Andylusion
Platinum Member
Ray, I don't believe your last statement is correct. Total Medicare expenditures in 2018 were $740.6 billion, and total income for for the trust funds was $755.7 billion, which consisted of $745.9 billion in non-interest income and $9.8 billion in interest earnings. Assets held in special issue U.S. Treasury securities increased by $15.1 billion to $304.7 billion. If by 2026, there is no change in the law, the Medicare Trust Funds will be depleted to a point where it will become a budget item.You are both right and wrong.Believe me, the payment is more than two thirds. I'm on Medicare, and have never paid the other third. Link please, proving it is only two thirds? Never heard of such a thing.You hit on two very important points with your reply. What you don't know is that Medicare and Medicaid does exactly that. They only pay about 2/3 for the services of government patients. And yes, health facilities have to recoup those losses by increased prices.
Not that's not bad for an eighty dollar doctors visit, but real bad for a 400K surgery and post care, which most of us will receive when we are on Medicare.
So now we have government healthcare. So who is going to make up the difference in the shortages once there is no private insurance to sack with those losses?
No one ever said that individuals couldn't buy into their own private plan. I know quite a few countries that have universal care with the ability to purchase a private plan.
No, they won't bill you either. They just take the loss. I worked in medical for ten years. My father is on Medicare, and he tells me what's going on with his bills. He does have secondary insurance that covers what Medicare doesn't, but a lot of older folks are not in that financial position to get that private policy.
Doctors limit new Medicare patients - USATODAY.com
Medicare reimbursement rates, that is Medicare approved amounts (which for part B is 80% from Medicare and 20% from the patient) is determined based on the relative, average costs of providing a service to a Medicare patient, and then adjusted to account for other provider expenses, including malpractice insurance and office-based practice costs.
Contrary to claims of a lot of people, Medicare rates are not determined by what insurance companies pay. It's actually the opposite in most cases because most insurance reimbursements today is paid to contracted providers. The medicare reimbursement rate provides a basis for negotiating contracts which makes Medicare and Insurance reimbursement rates pretty close in most places.
Getting back to the question at hand, for many years many healthcare providers would bill patients for the difference between Medicare rates and their fee . If a doctor accepted Medicare as full payment, they were "Accepting Medicare Assignment". At one time, about 25% of doctors would not accept Medicare Assignment and would bill the patient the difference. Today, due to the fact there is little difference between insurance reimbursement rates and Medicare and the number of Medicare patients, about 95% of doctors today accept Medicare Assignment. Thus patients rarely see any bill if they pay their 20% coinsurance at time service or have insurance supplement.
That's actually kind of the law. But my point is, they have to raise their rates on everybody, so it's a primary factor in private insurance premiums going up. But this is why when you see health facilities close down, they are usually in lower income areas where most of the patients are government patients and there are little to no private pay patients. There is nobody to make up the loss on.
When I got into the business back in 1979, Medicare was a gold mine for my company. It was like they were flushed with money. All you had to do is send them a bill, and they paid it no questions asked. As the funds started to show signs of weakness, that's when they started lowering their reimbursement rates. So what did we do? We raised the price of renting our hospital equipment, and again, you can't just raise it on one group of payers, you have to raise it on everybody.
Medicare is not self- supportive either. They are subsidized with money from the general fund, and of course, always trying to use as little as possible.
I suspect that closures of healthcare facilities in low income areas is caused by lack of payment for services received. These facilities are supported primarily by Medicaid which is a state program whose reimbursement rate is determined by the state legislature each year. If state revenues decrease reimbursement rates are cut. I remember living in Florida during a recession in which the the state ran short of money in October. There were no medicaid reimbursements till Feb.
Medicare operates is entirely differently than Medicaid. All Medicare medical costs are being paid for through the Medicare Trust Funds. In few years congress will have to start supplementing these funds or Medicare taxes will have to be increased. The budget items for Medicare will not be discretionary which means congress can not cut those funds.
Lastly, I think you might be confused as to how Medicare determines reimbursement rates. The rates are not dependent on what insurance companies pay or the patient. You're correct that Medicare increases in reimbursement rates does result in insurance reimbursement rate increases in since insurance companies rely on Medicare rate changes as a starting point for contract negotiations.
Medicare uses a committee of 26 physician representatives nominated from the the major specialty societies to look at actual cost of delivery of of all services, the CPT codes. Healthcare providers supply CMS with actual cost in delivering each service. The committee compares these costs against previous costs to determine whether an adjust in reimbursement is required. Each code is reviewed at least once every 5 years. Yearly the committee submits recommended changes in reimbursement rates to CMS. So you see Medicare reimbursement rates are not based on what insurance or individuals pay for services. Even if insurance companies disappeared, there would be little impact on Medicare reimbursements.
The various states use their own methods in determining Medicaid reimbursement. Unfortunately, these methods are very dependent on state revenues. So a bad year in state revenues means a bad for Medicaid reimbursements. Thus medical facilities that are very dependent on Medicaid would have a hard time.
How is Medicare funded? | Medicare
How Medicare, Other Payers Determine Physician Reimbursement Rates
All Medicare medical costs are being paid for through the Medicare Trust Funds.
Total Non-interest income used to pay for Medicare, is not just from payroll taxes, but also general revenue from all tax payers, taxes on the benefits themselves, and transfers from states. In short, you are paying for Medicare, not just from your 3% on your income, but also from your State and Federal income taxes, and even a tax you pay on the benefit itself.
Medicare is not entirely funded from the trust fund, and never was by the way.
Assets held in special issue U.S. Treasury securities increased by $15.1 billion to $304.7 billion.
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There are no real assets. You are actually 100% correct, that they are special issue US Treasury securities.
US securities have value, because you can sell them. What value does something have that you cannot sell? Say you buy a car, and the terms of the sale are, you can never sell the car for the rest of your life.
How much value does that car have, the day after you buy it? Zero. You can't sell it. Doesn't matter how much you paid for it, the car has zero value, because you can't sell it ever.
The US Treasury securities that are in the Social Security Trust Fund, and the Medicare Trust fund, have zero market value. They are nothing more than bits of paper.
If the government does not have the money to pay for Social Security, or Medicare, neither of those 'trust funds' can take those 'assets' and sell them on the market. They are not marketable assets.
In short, they are literally nothing more than post-it notes, saying 'IOU'. They don't even have legal protection. Meaning, neither trust fund, could even sue the government, to get payment on the securities, because they have no legal status.
Equally, by the way.... there is no real 'interest' on the 'assets'. A real asset, like a corporate bond, the money paying the interest comes from the profitability of the corporation. The government has no profitable operation. It taxes the public, to pay expenses. These securities, are just taking tax money, just like the Medicare 3% is taking tax money, just like the transfers from the general revenue is taking tax money. It's not like a Treasury bond, is magically producing value. All of the money in medicare comes from tax payers. There is no interest on the assets... the assets is the tax payer.
Medicare uses a committee of 26 physician representatives nominated from the the major specialty societies to look at actual cost of delivery of of all services, the CPT codes. Healthcare providers supply CMS with actual cost in delivering each service.
Medicare and Medicaid have always paid far less than the total cost of providing service. And by necessity hospitals, clinics and doctors, have no choice but to charge private patients a higher cost, to offset the loss of money on gov-patients.
As the payout from medicare and medicaid go down, the cost to private patients goes up.
This is unavoidable.
Yes, I understand Medicare has a committee of people, who sit around on our tax money blowing smoke in each others faces about how much stuff costs.
Doesn't change the facts. The fact is, Medicare and Medicaid both under charge for service, and that cost is passed onto private patients.
As Ray said earlier, if the number of private patients is too low, then the hospital can't survive and ends up closing. Again, Medicare and Medicaid under charge. This is well documented and established statistical fact.