Author Topic: Talking Heads - Healthcare Reform (Read 101123 times)

ANNIE · « **Reply #400 on:** October 13, 2009, 02:04:53 PM »

Steph,
I like your ideas! Why don't you send them to Congress?? Maybe they would wake up and smell the roses.

nlhome · « **Reply #401 on:** October 13, 2009, 09:20:01 PM »

Neither Social Security nor Medicare are "failing" but they do need some adjustments in funding.

Steph · « **Reply #402 on:** October 14, 2009, 07:47:25 AM »

I really dont understand why they dont adjust social security. They did that for years. It used to raise every year or so. Now it does not as far as I know.
The corruption involved in mostly medical devices is amazing in south FLorida. I dont quite understand why medicare does not investigate the people who apply to be a provider. It seems to take them years to figure out that something is wrong.. Seems strange to me. Just like the people who keep claiming social security after the person who actually was supposed to get it dies. I thought they kept track with death certificates.

bellemere · « **Reply #403 on:** October 14, 2009, 08:59:17 AM »

It takes a woman! Kudos to Olympia Snowe for having the courage of her convictions. She voted for the Finance Commitee's version in spite of the fact that it doesn't have exactly what she would want in health care reform. But it took guts to cross that party line.
Now, am one of the first victims of health care reform. My premiums, if I want to stay with my Medicare Advantage nprogram will go from 109 to 145 next year. so I am shopping. If my doctors' group continues to accept them, i may stay, and cut back somewhere else. What is a good Medicare supplement plant? Does anyone advocate "going bare" with only Medicare?

Babi · « **Reply #404 on:** October 14, 2009, 09:31:11 AM »

I'm happy with my own provider, BELLE, but some people like to stick with
Medicare and a supplemental insurance program. I suppose it depends on the
individual circumstances, and of course the integrity of the provider. As STEPH
points out, some providers apparently are just in for a fast buck.

bellemere · « **Reply #405 on:** October 14, 2009, 08:44:15 PM »

I take it you do not have Medicare, even Part A, the hospital insurance. and
Babi, are you not yet 65 or are you 65 with a government or state employee or labor union retirment plan?
I certainly intend to keep Medicare both parts A and B and am thinking of looking for a new Medicare supplement.
Interesting discussion of the public option tonight on the News Hour. Republicans vow never to vote for a plan that has one: certain
Democrats vote never to vote for a plan that doesn
t have one. Oboy.
Possible: the
trigger mechanism , suggested by Olympia Snowe that would start a public plan in any area if costs were shooting up because of no competition. Even more interestin: the suggestion to let states start a public option of ther own if they cannot get the private companies to hold down costs. Our state employees have a great insurance plan.
We could just open it to others and voila! Public option. No new beauracracy or anything.

nlhome · « **Reply #406 on:** October 14, 2009, 08:59:50 PM »

If you want some advice on switching from Medicare Advantage to a Medicare Supplement, or vice versa, a good place to start is with your state's SHIP counselors. http://www.medicare.gov/Contacts/staticpages/ships.aspx

These counselors are trained in Medicare and insurance. In some states they are volunteers, while in others they are paid, but they are knowledgeable and neutral.

One way to compare Medicare Advantage and Medicare supplements is to calculate the maximum out-of-pocket with the Advantage plan and compare it to the cost of the Medicare supplement premium and any co-pays. Another thing to consider, especially for those whose health is not good, is that the monthly Medicare supplement premium is a budgetable cost, while the ups and downs of co-pays and co-insurance in many of the Advantage plans (particularly private fee for service) can be hard to adjust for and may not be accurate.

Steph · « **Reply #407 on:** October 15, 2009, 08:24:57 AM »

We use the AARP program as our medigap program and love it. My husband has had numerous surgeries, etc for the past three years and we have never owed a penny. They pick up where medicare leaves off. They do not however pay for eye exams or dental..

ANNIE · « **Reply #408 on:** October 15, 2009, 08:35:06 AM »

I have been reading all of the interesting posts concerning keeping Medicare Original plus a supplement or changing to an Advantage plan.
I looked into selecting an Advantage plan for the last two years since the monthly cost is so much lower than what we pay for the for our supplement. Every time I come up with almost identical costs for each plan and we are still in my husband's supplement plan plus we have Medicare Original.
We have Original Medicare and a supplement with an Rx plan included that is merely co-pays for each Rx instead of having to deal with the donut for Rx. This makes the two most expensive plans, Medicare Original w/ supplement or Advantage's PPFS, pretty close in cost. Our supplement is really high but since we are both needing many Rx's it evens out. Also, I am not at ease, deserting the company supplement as we are so well covered, up to 2 million, by the catestrophic supplement. So, we will stay as long as we can with this arrangement.
In the past year, I read somewhere that our company may be dropping Rx coverage and I don't know where I read it so am waiting for the big ball to fall. We have not received our offerings for next year yet.
Fortuneately, my husband is a vet and can get his generic Rx's from the VA so that will be somewhat of a help. But, he takes two very expensive non-generic Rx's that we will have to pay for. Mine are mostly generic but I would have to depend on whatever the different pharmacies are offering here. This could wipe out any gain from changing to an Advantage plan. Well, we will see what the company offers if they ever get their annual insurance plans out to us.

I am interested in looking at the SHIPS as I have never heard of that group of people.

Babi · « **Reply #409 on:** October 15, 2009, 09:02:10 AM »

No, Belle, my 'provider' is a Medicare contract probider, Texas
HealthSprings, that so far have proved to be responsive to all my
problems. I have Medicare A and B, and I just turned 74.

ANNIE · « **Reply #410 on:** October 15, 2009, 09:05:43 AM »

HAPPY BIRTHDAY, BABI!!

Yes, you and I have similar plans. We are paying almost all of my husband's pension for our supplemental but thank God, he has the pension.
I have friends in Atlanta who are paying 1.5X what we pay and they are in a big city with many choices. What makes them need catastrophic coverage is her Post Polio Syndrome. She is 76 and already using a wheel chair when going anywhere. She is not needing it in her home yet.

ANNIE · « **Reply #411 on:** October 15, 2009, 09:40:33 AM »

Last night, I watched Lou Dobbs interview a congressman who wants us to do a common sense program of letting the illegals who are living and working here become legalized. Frankly, he made a lot of sense to me. Did anyone else see this???

Steph,
Which AARP supplemental plan did you choose? Does it include your Rx's??

bellemere · « **Reply #412 on:** October 15, 2009, 09:52:18 AM »

thanks so much for the responses. regarding notice of changes for next year, I believe there is a " deadlin" for companies to contact you, and I thought it was Nov. 1. That begins the window of time for changes to premium prices and coverage changes. We just got ours from our Medicare Advbantage Plan. Big jump in premiums; no change in copays; little reduction in covered services.
Yes, we have a counselor program called SHINE, and I am going to make an appointment.
the counselor is my neighbor, a retired exec of an insurance company; really knows the fine points.

nlhome · « **Reply #413 on:** October 15, 2009, 07:05:17 PM »

Prescription drug and Medicare Advantage plans must send out their annual notice of change this month. People must read everything that comes from their plans, because the information about changes for the next year may be stuck in with their monthly bill or explanation of benefits.

Almost every state has some prescription drug plans and some Medicare Advantage plans that are ending, at least in some counties, so people may have to switch plans or be stuck in original Medicare and/or without a drug plan. Those with the "extra help" may have to switch as well or they could end up paying a premium in their old plan.

Steph · « **Reply #414 on:** October 16, 2009, 08:09:56 AM »

We just got our changes.. from the prescription plan. I use the same AARP prescription plan as well as the medigap. My husband goes to VA for his meds.. and when we cost it out, his one very expensive prescription is the same price in the end as what it would cost him from the plan.. So I cannot convince him to join the plan. We both use the medigap however.

bellemere · « **Reply #415 on:** October 16, 2009, 10:14:11 AM »

I think we are all talking about the same things: let's see, Medicare Part A, the hospital coverage, with a ded;uctible. Part B, the coverage of doctor's fees, services like xrays and the deductible in part A for the hospital; Part D, the prescription coverage, purchased through private supplers with different copays according to the "tier" of the drugs.
Medigap, the generic name for plans that cover the 'gaps" inB and D and Medicare Advantage, the plans that cover these but have added benefits.
You have t practically be an economist to get a true comparison of some of these things, don't you?

nlhome · « **Reply #416 on:** October 16, 2009, 07:00:04 PM »

Just one clarification: Medicare Advantage is your Medicare A and B provided by a private insurance company, rather than the traditional Medicare. So Medicare Advantage plans must offer the same benefits as Medicare A & B, with different cost sharing amounts possible. Medicare Advantage plans sign yearly contracts with Medicare, so premiums, co-pays and deductibles can change significantly from year to year, as can these added benefits. These are the plans that cost Medicare about 13% more per person than traditional Medicare, so that all Medicare beneficiaries pay more in premiums.

Medicare Advantage plans cannot be supplemented, and some of the private fee for service Medicare Advantage plans can end up costing more over a year than if a person were paying the premium for a good medicare supplement - because of co-insurance. I think some areas of the country have really good and stable Medicare Advantage plans, while other areas are not well-served by those plans.

ANNIE · « **Reply #417 on:** October 16, 2009, 10:14:42 PM »

nlhome,
If what you say is correct, why do the people in Congress insist on telling us that the Advantage plans have failed miserably??
After researching the Advantage plans, I found that we were better off staying with Original Medicare and a supplement. Our company Aetna supplement covers are Rx's nicely plus picks up 80% of what Medicare doesn't pay.

nlhome · « **Reply #418 on:** October 17, 2009, 08:54:03 AM »

The Advantage plans may fail, if they do not get that average 13% subsidy from Medicare. What that subsidy does is increase premiums for everyone on Medicare, and that is one of the areas where the "savings" would be made in health care reform. And the subsidy allows these plans to compete with traditional Medicare with an "advantage." So when they are offered at a low or even no additional premium beyond the Medicare premium, it's easy to see why people sign up for them, but then they are often stuck, especially if they become ill and incur a lot of out-of-pocket costs and have a limited out-of-pocket max that doesn't apply to all services.

The private fee for service Medicare Advantage plans are especially confusing and, in my area, have large co-insurance payments required for things like oxygen, physical therapy and certain Part B drugs for cancer treatment. They offer things like dental and hearing aid and vision coverage that are not part of regular Medicare, and healthy people do well with these kind of plans. However, as people age or develope chronic illness, they don't necessarily benefit from the Advantage plans and would be better served by Medicare a Medicare Supplement. However, it may not be possible to get into a Medicare Supplement at that point because of underwriting requirements.

Just my thought, as we listen to the arguments about a public option. Medicare is a public option, and if these advantage plans can't compete without the subsidy, then no wonder the insurance companies are fighting tooth and nail to keep a public option out of the reform.

Steph · « **Reply #419 on:** October 17, 2009, 09:35:34 AM »

I dont understand why the government decided to do the Medicare Advantage plans to begin with. Seems weird.. I like our medicare plus a medigap and for me the same company for the prescription. I can use what doctor I want, when I want.. works for me. I had one before medicare that I had to use their doctors.. Which worked well for the internists.. Not so well for the specialist. I ended up with a dermo whose english was rudimentary to put it mildly. Never again..

ANNIE · « **Reply #420 on:** October 17, 2009, 10:31:21 AM »

I was told when I asked about the Advantage plans offered by Aetna that the Advantage promised to pay the drs in 30days and the drs really liked that. Although they were getting less, 85% total. If one had a bill with the dr for $100, an Advantage play paid $85 in a month. The original Medicare plus a supplemental would pay $86.40. So, they didn't get as much from the Advantage plan but it was paid in 30 days which saved them from having to rebill. That might be worth $1.40!

nlhome · « **Reply #421 on:** October 17, 2009, 12:18:02 PM »

Adoannie, who told you that about the prompt payment? That's interesting.
Also, not necessarily true for all plans. In our state, there are areas that will not accept certain Medicare Advantage plans, although they take others and definitely accept Medicare and a supplement. With the crossover between Medicare and supplements, often a provider files one electronic claim and payment comes both from Medicare and the supplement, IF the provider accepts assignment.

Medicare Advantage plans are a reincarnation of Medicare + Choice plans that were started years ago, so that seniors would have "choice." Most of those plans dropped out, some of then abruptly, so then this "Medicare Advantage" was developed, with the subsidy. Plans have yearly contracts, so change every year and can drop or add plans. This year, where I live, 4 plans are not available next year, which means those people in those plans must find another plan, IF they read their mail and find out what's going on. Otherwise they will probably end up in traditional Medicare without the protections of an advantage plan or a supplement. If their Medicare advantage plan also had drug coverage, they could lose that if they don't pay attention.

My theory is that as people age, they don't necessarily want to review their medical plans every year. They want to do other things in retirement. But, maybe I'm just lazy.

ANNIE · « **Reply #422 on:** October 17, 2009, 12:45:56 PM »

NLHOME,
AETNA TOLD ME THAT.

nlhome · « **Reply #423 on:** October 17, 2009, 02:50:32 PM »

ADO, then I think I'd ask your providers how they feel. It may be true. For Aetna anyway.

There are also sales people who don't really understand what they are selling. Medicare Advantage plans, except for the special needs plans for certain chronic diseases, cannot ask health questions when they sell a plan. It is, after all, annual enrollment or open enrollment, and anyone can move around to plans offered in their areas regardless of health (nursing home patients and renal disease may be different). So the companies cannot ask about health issues. That means that the customer needs to ask how the plan would work with their specific issues. The plans always stress their low copays for doctor and other regular procedures - the devil is in the details of more expensive treatments.

I'm sorry, I'm just in the midst of making some decisions right now, and I'd rather be reading my book then wasting my eyes on insurance choices. I get annoyed by this whoe process.

Babi · « **Reply #424 on:** October 18, 2009, 09:57:58 AM »

I've just gotten the yearly update from my provider. They've changed
the name of the plan, and so much else I wonder if they've changed ownership as well. Everything is going up, up. A med that has been costing me $4.00 will now be $30. Since I queston whether I still really
need it, I may drop it.
I could do a comparison of providers available in my area. I've done it
before; that's how I first found this one. But like NL says, it is so tiresome.
It is unlikely that most of the changes will have any major effect on me,
so ...I may or may not.

Steph · « **Reply #425 on:** October 18, 2009, 03:31:26 PM »

Generally our medicare provides a booklet with all of the plans listed and what counties they are in Babi,, Would that help?? I got my prescription plan revision the other day. We are going to have a small co pay this year. I suspect this will be the slippery slope for me. We will see.

nlhome · « **Reply #426 on:** October 18, 2009, 06:33:02 PM »

Babi, don't let the insurance companies win. Look for a different plan. The companies count on people not wanting to make the effort to switch. And don't drop that med without consulting your doctor - he/she may have some other suggestions.

ANNIE · « **Reply #427 on:** October 18, 2009, 09:28:54 PM »

Last year I had a long talk with one of the billing office ladies in my dr's office and she said to stick with the original Medicare and my supplement. Now to do that, I have to continue with what we have, Medicare Plus w/ Catastrophic coverage for $626 a month for two of us w/major changes(higher copays) in the RX's plan inside the supplementary and a limit of $2,000,000 for each of us. Or choose a Medicare Choice at $471 a mo for the two of us, with unlimited coverage and also includes RX's with the same copays that we have had in the past. And, again, the coverage is 85% of the amount that Medicare allows for a that dr or that procedure. We are responsible for whatever is owed after that.

This is getting really nasty, isn't it. I have spent the last three years trying to see if we could actually save any money by changing plans but am always afraid that we would end up paying out the same amounts, no matter what we choose.

This Medicare Choice offered to us this year is not the same as last years Advantage plan. And, we are only offered that one. Its an Aetna PFFS plan with Rx's. Lockheed Martin has worked this out for the retirees in our area. They offer more if one lives in the area of the company's address.

I am still not finished with my assignment for "The Last Dickens" so much say good night, sleep tight!

Steph · « **Reply #428 on:** October 19, 2009, 07:53:50 AM »

I find the idea that Medicare differs from area to area as unpleasant as can be. This is supposed to be a uniform plan for all.. The Advantage makes no sense to have only in certain areas..

Babi · « **Reply #429 on:** October 19, 2009, 08:59:10 AM »

I know I had a plan comparison available the last time I made a choice,
STEPH, but I'm not sure now whether it was on-line or in booklet form.
Probably the latter, as I find those easier to flip back and forth for
comparison.
Don't worry, NL, I will talk with my doctor about what I want to do
before dropping that med. There was a time, tho', that I stuck with a
medicine too long and am still paying the penalty on that one.

ANNIE · « **Reply #430 on:** October 19, 2009, 11:09:36 AM »

Oh, and let me tell another fact about the offerings that we received. We can choose the PFFS plan but must apply to Aetna for it and wait and see if we will be accepted. Whoa! With the history that we both have had in the past 11 yrs, I am staying with what we have for now!

nlhome · « **Reply #431 on:** October 19, 2009, 12:01:40 PM »

Good, Babi. I too always want to be sure the medicine is the best option. Fortunately, I don't need any regular prescriptions. Yet.

Steph, if you go on line at Medicare, you will see that Advantage plans vary in offerings, premiums, etc. county by county, not just region by region. The same for prescription drug plans. First and foremost, the private plans need to make a profit. Medicare doesn't control drug costs - in fact, it is prohibited from doing so. That's why Part D really isn't the most efficient or economical way to offer the drug coverage - but it makes the insurance and drug companies happy.

mrssherlock · « **Reply #432 on:** October 19, 2009, 04:06:36 PM »

As I must several meds daily, the costs are important. I have Med Advantage/Oregon. Used to get my meds at Costco, supposed to have the lowest mark-up. But, it is open only M-S, closes at 7 PM and is quite a distance. Plus the membership cost. When I switched to Walmart, just down the road a ways, I found that there are many of my meds which cost only $4 for a 30 day supply, $10 for 90 days. Open every day til 9. I can order refills online. They will even deliver though I haven't needed that service. There are long lines at Costco and Walmart so that's a wash.

bellemere · « **Reply #433 on:** October 19, 2009, 09:33:52 PM »

Reading over all these endless struggles with "plans" and "choices" makes me want to cry. Will the health reform bill do anything to make this maze clearer for seniors? How much worse could a single payer system be?
I really believe it is a matter of too much money going into health care all down the line. Hospitals are going to have to make less money: doctors are going to have to make less money; insurance companies are going to have to make less money; and pharmaceutical companies are going to have to make a hell of a lot less money. Then maybe we can control costs and have a rational system. I said rational, not rationed. Somehow rationality has taken on a bad reputation. Let's have hysteria instead!

ANNIE · « **Reply #434 on:** October 20, 2009, 07:48:23 AM »

Bellemere,
Lets have hysteria?? I think we already do have a mixed up message being delivered to the seniors in this country.
We should all remember to read every piece of paper that comes across our thresholds referring to what we can buy now. The rest of it, about the oncoming new health care reforms, hasn't been decided yet so we must deal with the NOW
in our healthcare offerings.
According to the talk on TV, we will start paying for this wonderful new healthcare reform next year but won't be able to get it for three or five years?? Am I hearing things?? Actually, its the people who are working who will be paying for it and we have a millions out of work and therefore not contributing from paychecks. And, we, the seniors, won't be charged?? since we don't have paychecks?? or are they going to get into our SS and take it from there?? AS BELLEMERE SAID, "LETS HAVE HYSTERIA!"

Steph · « **Reply #435 on:** October 20, 2009, 08:37:53 AM »

I am amazed about the reactions to the plan in Florida. According to surveys released today, Florida has the third largest amount of people who have lost their health plans this year. All due to losing their jobs.. What are they planning to do? We simply must have some sort of safety net.

bellemere · « **Reply #436 on:** October 20, 2009, 10:09:13 AM »

Steph, what plan are Floridians reacting to? there are four at last count, I believe. Is the reaction against specific elements of reform, such as the mandate to buy,a/ I think that is in all of them. the public option? That is is some of them.
I called my Medicare Advantage and asked how come such a big increase in premiums. Over thirty percent. The poor little service rep started out by saying, :We've been instructed to tell members: folowed by the eompany line about passing on increased costs. I had to laugh, wondering if my call was "monitored for quality control" and if he flunked.

mrssherlock · « **Reply #437 on:** October 20, 2009, 02:50:54 PM »

IIn today's Oregonian is a report from the St. Petersburg Times Politifact.com (which checks determine the truth in politics today) about the potential cuts to Medicare Advantage seniors. See it here: http://www.piurl.com/1vzt

bellemere · « **Reply #438 on:** October 20, 2009, 04:02:15 PM »

re: link www.piurl.com/1vzt
tried it several times to no avail. do I have it wrong?

mrssherlock · « **Reply #439 on:** October 20, 2009, 06:28:15 PM »

Tried to use tinyurl but it obviously didn't work Here's the unexpurgated version: http://www.politifact.com/truth-o-meter/statements/2009/oct/16/americas-health-insurance-plans/health-insurers-group-says-medicare-advantage-bene/

News:

Author Topic: Talking Heads - Healthcare Reform (Read 101123 times)