[CoachKandSportsguy]

Read an interesting view on using Medicare as catastrophic insurance and paying cash for PCP physicals and other appointments.

Thought that was an interesting view, such that PCPs would not shun time and tests with the patient, given the low reimbursement rate by Medicare.

One MD stated that based upon the insurance payments for annual physicals, the max time spend with a patient, include prep and review time, would be 10 minutes. Some insurance companies reimburse $28 for an annual physical. No wonder PCPs don't want many elderly patients.

Paying full freight for the physician's services would make sense once a year, not sure if that included blood work, etc, maybe not, as the pop doesn't benefit from that payment

any point counterpoint arguments for or against it?

[retiredguy123]

What about signing up for concierge medicine instead?

[golfing eagles]

Originally Posted by CoachKandSportsguy

Read an interesting view on using Medicare as catastrophic insurance and paying cash for PCP physicals and other appointments.

Thought that was an interesting view, such that PCPs would not shun time and tests with the patient, given the low reimbursement rate by Medicare.

One MD stated that based upon the insurance payments for annual physicals, the max time spend with a patient, include prep and review time, would be 10 minutes. Some insurance companies reimburse $28 for an annual physical. No wonder PCPs don't want many elderly patients.

Paying full freight for the physician's services would make sense once a year, not sure if that included blood work, etc, maybe not, as the pop doesn't benefit from that payment

any point counterpoint arguments for or against it?

OK, counterpoint argument-----

Now, my numbers are 10 years old, so reimbursement is probably 10-20% higher now, but.....

Medicare does not pay for "annual physicals" at all----it is considered preventative care, and they only pay if the patient has a diagnosis.
However, since everyone 65+ has some diagnosis, the physician can code the encounter as 99215 as long as they meet documentation criteria. That reimbursement was about $120 10 years ago.

Most Medicare rates only run about 10-15% below the best private insurers and is actually higher than some.

Also, I wouldn't try to obtain a new physician stating that you are just going to pay out of pocket----the saying in the medical field is "self-pay = no pay", and that is often true.

[villagetinker]

I am not sure but I think these are covered under part B.

[CoachKandSportsguy]

Originally Posted by villagetinker

I am not sure but I think these are covered under part B.

Its not about coverage for you,
its about the payer reimbursement for the service rendered.

[CoachKandSportsguy]

Originally Posted by golfing eagles

OK, counterpoint argument-----

Now, my numbers are 10 years old, so reimbursement is probably 10-20% higher now, but.....

Medicare does not pay for "annual physicals" at all----it is considered preventative care, and they only pay if the patient has a diagnosis.
However, since everyone 65+ has some diagnosis, the physician can code the encounter as 99215 as long as they meet documentation criteria. That reimbursement was about $120 10 years ago.

Most Medicare rates only run about 10-15% below the best private insurers and is actually higher than some.

Also, I wouldn't try to obtain a new physician stating that you are just going to pay out of pocket----the saying in the medical field is "self-pay = no pay", and that is often true.

That's why I asked for a point - counterpoint, to see what the argument I might be missing.

The medicare versus private insurers is magnified here in the Villages, with the huge imbalance of medicare as compared to the general population in the bulk of the working population.

However, the significant increase of medical cost is the mandated EMR systems and support. The benefits are huge, but so are the costs, nothing is free. Its the infrastructure costs of the medical costs which has increased substantially in 10 years

Its the local issue here which I piqued my interest

Thanks

[OrangeBlossomBaby]

Originally Posted by CoachKandSportsguy

That's why I asked for a point - counterpoint, to see what the argument I might be missing.

The medicare versus private insurers is magnified here in the Villages, with the huge imbalance of medicare as compared to the general population in the bulk of the working population.

However, the significant increase of medical cost is the mandated EMR systems and support. The benefits are huge, but so are the costs, nothing is free. Its the infrastructure costs of the medical costs which has increased substantially in 10 years

Its the local issue here which I piqued my interest

Thanks

Rather than hurting the poorest with privatization, we need to make Medicare more efficient. We ALSO need to reduce the cost of the practice itself, by reducing the cost of proper medical education in this country. By the time a high school graduate completes his residency and can be a private practitioner, she has spent a minimum of 11 years of education plus residency, up to 15 years, assuming she hasn't chosen a specialty. Then it'd be more, with fellowships.

She will be paying for the privilege the first 8 years, and then paid enough to pay the rent but not enough to make monthly payments on the school loans, for the next few years.

The average cost to attend four years of med school is $238,420.

But in order to attend those four years, you FIRST have to have a 4-year undergrad degree. So add another $100,000 to that, for the undergrad degree.

Unless they come from a wealthy family OR get a scholarship, they'll be owing more than they get paid, for many years once the first loan payment becomes due, which is usually the first year after they graduate from undergraduate studies.

They HAVE to charge an insane amount to recover from this debt. Medicare doesn't even cover the mandatory patient information software they use now, let alone living expenses. So we need to re-configure the education first. Then rework Medicare. They need a more efficient fraud department. Some random guy who ran a health care who is totally not a Florida elected official now, defrauded Medicare and Medicaid by several million dollars, and got away with it - and became an elected official who owns a different health care company now.

That kind of thing needs to stop. There should be regulations that state "if you get caught cheating old people with health care fraud, then you're not allowed to make money with any health-related company/organization ever again, you can't even buy penny stocks in a company that makes hand sanitizer for hospitals."

There needs to be more checks and balances, while at the same time, less red tape in the actual process of serving the patients. Too many people at the top of these health care companies are making too much money, while their customers - the patients - suffer or die due to denial of coverage.

I'd say - remove stock-owned health care from the Medicare system entirely. Outlaw it. Outlaw it in the whole country. Make it such that it no longer exists. It can be a profit-making company, but no "shareholders" should be allowed to decide how it's run. Or, make ALL health care "non-profit." That doesn't mean free. It just means any overage has to go back into the care of patients in the form of direct care, equipment, personnel, facilities, etc.

[TheWarriors]

Originally Posted by OrangeBlossomBaby

Rather than hurting the poorest with privatization, we need to make Medicare more efficient. We ALSO need to reduce the cost of the practice itself, by reducing the cost of proper medical education in this country. By the time a high school graduate completes his residency and can be a private practitioner, she has spent a minimum of 11 years of education plus residency, up to 15 years, assuming she hasn't chosen a specialty. Then it'd be more, with fellowships.

She will be paying for the privilege the first 8 years, and then paid enough to pay the rent but not enough to make monthly payments on the school loans, for the next few years.

The average cost to attend four years of med school is $238,420.

But in order to attend those four years, you FIRST have to have a 4-year undergrad degree. So add another $100,000 to that, for the undergrad degree.

Unless they come from a wealthy family OR get a scholarship, they'll be owing more than they get paid, for many years once the first loan payment becomes due, which is usually the first year after they graduate from undergraduate studies.

They HAVE to charge an insane amount to recover from this debt. Medicare doesn't even cover the mandatory patient information software they use now, let alone living expenses. So we need to re-configure the education first. Then rework Medicare. They need a more efficient fraud department. Some random guy who ran a health care who is totally not a Florida elected official now, defrauded Medicare and Medicaid by several million dollars, and got away with it - and became an elected official who owns a different health care company now.

That kind of thing needs to stop. There should be regulations that state "if you get caught cheating old people with health care fraud, then you're not allowed to make money with any health-related company/organization ever again, you can't even buy penny stocks in a company that makes hand sanitizer for hospitals."

There needs to be more checks and balances, while at the same time, less red tape in the actual process of serving the patients. Too many people at the top of these health care companies are making too much money, while their customers - the patients - suffer or die due to denial of coverage.

I'd say - remove stock-owned health care from the Medicare system entirely. Outlaw it. Outlaw it in the whole country. Make it such that it no longer exists. It can be a profit-making company, but no "shareholders" should be allowed to decide how it's run. Or, make ALL health care "non-profit." That doesn't mean free. It just means any overage has to go back into the care of patients in the form of direct care, equipment, personnel, facilities, etc.

And let’s not forget to get control of our PUBLIC Universities that squander our tax dollars on frivolous programs and ideals. DOGE could cut those costs in half as well as eliminate some coursework that provides little career enhancement for the professionals or the patients. Universities have become the new golden ticket job with NO accountability to taxpayers or society at large.

[Ponygirl]

Think the estimate of 234k for 4 years of med school is way low compared posted to what it cost my son

I have Medicare and stand alone insurance.

My PCP reaches out to me every year to schedule my Medicare annual check up exam

[GoldenBoy]

Originally Posted by TheWarriors

And let’s not forget to get control of our PUBLIC Universities that squander our tax dollars on frivolous programs and ideals. DOGE could cut those costs in half as well as eliminate some coursework that provides little career enhancement for the professionals or the patients. Universities have become the new golden ticket job with NO accountability to taxpayers or society at large.

DOGE? This sounds remarkably like a political comment. 1. It does not yet exist, 2. It is not a real thing with pretend staffing by individuals who were not voted into any office. It is somebody's dream, and a wet one at that. Please keep political comments out of the forums. Thank you.

[JMintzer]

Originally Posted by GoldenBoy

DOGE? This sounds remarkably like a political comment. 1. It does not yet exist, 2. It is not a real thing with pretend staffing by individuals who were not voted into any office. It is somebody's dream, and a wet one at that. Please keep political comments out of the forums. Thank you.

That's a pretty political response directed to a post that you're complaining is political...

Please keep political comments out of the forums. Thank you.