# Can anyone explain Medicare to me? **URL:** \ **Category:** Factual Questions\ **Created:** [February 22, 2019, 6:08pm UTC](https://boards.straightdope.com/t/can-anyone-explain-medicare-to-me/830032 "2019-02-22T18:08:16Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![nelliebly](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/nelliebly/32/5422_2.png) [@nelliebly](https://boards.straightdope.com/u/nelliebly)\ **Post date:** [February 23, 2019, 1:11am UTC](https://boards.straightdope.com/t/can-anyone-explain-medicare-to-me/830032/21 "2019-02-23T01:11:36Z")
Every time someone posts a comment on why UHC is crap, we should refer him or her to R **eimann** ’s excellent, informative, and disturbing post. But a question. The linked article says > [@](#): > > Because a federal policy solution might prove difficult, states may be better positioned in the short term to protect consumers. Why would a federal solution be difficult? A patchwork of state laws that provide no balance billing coverage, partial balance billing coverage, or full balance billing coverage seems like a great reason for having a federal law. Is “difficult” a euphemism for “insurance companies and hospitals would fight it like hell”? ---
**Author:** ![Mike\_Mabes](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mike_mabes/32/1782_2.png) [@Mike\_Mabes](https://boards.straightdope.com/u/Mike_Mabes)\ **Post date:** [February 23, 2019, 1:31am UTC](https://boards.straightdope.com/t/can-anyone-explain-medicare-to-me/830032/22 "2019-02-23T01:31:26Z")
> [@Beckdawrek](#): > > ^^^Youll eventually get turned over to collections. I still wouldn’t pay. That’s outrageous. Mr.Wrekker had his hernia fixed a few years ago. He did due diligence and made sure he was in his network with the surgeon and the hospital and the aftercare clinic the doctor required. Lo and behold his insurance balked on the aftercare clinic in the end. The bill was nearly $8000.00 for basically changing his bandaid everyday for 4 days. We appealed to the insurance company. And they decided to turn their attention to the surgeon and his little money making scam, the aftercare clinic. It went out of business after that lawsuit went down. Mr.Wrekker signed an affidavit as to what care he recieved. And was glad to do it. This was at least 8 years ago. Maybe we got a few collection notices; I can’t remember, she had other illnesses and passed a few years after this happened. It never affected my credit rating or anything. Maybe because it was she technically owed the bill? ---
**Author:** ![glowacks](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/glowacks/32/5548_2.png) [@glowacks](https://boards.straightdope.com/u/glowacks)\ **Post date:** [February 23, 2019, 1:47am UTC](https://boards.straightdope.com/t/can-anyone-explain-medicare-to-me/830032/23 "2019-02-23T01:47:24Z")
I would guess that unless you entered into a contract when taking on debt, there is no legal way for the creditor to force you to pay. They can deny you future service, but if there’s no contract, how do they convince a court that you owe them that money? Especially when you require emergency services and can’t agree to anything in your state, the debt is impossible to pin on you in court. They’ll try to collect it, sure, because well-heeled people will pay it. But it’s effectively similar to squeegee guys at an intersection who clean your windshield and demand payment. Or so I believe. I may be full of it since I’m only an accountant, not a lawyer. ---
**Author:** ![nelliebly](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/nelliebly/32/5422_2.png) [@nelliebly](https://boards.straightdope.com/u/nelliebly)\ **Post date:** [February 23, 2019, 2:02am UTC](https://boards.straightdope.com/t/can-anyone-explain-medicare-to-me/830032/24 "2019-02-23T02:02:52Z")
One of the forms you sign before you’re treated at a hospital is one which says you’ll pay whatever your insurance doesn’t. That would be the contract. ---
**Author:** ![Mike\_Mabes](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mike_mabes/32/1782_2.png) [@Mike\_Mabes](https://boards.straightdope.com/u/Mike_Mabes)\ **Post date:** [February 23, 2019, 2:18am UTC](https://boards.straightdope.com/t/can-anyone-explain-medicare-to-me/830032/25 "2019-02-23T02:18:42Z")
> [@nelliebly](#): > > One of the forms you sign before you’re treated at a hospital is one which says you’ll pay whatever your insurance doesn’t. That would be the contract. That is probably right. Which is why they started sending collection notices. But because they know they are grossly overcharging for services, they know a lot of people will not be able to pay. And if they get a lawyer, like Riemann did, the amount will be reduced. Looking back, I know I looked all this up at the time. No way would I have just ignored a collection notice entirely, I was trying to build up a credit rating, which I am now proud to say is over 800. I think I just said, screw it, if they really come after me I’ll deal with it then. Get a lawyer. But it never got to that point. And I now remember being surprised when I stopped getting letters. But this goes back to the main point, what a fucked up system. ---
**Author:** ![Mike\_Mabes](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mike_mabes/32/1782_2.png) [@Mike\_Mabes](https://boards.straightdope.com/u/Mike_Mabes)\ **Post date:** [February 23, 2019, 2:27am UTC](https://boards.straightdope.com/t/can-anyone-explain-medicare-to-me/830032/26 "2019-02-23T02:27:41Z")
I forgot one thing. When the hospital said she should stay overnight, they explicitly told me it would not be covered. HA! ---
**Author:** ![Riemann](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/riemann/32/3133_2.png) [@Riemann](https://boards.straightdope.com/u/Riemann)\ **Post date:** [February 23, 2019, 2:33am UTC](https://boards.straightdope.com/t/can-anyone-explain-medicare-to-me/830032/27 "2019-02-23T02:33:46Z")
> [@nelliebly](#): > > Why would a federal solution be difficult? A patchwork of state laws that provide no balance billing coverage, partial balance billing coverage, or full balance billing coverage seems like a great reason for having a federal law. Is “difficult” a euphemism for “insurance companies and hospitals would fight it like hell”? Yes, “difficult” in the sense of difficult to get the legislation passed. My understanding is that it was simply the _realpolitik_ of fighting so hard on so many issues to get the ACA passed at all, they just couldn’t fix everything. ---
**Author:** ![Mike\_Mabes](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/mike_mabes/32/1782_2.png) [@Mike\_Mabes](https://boards.straightdope.com/u/Mike_Mabes)\ **Post date:** [February 23, 2019, 2:46am UTC](https://boards.straightdope.com/t/can-anyone-explain-medicare-to-me/830032/28 "2019-02-23T02:46:50Z")
> [@Riemann](#): > > Yes, “difficult” in the sense of difficult to get the legislation passed. My understanding is that it was simply the _realpolitik_ of fighting so hard on so many issues to get the ACA passed at all, they just couldn’t fix everything. And they still haven’t. For crissake, they’re still trying to fight off repeals of the ACA. "Let’s call the whole thing off and come up with a brand new plan. " ---
**Author:** ![Riemann](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/riemann/32/3133_2.png) [@Riemann](https://boards.straightdope.com/u/Riemann)\ **Post date:** [February 23, 2019, 2:52am UTC](https://boards.straightdope.com/t/can-anyone-explain-medicare-to-me/830032/29 "2019-02-23T02:52:35Z")
> [@glowacks](#): > > I would guess that unless you entered into a contract when taking on debt, there is no legal way for the creditor to force you to pay. They can deny you future service, but if there’s no contract, how do they convince a court that you owe them that money? Especially when you require emergency services and can’t agree to anything in your state, the debt is impossible to pin on you in court. They’ll try to collect it, sure, because well-heeled people will pay it. But it’s effectively similar to squeegee guys at an intersection who clean your windshield and demand payment. Since you have received the benefit of the service, even without mutual consent you do have to pay something, it’s a question of how much. > **[Taking Surprise Medical Bills To Court - KFF Health News](https://kffhealthnews.org/news/taking-surprise-medical-bills-to-court/)** > > Some legal experts say contract law could provide consumers another avenue to challenge unexpected hospital bills. It’s not settled law, and providers may take an aggressive stance if you have assets, so you may need to go through the immense hassle and expense of a court case. And providers do their best to obfuscate pricing and argue that a “fair” price (which must ultimately be determined by the court) is much higher than the true number. That’s why they have these ridiculously inflated fantasy prices that are 5X or 10X what an insurance company would pay: so that it _looks_ like a reasonable compromise if they eventually settle for 2X or 3X what an insurance company would pay. ---
**Author:** ![pohjonen](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pohjonen/32/423_2.png) [@pohjonen](https://boards.straightdope.com/u/pohjonen)\ **Post date:** [February 23, 2019, 2:53am UTC](https://boards.straightdope.com/t/can-anyone-explain-medicare-to-me/830032/30 "2019-02-23T02:53:44Z")
> [@jasg](#): > > I believe that this can happen on Medicare. > > If you have Medicare Advantage, it is run by an insurance company or HMO that usually restricts you to their network. Which is why I wouldn’t touch a Medicare Advantage plan with a ten foot pole. Throwing in some useless dental coverage and a gym membership does not make up for having a gatekeeper to keep you away from specialists and telling you where you can go and surprising you with out of network charges. My original Medicare pays just as well as the insurance I had from my employer before I retired. Deductibles and such are just about the same as well. I remember when I had a parotid gland removal surgery, and my part after insurance was about the same as for this recent gallbladder surgery. Of course that was in 2009 and employer insurance probably sucks more now than it did then. ---
**Author:** ![Riemann](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/riemann/32/3133_2.png) [@Riemann](https://boards.straightdope.com/u/Riemann)\ **Post date:** [February 23, 2019, 2:56am UTC](https://boards.straightdope.com/t/can-anyone-explain-medicare-to-me/830032/31 "2019-02-23T02:56:47Z")
And I just noticed from a link in that article that there now appears to be draft federal legislation in the works to protect patients from balance billing: > **[Cassidy, Bipartisan Colleagues Release Draft Legislation to End Surprise...](https://www.cassidy.senate.gov/newsroom/press-releases/cassidy-bipartisan-colleagues-release-draft-legislation-to-end-surprise-medical-bills)** > > The Official U.S. Senate website of Senator Bill Cassidy of Louisiana ---
**Author:** ![pohjonen](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pohjonen/32/423_2.png) [@pohjonen](https://boards.straightdope.com/u/pohjonen)\ **Post date:** [February 23, 2019, 4:10am UTC](https://boards.straightdope.com/t/can-anyone-explain-medicare-to-me/830032/32 "2019-02-23T04:10:50Z")
The link to the NPR site in that article is appalling. [Almost 18,000 dollars for a drug urine test?](https://www.npr.org/sections/health-shots/2018/02/16/584296663/how-a-urine-test-after-back-surgery-triggered-a-17-800-bill) Some surgeon must have been getting some lucrative kickbacks from that testing company. And the medical providers wonder why so many people regard them with a jaundiced eye. ---
**Author:** ![Beckdawrek](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/beckdawrek/32/3647_2.png) [@Beckdawrek](https://boards.straightdope.com/u/Beckdawrek)\ **Post date:** [February 23, 2019, 4:43am UTC](https://boards.straightdope.com/t/can-anyone-explain-medicare-to-me/830032/33 "2019-02-23T04:43:20Z")
I do wonder if some of these specialists and surgeons are getting kickbacks. God knows they have expensive educations(school loans pending) and high priced malpractice insurance. It’s all so revolting. It makes for unscrupulous snake oil salesmen to get in and take you for all your insurance will allow and then coming after your assets. It’s wrong. Bottom line. ---
**Author:** ![Dereknocue67](https://avatars.discourse-cdn.com/v4/letter/d/6de8d8/32.png) [@Dereknocue67](https://boards.straightdope.com/u/Dereknocue67)\ **Post date:** [February 23, 2019, 9:44am UTC](https://boards.straightdope.com/t/can-anyone-explain-medicare-to-me/830032/34 "2019-02-23T09:44:11Z")
Medicare Part A pays about 80% of hospital/doctor related charges, This is why many purchase Medicare Supplemental Coverage. ---
**Author:** ![md2000](https://avatars.discourse-cdn.com/v4/letter/m/73ab20/32.png) [@md2000](https://boards.straightdope.com/u/md2000)\ **Post date:** [February 23, 2019, 3:22pm UTC](https://boards.straightdope.com/t/can-anyone-explain-medicare-to-me/830032/35 "2019-02-23T15:22:47Z")
Why shouldn’t UHC be federal? Too many people cross state lines on a regular basis, and risk being hospitalized out of state as a routine matter. Perhaps the Feds have the constitutional right, at least, to dictate standards for medical coverage when it’s out of state - commerce across state lines. Maybe if a hospital cannot find an anesthetist (or any other specialist) that can assist in operations “in plan” with all the insurance providers that the hospital accepts, it should not be allowed to offer those procedures - or lose hospital accreditation. I suspect at that point, things would change quickly. As a Canadian, to me the idea that “we can do that procedure if you have X company’s coverage, but not Y’s, unless you pay tens of thousands extra” is pretty sad. The idea that it is acceptable to spring that on a patient after the fact seems criminal. How any doctor for a procedure is worth more than a thousand or two is also criminal - $2,000 even for an all day operation, assuming 250 working days a year is $500,000 a year - if you’re making more than that, you better be the star doctor of the Mayo clinic. Perhaps another useful change would be to have hospital doctors not need malpractice insurance - the hospital’s insurance provides blanket coverage for all procedures done in the hospital. There’s got to be some form of economy of scale in doing that, plus encourages the hospital to better supervise the quality of care they provide - plus they are normally named in any lawsuits anyway. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [February 23, 2019, 8:28pm UTC](https://boards.straightdope.com/t/can-anyone-explain-medicare-to-me/830032/36 "2019-02-23T20:28:39Z")
> [@pohjonen](#): > > Which is why I wouldn’t touch a Medicare Advantage plan with a ten foot pole. Throwing in some useless dental coverage and a gym membership does not make up for having a gatekeeper to keep you away from specialists and telling you where you can go and surprising you with out of network charges. Not to mention the regional nature of many Medicare Advantage plans. Only one of the ones available when I signed up covered my doctor and the clinic I go to, so I got supplemental plan F which covers all the deductibles. I’ve paid a few bucks for medicine co-pays since I’ve gone on to Medicare, and that’s it. ---
**Author:** ![SigMan](https://avatars.discourse-cdn.com/v4/letter/s/13edae/32.png) [@SigMan](https://boards.straightdope.com/u/SigMan)\ **Post date:** [February 24, 2019, 1:57am UTC](https://boards.straightdope.com/t/can-anyone-explain-medicare-to-me/830032/37 "2019-02-24T01:57:23Z")
Though I don’t have much of a choice in medicine but I consider myself lucky that my medical is 100% free. I have Medicaid and Medicare. My coverage is Superior Star Plus and it used to be good. As years go by it gets worse. I have a painful neck and I used to get injections every 3 months. Since over a year ago it’s every 6 months. I have pains for 3-4 months before the next one. They refused to increase my pain medicine to control it. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [February 24, 2019, 7:05pm UTC](https://boards.straightdope.com/t/can-anyone-explain-medicare-to-me/830032/38 "2019-02-24T19:05:19Z")
> [@kenobi\_65](#): > > Pretty much, yes, save for the fact that they aren’t fictitious for the uninsured, who _would_ face those charges for the same treatment. This is incorrect. For the [uninsured](https://www.healthaffairs.org/doi/full/10.1377/hlthaff.27.2.w116)most of the time they get a discount and end up paying a little more than what Medicare pays. Unless the person is poor in which case they would be declared indigent and the state would pay or it would be written off. ---
**Author:** ![Riemann](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/riemann/32/3133_2.png) [@Riemann](https://boards.straightdope.com/u/Riemann)\ **Post date:** [February 24, 2019, 7:32pm UTC](https://boards.straightdope.com/t/can-anyone-explain-medicare-to-me/830032/39 "2019-02-24T19:32:57Z")
> [@puddleglum](#): > > This is incorrect. For the [uninsured](https://www.healthaffairs.org/doi/full/10.1377/hlthaff.27.2.w116)most of the time they get a discount and end up paying a little more than what Medicare pays. Unless the person is poor in which case they would be declared indigent and the state would pay or it would be written off. That’s highly misleading. That study is looking at average hospital revenue per uninsured patient relative to insured/Medicare patients. Since the uninsured category includes many who are too impoverished to pay _anything_, it means that providers are getting much higher prices from any uninsured (or out-of network) patient who can _afford_ to pay relative to insurance/Medicare pricing. And just looking at final revenues ignores the _process_, which is still abhorrent. The standard procedure for an uninsured patient is to send them a bill that is 300% to 1000% higher than an insured patient would pay, and then start a protracted and incredibly stressful process for the patient, who must then try to figure out exactly what his obligations really are, potentially worrying about losing his home or being bankrupted. In fact, the study also admits that a significant proportion of payments from uninsured patients are taken by collection agencies, because so many bills end up in collections, and that’s not reflected in the net provider revenues. As somebody who is relatively affluent, I believe that I _should_ pay more for my healthcare. But that extra contribution should be through a fair and transparent taxation system, not through being sent outrageously inflated “can we get away with it” bills for hundreds of thousands of dollars from an out-of-network hospital at the time I’m trying to convalesce from a horrific accident. Whatever uninsured or out-of-network patients _end up_ paying _on average_ after months or years of stress, collections agencies, attorneys, court cases - this is a fucked up and terribly dysfunctional system. ---
**Author:** ![Mdcastle](https://avatars.discourse-cdn.com/v4/letter/m/958977/32.png) [@Mdcastle](https://boards.straightdope.com/u/Mdcastle)\ **Post date:** [February 25, 2019, 2:50am UTC](https://boards.straightdope.com/t/can-anyone-explain-medicare-to-me/830032/40 "2019-02-25T02:50:08Z")
$4,000 on a $50,000 charge is a bit low even for Medicare but if I saw it as an insurance processor I wouldn’t blink. Since hospitals don’t really make any money on Medicare patients, which they’re forced to accept whether they want to or not, they make up the difference by charging more for people with commercial coverage. A procedure that costs the hospital $5000, they might get $4000 from Medicare, $2000 from Medicaid, and zero from someone walking in with no insurance. They make up for it by charging people with commercial insurance $8000. Having an astronomical billed amount is part of a negotaiting ploy. If the hospital only says they want $8000 the commercial insurance is going to offer them $7000. That all the hospitals would go out of business if all they got from everyone was current Medicare rates, and most people aren’t satisfied with just Medicare benefits is why you can’t just extrapolate the current cost per recipient for “Medicare for All” and call it done. [Previous page](https://boards.straightdope.com/t/can-anyone-explain-medicare-to-me/830032.md?page=1) [Next page](https://boards.straightdope.com/t/can-anyone-explain-medicare-to-me/830032.md?page=3)