Health Care Reform Part IV: The Trumpening

Discussion in 'Politics & Current Events' started by Knave, Dec 3, 2016.

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  1. M

    M Member+

    Feb 18, 2000
    Via Ventisette
    Unless he had original Medicare and no Medigap policy.
     
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  2. M

    M Member+

    Feb 18, 2000
    Via Ventisette
    The options are insanely complicated compared to what exists in most European countries. And hopefully you explain to people that if they buy one of UHC's Advantage plans that they will have to provide evidence of insurabality if they subsequently revert to original Medicare and want to but a Medigap policy.
     
  3. stanger

    stanger BigSoccer Supporter

    Nov 29, 2008
    Columbus
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    Columbus Crew
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    United States
    In that case he would be responsible for 20%. Almost no one does that considering the OOP protection from an MA plan can carry a $0 premium.

    It's not called evidence of insurability, it's called credible coverage, and that doesn't come into play when switching between MA and Med Supp. It's only necessary if you don't enroll within the allotted window around your 65th birthday. It also only applies to Rx coverage in the vast majority of cases.

    As to the complexity of the choices, you really only have three choices. 1) A+B only. 2) A+B+ Med Supp. 3) MA.

    Not complicated at all.
     
  4. M

    M Member+

    Feb 18, 2000
    Via Ventisette
    #5204 M, Jun 15, 2020
    Last edited: Jun 15, 2020
    And 20% of $1.1m is a shit load of money for most people.

    Some people choose original Medicare over an Advantage plan because the latter often restrict choice of doctors and are a lot less generous in coverage for things like rehabilitation.

    I disagree. It comes into play if you change from an Advantage plan to traditional Medicare and want to take out a Medigap policy at that point:

    "Once you’ve left your Medicare Advantage plan and enrolled in Original Medicare, you are generally eligible to apply for a Medicare Supplement insurance plan. Note, however, that in most cases, when you switch from Medicare Advantage to Original Medicare, you lose your “guaranteed-issue” rights for Medigap. You generally have guaranteed-issue rights for six months when you are both 65 or older and enrolled in Medicare Part B. Guaranteed-issue rights ensure that you can buy any plan sold in your state, and that you won’t be charged higher premiums based on your health status. Without guaranteed-issue rights, your insurance company may require medical underwriting before it sells you a plan."

    https://www.ehealthmedicare.com/med...-i-switch-from-medicare-advantage-to-medigap/


    I disagree. For starters, no other country I know of has a completely different system to cover over 65's from the rest of the population. Nor do they have effectively two systems within that provision (traditional versus Advantage). Nor do they have particular enrollment deadlines around all this. Nor do they have financial penalties for failure to enroll in time (and lol that the part B and D penalties are calculated differently). etc.
     
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  5. Naughtius Maximus

    Jul 10, 2001
    Shropshire
    Club:
    Chelsea FC
    Nat'l Team:
    England
    Can I just point out that your 'easy to follow' explanation still sounds a bit complicated...
     
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  6. stanger

    stanger BigSoccer Supporter

    Nov 29, 2008
    Columbus
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    Which is why the vast majority of people go with the OOP cost protection of a Supplement or MA Plan.

    When you say "Medicare over an Advantage Plan", are you talking about a Supplement over an MA? If you are, then yes, MA plans have a network and Supplements do not. As for what they pay for, CMS requires MA plans to cover whatever a Supplement covers. There is no reduction in coverage for an MA and in fact, most MA plans include dental and vision coverage that Supplements do not, along with Rx coverage.





    You lose GI rights as soon as your initial period is up regardless of the route you take. Losing GI isn't something that happens because you bought MA originally.



    That's your opinion.

    I run educational classes on Medicare and the people that I educate have no issue and really, the vast majority of people enroll within their GI window around their 65th birthday.

    You are intentionally making things difficult by conflating terms.

    Perhaps, although the people that I help make the decisions understand pretty clearly when I take their specific situation and give them their individual options. There can be some moving parts if you get into some pretty rare situations but it's generally pretty straightforward.
     
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  7. Funkfoot

    Funkfoot Member+

    May 18, 2002
    New Orleans, LA
    Hell, how much did it cost to prepare that bill and send it to him? With universal coverage, that wouldn't be necessary.
     
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  8. :DAmericans are smarter than Europeans.
     
  9. The Devil's Architect

    Feb 10, 2000
    The American Steppe
    Club:
    Chicago Fire
    Nat'l Team:
    United States
    To be fair, I didn't...

    Nor do I care. Now, having had to pay for 3 fairly routine elective surgeries in the past 3 years (2 for myself / 1 for Oldest Son) and having pretty decent employer (partially) funded insurance, I ended up with about 7,000 in out of pocket costs due to not being able to get my them counted towards the same deductible (calendar year & job change).

    Dude won't likely have to pay all of it, but someone is footing the bill for the inflated costs charged by health care facilities to absorb those who get treated with no insurance, and chances are, that's going to fall you & I the taxpayer & insurance premium payer.
     
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  10. M

    M Member+

    Feb 18, 2000
    Via Ventisette
    #5210 M, Jun 15, 2020
    Last edited: Jun 15, 2020
    Agreed, but some don't, which means that your original assertion regarding this $1.1m may not be correct. Or may not be correct for a small number of people with massive bills absent the CARES Act.

    Right. The only Advantage plans in my zipcode are HMO plans.

    You're missing the point. If you go the Advantage route, you lose the right to GI if you wish to go the original/Medigap route down the road. The only way to avoid the possibility of medical underwriting is, as you say, to sign up for a Medigap plan when you first enroll, and thus not go the Advantage route. And no amount of obfuscation from the likes of UHC changes that fact. I personally know people effectively locked into Advantage because of this, even though they wish to go to traditional Medicare.

    Which part of my comment that

    "For starters, no other country I know of has a completely different system to cover over 65's from the rest of the population. Nor do they have effectively two systems within that provision (traditional versus Advantage). Nor do they have particular enrollment deadlines around all this. Nor do they have financial penalties for failure to enroll in time (and lol that the part B and D penalties are calculated differently). etc."

    was inaccurate and why?

    Oh and here's two more interesting bits to this mess:

    (1) I'm eligible for Medicare late this year, Because my 2019 taxable income was very high but my 2020/2021 taxable income is/will be very low, an ACA policy will actually be a lot cheaper than Medicare. That's because Medicare uses the last tax return available to decide part B cost (e.g. 2019 filed in 2020 for the 2021 Medicare year) but the ACA uses current income and reconciles when you file a return (e.g. in early 2022 for the 2021 tax year). I can appeal to Medicare for an exception, but apparently the rate of successful appeals is low. And, you could say that's the fault of the ACA. But that's the point: all these disparate systems have differing rules. I mean, wtf?

    (2) Normally if you have employer coverage you can delay Medicare enrollment until that ends and then sign up at that time without penalty. But... if you are on COBRA coverage from your past employer, it doesn't count. So you can't sign up when it expires and you will be subject to late enrollment penalties. Again, wtf?

    Oh and there's more...

    (3) Part year coverage subjects you to a restart of annual deductibles. For example, if you have ACA the Medicare Advantage. Or COBRA then Medicare Advantage. Again, another piece of nonsense brought to you by virtue of disparate systems.
     
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  11. stanger

    stanger BigSoccer Supporter

    Nov 29, 2008
    Columbus
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    Columbus Crew
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    You can't legislate for the tiny percentage of people that simply don't try to understand. Medicare was never intended to be 100% coverage and it is right there in any information you look at. It's only 80% coverage if you don't get an MA or Supplement.



    All MA plans I have heard of are HMO's or PPO's. It's how they can reduce the cost of the monthly premium.

    I'm not missing anything. If you go the Supplement route and want to change outside your GI window YOU HAVE NO GI REGRDLESS. Any change to Med Supp after your GI window has closed subjects you to underwriting. And actually, if you went Supp first and decided to change to MA, you can do so during open enrollment without underwriting AND you can change your MA plan once a year (unless you have a special circumstance) during OEP, again without underwriting.

    IRMAA is adjusted every year so an appeal isn't necessary and your Part B premium should adjust. Just remember it's calculated on your tax returns from TWO YEARS PRIOR. Congrats on being in a high enough tax bracket to have to pay IRMAA premiums!

    COBRA is not considered credible coverage so you are correct. Generally, COBRA combines both your contribution and your employer's contribution, making it very expensive. I haven't seen COBRA being less expensive than Medicare coverage or ACA coverage, so you must be in the rare air of unicorns and flying pigs! Again, congrats!

    It would be difficult to say a deductible you paid for a BCBS employer policy should cover the deductible for a UCH MA plan.

    All Medicare plan deductibles reset Jan. 1 and all EGHP plan deductibles reset on the anniversary date of the policy. I don't know why you would think you deserve an exception, especially since your income should easily allow you to afford it.
     
  12. superdave

    superdave Member+

    Jul 14, 1999
    VB, VA
    Club:
    DC United
    Nat'l Team:
    United States
    My guess is it costs almost nothing per transaction. I'm confident that the hospital has an integrated system in which as the medical professional is entering something in the patient's chart, the charge is automatically added to the bill. I mean, when you check out at the grocery story, the same system that creates your bill as an item is scanned also tabulates in the store's inventory.
     
  13. superdave

    superdave Member+

    Jul 14, 1999
    VB, VA
    Club:
    DC United
    Nat'l Team:
    United States
    I'm mostly on your side in this discussion, but if I can Gordian Knot this sumbitch, yeah, you can. The US could adopt single payer.
     
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  14. stanger

    stanger BigSoccer Supporter

    Nov 29, 2008
    Columbus
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    Columbus Crew
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    I meant legislating inside the current program.

    Single payer is completely different and can be anything. What irks me is people saying M4A is Medicare for all. It's not, it's using a program that is really quite good to pull the wool over the eyes of those that aren't interested in knowing the difference.
     
  15. song219

    song219 BigSoccer Supporter

    Apr 5, 2004
    La Norte
    Club:
    DC United
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    Vanuatu
    I wonder if people had to go through so many hoops and decisions to put their kids in school how much school enrollment would drop.
     
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  16. superdave

    superdave Member+

    Jul 14, 1999
    VB, VA
    Club:
    DC United
    Nat'l Team:
    United States
    I know. That's why I made the reference to Gordian's Knot.
     
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  17. roby

    roby Member+

    SIRLOIN SALOON FC, PITTSFIELD MA
    Feb 27, 2005
    So Cal
    @stanger ......
    Assuming the 70 yr old has Medicare and Blue Cross he probably wouldn't be hit with much of a bill...would he? I've had knee & hip replaced and all kinds of scans. Wifey spent a Mo in hosp critical care, another in intensive care and then 100 days in Rehab Facility. Have not had any out of pocket expense since about '07. I find my quarterly statements interesting as a Dr will bill for $13k, Medicare approves $4k, Medicare pays $1.5k, BCBS pays $42.32.....My Bal. =0.00 :confused:o_O
     
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  18. stanger

    stanger BigSoccer Supporter

    Nov 29, 2008
    Columbus
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    Columbus Crew
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    United States
    Depends on what he has for a Supplement. If he has F or G, Medicare pays their 80%, BCBS pays the other 20% including deductibles, so he pays $0 for F, G he would pay the $185 Part B deductible.

    MA plans can vary, but most are pretty close in costs, so you could estimate his OOP for a hospital stay being around $1,200 for the first four days and $0 for the rest.
     
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  19. M

    M Member+

    Feb 18, 2000
    Via Ventisette
    #5219 M, Jun 15, 2020
    Last edited: Jun 15, 2020
    Sure you can. Not that I particularly agree with his approach, but Sanders' M for A would certainly "legislate for all". And in a sensible world we wouldn't have two separate Medicare tracks - Advantage on the one hand, and original Medicare/Medigap on the other.

    Indeed. But as it happens HMO is all that's available for my zip code with no PPO offerings. That's one reason I'm considering going the original Medicare/Medigap route.

    This is irrelevant to the point I was making, which was with regards to changing from an Advantage plan to traditional Medicare plus supplement. Please stop obfuscating the issue.

    Again, irrelevant to the point I'm making. I'll ask you a two simple questions: (i) if I initially go the Advantage route and in a later year wish to change to traditional Medicare plus Medigap, will I need to undergo medical underwriting for that Medigap policy? Yes or No. (ii) If I initially go the original Medicare/Medigap route and maintain that Medigap policy moving forward, will I need to undergo medical underwriting at any point? Yes or No.

    Sad thing is that many don't understand this underwriting gotcha and end up being stuck through poor health with an Advantage plan despite wishing to change to traditional Medicare plus Medigap.

    Well, in 2019, I had that high income, not in 2021. I can appeal for the 2021 year, but you are correct that in 2022 it won't be an issue. But the point I was making - which you ignored - is that having different rules for different systems - Medicare versus ACA - is a confusing nonsense. For the year 2021, why does Medicare use 2019 income and the ACA 2021 income?

    Again, not the point I was making, which is why is employer coverage treated differently in terms of creditable coverage than is COBRA coverage from an employer?

    Well, indeed, it can't. And that's why I highlighted it as another example of how having disparate systems screws the consumer. Heck I could well be moving from one UHC plan to another in this shuffle, but I'll still end up with two deductibles for my first year of Medicare coverage.

    Huh? Not asking for an exception, just highlighting how messed up healthcare access is in the US due to there being so many disparate systems with differing rules.
     
  20. stanger

    stanger BigSoccer Supporter

    Nov 29, 2008
    Columbus
    Club:
    Columbus Crew
    Nat'l Team:
    United States
    Apples/oranges. If you want single payer, don't use the ploy of calling it Medicare because people like Medicare, when it is actually something very, very different.


    It's not. You have one GI period and that is the three months before your 65th birthday, the month of, and the three months after. (There are special circumstances that can give you different GI periods but those are rare, except for keeping credible coverage from your employer) That doesn't change because you pick one or the other.

    i) Yes* ii) instead of going through underwriting, you would need to wait until OEP and the policy wouldn't take effect until Jan 1 of the following year.

    * UHC actually allows a trial period of up to two years to try out an Advantage Plan and, if you don't like it, they will allow you to go back to your Med Supp with no underwriting. Not all carriers offer this.

    If you hear of an agent not properly explaining the options you should report them and they will lose their ability to write Medicare policies.

    And also, when you say "stuck", I would like to examine that a bit. Let's say you are in a Plan G paying somewhere around $127 a month. You are also paying around $30 a month for your PDP. There is no dental or vision so that's OOP. Your total cost for the year is:

    $127+$30=$157x12 months = $1884 + whatever you pay for dental/vision.

    In central Ohio, UHC has a $0 premium MA with a max OOP capped at $4,900. But, that $0 premium plan includes dental, vision, hearing aid discounts, gym membership, telehealth, a 24 hr nurse line and a $40 per quarter credit to use on over the counter medications. Oh yeah, your Rx plan is included in that $0.

    So, in a really shitty year where you have numerous interactions with the healthcare system, yeah, it's a little more expensive to go the MA route. But in a year when you only go see your primary care doc for a check-up twice, you saved $1884.

    You would have to ask Congress that question. Seems dumb to me, but as I pointed out to you above, you don't always have all the information to make a credible argument one way or the other.



    Again, you would have to ask Congress or CMS. I don't make the rules, I just interpret them for you.



    If you are in a situation to be paying IRMAA, sure it sucks, but it's not like you are missing a months rent over it.

    The situation you have described is no where close to being the norm. The vast majority of the people I enroll sign up a month or two before they turn 65 so the policy is in place in their birth month and they thank me for saving them a bunch of $$$.

    You sound like a hedge fund manager bitching about paying taxes on his $100M yacht.
     
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  21. M

    M Member+

    Feb 18, 2000
    Via Ventisette
    Irrelevant. The point is that whatever you call it, it's perfectly possible to have one system - rather than a set of disparate systems as at present.


    It is because if you choose to go the Advantage route that GI period becomes moot.

    On (ii) if I maintain the same Medigap plan from initial enrollment onwards, I never need underwriting. Whereas if I move down the road from an Advantage plan to traditional Medicare/Medigap I always need underwriting.

    Is that Jan 1 of the following year correct? According to the Medicare website, "Generally, Medigap policies begin the first of the month after you apply.".

    https://www.medicare.gov/supplement...-can-i-buy-medigap/buying-your-medigap-policy


    That's useful information.

    I couldn't see anything on the UHC link you posted regarding this issue? Maybe I missed it.

    For many, it's not just about money but also about access to doctors of their choosing rather than being locked into an HMO and needing referrals for specialists.

    Well, how about UHC lobbying to fix this stuff? Additionally, it does illustrate that Medicare isn't exactly as straightforward as you'd like to claim it is.

    All of the issues I've described, bar the increased part B premiums under IRMAA, are ones endemic in having multiple systems with disparate rules and regulations. And thus can potentially affect anyone regardless of income level.
     
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  22. Naughtius Maximus

    Jul 10, 2001
    Shropshire
    Club:
    Chelsea FC
    Nat'l Team:
    England
    Ah, OK! Thanks.

    That makes it a lot clearer :)
     
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  23. stanger

    stanger BigSoccer Supporter

    Nov 29, 2008
    Columbus
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    Possible? Sure, other countries do it. I guess we could argue hypotheticals all day but I'm not really interested in that.


    Your GI allows you to either A) Enroll in a Supp without underwriting OR B) Enroll in a MA outside of the OEP.



    True, but if you want to change Supplements you need to be underwritten as well, and if you want to go from a Supp to a MA you need to wait for AEP.



    Even MA plans will start the month after you enroll if you have the ability to enroll outside of AEP, just like a Supplement. If you change plans during AEP it will take effect on Jan 1 of the following year.


    In for an agent to maintain their ability to write Medicare and maintain their clients, they need to certify every year. That certification includes what we need to communicate to the clients to remain compliant.

    UHC doesn't require referrals to see a specialist, but you do need to stay within the network. In Ohio the network for UHC is all of the Ohio Health facilities and doctors/NP's/specialists. We also offer the Passport program which allows you to see UHC network doctors in 47 states without being charged OON fees.

    I live on the west side of Columbus and doing a general search for primary care doctors I have the choice of 1285 network doctors. Not exactly "locked" into anything.

    UHC is certainly involved in lobbying and have been able to influence change. We know that the latest item they are working on changing is being able to cover people with ESRD, kidney failure requiring dialysis, under our existing MA plans.

    Although UHC has influence, CMS ultimately has control over what is covered.



    And again, it's a tiny percentage of my clients that have to deal with anything close to your situation. Almost everyone is enrolling due to A) Turning 65 B) Losing EGHP coverage due to retirement or C) Looking to change plans during AEP.

    Your situation, and the issues around it, simply don't come up very often.
     
  24. stanger

    stanger BigSoccer Supporter

    Nov 29, 2008
    Columbus
    Club:
    Columbus Crew
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    United States
    It is simple. Turn 65, chose either MA or Supplement with assistance of someone that can explain the differences, go on with your life.

    Some people just prefer to make things more difficult than they have to be.
     
  25. M

    M Member+

    Feb 18, 2000
    Via Ventisette
    I disagree. It is the differing regulations governing disparate health systems and their interactions with Medicare that makes it anything but simple. Too many gotchas in there for the unwary. Of course, that's great for insurance companies who can pay for legions of staff, like you, to explain and market their products. Compare and contrast to, say, the UK where turning 65 involves, well, precisely nothing. Just another reason why the US spends a way higher percentage of GDP on healthcare than any other western country.
     
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