Canadians may be worried about their health care system.
But would they trade it for the (far more expensive) US health care system? Or are they worried that it may become more like the US health care system in terms of costs and related issues?
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Many Canadians think that US hospitals are full of wealthy people or people who will face bankruptcy after they are discharged. The Canadian government, with the help of the media, has set up the US health care system as a bĂȘte noire. When Canadians complain about problems with their health care system the response is âJust be glad you donât live in the US.â and it all comes down to money.
Canadians cannot afford, or donât want to pay, what it would cost to train and support more doctors, nurses and other health care providers.
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Well, considering that the leading cause of bankruptcy in America is medical costsâŠ
But at least their health care needs were taken care of as opposed to being debt free and on a long waiting list for surgery.
It is perhaps uniquely American that some people refuse to get health insurance, even if they can afford it or it is heavily subsidized by the government. It is socialism which to them is a bad word. Remember the challenges to Obamacareâs requirement that everyone be insured or pay a tax penalty.
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People in the US go without care ALL THE TIME because their insurance companies turn it down.
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Every time we have this discussion the people who love their Medicare Advantage rave about their networks, etc. But then it turns out these are not MA programs available to the general public but are because of a specialized group they belong to. It would be helpful if you would tell us what MA company you are using and why you qualified for it, if you are so pleased.
Also, all insurance companies look like they pay their claims, until one day they donât pay yours. I felt good about my insurance company until they tried to slip surprise billing for an anesthesiologist by me earlier this year. And when I called about it they said, âoh youâre right, our software isnât handling that properly.â OUR SOFTWARE ISNâT FOLLOWING THE LAW? Insurance companies are scum. All of them, when itâs your health they decide to mess with.
And yes, Canadaâs system is collapsing too. I know cancer patients who canât get a primary care doctor because there are none, and who have had needed procedures, that would be considered emergent in the US, put off for weeks. The pandemic has broken many things in healthcare systems, both here and in other countries. Itâs bad everywhere and if itâs not bad where you are consider yourself very fortunate.
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Not unlike the US, where most such costs are borne by the prospective providers ($400k debt for medical school to become a physician these days), and the supply of space in physician and nurse education is still very restricted (as evidenced by the highly competitive nature of admissions).
I know a Canadian who lived in the US for decades who moved back to Canada due in part to health care, including observations of how their parents in Canada versus their American spouseâs parents in the US fared as they aged (the Canadian elders did better at much lower cost). The American spouse fully agreed.
Do you not consider Medicare to be socialism in medical insurance for the elderly?
Well, THAT got political pretty quick.
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Yes. IRMMA applies to TMC and MA. My point was that unless IRMMA gets waived as an incentive to join a MA plan, there is no reason for H or I to do so.
My MA plan is through HealthPartners, which does business in six upper Midwest states. The plans are not the same everywhere, but in my area, I have a choice of four different plans, ranging from $0 to $136 per month. The higher the premium, the lower the co-pays and out of pocket maximums. So itâs based on where I live, not on any group I might belong to.
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Not quite. Part B â which pays docs â is primarily (~75%) funded out of general revenues, i.e., income taxes. (The monthly premiums total 25%.) Part D (Rx) has a similar funding ratio with some $$ from states. There is no risk-sharing in the typical use of the term, just nearly unlimited health care benefits paid by the US Govt.
fwiw: Part A is funded thru payroll taxes today, but that is expected to run out in the next few years, so it too, will start to be funded by income taxes.
My MA plan is eligible to the general public. I have no specialized group. I picked it because of favorable ratings on Medicare website. I believe this will be the fourth year I had it. Before that I had an Empire Blue plan that was negotiating with hospital networks until the last possible second. Time to change!
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This!
IRMMA doesnât just apply to Medicare Advantage.
My husband qualifies for his MA plan because we live in Maine. The premium is zero in our county. I know thereâs a minimal premium in some Maine counties.
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I am out of gift articles (maybe someone else can post a gift link) but this article explains a lot.
Which to Choose: Medicare or Medicare Advantage?
Open enrollment for Medicare plans ends Dec. 7. Hereâs what you need to know about shopping for them.
https://www.nytimes.com/explain/2022/11/20/health/medicare-open-enrollment/
Supplemental plans and Advantage plans are state specific, in pricing, coverage, options, and ease of changes. In my state, premiums for the same plan can vary depending on county of residence.
After HOURS researching alternatives, DH and I chose Traditional + Supplement G. Caveat: This was several years ago, so options may be different. We knew our choice was more expensive than a MA plan, but thatâs what worked for us for a number of reasons. Your circumstances (and state options) might not be the same.
The book âMedicare for Dummiesâ was very helpful as an introduction to the choices. We then attended a seminar given by SHIP representatives, which helped clarify the nuances specific to our state.
Hereâs another overview: Medicare Advantage vs. Medigap: Key Differences
Our SHIP representative summarized a major difference between the two by describing Traditional + Supplement as a âpay-up-frontâ type program. Premiums are higher, and more complicated due to (3) separate billing entities, but depending on the chosen plan, co-pays (if any), and OOP (if any) can be non-existent. Great if/when youâre really sick.
Medicare Advantage is more like a âpay-as-you-goâ program. They have co-pays, co-insurance, & OOP costs. Great if youâre healthy. It gets more complicated (and often more expensive) when youâre really sick or have a chronic condition. It can also be more complicated to estimate your probable costs (with copays, etc.), but simplified monthly premiums. Advantage plans typically have more perks than Supplement Medicare programs. (Silver Sneakers, Dental, Vision & more). Prices vary wildly.
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Part 2: A few other highlights we learned in our Medicare Journey:
âą Assuming due to varying state regulations, plans in some states allow you to switch back and forth between MA & Traditional + Supplement plans during open enrollment with no underwriting. That is not true in my state. If DH wants to change his Traditional + Gap insurance from state A to state B, Supplemental plans in state B can require medical underwriting . Usually no problem â if healthy.
âą Each year, I can change to a MA plan during open enrollment, or switch between MA plans, but once in a MA plan, after the first year (basically a trial period), I cannot return to Traditional + Supplement without potential underwriting. Usually no problem â if healthy.
âą There can be a significant difference in premium costs between states, for the exact same coverage (i.e. BCBS Supplement âGâ): In one (state A), premiums are averaged - so same cost whether 65 or 95 . In another (state B), premiums are based on age, so a 65 initially pays much less than a 95 year old, but premiums increase with age. I think from memory, there is an eventual cap. This can be a budget issue when older and on a fixed income.
âą Even if choosing Traditional + Gap coverage, donât believe the usual adage that all levels of the Gap insurance are the same (i.e. âGâ supplement is a âGâ no matter the company). There are subtle but important differences. Perks, Billing methods, History of increases, What happens if you move, etc. For example, my current Supplemental plan was similar in cost to other G plans in my state, but mine covers Silver Sneakers which pays for my gym membership - a significant savings for me. They can eliminate this perk at any time however, which United did several years ago.
But is it?
Besides isnât infrastructure spending âheavily subsidizedâ by the government, or national/state parks, or our armed forces?
Does that mean we have a âSocialist Armyâ and never realized it? 
Isnât the whole purpose of humanity banding together in tribes/communities/countries, so that together they can pool abilities/talents/resources (e.g. through taxes) and accomplish more than each one could ever by themselves. Even Elon Musk couldnât bore enough tunnels to produce a working subway system.
Certainly, a healthy population to maximize everyoneâs ability, talent and productivity, and reduce societal cost, is such a mutual benefit that ought to be mutually funded - just like the Marine Corps?
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I am just mentioning a mindset that is common in the US. I donât subscribe to it, and it is not logical. But it exists.
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