Is it an entitlement for all American elderly and is it free ?
Do private health insurance companies still offer health insurance plans for the elderly?
It is an entitlement at age 65, but it is not free. It also doesn’t cover everything, by a long shot.
Private insurers offer coverage for the portions of bills that Medicare doesn’t cover (Medicare supplement). It is also possible to sign your Medicare over to an insurance company to have lower copays in exchange for using their network of doctors (Medicare HMO).
Medicare is also an entitlement for disabled people who are unable to work.
Medicare is about 100 bucks a month. That is not free.
Nope, not free.
I got off of disability last year and knew they’d start billing me for Medicare at that point (previously, payments had been taken out of my checks monthly so I’d never seen them). What I didn’t know was that they would then ask for quarterly payments of nearly four hundred dollars! No can do. So I let it go. Unfortunately, I also screwed up and missed my enrollment period for my work insurance, so I’ve got no coverage until November.
It’s not bad; they pick up a fair percentage, or at least they did for me. But its not free and it’s not that great. It is, however, far far far far far better than nothing at all.
Medicare is divided into parts.
Part A: “Hospitalization insurance.” This isn’t exactly free, because to be eligible for it you must have been a US resident for the past five years and have been paying Medicare taxes for the last ten (or you’re on Social Security disability, or you have end stage renal disease, or you’re on SSDI and have ALS). If you haven’t been paying your Medicare taxes, then you can buy in to Part A but it’s kinda steep.
Part B: “Doctor insurance,” which covers outpatient stuff. Calculating the cost of this depends on exactly when you enroll, but it’s a small monthly premium.
Part C: Medicare Advantage plans, where you combine the responsibilities of A and B and sign them over to a private insurance company. Fun fact, these will be vanishing soon (my speculation, and not based in any form on healthcare reform - just buzz within the industry).
Part D: Prescription medication insurance. These plans are supplementary plans designed and sold by private insurance companies and carry their own cost.
Just about everyone takes Part A, and the vast majority of people take Part B. These together, however, do not - by a long shot - cover all medical costs. Medicare Supplements (MedSupps, Medigaps, whatever) are a very popular add-on product regulated by the government but sold by private companies that drastically reduce the out-of-pocket exposure seniors face.
Private insurance companies will cover employees over the age of 65 on a group plan with no problem. In this instance, most seniors will use their group health insurance as their primary coverage and pick up Medicare as a secondary policy to reduce their exposure (if you wait to enroll in Medicare past the point at which you’re eligible, then you may incur penalties. These don’t always apply if you’re still working, but many seniors prefer to be safe rather than sorry and go ahead and pick it up).
A senior over the age of 65 has their choice of Medicare, Medicare Advantage, or Medicare plus a supplement. They will not be able to get a traditional health insurance plan in the individual market. Not a big deal, really, as Medicare plus a private supplement is generally pretty good coverage.
Side note: There is a specific type of Medicare Advantage plan called a PFFS, or private fee for service, plan. These are generally marketed as “free Medicare” to seniors because the premium costs are zero. If you know anyone with one of these plans, please encourage them to consult with a CMS registered agent in their area. These plans were all the rage not too long ago and are very seriously flawed. The depth of their failure to provide adequate coverage is now coming to light and you’d truly be doing a disservice to anyone you know with one of these plans if you let this go unsaid.
I am a retired teacher, but I retired on a disability when I was in my forties. At that time Medicare became my primary insurance and the insurance that I have had through the school system became secondary.
The thing that surprised me the most was that Medicare patients are charged much less than regular patients. A bill that might have been $500 may be dropped down to $225 for example. Then Medicare will pay a portion of that bill before passing it on to my secondary insurance. It’s possible that I might end up paying something like $25. Of course I do pay for the Medicare and the secondary coverage. But the school system pays for a good portion of that and since Medicare is primary, I don’t have to pay the school as much.
Medicare has been very, very helpful to me and I am grateful. I thought that it would be a big mess, but I have had no problems with it in twenty years.
Medicare is not for all Americans. I don’t know about the medicare for disabled, but I am an American who spent virtually all of his working career in Canada and would love to move back to be with my kids (two of whom are living in NYC), but I am not elegible for medicare except by paying about $400 a month for me and another $400 for my wife. That would still be worth it if the coverage were anything like complete, but it is hedged with copay, deductible, etc.
I am currently paying about $700 a year for medicare but the coverage is total. No deductions and no copay. For drugs, I pay about $600, but there is both a copayment and deducdtible, but no “doughnut hole” in the coverage. And Quebec has been quite successful in negotiating lower prices from the drug companies.
There is also Medicaid, which is available for people of limited means.
Doctor fees for a procedure are more than they should be. If a procedure is reimbursed 120 for a 180 dollar procedure, the doc takes it and writes off the rest. If another policy kicks in 140 for it they take that and ignore the 40. If you pay out of your own pocket ,you are charged the 180. The procedures are priced at a level to get maximum from the insurance company.
Medicare was very good to have when my dad had repeated hospitalizations and then went into rehab/skilled nursing and had ALZ. The folks also have a Blue Cross Anthem PPO.
Medicare has done quite well by mom, who recently had breast cancer removed.
It was easy to deal with Medicare/SS when dad passed. No complications.
Nitpick - You don’t actually have to have paid Medicare taxes for the *last *10 years, just for any 10 years. Plenty of people don’t work straight up to age 65.
You are correct, my mistake. Thanks for catching that!
Part B, which is called “Supplemental Insurance” (not to confuse it with supplementary insurance which you may buy from an insurance company to cover gaps in Medicare and for catastrophic events - there are many levels of this insurance) is not free, the cost being about $100 a month. Part B covers not only doctor fees, but durable medical equipment, home health care, skilled nursing facility care, and other stuff that Part A does not cover.
I don’t know if doctors’ fees are more than they should be, but if you are going to be a provider for people with Medicare, you must agree to Medicare’s schedule of fees, which are quite small. You get only a fraction of what you would normally bill, and what those without coverage are charged.
To be eligible for Medicare you must be “fully insured,” which is no longer 65. It is either 66 or 67 now, as it has been going up incrementally each year for people born after 1937. You can also get it if you are “disabled” (that is, determined by SSA that you are, in fact, disabled), but only if you are disabled for two years or more. (No Medicare until you’ve been disabled for two years.) You can also get Medicare if you are a surviving spouse over the age of 60, or over the age of 50 if you are disabled. If the wage earner is still alive, but entitled to benefits because of disability, the same rules apply.
Medicare limits the amount of hospitalization days and you would need supplementary insurace to cover days over the limits. After a hospitalization of at least three days, you are eligible for benefits for post-hospitalization coverage, including a skilled nursing facility or home health care, but only if you have purchased Part B.
To be eligible for retirement benefits (“old age insurance benefits”) and/or Medicare, you need to be “fully insured”; i.e.,40 quarters of coverage. No time period to acquire them. However, to be eligible for disability benefits (and Medicare after two years), you need to be both fully insured and “currently insured.” IIRC, 20 quarters of coverage in any 10-year period. It’s been a while and I no longer have my books. So, these numbers may be off, but I think they are right.
I have never felt that my doctor was trying to rip me off. I am just grateful that he accepts Medicare patients.
I have felt abused by hospitals charging outrageous amounts for various items. But I am aware that I am paying for someone who can’t aford to pay. I read somewhere recently that each of us pays at the rate of about $1000 a year for others. That’s better than their not getting treatment.
And of course drug companies charge a lot, but they produce a lot too. I just resent Americans paying more than other countries for medicines produced here.
And I don’t like it when my private insurance company tells my doctor that he has to prescribe one medicine and not another. That has just started recently.
But Medicare has made a big difference in how much I am charged. I was switched from disability Medicare to regular Medicare at age 66. The transition was seamless. (I don’t use Medicare for medication. My other provider takes care of that.)
I use my supplementary l insurance provider to pay for my meds, when I need them, which, thankfully, has been rare, and it pays most of the charges. There’s no need to get them through Medicare. (I have BC/BS, which is also the fiscal intermediary for Medicare in my area.)
Perhaps your insurance company wants the doctor to prescribe the generic form of the medicine, which is much cheaper, and just as effective.
To clarify a prior post, a “quarter of coverage” is a very small amount. It was, a few years ago, only $60, so that you could earn $240 a year and get four quarters. This is far from needing 10 years of wages with the considerable FICA taxes. I don’t know what the amount is now, but it is not large. (I can search for it, but I’m lazy.)
I also want to emphasize that Part B costs the government no small amount, inspite of the fact that you have to pay $100 a month for it. Skilled nursing facilities and home health care, which includes all sorts of therapy (occupational, physical, speech, etc.) are expensive. It also includes much of the cost of hospitalization: physicians’ fees, drugs, etc. And durable medical equipment can be expensive, such as wheelchairs.
Correct me if I am wrong, but Part A Medicare covers stays in skilled nursing facilities.
You’re right. I was in error. Skilled nursing facilities and home health care are both covered under Part A; however, usually some of the expenses will not be covered unless you also have Part B. Medicare is covered under 42 CFR. Unfortunately, I no longer have the copies of the regs.