Health Care Reform Part IV: The Trumpening

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

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  1. stanger

    stanger BigSoccer Supporter

    Nov 29, 2008
    Columbus
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    Columbus Crew
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    I actually explained all of the unusual situations you have encountered.

    At this point I don’t see a whole lot of reason to continue this conversation. Medicare has its issues, MOST of which were put in place for a reason, some are because of a changing system that hasn’t adapted.

    But the fact that a majority of people enrolled are happy with their coverage and the vast majority have zero difficulty enrolling is a point you simply won’t cede.

    Good luck to you M.
     
  2. M

    M Member+

    Feb 18, 2000
    Via Ventisette
    And yet the internet is littered with articles, even from organizations like AARP, - an organization you recommended in this thread for Medicare info - warning people of all the inconsistencies and gotchas... Strange that they waste their time if they're so unusual. Except if they're not.
     
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  3. M

    M Member+

    Feb 18, 2000
    Via Ventisette
    #5278 M, Jun 24, 2020
    Last edited: Jun 24, 2020
    Oh look, an NY Times article covering many of the issues I've been droning on about, including COBRA:

    "But Mr. Farrell unknowingly ran afoul of one of the complex rules that govern the transition to Medicare — and now he is paying the price."

    ...

    "The transition to Medicare from other types of insurance is plagued by problems like Mr. Farrell’s — and, so far, there isn’t much of an early warning system to alert people close to retirement age of the pitfalls. These complex rules also affect people moving from Affordable Care Act exchange plans and retiree health coverage. "

    ...

    "If the rules governing the transition to Medicare sound complicated, rest assured that experts agree."

    https://www.nytimes.com/2019/01/31/business/medicare-enrollment-how-to-sign-up.html
     
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  4. stanger

    stanger BigSoccer Supporter

    Nov 29, 2008
    Columbus
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    Keep beating that straw man.

    I said it was rare, and it is. I’m not surprised your google-fu was able to find something, and your article didn’t state how many people have the same issue because it is such an insignificant number it would make the article as written moot.

    The man in the article should have consulted his HR department. I regularly work with the HR departments of large corporations doing this kind of advising.
     
  5. What's worse financially, being hit by a very rare disease or by a rare bureaucratic blip in the health insurance rules? And what would be rarer?
     
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  6. stanger

    stanger BigSoccer Supporter

    Nov 29, 2008
    Columbus
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    Columbus Crew
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    I know your purpose participating in this thread is so you can gloat, but what M has been posting about is rare despite his attempts to show otherwise.

    Like our tax code, legal system and everything else, it can be difficult to understand if you aren't versed in the nuance. I charge exactly $0 for consultations and there is no pressure to buy anything. As a matter of fact, if you aren't a good fit for one of my plans I won't enroll you.

    M should have sought out someone to advise him but he didn't, opting instead to vent on a soccer message board.
     
  7. Actually I wish the people of the states a better incarnation of our system (it has faults) so no gloating, but pitying your ordeal.
     
  8. stanger

    stanger BigSoccer Supporter

    Nov 29, 2008
    Columbus
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    The big holes in the US Healthcare system are the fact that it is tied to your work until you reach Medicare eligibility and at the low end there are people that do not qualify for Medicaid but can't afford coverage even if a work policy is available or they are not offered it through work/unemployed.

    Affordability is an issue as well, at least until Medicare eligibility, because of outrageous price gouging for DME and Rx.

    People think the insurance companies are the issue when it's really the point of service and drug manufacturers inflating prices that force the insurance companies to raise rates.

    If you want to have an open, honest conversation about cost and access in the US, as well as quality, we can do that. I'm not interested in having another back and forth like I had with M.
     
  9. M

    M Member+

    Feb 18, 2000
    Via Ventisette
    #5284 M, Jun 24, 2020
    Last edited: Jun 24, 2020
    So who should I give more weight to? On the one hand the NY Times and the experts it quotes or, on the other, someone who shills for insurance companies and their Medicare products? Hmmm... tough choice!

    Also "interesting" that you describe my researching my Medicare situation as a "google-fu"... And also interesting that that NY Times article confirms everything I've said about the asinine rules surrounding my situation.
     
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  10. M

    M Member+

    Feb 18, 2000
    Via Ventisette
    A big assumption there....
     
  11. M

    M Member+

    Feb 18, 2000
    Via Ventisette
    If the Supreme Court overturns the ACA aka Obamacare this fall, it's going to be an even bigger shit show than it already is.
     
  12. rslfanboy

    rslfanboy Member+

    Jul 24, 2007
    Section 26
    Huh. You really think insurance companies aren't inflating the price? Not at all?

    Drug manufacturers: ABSOLUTELY. THE WORST!

    POS: The indictment I hear about this is that hospital administration has gone full capitalist, starving the beast that feeds them. Elective surgery, usually not covered, is where medical professionals go if they want to make the $$$.
     
  13. M

    M Member+

    Feb 18, 2000
    Via Ventisette
    Agree about tying health insurance to employment, as this pandemic has illustrated. But having disparate systems with disparate rules that interact in disparate ways is a big flaw too.
     
  14. stanger

    stanger BigSoccer Supporter

    Nov 29, 2008
    Columbus
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    Shills? Hardly.

    I just understand the system and advise people on the best way to access based on their individual situation.

    You have continuously implied that your situation is somehow normal and, in my professional experience, know that it isn't even close to normal. None of your articles have said anything close to that implication, either.
     
  15. M

    M Member+

    Feb 18, 2000
    Via Ventisette
    As the NY Times article implies. it's hardly abnormal.

    Not sure why you're so hung up trying to defend Medicare at all costs. It's interactions with other means of insurance are clearly in need of sorting out.
     
  16. stanger

    stanger BigSoccer Supporter

    Nov 29, 2008
    Columbus
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    Columbus Crew
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    Considering insurance companies are the ones paying for the services, no, I don't think they are inflating the cost of service.

    As for elective surgery, insurance needs to approve and then they pay a negotiated rate. For instance, knee replacement is sometimes considered elective but having a doctor state the medical need can get it covered.

    Breast augmentation is more difficult to prove a medical need for so it isn't covered. ;)

    I am not going to defend the insurance companies when it comes to how they determine what they will cover considering I have had to fight with BCBS to cover my daughters wheelchairs when they can't walk, and in the realm of EGHP coverage it seems to be carrier and policy specific.

    As for Medicare, CMS decides what is covered and the companies that offer Medicare plans are bound legally to adhere to those decisions.
     
  17. stanger

    stanger BigSoccer Supporter

    Nov 29, 2008
    Columbus
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    I have seen the benefits of Medicare coverage on hundreds of people that are saving thousands of dollars a year when they become eligible. Rules like IRMAA were put in place in an attempt to keep the system solvent, charging more to those that can afford it based on their income.

    And actually the ACA plays a part in your other gripe. Simply having COBRA doesn't mean the EGHP you enjoyed while working was good enough to be considered credible coverage. Continuing that inferior plan shouldn't validate the bad plan you were covered by before enrolling in Medicare. The ACA set new baselines on what the minimums for coverage should be and instead of forcing CMS to evaluate every single EGHP they just axed all COBRA coverage from their consideration. The fact that there were so few people that were willing to pay the astronomical costs of most COBRA plans past their Medicare enrollment window it was palatable politically to just state they aren't credible coverage.

    This isn't me "shilling" for anything, it's just explaining how it works and why.
     
  18. M

    M Member+

    Feb 18, 2000
    Via Ventisette
    #5293 M, Jun 24, 2020
    Last edited: Jun 24, 2020
    I don't have an issue with higher incomes paying more. I do have an issue with 2019 income being used to set 2021 premiums, as is the case with IRMAA. The ACA gets this right, Medicare doesn't.

    The big issue with ACA coverage is this backdating of part A coverage by six months, precluding you from getting any ACA subsidy during that time. So you end up partially insured (no part B backdating) but with no subsidy. If you bothered to read the NY Times article, you'll see it actually links to a CMA document document that, because the issue has been so pervasive, offered relief (which expires before my Medicare eligibility starts) to the many who have found themselves in this position.
     
  19. stanger

    stanger BigSoccer Supporter

    Nov 29, 2008
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    Paywalled. I can't explain what I can't see.
     
  20. M

    M Member+

    Feb 18, 2000
    Via Ventisette
    Odd you were so dismissive of the NY Times article then.

    Here's the CMS document that is linked to:

    https://www.cms.gov/Medicare/Eligib...SHIP-and-Navigators-Fact-Sheet-10-10-2018.pdf

    And given you can't read the article, here's a push to fix this stuff that you claim is exceedingly rare:

    "The Medicare Rights Center and other advocacy groups have proposed legislation that would require the federal government to notify people approaching eligibility about enrollment rules, and how Medicare works with other types of insurance. The legislation — the Beneficiary Enrollment Notification and Eligibility Simplification Act, also would eliminate coverage gaps now experienced by enrollees during the Initial Enrollment Period and General Enrollment Period. The legislation was introduced in Congress last year, and will be reintroduced this year."
     
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  21. rslfanboy

    rslfanboy Member+

    Jul 24, 2007
    Section 26
    I thought you said you were going to stop engaging in this conversation.
     
  22. stanger

    stanger BigSoccer Supporter

    Nov 29, 2008
    Columbus
    Club:
    Columbus Crew
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    United States
    Do you understand what that document is? It's not about people like you that have apparently weighed their options and decided not to use their IEP to enroll in Medicare, it's for people that were mistakenly enrolled in the wrong program and want to correct their error. SHIP stands for State Health Insurance Assistance Program.

    Here is the operative part

    I do not believe, from what you have explained, that you fit that description.

    And yes, there are plenty of people that are given bad advice. They shouldn't be penalized because their advocate was negligent.

    So either the NYT article took that out of context or you misinterpreted the document and the point of the article.


    I can't help it. I do this kind of explaining for a living.

    As long as the conversation stays civil I have no problem continuing. Unless you want me to stop? I'm not particularly interested in "winning the internet" but M's last few posts are needing of clarification.
     
  23. M

    M Member+

    Feb 18, 2000
    Via Ventisette
    #5298 M, Jun 24, 2020
    Last edited: Jun 24, 2020
    You missed this part:

    "
    In summer 2018, CMS mailed two notices to individuals offering the assistance. The first went to individuals enrolled in Medicare Part A who were also enrolled in the Exchange and receiving financial assistance (i.e., APTC). [i.e. the exact sitation I've raised here] The second notice went to all those enrolled in Medicare Part A and the Exchange.

    The assistance allowed them to enrol in part B immediately, thus saving them an arm and a leg having to have for an ACA policy with no premium assistance until the next general enrollment period came along. It does leave open the question as to whether people still got stung with having to repay any ACA premium credits they got post Medicare part A enrollment.

    The NY Times covers many of the issues I've raised here relating to transitioning to Medicare from COBRA, ACA and Retiree Coverage. It also covers the gotcha regarding HSA contributions/backdated part A coverage.

    Nothing I've posted has been shown to be inaccurate.
     
  24. stanger

    stanger BigSoccer Supporter

    Nov 29, 2008
    Columbus
    Club:
    Columbus Crew
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    And I never said it was inaccurate, just rare.

    Rare enough to ave only come up a few times in my career.

    Medicare is not perfect and I never said it was. But it certainly isn’t as difficult to navigate as you continue to say it is.
     
  25. rslfanboy

    rslfanboy Member+

    Jul 24, 2007
    Section 26
    Do you really care? :D

    I was just trying to give you a friendly prompt to back out. Like when I tell my wife I'm not going to drink this weekend, and then she reminds me of my previous conviction as I reach for a beer in the fridge after the kids have been screaming for two hours straight on a Sunday morning.
     
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