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Trusted Social Butterfly

Re: What is Wrong With Medicare ?

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Message 1 of 7

"Actual cost" is the sum of negotiated prices to Medicare, not the actual internal costs of manufacturers and suppliers of drugs and medical services.  Plan C and D insurers don't negotiated lower prices, in part, because it doesn't know the internal costs of the suppliers.  (An exception is CVS owns Aetna.)   It would be better for Medicare to negotiate drug prices.  T

 

As a consumer, to make rational decisions about drug costs, you need to have anchor prices that are close to the internal cost of the supplier.  For drugs, you can get good anchor prices by finding  minimum drug prices on this website:

 

https://www.goodrx.com/

 

If you compare these minimum prices to what Medicare pays to insurers, you will see that plan C and D insurers are either incompetent negotiators or getting kickbacks from pharmacies and drug manufacturers.  And, I point out that this website is available to insurers and Medicare bureaucrats therefore they have no excuse for being poor price negotiators.

 

Regarding "kickbacks," in some states, e.g., Illinois, pharmacists are forbidden by law from voluntarily alerting customers that their insurance copay for a drug is higher than the price to the uninsured public. If government were on the side of its citizens, it would force pharmacists to automatically give customers the best deal.  Medicare would save money with such a law.  

 

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Valued Social Butterfly

Re: What is Wrong With Medicare ?

682 Views
Message 2 of 7

Everybody pays Part B premiums regardless of how they get their Medicare benefits - original Medicare or a Medicare Advantage plan.

 

Those Part B premiums are based on the actual cost of this part of Medicare - doctor visits, outpatient, chronic illness management, etc.  Premiums represent about 25% of the program cost with about 75% of the program cost coming from the general fund.

 

With the number of baby-boomers increasing, with beneficiaries getting older, with the cost of medical getting higher, the cost of Part B Medicare is going to keep going up.

 

The economy seems to be growing faster and with that, I believe that we will see a related COLA increase more often than in the last several years but if all or most of these COLA increases taken up by increasing Part B premiums, many will just be spinning their wheel on any increase in their Social Security benefit.

 

I do not know what the answer to this problem is without actually affecting Part B benefits.  Anybody got any suggestions?  Guess we might try some of the medical cost containment methods which other countries use - although I don't think these will be to the liking of many beneficiaries because it does involve more government rules and controls.

 

However on a positive note - when Medicare was 1st established - Part B premiums represented 50% of the program cost but was reduced to the current 25% of program cost a few years later.

 

 

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Trusted Social Butterfly

Re: What is Wrong With Medicare ?

699 Views
Message 3 of 7

I have experience with C and D. 

 

As you should know, C is of two types, HMO and PPO.  HMO does not allow out of network doctors.  A variable that is unknown to the customer is the probability that your doctor's contract with the insurer will terminate while you are insured.  But, the insurer knows this variable and keeps it a secret.  In my experience, HMOs are a gyp. 

 

The problem with plan Ds is that combined cost of drug copays and premiums is about the same as the uninsured minimum price of drugs using GoodRx coupons.  See https://www.goodrx.com/ .  This is because the negotiated drug prices between the insurers and drug stores are fictitious and Medicare allows this kind of lying.  And, depending on the State, pharmacists are forbidden by law from alerting customers to better drug deals.  Thus, for some drugs, your plan D copay may be higher than the uninsured price.  In my experience, plan Ds are a gyp. And, for other medical services, plan D is the same as plan B, which in my experience, isn't much worse than with an HMO.

 

In my experience, the best deal, by far, is a PPO. I have zero premiums, no deductible, and my cost for out of network doctors is 35% which isn't much more than the 20% for Plan B. 

 

 

A problem for all D and C plans is that you have to get "prior authorization" for certain drugs, every time you switch insurers, from the insurer.  It would be more efficient to get prior authorization only once from Medicare.

 

In any event, you should not rely on advertising or let your current plan automatically renew itself, but, instead use this government website every year to find the best plan:

 

 https://www.medicare.gov/find-a-plan/questions/home.aspx?AspxAutoDetectCookieSupport=1

 

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Conversationalist

Re: What is Wrong With Medicare ?ANSWER

845 Views
Message 4 of 7

If you are a baby boomer who worked all yer life,and you all paid billions of buxks taxes to soc. sec. and medicare, your insurance money was stolen by Democrats(Obama) to be transferred to AFORDABLE CARE INSURANCE--where the very poorest non work people get it.That was to be 700 billion bucks over 10 yrs. ALL THAT TRILLION or close amt, has all been used, ACI IS BROKE.it has not been relegated any new funds.

 

however, we now realize this "sending tons of taxes to the fed. for medical insuramce" does not work; SEVERAL senators told AARP MEMBERS all the lock boxes for medicare and  soc, sec, were raided, stolen by our political leaders we voted in. --THAT IS WHY IT IS SHORT. --NOT BECAUSE THERE ARE TOO MANY SENIORS.

 

You want our advice?  You won't like it.It involves millions of taxpayers revolting--and would be an organized nation wide action of no longer paying our fed.. taxes--none of them. (Altho grass roots is best) We do NOT HAVE ANY OTHER POWER--OUR VOTES are useless! but the work class and middle class atill pay most taxes to support the fed. govt.---yes, there is your power--together. MONEY TALKS. I advise very active seniors groups to organize "below the grid" not use the Net,and start planning.I am NOT JOKING.

 

the only other tool would be, all you seniors who have sons and daughters,Espec. younger,(and other relatives in all military)--talk to these relatives.--The fed needs a big bunch of soldiers.--But how would all these military relatives like seeing granddad and grandma, affter work a lifetime, be dumped out on the trash heap of medical care? huh?It is bad enough what the VA members get stuck with---how do they like seeing loved old onea, who worked all their lives, screwed by the fed?--adter it took all their money?

 

Your relatives in the military fight all these foreign wars--go ahead, phone em,write em email em, ect ect. Talk to em.The fed. still needs them to fight, no?And why should they kill themselves, when their repayment is to have mom,or dad,or the grandparents, having their medicare and/or soc. sec. stolen?--and their realatives left to die?I know if I were in the military, I might think about a "blue flu"(police members strike) or part of one. Or,howver it atriikes them. Let your discussion with military relatives be YOUR PRIVATE BUSINESS. --between you all.

 

But you all have power--you just have to level it at the right point with the right tools.--if that sounds very "military-ish" so be it.Think  Ghandi. ---or however you like--just realize those 2 areas of power are there. YOU ALL HAVE THEM.--and they are important to the fed. govt. Without a lot of tax money, that fed. is no longer so powerful. And having a huge military force that obeys, is also very important to the fed. govt. Those 2 depts, are a big bargaining point.

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Valued Social Butterfly

Re: What is Wrong With Medicare ?

1,019 Views
Message 5 of 7

GailL1 wrote:

What is wrong with Medicare, in your opinion?

 

One particular Part - A,B,C, or D -

How you get your benefit - original Medicare or Medicare Advantage

Or just all of it.

 

Is it what you were expecting when you came onboard to the whole program?  

 

Do you have health needs that are not covered?  What value would you out on these needs that are not met?

 

Would you be willing to do things that would save the program money?

Like in original Medicare, picking a personal care physician and be required to get referrals through him/her before you see a specialist.

 

How are the various associated cost for you? In Parts A,B,C and D?

 

So in your opinion -'What, if anything, is wrong with Medicare?

 

 


Gail, If Medicare didn't exist seniors would die in the streets. So, let's go from there.  
There are many things that Medicare lacks, we all know about that and that is the reason for having Supplements, and Medicare Advantage programs What is appalling that any of this happens in the richest country of this world. sometimes I thinks we live in Zimbawe or in the jungles of Brazil or in any other country in which people don't have access to health care. in this country  Health care is not considered a right.  but a privilege. so we should start from there.
Even in Saudi Arabia today, they are actually dealing withe their corruption that exists in that country. And taking action to stop it.
But in the US. wed seem to become paralyzed when it comes to Health Care.
Some want more and some think we have too much.
The inequality that exists for people over 65 is appalling. and you know it as well as I do.
And now, it's going to get a lot worse. But, I am planning on sitting down and laughing at all the people when they prepare their 2018 taxes and really see what is going to happen to them.
So, what is wrong with Medicare? Congress, the Senate, The President of the United States. because none of them want to do what needs to be done, so that American citizens have the health care that they deserve.

 

 

 

 

 

 

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Info Seeker

Re: What is Wrong With Medicare ?

1,055 Views
Message 6 of 7

My concern is about medication that is needed by organ transplant patients.  Immune suppressents are required to control organ rejection that can cause the new transplanted organ to fail resulting in possible death or other illnesses.  For example, the brand name is Prograf ( aka tacrolimus) that causes kidney damage after using for a number of years.

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Valued Social Butterfly

What is Wrong With Medicare ?

1,119 Views
Message 7 of 7

What is wrong with Medicare, in your opinion?

 

One particular Part - A,B,C, or D -

How you get your benefit - original Medicare or Medicare Advantage

Or just all of it.

 

Is it what you were expecting when you came onboard to the whole program?  

 

Do you have health needs that are not covered?  What value would you out on these needs that are not met?

 

Would you be willing to do things that would save the program money?

Like in original Medicare, picking a personal care physician and be required to get referrals through him/her before you see a specialist.

 

How are the various associated cost for you? In Parts A,B,C and D?

 

So in your opinion -'What, if anything, is wrong with Medicare?

 

 

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