advantage plans do not keep going up, and that is for 1 person. So a couple at this time will probably pay 1000 and still have dental , eye glasses and assessment, and hear aids to pay for out of pocket.

Medicare today is 134/ month so I am not sure how you are paying 450 for medicare, unless you have an expensive advantage plan.

I pay 134/month for medicare and an advantage plan, because I don't use medical more then a few times a year it is pretty cost efficient for me. I also get free gym membership.

My wife has to buy hers and she pays 450/month for a really crappy plan. 750 dollars for an ER visit. She is getting her knee replaced soon and I have no idea how much that is going to cost. Maybe i don't really want to know.

How much is your advantage plan? What is your wifes OOP max, that is the most it can cost you. Best to make sure you have time for elective sx as she will probably need some rehab. You do not want to go into next years deduct.

My advantage plan cost me zero, but it isn't that much better then just having medicare. There are some perks, like free gym membership, but I do have some problems with how they charge for things like durable medical equipment.

This will be my third knee replacement I have been the nursemaid for. Second for my wife and my father had one done at 88. I am used to the suffering. I believe her out of pocket is 7500 so that is what I am expecting to pay.

Well I guess you know what to expect. Your father must of been in decent shape for getting one at 88. Yes hate to say it ,but that does sound like you will be reaching your OOP max. Anything else she needs done this year, a cataract removal? ! Well so your Advantage Plan is free, well might as well take whatever they can give to you. So then you are in a HMO I guess. Do they cover any meds?

 

[Freewill]

I pay close to 450 a month for medicare, Part d (400 deduct) and medigap. As long as gaps and advantage plans do not keep going up, and that is for 1 person. So a couple at this time will probably pay 1000 and still have dental , eye glasses and assessment, and hear aids to pay for out of pocket.

Medicare today is 134/ month so I am not sure how you are paying 450 for medicare, unless you have an expensive advantage plan.

I pay 134/month for medicare and an advantage plan, because I don't use medical more then a few times a year it is pretty cost efficient for me. I also get free gym membership.

My wife has to buy hers and she pays 450/month for a really crappy plan. 750 dollars for an ER visit. She is getting her knee replaced soon and I have no idea how much that is going to cost. Maybe i don't really want to know.

How much is your advantage plan? What is your wifes OOP max, that is the most it can cost you. Best to make sure you have time for elective sx as she will probably need some rehab. You do not want to go into next years deduct.

My advantage plan cost me zero, but it isn't that much better then just having medicare. There are some perks, like free gym membership, but I do have some problems with how they charge for things like durable medical equipment.

This will be my third knee replacement I have been the nursemaid for. Second for my wife and my father had one done at 88. I am used to the suffering. I believe her out of pocket is 7500 so that is what I am expecting to pay.

Well I guess you know what to expect. Your father must of been in decent shape for getting one at 88. Yes hate to say it ,but that does sound like you will be reaching your OOP max. Anything else she needs done this year, a cataract removal? ! Well so your Advantage Plan is free, well might as well take whatever they can give to you. So then you are in a HMO I guess. Do they cover any meds?

No med coverage. I take what I call old man pills so the cost is cheaper to just buy pills then to join a plan. Of course there is a small penalty if I ever do join a plan.

Which brings up another problem with healthcare, prescriptions drugs. My wife sent me to pick up her prescriptions one day and one of those cost 150 dollars. the Pharmacist saw me having a stoke and told me to search the internet for coupons. So I did, we got the prescription for 5 dollars. The pharmacist would have been more then happy to take the 150 dollars without saying a word. When I called a pharmacy to see what it would cost me without a drug plan some would not tell me without a prescription. I told them it didn't matter I was paying the full load, didn't matter to them. Some did tell me that the price would be something like 70 dollars. I searched the internet and got them for about 10 dollars. It is all a rip off. BTW, you can buy drugs from Canada, that was the next best option.

 

[Penelope]

Why is Health Care so expensive? - Consumer Reports

Good article, and that is why we are seeing so many "get checked for hepatitis" commercials. At least with insurance you know what OOP max you will pay, but without it they can seize your assets and even your home I've been told. People who do not have insurance and assets are playing Russian roulette with their assets.

They do need to do something with the costs. T thinks it should be left up to the states, and yet he talks about insurance companies crossing state lines, well they can't because each state has different standards, but now they can due to the ACA, with min standards that all ins needs to cover.

 

[Penelope]

I pay close to 450 a month for medicare, Part d (400 deduct) and medigap. As long as gaps and advantage plans do not keep going up, and that is for 1 person. So a couple at this time will probably pay 1000 and still have dental , eye glasses and assessment, and hear aids to pay for out of pocket.

Medicare today is 134/ month so I am not sure how you are paying 450 for medicare, unless you have an expensive advantage plan.

I pay 134/month for medicare and an advantage plan, because I don't use medical more then a few times a year it is pretty cost efficient for me. I also get free gym membership.

My wife has to buy hers and she pays 450/month for a really crappy plan. 750 dollars for an ER visit. She is getting her knee replaced soon and I have no idea how much that is going to cost. Maybe i don't really want to know.

How much is your advantage plan? What is your wifes OOP max, that is the most it can cost you. Best to make sure you have time for elective sx as she will probably need some rehab. You do not want to go into next years deduct.

My advantage plan cost me zero, but it isn't that much better then just having medicare. There are some perks, like free gym membership, but I do have some problems with how they charge for things like durable medical equipment.

This will be my third knee replacement I have been the nursemaid for. Second for my wife and my father had one done at 88. I am used to the suffering. I believe her out of pocket is 7500 so that is what I am expecting to pay.

Well I guess you know what to expect. Your father must of been in decent shape for getting one at 88. Yes hate to say it ,but that does sound like you will be reaching your OOP max. Anything else she needs done this year, a cataract removal? ! Well so your Advantage Plan is free, well might as well take whatever they can give to you. So then you are in a HMO I guess. Do they cover any meds?

No med coverage. I take what I call old man pills so the cost is cheaper to just buy pills then to join a plan. Of course there is a small penalty if I ever do join a plan.

Which brings up another problem with healthcare, prescriptions drugs. My wife sent me to pick up her prescriptions one day and one of those cost 150 dollars. the Pharmacist saw me having a stoke and told me to search the internet for coupons. So I did, we got the prescription for 5 dollars. The pharmacist would have been more then happy to take the 150 dollars without saying a word. When I called a pharmacy to see what it would cost me without a drug plan some would not tell me without a prescription. I told them it didn't matter I was paying the full load, didn't matter to them. Some did tell me that the price would be something like 70 dollars. I searched the internet and got them for about 10 dollars. It is all a rip off. BTW, you can buy drugs from Canada, that was the next best option.

So they have coupons for meds. Yes Part D is kind of a rip off. I read the cost of generics are going up to cover the cost of hepatitis meds. I know there is a penalty for going without Part D, forget what it is.

 

[Admiral Rockwell Tory]

What is the problem if everyone, everyone, is covered by a program like medicare? Where their premium pays 80 percent of cost and the person pays 20? Then if so desired the person can buy "advantage" or "gap" plans to enhance their coverage?

this would require dropping the company sponsored healthcare and in exchange people would have a choice of which private insurance they would buy advantage plans, which could be provided for by the company they work for. It would make every one in the same group.

Seems to me that would be fairly simple and would maintain both sides of the argument.

I am not really sure why private healthcare insurance, which has allowed costs to skyrocket, needs protection.

Because Medicare artificially sets prices for reimbursement that severely restricts the number of doctors which will accept Medicare. There is very little profit in it.

Also, the premiums are insufficient to offset the cost of the care, so we wind up passing the costs off to those with "real" insurance. Those $5.00 aspirins are paying for Grandma's bypass surgery a couple of dollars at a time.

You want healthcare costs to explode, just expand Medicare beyond its current scope.

One thing I do know for sure, the current system is unsustainable, if we don't want to bankrupt everyone. Health care cost are going up much faster then inflation rate.

I have not been denied because of medicare payments.

I am thinking that passing the cost off so that the insurance companies can be more profitable just seems wrong.

Costs are increasing because of Medicare and Medicaid. Expand them and you will really see costs shoot through the roof!

You may not have been denied because of payments, but have you ever tried to find a new doctor that will accept Medicare? My mother, God rest her soul, needed some psychiatric care to deal with her blindness, and other health issues. I tried unsuccessfully to locate any mental health care providers in a city with over 1 million people that would take her as a Medicare patient. I spent days calling every provider I could find to try and get her help. I found one that would evaluate her and see if they could help her, but I would have to pay them out of pocket first. The next appointment available was after she had already suffered a stroke and died.

Could you provide a link to the information you are giving? It seems to me to be a canned response.

It is not a canned response. It comes from my experience as an insurance agent and as a benefits instructor for AT&T.

Medicare and Medicaid simply do not cover the costs for the providers, so they bill everyone more to make a profit. It is the same with their losses on treating those without insurance and illegals.

Here is another example. Through a coding error by my doctor, I was once billed over $4000 for my share of a colonoscopy that was listed as being "elective", despite the fact that Obamacare requires all plans pay for required colonoscopies as preventive care. When I fought the billing tooth and nail, the hospital accounting department charged me what they said was the uninsured rate, which was a little over $300, rather than my 20% of the $4000 had I convinced the insurance company to cover it. I saved almost $500!