Walter Hinteler wrote:That really sounds very complicated (at least for someone like me who only knows the European health insurance systems).
Do seniors get easily what to do when?
Some do and some don't. It is what it is Walter - you are blessed if you have good Dr's and don't have to worry about insurance.
roger wrote:Mismi, you are a living doll. I think I'll wait about a year and check back with you and Diane for a quick refresher course.
Anytime Roger - glad to help :wink:
Gelisgesti, I just watched Sicko. Thank you for providing the link.
It is one of the most depressing films I've ever seen, but I think everyone in this country should see it. Unfortunately, there is little doubt in my mind that this country will put off universal health care as long as private hospitals and pharmeceuticals are so profitable and as long as Congress is so beholden to their lobbiests.
The health care system in the US is horribly embarassing, isn't it? Not to mention immoral.
Diane wrote:Gelisgesti, I just watched Sicko. Thank you for providing the link.
It is one of the most depressing films I've ever seen, but I think everyone in this country should see it. Unfortunately, there is little doubt in my mind that this country will put off universal health care as long as private hospitals and pharmeceuticals are so profitable and as long as Congress is so beholden to their lobbiests.
The health care system in the US is horribly embarassing, isn't it? Not to mention immoral.
Actually it is excellent if you are a congressman .... free full coverage for life!
Paid for by those denied with no voice in the matter.
Phoenix32890 wrote:mismi wrote:Phoenix, you can get Medicare Advantage plans that have drug coverage included and that do not require additional premiums. Many insurance companies offer them. You just pay your Medicare B premium to the insurance company.
The doughnut hole is not an issue unless you are on a lot of medication. So if you are in fairly good health signing up for one of those Advantage plans would keep you from being penalized for taking out Part D at a later date if you suddenly need it. As I said earlier, this does vary from state to state. If your medical needs changed during the year then the next open enrollment you could change to one that better suits your needs.
There is a major problem with the Medicare Advantage plans. In those plans you obliged to use the doctors and hospitals who are in their network. If you are relatively healthy, there is probably no problem, but if you get sick...................
In addition, the vast majority of those programs make you get a referral from your primary doctor in order to see a specialist. There are some deals that these programs have, where doctors are given financial incentives NOT to refer to specialists. If they cost the insurance company too much money, it comes out of the doctor's butts. That is quite a conflict of interest, but there it be!
By law, the insurance companies have to disclose the deals that they have with doctors (in general, not for a particular doctor). I have a letter that I got from one of the insurance companies a number of years ago when I had to put my mom on an HMO (Medicare Advantage is the politically correct term nowadays), and my hair stood on end when I read it.
I have had a number of friends who have had to change their plans often, because the doctors' group could not come to an agreement with the insurance company, and did not renew their contract with them. I have one friend who is limited to only one group of doctors in town, (and they are awful). They are the only ones on her plan.
To me it is a matter of priorities. I wll do without something else, if I can pick the doctor and the hospital that I want.
That's good Pheonix...I am just trying to help. The PPO lists do make it difficult in some states. Some states are better than others. And in light of that, my knowledge really only extends to the state of Alabama at this time.
The supplement plans here are excellent - but you do pay dearly for them. The Advantage, well, some are better than others and it does depend upon the the providers that are participating with that plan.
Diane wrote:Edgar, Dys likes for me to stay on my medications.....
Having a Med-Gap insurance plan with your Medicare plan could smooth the way for you...Have you thought of buying a Medi-Gap plan?
mismi- Many years ago, my mom was on a traditional Medicare/Medigap plan. It had gotten to the point where the monthly premiums were becoming burdensome to her. Since she was in her early nineties, I figured that she would not be going in for major surgery, so that an HMO might be advantageous to her.
With the HMO, she paid no premiums, but each time she used a service, there was a copay. The hospital copays were pretty steep. In those years, after you paid $2,400 out of pocket, the copays stopped. (Stop-loss). After a couple of years, they raised the stop-loss to $3,600-. She was using a lot of services at that time.
I did the math, and figured out that it was no more expensive to pay the premiums for the Medicare/Medigap/Part D package, than to stay with the HMO. On top of that, she could see which doctor she wanted, and had a lot more freedom in choosing her medical care.
An ongoing problem today with HMOs is they're being overbooked with patients, while being understaffed with physicians.
Some HMOs are now filling MDs spots with DOs.
Phoenix32890 wrote:Miller wrote:An ongoing problem today with HMOs is they're being overbooked with patients, while being understaffed with physicians.
Some HMOs are now filling MDs spots with DOs.
It wouldn't be so bad if it were only DOs. I have had friends on HMOs who tell me that if they wanted an appointment quickly, they would have to see either a physician's assistant, or even a nurse practitioner!
The HMOs remind me of the old days of the health clubs. The clubs would enroll as many people as they could, and hope that most of them would drop out after awhile. Since many doctors on HMOs are paid by capitation, (per head) it is to their advantage to have as many patients enrolled as possible.
And the latest title in nursing is Dr. Nurse. I don't know what they do, and I surely don't want to find out in an emergency.
All of these stories make me think more highly of Michael Moore's film, Sicko. Great Britain started universal health care right after WWII--at a time when they could little afford it, but they wanted their countrymen to feel safe and to know that they could receive good health care no matter their personal wealth.
One reason I have such antipathy toward insurance companies in this country is a horrible experience my brother had in Tucson, AZ. John has mental retardation and is rather low functioning, although he used to take a bus to work and could even make a transfer.
One day as he was walking across the street, in the crosswalk, he was run down by a truck. He suffered a broken leg, collar bone and internal injuries (and I don't remember what else).
He stayed in the hospital quite a long time, because it was difficult for him to understand abstract concepts. Where does it hurt?---how much does it hurt?--does it feel better today?--were all questions it was impossible for him to answer with any detail. Plus, people with mental retardation often say what they think the questioner wants them to say (that's why they are so often charged with crimes they didn't commit).
After his stay in the hospital, he was sent to a nursing home--he is on Medicaid because of his disability. There are only a few nursing homes that accept Medicaid and they are, typically, the very worst.
John had to be sent back to the hospital twice for bed sores. Again, he didn't or wouldn't complain. For him, this was all tremendously more traumatic than it would have been for most people.
The director of the home John was in would go to the nursing home and check on him. He would only eat when she was there. She always asked if he had anymore bed sores and she was assured that he was fine.
The third time John was sent back to the hospital, his bed sores had eaten all the way through to his colon. Needless to say, he almost died.
Luckily, the nursing home was sued and John received enough to have 24 hour care for the rest of his life.
John is doing well, but he will never be the same. He still has the same sweet smile, but there isn't anything behind it. He is withdrawn but he does trust the women who take care of him and I, an agnostic, am convinced they are true angels. But what about skid row bums, street people and all the rest of the people most of us never see?
The system is sick. Horribly, immorally so. It won't get better as long as the medical and pharmaceutical companies have more lobbiests with more money than most of us can even begin to conceive--in addition to which, they have so many lobbiests, that no member of Congress can escape their tempting offers.
It certainly make me sick.....and furious.
BBB
I've always admired The Lady Diane's devotion to her brother. She has frequently driven hundreds of miles to be with and check up on him. He's lucky to have such a devoted sister.
BBB
Our health care system is all for profit. Just the opposite should be true to insure that everyone has the same access.
The most vulnerable are seldom treated with respect, access to beneficial medicines, healthful food and personal attention. All those things cost money. When a doctor receives a bonus for the fewest prescriptions and tests given, he or she will opt for the money. I know a few who refuse to be part of the system, but they are in a minority.
Diane wrote:
The most vulnerable are seldom treated with respect, ...
Are you saying that welfare recipients are not treated with compassion?
Diane wrote:... When a doctor receives a bonus for the fewest prescriptions and tests given...
Does this make sense?
Why should a physician receive a bonus, when increased medical expense as a result of patient illness ( due to fewer Rxs and tests ), is the result?
When a mammogram or a colonoscopy is ordered for a patient and the patient follows through with the exams, this is money in the bank for the healthcare facility providing the tests to the tune of about $500/mammogram and $2000+/colonoscopy, all paid for by most if not all health insurance plans.
So...why would the physicians order fewer tests?
Here is a link from The Center for Health Policy Research--part of the AMA.
It has some good information on how doctors are compensated if they work for an HMO. The relevant information starts on page 2.
http://www.ama-assn.org/ama/upload/mm/363/prp981.pdf
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American health care...
