Dems are you smoking something – Medicare for all? High taxes; long waits to see a doctor; a Broken US Economy. That’what you want?

When the Democrats say they wish Medicare for all and to be rid of free enterprise Insurers in the Private sector, I ask what have you been smoking people.

 

I am 72, I have Supplemental Insurance with a private insurer, under a Form F No Deductible No Coinsurance Form.  After Medicare pays the doctor bill at their fee not the doctor’s fee, my private insurer, Bankers kicks in and pays the 20% of the accepted fee and my deductible.   Yes, I pay extra for this insurance and it runs slightly under 215 monthly.

 

These democrats cannot illuminate private insurers who provide many coverages not provided by Medicare (Take for instance the programs provided by Aflac).  

 

Many in the Workforce have special options of coverage through Private Insurers.

 

Frankly I do not wish to pay 20% coinsurance and the annual deductible.  I do not want a Medicare Advantage which may be less than $100 a month, because I wish to go to any doctor I wish and be able to go to doctors or hospitals anywhere in the United States that accept Medicare.  The reason is the low fee allowed by Medicare.  For instance, I was recently dehydrated and went into the emergency room at the advice of my doctor for a bag of saline. The hospital charged over $3,000 and Medicare’s fee was less than $300 of which Medicare paid 80% of their fee and the balance was paid by my supplemental insurance..

 

The Medicare Advantage Plans are restrictive; you may not choose your doctor like I can with Supplemental Coverage under a stand alone plan.  Instead your plan will be an integrated plan such as PPO’s and HMO’s where you have to go to an approved physician or hospital, etc.)

 

This is the way Medicare is today: and you will not like the manner in which coverage will be provided if all individuals are included under The Government Medicare Plan.

 

Not only will you pay an annual deductible but 20% coinsurance.  Currently under Part C Medical Advantage Plans a doctor is only to spend 8 minutes with you at maximum because the cost is low and it’s a PPO or HMO.

 

In England, a friend of mine about 10 years ago advised that the 45% tax on earned revenue went toward insurance as well.  And in England, Dental is provided (like in Canada).  He had a tooth problem and tried to schedule an appointment and was told the earliest he could be seen was in six months.

 

Is this what you want?  We will have less physicians and practitioners because of the low cost they will be able to earn plus the high cost of schooling and school loans.

 

Private Insurers are necessary.  And before I go through te coverage points of Medicare, please allow me to address PRE-EXISTING CONDITIONS.

 

Pre-existing coverage has never been a problem.  If you had insurance previously and have been accepted by your new insurer, you get automatic pre-existing coverage immediately.

 

If for instance you did not have previous insurance and started with a new Insurance Company, that Insurer would say that no pre-existing coverage would be allowed for a six or 12 month period.  After that, coverage applies.

 

The problems that people have had are related to the fact that under the Affordable Care Act, there is no limitation on the insurance amount, whereas previously Insurers were allowed to limit coverage under major medical to $500,000 or $1,000,000.  Now it is like gambling and it can cost insurers far more than a million dollars with a critical and cronic condition.  I say, let the private sector insurance companies provide a limit on the policy and if the individual feels from prior history they will need a larger limit, than say $1,000,000, then buy an Umbrella type Health policy over and above the initial private insurer’s policy.

 

Now the major problem comes up when the private insurer reaches the maximum limit under their policy – they cancel the policy or non-renew the coverage.  Then if any prospective insurers, usually three, decline to write your coverage, it usually goes to a State Fund or Assigned Risk type plan in that state with limited coverage and higher deductibles like the ACA.  THESE ARE THE PROBLEMS NOT PRE-EXISTING COVERAGE DEMOCRATS WHO APPARENTLY DO NOT UNDERSTAND ECONOMICS ONE IOTA.

 

 

Part A:  Hospital Insurance (inpatient) benefit

You don’t pay a monthly premium if you or your spouse paid Medicare taxes while working for a certain amount of time.

 

provides inpatient care in a hospital, skilled nursing facility or home health or hospice care.  Medicare requires a deductible for days 1-60 (No coinsurance).

 

From days 61-90, you are required to pay a per day co-payment or coinsurance

 

Each person who is eligible for Medicare also has a 60 day lifetime reserve for hospital coverage.  These reserve days are not renewable and the individual must pay a co-payment for each day of the lifetime reserve used

 

Hospitalization coverage is for a semi-private room and board, general nursing and miscellaneous hospital services and supplies.

 

 

 

 

Skilled Nursing facility care applies after one is in a hospital for at least 3 days, enters a Medicare approved facility within 30 days after hospital discharge and meets other program requirements.

 

Medicare will pay up to 100 days in a skilled nursing facility during each benefit period.   Coverage includes inpatient skilled nursing care or rehabilitation, semi-private rooms, all meals, drugs and medical supplies. You pay Nothing for the first 20 days of each benefit period.  You pay Coinsurance per day for days 21-100 of each benefit period and All costs for each day after day 100NURSING HOME CARE IS GENERALLY NOT COVERED

 

Blood:

If the hospital gets blood from a blood bank at no charge, you won’t have to pay for it or replace it.  If the hospital has to buy blood for you, you must either pay the hospital costs for the first three (3) units of blood you get in a calendar year or have the blood donated by you or someone else.

 

Home Health Services.

You can use your home health benefits under Part A and/or Part B for Medically necessary part-time intermittent skilled nursing care; and/or physical therapy, speech-language pathology services or continued occupational therapy services and may include social services, health aide services, durable medical equipment iand supplies for use at home.  You have to be homebound.  You pay 20% of the Medicare-approved amount and the Part B deductible applies for Medicare covered medical equipment.

 

 

Hospice care

If you are terminally ill and have a life expectancy of 6 months or less, coverage is provided for items and services needed for pain relief, medical, nursing and social services, drugs, certain durable medical equipment, aid and homemaker services, spiritual and grief counseling.

 

You pay nothing for hospice care.  You pay a copayment of up to $5.00 per prescription drugs for pain and symptom management; You pay 5% of the Medicare-approved amount for inpatient respite care.

 

 

 

 

Medicare Part B – Medical Insurance (Outpatient) coverage.    Part B is considered to be medical insurance and is optional to all applicants for a monthly premium when they become entitled to Part A.  It also may be purchased by persons age 65 and over who do not qualify for premium-free Part A.

 

Part B helps to pay for the individual’smedically necessary doctor’s service, outpatient care, home health services, durable medical equipment, mental health services and other medical services including preventative services. services and other services which are not covered in Part A.

 

Covered services are subject to both a flat annual deductible and coinsurance percentage.  Part B will pay for 80% of all covered services while the individual must pay the remaining 20%.  A Deductible also applies ($183 in 2018).  You must pay all costs until you meet the yearly Part B Deductible.

 

 

Some doctors may not accept patients who may be on original Medicare because of the set fee paid to them by Medicare.  These doctors may only charge an excess of 15% over the original Medicare fee allowed by law. And you will be fully responsible for the additional 15%.

 

Medicare Part B also covers Clinical Laboratory Services such as blood tests, biopsies, urinalyses and other similar tests, covering 100% of these services.

 

Home Health care which is medically necessary is provided consisting of intermittent skilled care, home health aide services, medical supplies, etc, but again only 80% of durable medical equipment is included.

 

Outpatient Hospital Treatment which is reasonable and necessary for the diagnosis or treatment of an illness or injury is covered.  Medicare pays for 80% of the billed amount for the doctor and 80% of the amount for the facility minus the annual deductible.  

 

Under the outpatient Hospital Treatment, 80% of the costs for blood are covered by Medicare, except for the first three pines which you are responsible for.

 

Your Medicare Part B will not cover Private duty nurses, outpatient prescription drugs and dental care, routine physical examinations, cosmetic surgery, eyeglasses and hearing aids.

 

Although Original Medicare may cover injectables which are not self-administered; drugs taken using durable medical equipment; injectibles for clotting factors; injectable osteoporosis drugs if related to post-menopausal osteoporosis and if you cannot self-administer the drugs; certain oral anti-cancer drugs and anti-nausea drugs, and certain drugs for home dialysis, prescription drugs are not included.  And, remember, you are subject to 20% of the amount as your share of such expenses.

 

 

 

This coverage is provided through private prescription drug plans that contract with Medicare.   To receive the benefits provided, beneficiaries must sign up with a plan offering this coverage in their area and must be enrolled in Medicare Part A or in Parts A and BMedicaid recipients are automatically enrolled.  If you do not enroll within the open enrollment upon turning 65 or upon leaving another qualified plan, you will be subject to a penalty of 1% per month until comparable coverage is secured.

 

This means that if Part D is not secured through a qualified plan for 36 months, your charge will continually be 36% more than it would have been should you have secured Part D when you qualified.

 

Medical  Insurance for all is NOT a right under the Constitution and if one of you thinks it will be great expect taxes on income of 45-65%, less care by doctors, less doctors, you cannot choose your doctor, and everyone will have to pay 20% coinsurance and annual deductibles, unlike what Private Insurers now provide as supplemental insurance over Medicare fees that not all doctors will accept.

 

 

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