On 3/26/2021 7:20 PM, Sheldon Gitis wrote:
> Correct me if Iâm wrong, but I think itâs a government agency reimbursing the
health care provider for Medicare coverage, not a private insurance company.
As such, Medicare is government-funded health care, not an AARP
UnitedHealthcare insurance product. It seems to me, it's fraudulent for the
insurance companies to call the half-dozen or more different policies they're
marketing, incessantly, with reams of junk mail, "Medicare".
>
> Weâd all have much better health care coverage at a much lower cost if we
were paying for health care rather insurance industry marketing, profits and
administrative costs.
Medicare has four parts. They are all in essence insurance, not "care".
Part A is hospitalization, and everybody who qualifies gets Medicare's
coverage without charge. Note that this coverage does NOT cover the
entire bill, more like 80% of it. Payouts go to the care provider.
Part B is outpatient, and like Part A does not provide complete
coverage. It is optional. Payouts go to the care provider. Anybody who
qualifies and wants Part B pays a monthly fee deducted from Social
Security, $148.50 this year for people with an income below $88K
(assuming you have maintained coverage... if you have gaps in
coverage, the cost increases a bit for each month you didn't have
coverage).
Collectively, Parts A and B are sometimes called "Original Medicare".
Part D is private insurance plans for drug coverage. It is optional.
Payouts ultimately go to the pharmacy. As with B, if you don't have
coverage but later on get it, the cost increases.
Part C (also known as "Medicare Advantage") is private insurance
plans. It is optional. In general, they cannot provide LESS coverage
than A and B, and do include drug coverage. They may (and usually do)
cover some things that Original Medicare doesn't, and may restrict
what care providers are covered (Original Medicare does this also).
They may or may not charge a premium in addition to the Part B premium
(which I assume Medicare (or CMMS, the actual agency involved) pays to
the private insurance plan). Payouts from the insurance plan go to the
providers. AARP/UHC plans are examples of this, as are plans by
Medica, BCBS, UCare, HealthPartners, Humana, et al. Most have several
different plans, with differing coverage and prices. For example, this
year I'm on a plan that does not charge an additional premium, covers
the doctors I usually use anyhow, and covers the complete cost of the
drugs that I take. For me, that's better than Original Medicare. Last
year (on a different plan), I was in HCMC for 4 days. The billed
amount was about $30K. My portion was about $1K. I think Original
Medicare would have had me pay 20%, or $6K.
Would it be better if everything was automatically paid for completely
by Medicare? Sure. I have a friend who was hospitalized in a
third-world country, and when they were discharged asked how to make
payment. The hospital staff didn't understand what they were talking
about, there wasn't any charge to pay. But I don't see that happening
here in my lifetime.