Max, spot on. Here’s another —- totally F’ed up dimension —- of the MM mess. Most educators retired from the public sector have post employment benefits that include health insurance. That large group of Medicare eligible seniors continue to be represented by their unions. Fine. But those unions select the provider of that insurance and the all too cozy relationship between the unions & AARP/United Health means they are being sold DIS-advantage plans. And there’s nothing really any one retiree can do about it except forego the benefit … cut off nose/spite face.
Making matters worse … you can’t buy Medicare from Medicare. You have to buy it thru some useless insurance carrier … as an individual. As far as I can determine there is no such thing as a group Medicare plan. You’d want a group plan so there’d be an advocate for you when shit goes wrong.
If the public education unions had broken with United Disadvantage and gone to Medicare saying “hey, we will bring you 10M relatively healthier seniors but we want to buy these plans direct from Medicare” that might have been a long enough lever.
Nope. United Health has a generous kick back program and it loves them Disadvantage Plans.
I thought Medicare IS the group plan. All this incl from Brother Cohen above reinforces my resolve to just sit tight and pay through the nose. Fortunately I am generally frugal and can afford it.
Medicare is not a group plan in the sense that there’s a group administrator who advocates for members of the group. When we were active employees we had a group health plan & when insurer X decided you had to wait 5 years before a recommended procedure or test, group admin goes to bat for you.
Medicare would be/could be a group plan if we were buying it from Medicare. Then there could be advocates based in states & cities. Right now in Maine, the 500k enrolled in medicare are spread over 18 plans of 20 odd insurers. Even the retired teachers are spread over a dozen plans all with United Health Disadvantage.
If the ItThing had lost the election I was going to try to push for a pilot project of the 7 states with 500k or fewer Medicare enrollees to see what is actually required to get them into 1 plan per state, sold by Medicare.
Medicare for all, Single Payer … what people want is Universal Health Care coverage. Again recommending The Healing of America. There’s a documentary version if you don’t want to read the book. It’s a terrific book!
Little-known (in my experience) fact about traditional Medicare vs. Medicare Advantage:
About four years ago, I was induced to switch from traditional Medicare + Supplement (Parts A, B and D)to a Medicare Advantage Plan (Part C). It saved me some money on one medication. I had no real problem with it but I began to hear horror stories from others about this procedure or that not being covered of this or that practice not accepting MA. I decided I needed to switch back.
I tried.
No such luck. I chose a plan with a supplement from Mutual of Omaha. Highly rated.
I was rejected. Why? Seems I had “degenerative bone disease”, something I was not aware I had. Me, who was cycling over 75 miles a week on a traditional bicycle, not an E-Bike. I called to complain. What the hell is “degenerative bone disease”?
It turns out that DBD is a fancy name for “arthritis”, something that, what, 98% of those of Medicare age (I’m guessing) have somewhere in their medical records. Mine was not severe in the least, something that some doc at some time just wrote in my chart before Medicare Advantage existed, probably.
I called Mutual of Omaha to complain and was directed to some broker. She said she thought she could find me a decent plan but it wouldn’t be easy. You see, here is the thing not many people know: the decision to take Medicare Advantage is practically irreversible. When you first go on Medicare they can’t reject you for any preexisting condition. You have what they call “right of issue”, the right to be issued a policy, no questions asked. Once you take MA, you no longer have this right and preexisting conditions can be and are considered.
I can’t tell you how many people I’ve spoken to who do not realize this.
However, I was in luck. This broker knew her stuff. I casually mentioned that I’d just moved from Illinois to Arizona, and a light went on in her head. This light did not go on in the head of the consultant who worked for my previous employer who I had previously spoken with. There is an exception to the above right of issue rule.
IF you happen to move to a different state, then right of issue is back in force and they have to take you! And so Mutual of Omaha, once informed of my move, gave me the policy they had previously rejected me for.
I had no idea of any of this when I moved. But anyone in greater need than I of getting back to Traditional Medicare might seriously consider such a move if feasible.
After a few surgeries and various procedures (stress tests, heart catherization, colonoscopy, etc.)—nothing catastrophic—Medicare has served me well. Medicare limits what doctors and hospitals can charge, so the 80% payment figure isn’t quite accurate (which is why some doctors won’t accept Medicare). Many bills are already reduced perhaps 25 to 30% by Medicare, so patients pay about 20% of an already reduced medical bill.
I used United Healthcare for a time to cover prescription drugs, but realized there were no savings for drugs because of the high premiums. Instead, I joined a prescription club at Walgreens that gives me almost the same reduction in price as United for only $25 a year rather than $100 a month premium. (Medicare itself last time I looked cost me $115 a month, taken directly from Social Security.)
So, my experience with Medicare has been positive, and Medicare for all as a step toward universal healthcare seems sensible. Besides the premiums, the biggest difference between Medicare and private insurance is that Medicare limits what patients can be charged and private insurance limits what it will pay (if anything). Of course, Medicare won’t pay for everything, but it does for much more than standard insurance plans.
Max, spot on. Here’s another —- totally F’ed up dimension —- of the MM mess. Most educators retired from the public sector have post employment benefits that include health insurance. That large group of Medicare eligible seniors continue to be represented by their unions. Fine. But those unions select the provider of that insurance and the all too cozy relationship between the unions & AARP/United Health means they are being sold DIS-advantage plans. And there’s nothing really any one retiree can do about it except forego the benefit … cut off nose/spite face.
Making matters worse … you can’t buy Medicare from Medicare. You have to buy it thru some useless insurance carrier … as an individual. As far as I can determine there is no such thing as a group Medicare plan. You’d want a group plan so there’d be an advocate for you when shit goes wrong.
If the public education unions had broken with United Disadvantage and gone to Medicare saying “hey, we will bring you 10M relatively healthier seniors but we want to buy these plans direct from Medicare” that might have been a long enough lever.
Nope. United Health has a generous kick back program and it loves them Disadvantage Plans.
I thought Medicare IS the group plan. All this incl from Brother Cohen above reinforces my resolve to just sit tight and pay through the nose. Fortunately I am generally frugal and can afford it.
Medicare is not a group plan in the sense that there’s a group administrator who advocates for members of the group. When we were active employees we had a group health plan & when insurer X decided you had to wait 5 years before a recommended procedure or test, group admin goes to bat for you.
Medicare would be/could be a group plan if we were buying it from Medicare. Then there could be advocates based in states & cities. Right now in Maine, the 500k enrolled in medicare are spread over 18 plans of 20 odd insurers. Even the retired teachers are spread over a dozen plans all with United Health Disadvantage.
If the ItThing had lost the election I was going to try to push for a pilot project of the 7 states with 500k or fewer Medicare enrollees to see what is actually required to get them into 1 plan per state, sold by Medicare.
Medicare for all, Single Payer … what people want is Universal Health Care coverage. Again recommending The Healing of America. There’s a documentary version if you don’t want to read the book. It’s a terrific book!
Little-known (in my experience) fact about traditional Medicare vs. Medicare Advantage:
About four years ago, I was induced to switch from traditional Medicare + Supplement (Parts A, B and D)to a Medicare Advantage Plan (Part C). It saved me some money on one medication. I had no real problem with it but I began to hear horror stories from others about this procedure or that not being covered of this or that practice not accepting MA. I decided I needed to switch back.
I tried.
No such luck. I chose a plan with a supplement from Mutual of Omaha. Highly rated.
I was rejected. Why? Seems I had “degenerative bone disease”, something I was not aware I had. Me, who was cycling over 75 miles a week on a traditional bicycle, not an E-Bike. I called to complain. What the hell is “degenerative bone disease”?
It turns out that DBD is a fancy name for “arthritis”, something that, what, 98% of those of Medicare age (I’m guessing) have somewhere in their medical records. Mine was not severe in the least, something that some doc at some time just wrote in my chart before Medicare Advantage existed, probably.
I called Mutual of Omaha to complain and was directed to some broker. She said she thought she could find me a decent plan but it wouldn’t be easy. You see, here is the thing not many people know: the decision to take Medicare Advantage is practically irreversible. When you first go on Medicare they can’t reject you for any preexisting condition. You have what they call “right of issue”, the right to be issued a policy, no questions asked. Once you take MA, you no longer have this right and preexisting conditions can be and are considered.
I can’t tell you how many people I’ve spoken to who do not realize this.
However, I was in luck. This broker knew her stuff. I casually mentioned that I’d just moved from Illinois to Arizona, and a light went on in her head. This light did not go on in the head of the consultant who worked for my previous employer who I had previously spoken with. There is an exception to the above right of issue rule.
IF you happen to move to a different state, then right of issue is back in force and they have to take you! And so Mutual of Omaha, once informed of my move, gave me the policy they had previously rejected me for.
I had no idea of any of this when I moved. But anyone in greater need than I of getting back to Traditional Medicare might seriously consider such a move if feasible.
After a few surgeries and various procedures (stress tests, heart catherization, colonoscopy, etc.)—nothing catastrophic—Medicare has served me well. Medicare limits what doctors and hospitals can charge, so the 80% payment figure isn’t quite accurate (which is why some doctors won’t accept Medicare). Many bills are already reduced perhaps 25 to 30% by Medicare, so patients pay about 20% of an already reduced medical bill.
I used United Healthcare for a time to cover prescription drugs, but realized there were no savings for drugs because of the high premiums. Instead, I joined a prescription club at Walgreens that gives me almost the same reduction in price as United for only $25 a year rather than $100 a month premium. (Medicare itself last time I looked cost me $115 a month, taken directly from Social Security.)
So, my experience with Medicare has been positive, and Medicare for all as a step toward universal healthcare seems sensible. Besides the premiums, the biggest difference between Medicare and private insurance is that Medicare limits what patients can be charged and private insurance limits what it will pay (if anything). Of course, Medicare won’t pay for everything, but it does for much more than standard insurance plans.