[tophcfa]

Originally Posted by Topspinmo

Laughing out loud! ACA was supposed fix healthcare. It might have had chance if they would have read it before they passed it. IMO and I can have one IT just MADE it worse…….>

Depends on one’s income. For some it made healthcare more affordable, but for others it made it significantly more expensive. It’s a zero sum game, one person’s subsidized healthcare premiums are ultimately paid for by others increased premiums or those actually paying income taxes. In a way, it was simply a government mandated redistribution of wealth.

[GoRedSox!]

While the ACA is far from perfect, it is much better than the alternative—nothing. The main detractors of the ACA have had 14 years to come up with a “repair and replace” plan and they have never put forward any concrete proposal. The ACA now covers over 40 million Americans, including over 21 million in marketplace plans. There are many challenges with our health care delivery system. These challenges were not caused by the ACA. We really don’t want to go back to the days of pre-existing conditions and catastrophic plans. As an FYI, there is no Pre-existing condition limitation on Medicare Supplemental plans if you sign up at the time of eligibility. No underwriting, no pre-ex. Must issue at age 65.

[SusanStCatherine]

Originally Posted by GoRedSox!

While the ACA is far from perfect, it is much better than the alternative—nothing. The main detractors of the ACA have had 14 years to come up with a “repair and replace” plan and they have never put forward any concrete proposal. The ACA now covers over 40 million Americans, including over 21 million in marketplace plans. There are many challenges with our health care delivery system. These challenges were not caused by the ACA. We really don’t want to go back to the days of pre-existing conditions and catastrophic plans. As an FYI, there is no Pre-existing condition limitation on Medicare Supplemental plans if you sign up at the time of eligibility. No underwriting, no pre-ex. Must issue at age 65.

But when signing up at age 65 and selecting an Advantage plan, it is basically the selection for the rest of your life (you can change within first six months or something like that). But selecting a MediGap plan allows you to switch to Advantage later, but not the other direction. Some states allow the change. A fair number of people don't understand this. Also some people don't know your Medicare premiums can double or more depending on your income. My widowed cousin sold her house and is now stuck paying double for two years - pretty sad.

[Justputt]

I have no problem using my MA plan as a snowbird in NY or FL. Spent 4 decades in healthcare and neither is perfect, and both have issues. The biggest problem we had with Medicare, MA, and private insurance was the SLOOWWWW play. It often seems like the deny claims for as long as possible so they can hold onto money longer and gain interest, etc. Then there's the Medicare RAC audits which cover many years, they start out claiming you own a ton of money from overpayments, etc., and if you did your paperwork right, you end up owing little to nothing!!! If you don't keep your paper straight, you pay BIG!!! The main difference between Medicare and MA is Medicare doesn't require preauthorization and MA's sometimes do but they still cover the same things. MA are required to cover whatever Medicare covers, but they through in dental, vision, etc. as inducements. Medicare and MA generally use the same guidelines for what is and is not covered, e.g. if Medicare won't authorize a procedure for something, chances are good MA won't either; that's just the way it works. So, what's the fix? I suspect it'll end up being Case Rate, no more prior authorization, etc., e.g. stage IIB lung cancer and you (hospital, clinic, etc.) get paid $60k and the care which they and the patient pick. I would like to see legislation for prompt pay, but insurance companies have generally shot it down. Slow pay cases should include significant interest as a penalty.

[RICH1]

Originally Posted by kansasr

And yet, in Florida, we rewarded one of those fraudsters by making him governor and then making him a US senator!

you speak the Truth .... finally someone who remembers

[LarryL]

Go to this website and see what this group of Doctors think about our current "healthcare" system: Physicians' Proposal - PNHP

[Ken D.]

Originally Posted by bowlingal

LaLamy, yes it's true. A friend who has Medicre Advantage was denied a nuclear test. If they had a traditional they would have been covered, no problem. So, just because you never heard of it, doesn't make your statement true. The advantage plan is good as long as you don't get sick. But, no one knows when you will get sick.....and you will get sick

I had that very test, MA paid for the test, but I was responsible for 20% of the cost for the “nuclear injection”, which equates to approximately $970.

[MSGirl]

Originally Posted by Michael 61

Reading these threads you have “die hards” supporting traditional Medicare and those that champion Medicare advantage plans. For those under 65, this is a major decision you will have to eventually make. Research is key. Everyone’s personal situation is unique, and one’s health history needs to be taken into consideration. Someone who is very healthy, and goes to the doctor just once a year for their annual checkup will probably rave about how much they love their advantage plan. When it comes to quality health care, cost (though important) should not be the over-riding decision as to which way to go. I personally would want to talk to people well into their 80s, who have multiple health issues going on, who have had multiple hospital stays and rehab, and ask them how their coverage and the plan they selected has worked out for them.

I chose UHC MA and am very happy with it. I’ve had numerous surgeries and health issues and had no problems with my MA plan. I don’t pay a monthly fee for a supplement. However, with my plan I had to pay a co-pay for the surgi center /hospital. $150 per day. Up to $2400 out of pocket max. A supplement policy would cost me $2400+ per year. I see it as you either pay at the front end with a supplement or the back end with an MA plan. Plus you get some perks, dental, optical, gym membership, Part D meds.

[GoRedSox!]

Originally Posted by tophcfa

Depends on one’s income. For some it made healthcare more affordable, but for others it made it significantly more expensive. It’s a zero sum game, one person’s subsidized healthcare premiums are ultimately paid for by others increased premiums or those actually paying income taxes. In a way, it was simply a government mandated redistribution of wealth.

In the original ACA, everyone had to have insurance. There was an individual mandate. If everyone was insured, the burden of those who can't or don't pay for care would have been eliminated. One way or another, we all pay for those who don't have insurance, and in 2010, there was 50 million uninsured Americans.

The individual mandate was thrown out, that took many healthy young people out of the pool and increased costs dramatically.

I can't tell you how many people I have heard complaining about the ACA, while their own kids got to stay on their parents health insurance until they were 26 years old. The number of uninsured Americans has dropped by more than 20 million since 2010.

The biggest reason that it is costly is because there is no pre-existing condition limitation and the people who need care the most are the most likely people to sign up for it. And it required all insurance policies to include certain essential benefits so that insurance companies weren't selling plans to people which were so skinnied down that they didn't pay for much of the care that people needed.

The United States remains the only industrialized democracy in the entire world where health care is a privilege and not a right. We are the only country that ties health insurance to employment. We also spend far more than any other country per capita on health care and our outcomes are not superior.

Saying all of this does not make me a communist or a socialist. The US is the only outlier. Millions of Americans routinely travel to other countries to receive care, the nickname for this is medical tourism.

Many folks think that a government health care system is socialism. But we already have tens of millions of people in a government health care system who are on Medicare and Medicaid, and generally, the folks who are covered are ok with their coverage and don't see themselves as participating in a socialist system. There is no reason that Medicare can't be expanded to cover everyone.

For those who would not want everyone to be covered by Medicare, do you think it's better run by a handful of gigantic for-profit health insurance companies, big pharma advertising all over TV, and conglomerate health care systems buying up individual practices?

[kendi]

MA works great for my mother. She never leaves her home city and is in a medical system that accepts her plan. Not so much for a woman I know who lost her life cause she wasn’t approved for the specialized medical facility she needed in Florida. All depends on what MA plan you get and where you live. As for myself, I stay far away from the MA plans. Don’t want an insurance company making my medical decisions for me.

[tophcfa]

Originally Posted by GoRedSox!

The supplemental plans are good, but you could be looking at an additional $3,000 or more in premiums each year, depending on which plan you choose.

How is that a problem? That’s chump change compared to what we pay through Obamacare! And the Medicare Supplement benefits blow away the ACA benefits. $3K in premiums per year for outstanding benefits, a national network, and no referrals, absolutely blows away close to $3 k per MONTH for inferior benefits, with a limited local network, needing referrals for everything, and dealing with co-pays and max out of pockets.

[Peachbelle]

Heres what's currently going on with MA plans in Congress. These plans are funded 80% by Federal funds. Congress wants to lower that 80% funding given to insurance companies. When they do lower it you can bet that benefits with MA plans will be lowered. Once on MA plan you cannot change back to Medicare. Do you now get the "hook and bait" that Congress had planned?

[Mrprez]

Originally Posted by Peachbelle

Heres what's currently going on with MA plans in Congress. These plans are funded 80% by Federal funds. Congress wants to lower that 80% funding given to insurance companies. When they do lower it you can bet that benefits with MA plans will be lowered. Once on MA plan you cannot change back to Medicare. Do you now get the "hook and bait" that Congress had planned?

Stop the BS. You can always switch back to regular Medicare.

Joining a plan | Medicare

[retiredguy123]

Originally Posted by Peachbelle

Heres what's currently going on with MA plans in Congress. These plans are funded 80% by Federal funds. Congress wants to lower that 80% funding given to insurance companies. When they do lower it you can bet that benefits with MA plans will be lowered. Once on MA plan you cannot change back to Medicare. Do you now get the "hook and bait" that Congress had planned?

Does the 80 percent include the Medicare Part B premiums paid by the retirees, or do the MA plans also receive those premiums in addition to the 80 percent?

Also, how much does it cost to operate the traditional Medicare program, to include the benefits paid to medical providers, and the salaries and benefits of the Government employees and contractors who manage the program (including lifetime pension and SS monthly payments after they retire)?

[tophcfa]

Originally Posted by Mrprez

Stop the BS. You can always switch back to regular Medicare.

Joining a plan | Medicare

You can always ATTEMPT to switch back, with medical underwriting, and you will most likely get rejected if you have a history of expensive health conditions. Insurance isn’t designed to allow people, with minimal health care needs, to get free/inexpensive coverage and then be able to switch to better/more expensive coverage when they get a serious/expensive health condition.