Some book, some story…

Medicare: no, it ain.

January 4, 2010 at 4:15 pm | Posted in main category | Leave a comment
Tags: prescription drug

C2 commenter “realwest” (scroll down to comment #16) has some choice words of explanation for people who think Medicare coverage is free. Go over there or click “read more” to see his remarks.

Summary for non-Americans and the unitiated: Medicare (which covers people over 65, as well as certain other people with eligible chronic diseases or disabilities) is basically structured as four parts.

• Part A is catastrophic coverage (visits to doctors and hospitals for life-threatening emergencies). It is “free” if you have paid social security taxes for at least 10 years (defined as 40 quarters, which need not be consecutive). If you have worked between 30 and 39 quarters, you can buy Part A coverage for (as of 2009) a premium of $225/mo: if you have worked less,  $423/mo.
• Part B covers visits to doctors, hospitals, medical imaging,… only up to 80% of the fees on the Medicare reimbursement schedule. The remaining 20%, as well as any fees charged over and above the Medicare rates, are the patient’s to pay. Part B has a monthly insurance premium of (as of 2008) $96.90/mo.
• Part C (a.k.a. Medicare Advantage): supplemental coverage plans that cover the remaining 20% plus (depending on the specific plan) additional fees and services. This is generally the preferred option for people who require a lot of medical attention. “Realwest”, for example, plays about $300/mo, adding up to about $400/mo in Medicare insurance premiums. Alternatively (mutually exclusive with part C), one may choose to enroll in a private Medigap (supplementary coverage insurance) plan.
• Part D is the Prescription Drug Benefit. , including the infamous “donut hole“. That is, under Part D, the first $295/yr are on the patient, the Part D covers 75% of the part between $295 and $2,700/yr. Above that, you enter the “donut hole” where all expenses are out of pocket until the “catastrophic coverage threshold” is reached, at which point Part D picks up 95% of any additional expenses.

Note that the above only describes coverage. Coverage is worthless without access: already now, nearly one-third of physicians (usually specialists) will not accept Medicare patients,  and this number of “girls gone wilddocs gone Galt” is expected to increase if further Medicare fee reductions take effect.

(link to C2 thread)

realwest   1.3.2010 6:00 PM     #16

Well, not to cut off any banter or good morning cheeriness (?!) but I do want to put out here something about Medicare which JCM was kind enough to provide some thoughts on in the Post itself.

I think the below information is sufficiently important that – although this is somewhat long, I hope you all will read it, carefully.

Many folks are of the mistaken idea that Medicare is FREE health care once you reach a certain age.  Well, maybe not many people, but I sure was! LOL!

But that’s all that’s funny about Medicare.  Y’all need to know that all you get from basic (called Part A) Medicare, which  you don’t need to pay any more for, is emergency – life threatening emergency visits to doctors and hospitals.  If you pay income taxes in the U.S., you’ve been paying some small amount to Medicare since you started working.  It’s “hidden” in that Social Security/FICA crap.

BUT – if you want medical coverage, you  MUST purchase Medicare Part “B” – which costs $96.90 a month.  IF you spend that $1,200 a year on Medicare part B, that enables you to have Medicare pay for up to 80% of Medicare ALLOWED doctor and hospital charges; the other 20% and any charges above the amount that Medicare allows to doctors, hospitals, x-ray and lab stuff are out of your pocket.  So if you are seriously ill, know you’ll be seeing a lot more doctors, prescription cards x-ray labs and hospitals than you’d like, you buy Part “C” – which [for Realwest's plan in his state --- Ed.] currently costs $297.65 a month – that’ll cover the additional 20% that Medicare ALLOWS doctors, hospitals, labs etc to charge to Medicare.  So we are now up to about $400 a month for Medicare Insurance – even though you’ve already paid into it, as I said, your entire working life.

PLEASE NOTE THAT THESE CHARGES AND THE AVAILABILITY OF COVERAGE VARY STATE BY STATE.  YOUR MILEAGE MAY VARY.

But if you also want prescription drug coverage, it will cost you another $67.50 a month and you will pay 20-30% Co-Pay of what Medicare ALLOWS pharmacies to charge you.  Until Medicare has paid up to $2,050 in drug coverage for you. Thereafter you fall into what is described as the “gap” or the donut – the next $4,700 a year in prescription medications you must pay out of your own pocket.  So we are now up to $800 a month (amortizing the $4,700 on a monthly basis) PLUS THE CO-PAYS before you got into the “Gap” or in my case,for example, about $925 a month.  That is to say, Medicare coverage for doctor visits, labs, x-rays, and prescription coverage is costing about $11,000 a year.  Of course, once you get out of the “gap” you are on what Medicare so quaintly calls
“catastrophic” coverage and suddenly the drug I take every month that costs me $525 retail (when I’m in the Gap) now costs me only about $28.00 a month.  My own drug costs  is such that I get in the Gap by April 30th and get out of it by October 1st of each year. So that’s another oh $360 or so per annum for my Catastrophic coverage.

Y’all still with me here? You ought to be, because if you don’t wind up needing Medicare, it’s almost a sure thing your parents or siblings will. So Medicare costs me roughly $11,500 a year or about $960 a month.  For the most basic coverages available.  My mother and I each had to stop taking prescribed medications by our oncologist – one medication each – to be able to afford living while in the Gap.  And no, we each make a tad more than that which is allowed by State Medicaid for additional health care assistance.

And the LEFT Congressional Party is proposing a further 21.5% cut in the reimbursement to doctors (google Mayo Clinic, Phoenix) with the result that while there are NOW 27% of doctors who WILL NOT ACCEPT MEDICARE PATIENTS (mostly specialists like surgeons, oncologists, urologists, cardiologists, etc), that percentage may grow to something like 35%-40% of doctors who will not accept Medicare PatientsAT ALL.

And yet, in addition to increasing income taxes and fees etc. the Obama administration is proposing to further cut aid to Medicare recipients by another $500 BILLION  to help fund free Health care for those – well, actually a little less than half of those who don’t have medical insurance, NOW.  Of course those benefits to those who are uninsured won’t start until 2013 although the cuts to Medicare recipients and the increased taxes started THIS YEAR.

While I recognize that this health care reform is about POWER not about providing decent health care, I can’t help but wonder at a United States Government that would handle MEDICARE as poorly as it does, EVER running National Healthcare, or as the Left Party likes to call it “the Public Option”.

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