#Medicare #MedicareAdvantagePlans #MedicarePartC #HealthCareNetworks
The ads are relentless this time of year, trying to get those on Medicare to sign up for Advantage plans, the so-called Medicare Part C.
These plans can indeed, in many cases, offer more benefits and lower costs.
But, if you want absolute – or as close to absolute as possible – freedom of choice in where you get your care, stick with the Medicare Part A, B and D plans.
These Part C plans, in most cases, are tied to a network of practitioners. In other words, you have to go to someone in that network to get your care covered by your insurance. In many cases, practitioners outside the network will not take you as a patient.
As a patient, you may develop a rare or complicated disease, even if you are relatively healthy today. Sometimes, going to see a specialist that is far from where you live would give you the best chance at recovery or survival. Chances are, that specialist won’t be in the network with which your Part C plan is affiliated. That may preclude you from the best care you can get.
Also, some of the Part C plans also require referral from a gatekeeper, usually a primary care doctor in the network, to see a specialist within the network.
Then, with Part C, there is the risk that large medical providers within the network will have battles with the insurer over reimbursements. When the practitioners hold the insurer hostage, or vice versa, the patients suffer and may lose their health care providers – temporarily or permanently.
These Part C plans are the more profitable products for the health insurers. Those who sell them earn much higher commissions. And, as we all see, they spend a fortune in advertising that might be better spent on patient care. Reports indicate that these plans actually cost the government more than regular Medicare.
All this isn’t to say that everyone should stay away from a Part C. plan. If you are someone who doesn’t often go far from home, and the practitioners you like are in the network, it could work for you. Be advised, however, that in many of these plans, the practitioners can come and go at will, while patients are locked in for the year.
If you do shop your Medicare plans, it might be best to find someone who sells multiple plans and could give you more choices. However, if want the flexibility that Part C plans do not give you, don’t let someone talk you into settling for a Part C plan. As of today, Parts A, B and D are still an option.
Medicare has been a marvelous way for retirees to get health insurance, usually with no questions asked. If you opt for a Part C plan, and it doesn’t work for you after a time, going back to Medicare parts A, B and D may be difficult, more expensive and may not cover pre-existing conditions.
Some of the ads for Medicare Part C often are created to make older people look stubborn, angry and, well, uniformed. Not everyone is like that. Or, others have celebrities doing everything they can to get you to call a certain number to examine plans.
But, it boils down to a simple decision: do you want flexibility in deciding where to get your care? If it doesn’t matter to you, then shop around for the best price, most convenient practitioners or whatever you are looking for.
If you get sick or injured on vacation, the practitioners you need where you are may not be in your network. Make sure you know what will happen to you, financially, if that occurs.
The hard sell for these Part C plans not only turns people off, it should be unnecessary.
Peter
Tag Archives: Medicare
PRESCRIPTION DRUGS, THE U.S. SYSTEM AND NEGOTIATIONS
#PrescriptionDrugs #DrugPriceNegotiations #DrugCompanies #tgovernment #PrivateSector
The United States is the only country in the world that puts medical care in the free market.
That tells the country that you get what you can afford, or, perhaps, you suffer or die.
The large drug companies, as well as academic research institutions, do the research that creates the newest, perhaps blockbuster, drugs, therapies and treatments.
That research, in the case of private companies, is funded largely by the (mostly U.S.) profits it makes from drugs, when they are approved and sold.
These companies want to maximize their profit initially because they know that drugs will eventually come off patent and can be duplicated by rivals.
That will lower the cost of the drug, usually.
Once a drug is developed and approved, the cost of manufacturing usually drops. Some drugs that cost relative pennies per dose to make are sold for up to thousands of dollars because the companies are trying to recover all their research costs.
So, the question becomes: why should a drug that has been prescribed for many years, that costs relative pennies to make, still cost so much long after the companies have recovered most or all of their research costs?
Perhaps it could be argued that the company is trying to pay for current research on drugs not yet approved. (What will they charge for that drug later, if approved?) Perhaps it could be argued that the companies are also trying to recover research costs on drugs that turned out to be busts, and never approved for sale.
Most of the drugs in the initial rollout of Medicare price negotiations with companies are drugs that have been around awhile. The companies by now should have recovered most, if not all, of their research costs on those drugs.
In some cases, companies are spending millions of dollars on television and other advertising to get people to ask their doctors about these drugs.
Perhaps, when Medicare starts negotiating prices it will pay for some of those drugs, the TV ads for those drugs will stop, or be cut back. That’s not good news for the TV networks and other media outlets that depend on such advertising.
In essentially every other country, drug price negotiations are the norm. There is usually only one buyer – the government – for the whole country. That gives those countries leverage to determine how much drugs will cost within their boundaries. (That’s why a lot of Americans buy their drugs from Canada or Mexico).
Because most medical care in the U.S. is in the free market, that hasn’t been possible here. Because of that, people not only had to be concerned whether a drug, or other medical treatment, was going to be the best for their conditions, they had to worry how they were going to pay for it. That’s stress atop stress unnecessarily.
In the U.S. private sector, a large-volume buyer usually negotiates prices. The more one buys, the lower the price per unit. The sellers want to sell lots of product. The buyer wants to pay as little as possible. So, they negotiate. Medicare is a bulk buyer of prescription drugs, and has never been allowed to negotiate prices – until now.
There is no telling yet how much prescription drug price negotiations will bring down the federal deficit, but, very likely, it could be considerable over a few years.
Therefore, there could be a two-part bang for the buck here. Medicare, and, ultimately, patients will pay less for the drugs they need, and the federal deficit could come down a lot. As a bonus, the drug companies will still make plenty of money.
And, over time, as the number of drugs that are subject to price negotiation increases, the difference could be huge, compared to the current situation.
The actual results have not yet been realized, but the whole idea could be a game-changer for the country.
Peter
DECISIONS FOR A SECURE RETIREMENT
#retirement #SocialSecurity #PensionFunds #pensions
Recent reports and studies have Medicare funding drying up by 2026, with Social Security only secure for a few years after that.
Geoff Mulvihill reports that many pension funds for public workers already owe far more in benefits than they have in the bank. His article for the Associated Press was published May 26,2018, in The Atlanta Journal-Constitution.
Just two days later, the Atlanta paper published an article by Susan Tomor for the Detroit Free Press discussing how to become a 401(k) millionaire. In summary: start saving at a young age, consistently, from every paycheck you receive. Also, if you get raises, put those in the bank, too, and don’t touch the money, except to reinvest or improve your investment portfolio.
We’ve all heard the stories about people at or near retirement age who have very small nest eggs stashed away.
Obviously, they did not make that a priority as they’d gone through various life stages – marriage, children etc. Some of them might argue that there is no way they could have saved money and dealt with whatever life threw at them.
For the young person, making retirement saving a priority is essential if, of course, you don’t want to be broke in your elder years, when you might have the time to do things that you never had time to do as a youth.
It really doesn’t matter what you earn. It matters only that you take what you earn and use it wisely.
Spontaneous – some might call it frivolous – spending ought not be a big part of your life. Knowing where every cent you have is going is essential. Of course, a life of complete amusement deprivation is not good either. But choose your fun wisely, as cheaply as you can.
Check you daily expenses. Are you buying your lunch at work every day? If so, bag your own. Are you making daily coffee shop runs? Buy a Thermos, brew your own and take it with you.
Are you ending your workweek with “happy hour?” Why not have you, and your friends, pick someone’s house, each buy a favorite beverage or snacks, and gather there instead of at your favorite watering hole.
Of course, not everyone has to cheap out. But for those who insist they cannot afford to save money, it has to become a conscious decision.
Even bigger life decisions, such as how many children to have, and when, should be considered as part of creating a financial future.
Young folks, too, have to decide when, or whether to buy a home. It may be considered part of The American Dream, but there is no shame in renting, if that works better for you. On the other hand, a house can be an investment you could use later as part of your overall net worth.
If you are older, and think you are out of luck now, or even if you are younger and are looking to secure your future, there are many ways out there to earn a decent, potentially lucrative, income by spending a few part-time hours a week. The bonus: if you are diligent and consistent, it’s money no one can take away from you. To check out one of the best such vehicles, message me.
The lesson to learn with these various reports on retirement is that a secure financial future is in no one’s hands but yours. Take charge. Use what you have, to the best of your ability. Perhaps even be open to looking for things that may help boost your future.
As the adage goes, if it is to be, it’s up to me.
Peter
MEDICARE’S EFFICIENCY
Medicare gets bad press as a big federal expense, but it is the hero of a recent expose on health care costs.
In fact, journalist and author Steven Brill, who investigated hospital costs nationwide, found huge markups on things you purchase as part of your hospital care.
Brill wrote the piece for Time magazine, and Time Managing Editor Richard Stengel cites the 10,000 percent markup hospitals put on acetaminophen as just one example.
In fact, Brill said on ABC’s This Week Sunday morning show Feb. 24, 2013, that if the introductory age for Medicare were lowered, not raised, health care costs would drop.
Unlike most businesses, hospitals charge you for everything you use, including the little paper cup you get with your acetaminophen in it. It probably costs the hospital pennies per cup to buy, but they might charge a few bucks for it.
And prices vary from place to place, as consumer adviser Clark Howard cited in an Atlanta Journal-Constitution column Feb. 28,2013.
What’s happening is that if you don’t have any insurance, you’ll get billed the marked-up price for your hospital care. Insurers, because they represent lots of people, can negotiate those prices down. And Medicare, the federal health insurance program for senior citizens, is only allowed to pay, by law, somewhere around the hospital’s cost for the item.
We can certainly debate whether hospitals would lose money if more people were on Medicare. Health care workers sing the blues over how little Medicare pays for things, and some providers won’t treat Medicare patients for that reason.
We also know that hospitals and other health care providers have to make up for those people whom they treat, but who can’t, or won’t, pay them. Hence, they mark up bills for paying patients to help recoup.
Brill also pointed out on This Week that Medicare processes claims for less than a dollar per claim, while private insurers pay about $20 to process each claim.
The point the Brill story makes is that insurance lowers medical costs. Medicare lowers them the best, but would a system in which everyone were on Medicare be sustainable? Would hospitals and other health care providers be able to survive on Medicare pricing?
Unlike other businesses, in which technological advantages and competition LOWER costs, technological innovation and competition can RAISE costs in the health care arena. Suppose Institution X get a CT scanner. Institution Y across town will want one, too, even though one scanner would probably service the whole area.
Institution Y doesn’t want to send its patients to Institution X for CT scans, out of fear that patients will elect to get all of their care at Institution X out of convenience. What if Institution Y LOWERED its prices because it doesn’t have the overhead to maintain the expensive CT scanner? If you cut your hand, would you want to pay the overhead for a CT scanner just to get a bandage?
The point is that people need to see, and care about, what things cost and how they are billed. Insurance makes people less concerned about that, but even though the patient may not be paying much of the cost, he still should negotiate bills. Don’t pay $5 for a paper medicine cup that you know costs the hospital a few cents. Or, better yet, have insurance for everyone and have the insurers negotiate prices down, Brill points out.
Health care is tricky, and there is plenty the average person doesn’t know, or care about. The Brill piece helped expose some of it, but it will be tough to get health care costs down considerably. Also, if we could reduce the costs considerably, how many health care providers can survive with the lower margins? Health care costs are high, in part, because we, as patients, don’t know where the money goes. If everyone were losing money, the system would have changed a long time ago. Someone, or some entities, benefit largely from this lack of knowledge. The money trail needs to be exposed, and the Brill piece goes a long way to do that.
If you don’t want to worry so much about costs, visit www.bign.com/pbilodeau. Not only will it help you save money on some medical care, it can help you earn enough money, perhaps, that you can easily pay for anything you need.
Peter