As Medicare is today the only real benefits are going to the insurance companies, this is easily verified when the annual window opens for recipients to either apply for Medicare or change their current policy. If you are not disabled or near retirement age you may not yet be aware of this but those of us who are see an annual bombardment of advertisers attempting to lure the unprepared into their web of endless options and opportunities.
Let’s see how the scam is currently being manipulated. First, Part A is mandatory for everyone reaching their 65th birthday. Part B is mandatory as well unless you are still working and have company sponsored coverage. Once you officially retire and your coverage ends Part B is mandatory; however, you may decide to choose either a Medicare Advantage Plan or a Medigap Supplement Plan to satisfy the government requirement for Part B. If you choose a Medigap plan you will also need Part D, a Prescription Drug Plan
According to Medicare.gov Original Medicare includes Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). To make it more profitable for insurance companies and more confusing for recipients there’s much more.
Medicare Part C is also referred to as Medicare Advantage which is a Medicare-approved plan from a private company not affiliated with the government that offers an alternative to Original Medicare Part B for your health and prescription coverage. These “bundled” plans include Part A, Part B, and usually Part D. In most cases, you’ll need to use doctors who are in the plan’s network. Plans may have lower out-of-pocket costs than Original Medicare. Plans may offer some extra benefits that Original Medicare doesn’t cover—like vision, hearing, and dental services.
Medicare Part D is coverage for drugs or (Prescription Drug Insurance). All Part D plans must cover a wide range of prescription drugs that people with Medicare take, including most drugs in certain “protected classes,” like drugs to treat cancer or HIV/AIDS. A plan’s list of covered drugs is called a “formulary,” and each plan has its own formulary. Medicare drug coverage typically places drugs into different levels, called “tiers,” on their formularies. Drugs in each tier have a different cost. For example, a drug in a lower tier will generally cost you less than a drug in a higher tier.
Medicare Supplement Insurance, also referred to as (Medigap) is extra insurance you can buy from a private health insurance company to help pay your share of out-of-pocket costs in Original Medicare. You must have Original Medicare – both Part A (Hospital Insurance) and Part B (Medical Insurance) – to buy a Medigap policy.
Now, if you think all that is confusing just wait until you must decide.
The bottom line among all this confusion is, even after all is said and done and you have made the decision you think is best for you, you still will not be ready for the rest of the scam. No matter which plans you decide on you will still be responsible for the copay, deductible, and the possible 15% overcharge allowed by the government. You heard that right, if your doctor or medical facility does not accept ‘Medicare Assignment’ they are allowed to charge up to 15% more than Medicare assignment.
Some providers who don’t accept assignment still choose to accept the Medicare-approved amount for services on a case-by-case basis. These providers are called “non-participating.”
According to medicare.gov “if your doctor, provider, or supplier doesn’t accept assignment you might have to pay the full amount at the time of service. They should submit a claim to Medicare for any Medicare-covered services they give you, and they can’t charge you for submitting a claim. If they refuse to submit a Medicare claim, you can submit your own claim to Medicare. Get the Medicare claim form. They can charge up to 15% over the Medicare-approved amount for a service, but no more than that.” This is called “the limiting charge.”
If this is not messy enough for you the entire Medicare system is scheduled to run out of funds by 2031. Medicare trustees say the Part A program will begin running deficits again in 2025, drawing down the trust fund until it depletes in 2031. After that date, the program would not be bringing in enough money to fully pay out Part A benefits. 70% of people 65+ will require long-term care.
My next blog will offer a simple way to turn this Medicare mess into real health care even the disabled and elderly American citizens can understand and afford.
