Insureds To Pay A Portion Of Part B Coinsurance Or Copayments: Fill & Download for Free

There is already a voucher system in place: The Medicare advantage system.Some background info first though. For those who are not familiar with it, Medicare is the health insurance system that the US government has set in place for people over 65 years of age and those who are permanently disabled. Unlike Medicaid, is not a means-tested system. When a person turns 65, or after two years of receiving SS disability benefits, they can apply for Medicare coverage. This consists of the following:Medicare Plan A: Hospital insurance. This includes medication, surgery, medical support that a recipient receives while hospitalized. This coverage has no cost to the insured.Medicare Plan B: Medical insurance. This includes all doctor’s visits and appointments made on an outpatient basis. This insurance is not free. It costs $104.9/month, which is billed to the insured, or if you are already receiving SS retirement or disability benefits, they would be deducted from your check.This is what is called the Original Medicare.This insurance does not over everything though. It covers 80% of the bill, without an annual out-of-pocket maximum. So if you have a stroke and incur in a massive health insurance bill, you will be required to pony up 20% of the total.Enter the Medicare supplemental plans. These are programs run by private insurers, such as Aetna, Anthem, Prudential and all major insurers. They offer to cover up the remaining 20%. They have different tiers of programs. In some you pay small copayments or have a small deductible, and therefore you pay a smaller premium. In others, you pay absolutely nothing - but pay a higher monthly premium. We have one of such policies for my husband - who had to entered Medicare due to disability-. His premium is higher because of this, but for a policy that covers 100% of his medical costs, without deductibles and copayments, we pay only $260/month.However, these programs do not cover prescription medication. Under the last Bush administration, a third program was created. Enter Medicare Plan D: This is insurance for prescription medication. This insurance subsidizes the cost of medication for Medicare recipients. Under this program, you can buy a policy with a private insurer (Humana, Anthem for example) and based of the medications you are in your premium will vary. For a program that covers pretty much 100% of my husband’s medication (which are not particularly expensive) we pay $15/monthSo the monthly insurance cost for my husband is $379.9/month for a plan in which he has zero out of pocket costs. When he was waiting for Medicare enrollment, a Gold plan under Obamacare was over $500/month, which had a 20% coinsurance. Given the high cost of his disabilities out of pocket medical costs were about 10k/year. However, this was preferable to the cost of his medical coverage through COBRA - which was close to $800/month. See why old people don’t want you to mess with their Medicare?Under this structure, when a patient receives medical care, the hospital bills Medicare, who then vets every single line. If they feel that a charge was not medically necessary - they won’t pay a dime!. The hospital cannot charge a patient for the charges that Medicare did not pay. Therefore it creates an incentive for the providers to be diligent in their care, but not profit at the cost of the patient. After this is completed, Medicare mails the patient a statement explaining what it did and did not pay, the price they negotiated, and your portion of the bill. If you have a Medicare supplemental plan, Medicare will send a copy of that statement to your insurance, and they will pay their portion of the bill.Finally - enter the voucher planSeveral insurance companies, such as Kaiser, Humana and others, sell what is called Medicare Advantage plans. Pretty much they said to Medicare: send me a fixed amount of money per every Medicare recipient that is covered under my plan, and I will administer the plan. So a patient that is enrolled in a Medicare advantage plan pays the $104.90 of the cost of the Medicare part B portion, and an additional premium that would cover all the remaining medical care. Most of these programs have deductibles, coinsurance and such - but the scale of benefits are significantly better than a Platinum plan under Obamacare. The cost for a senior would be between 90–200/month (plus the $104.90 of the cost of Medicare part B).The idea behind creating Medicare advantage programs was the belief that a privately held system would be far easier to administer and that private insurers would find ways to run the program more efficiently. In fact, the opposite was found: Medicare spends 14% more per enrollee than the cost of care of those receiving traditional medicare (see: Medicare Advantage). The reasons are…complicated (Does Medicare Advantage cost less? Or does it cost more?)I often wonder how much our health care system would be if Medicare was universal. It would be far easier to administer - and I think that most companies (mine included) would rather pay the thousands and millions of dollars in Health insurance premiums to Medicare than to deal with the nightmare of providing mediocre and expensive insurance benefits. There is an argument to be made that Medicare is the most cost efficient way to provide medical insurance in the US.Can it be improved? Definitely. Particularly considering the perverse incentives of our healthcare system (which I have discussed at lenght here Andrea Pargel's answer to What's wrong with the US healthcare system?) we can certainly lower the costs of the program and improve outcomes. But to completely convert it to a voucher program? I would like to see some data first.

Being insured significantly reduces the probability that medical bills will cause bankruptcy. Medicare Part B recipients need add-on insurance to help with their unlimited 20% coinsurance bills, but my group health coverage has an annual out-of-pocket limit that is affordable. My insurance pays 100% after the medical costs they have determined I am financially responsible for hit the annual out-of-pocket limit.The bills associated with the acute care after my stroke were about $750,000. The portion I was responsible for was less than $10,000. My insurance paid the rest.My husband and I would have been financially “ruined” if we’d been responsible for the full $750K. We could have sold our home of 30+ years and cashed out our retirement savings to pay the bills, but my husband was over 70 and already retired (after teaching for 40 years) and I was in my late 50’s. We would have been in a tough spot.Medicare participants should buy supplemental insurance to help with the (uncapped) 20% copays. When someone on Medicare Part-B has medical bill, they are responsible for 20%. Given that cancer treatments are generally outpatient, they are covered by Part-B of Medicare. The 20% payments add up fast!

It seems that the general public assumes that Medicare is free. Unless there is an entire overhaul to the existing system, Medicare is anything but FREE. Allow me to disabuse you of any misunderstandings by setting the record straight.The only part that is free is Part A, hospitalization, which has no monthly premiums. But, like car and homeowners insurance, there is a “deductible” (as well as a high copay) which is the amount you must pay in full before the policy starts to pay. After you’ve paid that amount out of pocket, called "meeting the deductible", then the insurer starts to pay some, but not all. This is from their site:Medicare Part A deductibleMedicare Part A benefits include inpatient hospital care, skilled nursing facility care, home health services, and hospice.For a hospital stay, you usually have to pay the Part A hospital inpatient deductible, which is $1,408 in 2020, for each benefit period (hospital stay, even if it’s for the same illness as the previous one, and it does not carry over into the remainder of the year). Additionally, you may have other costs for the specific health-care services you receive while in the hospital. On the 61st day of a hospital stay, you would also start to have coinsurance costs. Your coinsurance costs depend on the length of your stay:• Days 61 to 90: Daily coinsurance of $352 in 2020 for each benefit period• Days 91 and over: Daily coinsurance of $704 in 2020 for each “lifetime reserve day” in each benefit period (up to a maximum of 60 days over your lifetime)• After your 60 lifetime reserve days are used up: You pay all costs• For home health-care services, all costs are covered under Medicare Part A for a limited time under certain conditions. However, if your doctor orders durable medical equipment and supplies it as part of your care, you’ll pay 20% of the Medicare-approved amount for the equipment.For hospice care, all costs are covered. Some exceptions include:• If you take prescription medications or similar items for pain relief or symptom control while on hospice. You may be responsible for a copayment of no greater than $5 per prescription drug.• If you need inpatient respite services. You may need to pay 5% of the Medicare-approved amount for that care.• If you get hospice care in a nursing home. You typically pay for room and board costs.Medicare Part BMedicare Part B is the health-insurance portion of Medicare. Benefits include (but aren’t limited to) doctor’s office visits, preventive screenings, and durable medical equipment. The monthly premium for Part B is $144.60 for 2020, an increase of $9.10 from 2019 (costs adjust up each year). The annual deductible for all Medicare Part B beneficiaries is $198 in 2020, an increase of $13 from 2019. For some of these services, a deductible will apply ($198 in 2020). Often, you will pay 20% of the Medicare-approved amount for a health-care service after this deductible is met. Make sure to check with your doctor and Medicare because each benefit’s coverage is different.NOTE: If you are what Social Security considers a “higher-income beneficiary,” you pay more for Medicare Part B, the health-insurance portion of Medicare.But, what about prescriptions and other costs not covered by Parts A and B? That’s where you have to find an additional private plan, Part D, from a Medicare approved provider. This part gets very complex and varies in cost and coverage depending on the particular deal you have found. This takes a ton of research, and may need to be redone each year, as policies change. But, let’s just say that, even though I have this as a retirement benefit from my former employer so it’s cheaper than most, my Medicare monthly premiums for Parts B & D come to just under $200 per month, plus copays for doctor’s visits, and lowered, but not free, prescription costs through Part D.So, anyone who naively believes that Medicare for All will be FREE healthcare doesn’t know our government very well. This “FREE” healthcare coverage costs me 4x more each month than my employer provided plan while I was still working, and that’s without going to the doctor! They still take FICA out of my retirement checks, too.Beware of promises made by politicians! They are all snake oil salesmen. The youth is screaming that they want free healthcare, but the Democrat candidates respond with Medicare for All, which isn’t free at all. However, they know that the voters aren’t aware of the huge difference between those 2 terms. I assumed Medicare was free, too, until I was forced to go on it in retirement. As they say, you don’t know what you don’t know, and no one has thought to ask because the politicians have allowed you to assume without attempting to clarify.Sneaky little devils, aren’t they?