We could form a mutual reading/admiration society!
Definitely – you post, and I’ll read and admire.
@Dinsdale, are you persuaded yet?
I actually I think I ended the debate by reminding everyone of IRMAA. (does anyone read my posts?)
Medicare is means tested. Right now. Significantly.
Look at page 2 of this pdf.
“Well-off” or not, they pay taxes like the rest of us so they deserve the services provided. But, let’s say for the sake of discussion, that you want to “means test”. What criteria would you use? Major diseases can be phenomenally expensive. How “well-off” do you have to be to tackle medical bills that could literally be a million dollars or more?
Hey, if we can afford to give the truly wealthy a $1,000,000,000,000+ tax break, we can afford to give the “well-off” medical care.
There we go! Problem solved.
Thanks for that. Yes, I’m persuaded I was mistaken. Ignorance fought.
Now I’m trying to figure out how to put into words my unfavorable reaction to what I perceive as a greedy/entitled/cheap (poor choice of words) attitude on behalf of so many well-to-do retirees.
And this morning I biked with my sister - whose husband recently retired and signed up for Medicare. She was discussing another friend who had been mentioning the need to take minimal withdrawals from his retirement funds. I asked her if, with everything she knew of this couple - who they’ve known for 40-50 years, whether she was comfortable that they were at least as well-situated financially as my sister and her husband are. She answered, “Of course.”
I can imagine someone not ever really caring or thinking of such things, but I don’t understand how one could not make some educated guesses as to the financial situation of those you have known best/longest.
I apologize in advance if I misunderstood this, but isn’t that just income testing? Let’s say I earn fucktons of money but it all comes in before I shift to Medicare, and then my income is relatively low, just a runoff pension of some kind. So I’m sitting on millions and millions, and I have the means to pay for a lot, but this would be the test?
Apologies again if I misunderstood.
Supposedly, lots of wealthy people still shop at Walmart. (I say “supposedly,” because I don’t know any genuinely rich people to ask.) Getting a good deal – or getting something free or inexpensively that others pay full price for – makes people feel smart, and even rich people like to feel smart.
Conversely, paying a lot for something others get free or more cheaply can make you feel like a chump, and no one likes feeling like a chump.
/poppsychology
Private insurance rates get more expensive the older you get. How much would the premiums be if people over 65 had to get private insurance rather than Medicare? That is, not the cost of Medicare supplemental plans, but the premiums to have 100% traditional, private insurance? I would guess the premiums for traditional insurance for 70 and 80-year-olds would be pretty pricey. People who were just rich rather than wealthy would likely burn through a significant portion of their retirement savings on premiums alone.
Yeah - good point. I don’t know enough about how retirement income is styled - what parts qualify as “income.” Wait - does that mean I’m still ignorant? 
As I understand it, considerable thought goes into how to extract funds from various sources so as to minimize tax liability. Yeah, to some extent, that is just fiscal responsibility. But when I perceive folk bemoaning having to pay capital gains on some funds they are withdrawing, I don’t get the impression that they are appreciating how well off they are compared to the many folk who have never been in a position to even think about capital gains.
Means testing pretty much always means income testing. Income is fairly easy for the government to figure out — it has to be reported every year. Money just sitting in accounts does not.
I just had my latest 6-month check up with my cardiologist yesterday. She’s pleasant and always answers my questions in depth. When the nurse gave me my EKG she said “just checking to see if you still have Afib” or words to that effect. I asked if that happens (that Afib goes away), and she said rarely, but it does happen. If it ever did, I’d be happy to never see Dr. Fong ever again … no matter how nice and knowledgable she is.
I live in a condo complex with a mixed population. I assume those still working have decent incomes, and those retired have decent retirement incomes, because we live in a high-priced area. But I really have no idea how many are comfortably wealthy and those that are hanging on by their finger tips.
I meant to comment on this! Yes, I’ve paid for my Medicare, and I still pay for it…not a huge amount, but I still pay something.
Actually if you are withdrawing from an IRA, you don’t pay capital gains tax, you pay straight income tax rates. I’ve never heard anyone moaning about this - we knew the deal when we put the money in, and you can often control your income in other ways to reduce the tax bite.
I have heard people moaning about mandatory withdrawals when you don’t need the money, but I understand the reason for this and again that was part of the deal.
A little casual googling tells me that the UK means-tests both income and wealth. Example:
That’s for social, rather than clinical/medical care: not the care that saves your life and keeps you breathing, but the support and looking after that you need to make a life beyond just breathing, whether in your own home or in some form of care home.
I think I mentioned above that updating and reforming the existing rules on financing this is such a hot political potato that successive governments haven’t been able to find a way through that they think they can sell to the voters. It’s a mess.
Can you concisely describe/link the difference between social and clinical/medical? When my google finds definitions like:
includes support for older people, people with mental health problems, learning or physical disabilities, those with alcohol and substance misuse problems, prevention of abuse or neglect, needs related to homelessness, domestic abuse and associated support for families and carers.
That seems to include a lot that Americans lump into medical care, and that is covered by Medicare.
Social care in this context is (in theory) whatever is necessary to try to fill a gap in income and daily living that would not exist for an able-bodied, generally-healthy person in full time employment. Disability being probably the most obvious example; if you have a disability that makes it impossible to work a full time job, that’s (supposed to be) addressed by social care. It’s not treatment- it’s whatever else is necessary to try to live as normal and functional a life as possible.
Medical care is about the actual treatment of health conditions; diagnosis, surgery, medication, etc.
There is a bit of overlap - for example people receiving certain categories of social care are not liable to pay prescription charges.
Medicaid in the US is also means-tested based on assets.
The NHS will diagnose and treat your disease, stabilise your condition and get you as close as they reckon they can to a normal life. Social care takes over when that isn’t what most of us would consider normal independent living.
So things like an occupational therapist assessing what adaptations might be necessary to your home, or a social worker judging whether you need a home help - or would need to move into some form of supportive housing - that’s all social care, which is run by local government rather than the NHS.
That does not seem to be true.
MAGI is the basis for determining Medicaid income eligibility for most children, pregnant women, parents, and adults. The MAGI-based methodology considers taxable income and tax filing relationships to determine financial eligibility for Medicaid. MAGI replaced the former process for calculating Medicaid eligibility, which was based on the methodologies of the Aid to Families with Dependent Children program that ended in 1996. The MAGI-based methodology does not allow for income disregards that vary by state or by eligibility group and does not allow for an asset or resource test.