Author Topic: US Medicare experiences  (Read 186 times)

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Online Mr. Beagle

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US Medicare experiences
« on: January 06, 2017, 07:38:16 PM »
Having lived for the last eight years with an expensive high-deductible health insurance policy and some significant uncovered health expenses, I have been pleasantly surprised at my experience this last year on Medicare. Are there any other old duffers on this board with similar or contrary experiences, or horror stories from members' parents?

I currently have a basic insurance supplement to cover Part B (Part A is hospitalization and Part B is "normal" doctor expenses). I have had some doctor visits and tests (getting old is a pisser) but I have had zero bad experiences in getting the approvals I once had to get under my old plans, the deductibles have been minimal, the monthly costs are low (relatively) and the bills have been reduced to near-zero.

So I am sucking up health care to the detriment of the younger people here, but so far I have to say I am pleasantly surprised. "Single payer" seems to work pretty well so far. I think this is why even Tea Partiers are saying "Keep the government's hands off my Medicare!"

The biggest Medicare complaints I have heard are the limits on the fees doctors can charge, but the non-profit health center I volunteer for has done fine on this level of reimbursement. They even do fine under the lower Medicaid level of reimbursement, now that more low-income people are covered under Medicaid (as we hold out breath on this one).

Any other experiences?

Mister Beagle
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Offline Noisy Rhysling

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Re: US Medicare experiences
« Reply #1 on: January 06, 2017, 08:00:16 PM »
I am on a first name basis with the first-responders around here, they take me to the hospital I prefer without needing to told, which is good because I usually can't tell them anything when they get here. Medicare picks up almost everything when I have to go for a noisy ride, otherwise I'd be dead broke and dead.

Offline PatrickG

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Re: US Medicare experiences
« Reply #2 on: January 09, 2017, 03:04:02 PM »
Good to hear some decent experiences.

I am not on medicare but on a PPO provided by my employer. My personal experience with the cost and how it is controlled is poor. Actually, it is probably a good illustration of what is wrong with the non-single payer system here in the USA.

I have good comparison material: I had 3 times the same hernia repair surgery, but each time at a different hospital. Each time I spent about 4 hours in the hospital, of which ~1 hour in the operating room under full anesthesia. There were no complications, so the hospital effort should be similar each time.

The negotiated amount the hospitals charged varied wildly: from $8,000 (Good Samaritan San Jose), $17,000 (Stanford) to a whopping $25,000 (Fremont surgery center). This excludes the fees for the surgeon and the anesthesiologist.

So: a factor 3 difference in hospital costs for the same thing! Hernia repair costs between $1000 and $2000 in most European countries, by the way.

Since this was non-emergency surgery I had the option to 'shop around' for the hospital. And since past experience wasn't too die for I picked a different one each time. The problem was: no hospital would tell me up front what they would charge, not even remotely. So there was no way for me to trade off cost vs quality.

The expensive $25K hospital was out-of-network. They only told me that I would pay less out-of-pocket than the in-network hospital (Stanford). That was true, but my employer (who is self-insured via United Healthcare) forked over the rest of the money. I had no incentive to stay in-network, nor did I have any indication that they would scam us so bigly.

I was able to negotiate my out-of-pocket part of the $25K bill down from $3K to $1K by explaining that they charged 3x the amount that the previous hospital did, and that the out-of-pocket co-pay limits are rather nebulous with so many charges. I tried to make the case that my bill should be $0 as I brought them a very lucrative business at my employer's expense. That did not work, but I thought that I should be entitled to a larger part of the 'action'.  If doctors and hospitals conspire to extract money from insurances, why can't patients?

I tried to bring this scam under the attention with my employer and the insurance company that handles the claims for my employer. Nobody seemed to care, even though they just got ripped off by serious amounts of money.

Healthcare and capitalism simply don't go together well. Good information is needed for capitalism to do 'its thing'. It needs realistic options to walk away from if needed. But when you are sick you are not in the position to comparison shop and negotiate. And even in non-emergency cases, hospitals bend over backwards to not give any meaningful cost information beforehand. After the fact they send an astronomical bill (which is hard to comprehend and check), which then get 'negotiated' to about 1/3 by the insurance. As a result the USA pays 2x more for healthcare per capita as other western countries for less coverage. The system is rigged.
« Last Edit: January 09, 2017, 05:23:01 PM by PatrickG »

Offline Hanes

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Re: US Medicare experiences
« Reply #3 on: January 09, 2017, 09:53:28 PM »
I wish I had medicare experiences to share.  Instead I'm dependent on my employer for healthcare.  For this year's annual enrollment they switched the options up on us (benefits were "more significant than comparable employers offered" or whatever their euphemism was for "too good"), and they offered a high deductible option that allowed us to invest in an HSA (basically a Roth IRA that can only be spent on medical expenses).  I figured that, when it comes to those sorts of savings, it's better to start young and since I'm relatively young (31) I'll roll the dice with my health and not visit a doctor this year.

Four days ago I found a lump in my wrist.  It's almost certainly "just" a ganglion cyst, but I essentially have zero insurance until I reach my max deductible of a bajillion dollars, so I'll just live with it until it goes away on its own, it becomes much worse, or next year rolls around and I can get a normal healthcare plan.

Yay america.  :(

Online Mr. Beagle

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Re: US Medicare experiences
« Reply #4 on: January 10, 2017, 08:18:44 AM »
I was an ideal candidate for Health Savings Accounts in my last ten years of work, and because I have spent a lot of time around healthcare, I went this route until Medicare.

Ideal candidate: healthy, moderate tax bracket (half of America gets minimal tax benefit, the rich get big tax benefit), able to afford the high deductible.

In short, I no longer recommend these policies. The savings in monthly cost can quickly disappear with a relatively minor health issue, such as the previous poster's wrist issue. A large dental bill, typically uncovered, can drain your HSA account. It did mine, for multiple years. And you can't really shop for better medical prices. No facility will give you a definitive cost ahead of time for anything but trivial procedures.

Like 401k retirement plans, HSAs are designed to benefit high income people and screw low income people who need them the most.
Mister Beagle
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Offline Soldier of FORTRAN

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Re: US Medicare experiences
« Reply #5 on: January 10, 2017, 08:54:59 AM »
I wish I had medicare experiences to share.  Instead I'm dependent on my employer for healthcare.  For this year's annual enrollment they switched the options up on us (benefits were "more significant than comparable employers offered" or whatever their euphemism was for "too good"), and they offered a high deductible option that allowed us to invest in an HSA (basically a Roth IRA that can only be spent on medical expenses).  I figured that, when it comes to those sorts of savings, it's better to start young and since I'm relatively young (31) I'll roll the dice with my health and not visit a doctor this year.

Four days ago I found a lump in my wrist.  It's almost certainly "just" a ganglion cyst, but I essentially have zero insurance until I reach my max deductible of a bajillion dollars, so I'll just live with it until it goes away on its own, it becomes much worse, or next year rolls around and I can get a normal healthcare plan.

Yay america.  :(

Please don't die. 
Every soup ladled to the hungry, every blanket draped over the cold signifies, in the final sense, a theft from my gigantic paycheck.

Offline Hanes

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Re: US Medicare experiences
« Reply #6 on: January 10, 2017, 12:17:40 PM »
I wish I had medicare experiences to share.  Instead I'm dependent on my employer for healthcare.  For this year's annual enrollment they switched the options up on us (benefits were "more significant than comparable employers offered" or whatever their euphemism was for "too good"), and they offered a high deductible option that allowed us to invest in an HSA (basically a Roth IRA that can only be spent on medical expenses).  I figured that, when it comes to those sorts of savings, it's better to start young and since I'm relatively young (31) I'll roll the dice with my health and not visit a doctor this year.

Four days ago I found a lump in my wrist.  It's almost certainly "just" a ganglion cyst, but I essentially have zero insurance until I reach my max deductible of a bajillion dollars, so I'll just live with it until it goes away on its own, it becomes much worse, or next year rolls around and I can get a normal healthcare plan.

Yay america.  :(

Please don't die.

Hah.  I doubt it's wrist cancer, but thank you for your concern.  355 days until I can get it checked out.

 

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