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Kirk W

Where will healthcare go in the near future?

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I am not sure how the billing for out of network care works today but a few years I had to have out of network surgery.  My insurance paid in network prices but the hospital charged the full rate without any discount.  I was responsible for the difference.   The bill was staggering.   The surgeon's bill alone was $18,000!  My neighbors son was told his share of the ER bill in the example I gave above is $4,000. I don't know what his insurance situation is. Another time I went to an in network surgeon and an in network hospital but the hospital assigned an out of network anesthesiologist.   I didn't even know to check.  Once again the insurance paid in network prices but the anesthesiologist charged full price. My DW's doc wrote her a prescription last year.  The price was $13,200 a month.  Even the insurance discount of nearly 50% left some huge bills for the insurance and us.  Luckly we have found an alternative but the bill after discounts to the insurance is several hundred dollars a month.  My experiences are somewhat limited but I think we need to find a way to rein in these costs.  Insurance left to pay these kinds of bills can't be cheap under any plan.

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I think we were all dreamers thinking the government could fix health insurance. They can't even but a bolt for an air plane at a good price. Have you ever sold a product to the federal government just before fiscal year end? If they have money left in there budget the will but anything instead of trying to save money. In the last six years my premium has doubled and my deductable went from 5000 to 12000. If you think going for the ACA and exchanges is the answer it is not. When you get money from the government to pay your premiums who do you think that money comes from. WE the people. $20 trilion in debt and counting. The result is any time the Federal Government gets involved cost skyrocket and efficentcy  goes down. Sorry for the rant!!!!!

 

Edited by Dan Johnson

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The insurance companies are setting the costs and increasing premiums while limiting network providers and travel out of state.  We need more choices through less regulations and more competition.

 

 

 

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2 minutes ago, trostberg said:

The insurance companies are setting the costs and increasing premiums while limiting network providers and travel out of state.  We need more choices through less regulations and more competition.

 

 

 

I dont believe the insurance companies are setting the costs.  The healthcare provider sets the cost.  Insurance companies raise rates to cover these costs.  There is no, and there can be no "free market" in the healthcae industry.  When you are lying on the floor having a heart attack or have been in a serious car accident, you or someone on your behalf, does not have the ability to call around to find the best rate on an ambulance call, or which hospital has the best rate to treat your condition.  You are at the mercy of the ambulance provider for where you are, and they are required to take you to the nearest hospital that can treat your condition.  No free market there.

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Agree that providers are involved as well.  If the insurance companies can't make a profit they pull out.

The examples of government involvement in healthcare is the VA system or buying supplemental plans to cover what Medicare does not.  Or in Canada long waits for elective procedures such as knee placement and higher taxes.

 

 

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4 hours ago, trostberg said:

The examples of government involvement in healthcare is ...... buying supplemental plans to cover what Medicare does not.  

 

Are you using this as an example of a "failure of a government health insurance system"?  What Medicare covers and doesn't cover is governed by the laws under which it operates.  The "gaps" that supplemental plans fill aren't caused by "failures" on Medicare's part.  That's the way the Medicare system is designed.  If you think that it should cover everything without a need for supplemental insurance, then talk to your legislator.  It's not about Medicare not being run properly.

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Apparently healthcare costs can be contained in at least some situations. For the past 5 years I've had a Medicare Advantage Plan that provides significantly better coverage than Medicare direct, and includes Part D drug coverage with very reasonable co-pays, yet all I pay is the standard Medicare monthly premium, nothing additional. I could be wrong, but given the length of time this plan has been available in various areas, I suspect United Health Care isn't losing money on it.

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That's because United Healthcare can NEGOTIATE prices for drugs, which Medicare is legislatively prohibited from doing.    And they pay to the hospitals, the Medicare rate, nothing more.  You aren't getting any better coverage than Medicare gives - it is the same.  Now they may through in dental/vision for the same premium you are paying to Medicare (or a little more) and they also get a fee from the government for having you enrolled in their program.  That fee is going to sunset soon and then it will be interesting to see how many Advantage programs remain.

Barb

 

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I don't really care how they're able to do it, Barb, just that they are able to. There are many procedures where Medicare only pays 80%, yet I only pay a flat co-pay, such as the $10 I pay for primary care provider visits, and nothing for a number of preventative services like flu shots, etc. I also receive an annual physical and 6 month follow up that Medicare doesn't cover at all. I haven't checked lately, but the last I knew Medicare only covers a complete physical once every 3 years, with some sort of "wellness visit" in between I believe. And of course Medicare doesn't cover Part D meds at all, but my UHC plan does with co-pays starting at $3. Of course neither my crystal ball or yours knows that will happen when the enrollment fee ends, so I guess we'll just wait and see what happens.

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Medicare Advantage plans are PPO's and HMO's so it's not surprising that some costs are lower just as they are with most such plans.  But with the PPO and HMO come some restrictions on doctors and hospitals you can utilize and you usually incur the requirement that referrals be obtained before seeing a specialist.

In comparison, my Medicare supplement Plan F has no co-pays whatsoever and the cost of my UnitedHealth Part D plan is only ~$30/mo.  Everyone makes his own decisions; for me the cost of these plans is worth it in order to get the freedom to use whatever provider I wish.  We feel this makes it simpler to get care regardless of where we happen to be regardless of whether or not such care would be considered to be an emergency.

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Dutch, like docj, we have regular Medicare and a supplemental (similar to plan F) plus Part D.   Our supplemental covers the 20% that Medicare doesn't, no copay every,  and we pay the first $20 on each 90 day prescription.    We can see anyone, anywhere who excepts Medicare and since we spend the winter months in the Phoenix area, we have established relationships with physicians in this area.  We do not have to get a referral - though we usually ask for one because in a metro area, if you find a good primary care physician, they can help you find the right specialist.    For lots of people Medicare Advantage works, but for fulltimers there can be real problems traveling many months during the year. 

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Of course Medicare Advantage Plans don't work for everyone, but we've made it work for us with a significant savings. But then we only travel 10+ months a year. Our UHC plan does not require referrals, and we can see any doctor we want if we're willing to pay the higher out-of-plan co-pays. Emergency/Urgent care is covered everywhere anyway. So far, we've had no problem finding in-plan providers though, using UHC's "Passport" feature that lets us notify them when we're out of our home region. With Passport, we still pay the in-plan co-pays using in-plan providers that they help us select in a given region. For instance, when my wife was getting monthly oncologist checkups following her cancer surgery and radiation treatments, UHC's Passport  allowed her to find an oncologist in Florida that coordinated with her NY oncologist so we could still spend the winter months in the warmer climate while she continued her recovery with no extra expense. As for Joel's $30/mo Part D plan, my total prescription drug costs are less than $100/year. My wife's meds cost considerably more, but because we chose to keep our domicile in NY, she's eligible for a senior's prescription drug secondary plan that kicks in before the Medicare "donut hole" and limits her drug co-pays to a $20 max/30 days with most much less. As I said, an MA plan isn't for everyone, but it has worked well for us. In an average year, our total medical costs average significantly less than typical supplement plus Part D annual premiums.

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The only reason I mentioned supplements was from an interview about ACA someone suggested needing to purchase a supplement on top of your ACA plan to cover what it does not.

 

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Well this discussion has been quiet. I guess everyone is just mesmerized by the slow speed train wreck unfolding before us.

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8 hours ago, Daveh said:

Well this discussion has been quiet. I guess everyone is just mesmerized by the slow speed train wreck unfolding before us.

Well for some time back in the stone age I had to go to some aircraft crash sites as a "interested--party" (some of our equipment was installed on the aircraft).......so......as we approach the "event" that Daveh mentions ..."the slow speed train wreck"  I wonder how many people will needlessly die before the system becomes so over-top-expensive that we have no choice left but the looming single-payer system like the rest of the world........

How can 4,203 billion-ares keep the entire health care system up and running......not sure $2,445,989.17 / month premiums will keep the system afloat..........maybe $999.000.000.17 Co-Pay??

Just like airplane crashes...........after we bury the dead we then roll up our sleeves and fix the problems......

 

Drive on..........(Dont get sick......) 

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