It’s a social program, yes, but can you explain what you mean by ‘absorb risk’? (I can understand risk shifting, from seniors to the government payor, but what is actually being absorbed?)
Our (CA) Blue Shield plan also offers a discount (7% if I recall), if we are both on the same letter plan. And it is one policy number.
It is essentially risk shifting like any other insurance, but commercial insurances also need to find profit. Medicare doesn’t. It gets back to primary mission, pay for healthcare versus make money.
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I, too, am a satisfied MA customer. I was advised by a friend to stay away from Humana and United because they are for-profit, and ultimately decided to go with the same company we had for years through H’s employer. It’s a regional company (only MN and WI?), but is a PPO with a huge network and a 5 star Medicare rating. They also include this:
“Enjoying the snowbird or RV life? All plans include in-network coverage for up to nine months of annual domestic travel. You’ll also have access to pre-travel consultations and worldwide emergency and urgent care coverage, with additional assistance through Assist America”.
I don’t understand how they could refuse to pay, since all coverage is clearly spelled out in their Evidence of Coverage, so there are no surprises. I am relatively healthy, with only one Tier 1 prescription, which costs me nothing. For all of 2020, except for the $51 monthly premium, I paid a total of $80, for two specialist visits (dermatologist and ophalmologist). 2022 was a very unusual year for me as I broke my wrist and a finger and had cataract surgery, so I’ve spent around $1100.
For the person upthread who talked about qualifying for Medicare while still on H’s insurance, if I recall correctly, you will get a Medicare card in the mail with something to send back to decline Part B. Then when your H retires, there’s a form that his employer/HR Dept has to fill out for you that states you had insurance, to avoid the penalty for not signing up as soon as eligible.
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No, commercial insurance is risk-pooling; Medicare is risk-shifting. Big difference.
You will only receive a card in the mail when you turn 65 if you are already receiving SS benefits under your name. (Otherwise, you have to apply a couple of months before you turn 65 if you want Medicare coverage in the month you turn 65.)
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But then aren’t Medicare supplement plans also private plans?
Also, doesn’t original Medicare have a reputation of paying easily, but not paying very much? If so, that may explain why one major medical group around here has Medicare pages that mostly write about Medicare Advantage HMO and PPO plans that they accept, rather than original Medicare (which they do accept).
Likely just a poor web designer. Found the same thing in Denver, when a good friend relocated downtown and was in walking distance to the University of Colorado Med Center. She said that the hospital links to all of the HMO’s and EPO’s that they accept, including a list of Medicare Advantage plans, but does not list Original Medicare specifically. Obviously, a major Uni med center just has to accept Original Medicare, and therefore Medigap plans, but it wasn’t clear on their website.
Thanks for clarifying. I was already getting SS, so I forgot that that was a requirement.
Blue Cross is a nonprofit … but “ Blue Cross Blue Shield of Michigan reports $360 million profit for 2021; CEO made $15.6 million.”
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BCBS companies include a mix of non-profit and for-profit companies. Of course, non-profit companies do need to avoid making negative profits and maintain reserves against unexpected negative profits if they want to stay in business, even though they may not have the profit-maximizing motive that for-profit companies do.
Both non-profit and for-profit companies in general can have issues with excessive executive compensation and such.
And many of the BCBS plans are part of publicly traded Elevance Health (formerly Anthem):
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They are, but they are required to cover anything Medicare covers.
Medicare does pay less, but the system has become so bloated in this country that those who say they can’t survive on that reimbursement, have just made poor business decisions. You don’t need a palace to provide healthcare.
Nonprofits in healthcare are a HUGE problem. There are no incentives to be efficient and cost effective. In fact, the opposite is true. There is a reason that modern hospitals and clinics look like spas and hotels. We paid for those. Dooh!
I did all the research 4 years ago when H became Medicare eligible. His doctor - who was in one of the very few, small private practices - sold that practice to the largest HC company in our state. H lucked out because previous to the sale, his doctor was not taking ‘Medicare assignments’. That large HC company is pushing the MA plans heavily. Like - not only with mailers but with customized emails and reminder emails and even texts. Nope, staying with traditional MC.
In the process of setting up H I learned that if one is a patient in good standing (has to have been seen by a doctor in that organization within the last 3 years for something other than urgent care), that practice HAS to take you as a Medicare patient if they are a ‘Medicare assignment’ organization. Since learning that, I have actively kept a PCP in each of the two different large HC provider networks. AFAIK, one group (Sutter Health) was not taking any new traditional MC patients, you had to be established. But, they are taking any and all AM applicants.
I will be going the traditional MC route in 1.75 years when I am eligible.
As for the cost - I have to laugh. Currently paying $1380/month premium for ME and only me to stay in a BSCA PPO. That lovely plan has a $6500 annual deductible. So…the difference between my cost now and MC is a few nice business class flights each year.
Now, if the Advantage plans ever get to the point where they do not result in an IRMMA upcharge - I will reconsider. H’s whopping 8% SSI increase was more than wiped out by his IRMMA contribution.
Correct me if I’m wrong, but isn’t IRMAA charged by Medicare? Everyone on a MA plan must have Medicare Part B, which is paid to Medicare, and then they pay extra to the MA company (or sometimes $0). So if you have traditional Medicare with or without a supplement, IRMAA still applies.
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But if you are physician, you do need $400,000 of medical school debt if you do not have wealthy generous parents.
Perhaps you mean to say that it is a poor business decision to become a physician if you do not have wealthy generous parents.
That’s simply another piece of evidence that the system is broken
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That is correct. IRMMA is a Medicare tax on high income earners. And yes, it applies to all Medicare beneficiaries, whether they opt for Original Medicare or Medicare Advantage.
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This is a semantic argument. Yes you pay into one system before you can use it and profit is factored into the other system. In both cases though you have a pool of money to pay for services that people use at differing rates.
Many here complaining about the “for profit” nature of some health insurers. You may want to take a look at what is happening in Canada. Health care there is all virtually all non-profit and controlled by the government. The grass is not always greener…
Canada’s health-care system is ‘collapsing around us,’ warns CMA president | CTV News
The health system is bad now. It’s going to get a lot worse — and here’s why | Montreal Gazette
With the internet dirty little secrets are hard to keep.
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