Medicare Is Not Free Insurance

During the 2016 presidential campaign, we heard “Medicare for all” as the solution to insure all Americans.  We are hearing it again now in 2019.  Currently, Medicare is not 100 percent coverage at no cost to the insured.  If politicians in D.C. can’t make it available without costs to those with Medicare now, how are they going to make it a reality to all Americans?

I am guilty of thinking that after paying into Medicare for more over 40 years, that once I reached 65, I would have healthcare insurance for free.  I was mistaken.

Medicare has four (4) parts.  The parts are explained in a handbook.  As I write this, next to me is “The Official U.S. Government Medicare Handbook”.   The subtitle is “Medicare and You, 2019.”

Medicare Part A is “premium free” and only covers hospital admissions, skilled nursing facilities, hospice care, and home health care.  I found at this link that Medicare Part A has a $1,364 deductible for each benefit period.  Benefit periods begin with admission to a hospital through the date of discharge.  After 90 days of hospitalization, the insured is responsible for all hospital costs.

Medicare Part B covers doctor services.  If an insured is admitted to a hospital without Medicare Part B, they are responsible for the cost of doctor services.  There is a $185 deductible per year for Medicare Part B. After your deductible is met, Medicare Part B covers 80 percent of doctor services.

The current cost for Medicare Part B is $135.50 per month.  That amount might be higher depending on annual income.   Currently, most providers do not accept Medicare for vision and dental because what they pay for is limited.

How do people avoid all the confusion and prevent surprises to their pocketbook and bank accounts in the event of illness?  Enroll in Medicare Part C.  Medicare Part C is the Medicare Advantage Plan.  It is coverage through a private insurance company.  The cost is generally what Medicare Part B costs.  If receiving social security benefits, it is deducted from monthly benefits and paid directly to the private insurance company.

Some private insurance companies offer benefits that raise the price.  That price is tagged onto the Medicare Part B premium and automatically deducted from social security benefits.  For example, I paid an additional $19 per month for Medicare Part D coverage.

Medicare Part D covers prescription drugs.  However, based on the Handbook it is confusing as to whether you can get Part D unless you’re enrolled with a Medicare Advantage Plan.   The monthly fee for Part D is in addition to the amount paid for Part B.

I have a Medicare Advantage Plan, and the condition for chemo drugs is the same as under Medicare Part D.  It’s 20 percent.  Logically, they cannot set a co-pay for chemo drugs because there are different drugs depending on the type of cancer, and chemo drugs vary in price.  My out-of-pocket cost for a year is $4,500.  One of my chemo treatments is $37,000, so my annual 20 percent co-pay is covered after one treatment.  The time of year when treatment begins should be considered.  For example, I began treatment in October.  January started a new year and therefore, another $4,500 out-of-pocket cost.  That’s a $9,000 bill in 4 months.

My advice?  If you have a Medicare Advantage Plan, don’t become seriously ill towards or at the end of a year.

If you look at the last page number of the Handbook, it is 123 pages.  However, that is rather deceptive.  For example, Section 11 starts with page 113 and is titled “Compare health & prescription drug plans in your area”.   After page 116, it is numbered pages 116a through page 116p.  Thus, there are 17 pages of insurance companies listed, what counties they cover or “service area” along with other columns, an important one titled “Annual out-of-pocket maximum”.

I would love to see a plan where all Americans are covered with healthcare.  I do believe that healthcare is a right.  However, unless a major overhaul is done, Medicare is not the plan. Bernie Sanders has a plan that requires a tax increase and he promotes that it will be balanced by taxpayers no longer paying insurance premiums, deductibles and co-pays for healthcare, which Sanders wants to eliminate.  A possible issue under that scenario is that social security benefits are exempt from taxes for many retirees.  It will be the working class that bears the tax burden.

Maybe the plan should be to eliminate Medicare deductibles and copays for senior citizens and the disabled first and see how it works without Medicare Advantage Plans.

The government bids out contracts for goods and services, and maybe a bidding system by private insurance companies should be considered.

Posted on 07/10/2019, in politics and tagged , , . Bookmark the permalink. 49 Comments.

  1. out of my tiny $890.00 a month SS payment, they are now deducting $135.00 for medicare. I was smart and checked out every single advantage plan available…in depth, and finally found one with zero deductibles, zero copays, pays 80% of everything imaginable and is paid for by my deduction from SS. I don’t see how everyone could possibly afford medicare for all, and if Bernie’s plan goes into action I will lose even more of my benefit. I can barely live on what I get now……….

    Liked by 1 person

    • Suze, you are a good example for what I meant by if Medicare premiums, deductibles and co-pays can be eliminated, then they should be eliminated now for those receiving social security. Bernie’s plan is to eliminate all costs to the insured and increase federal income taxes by 20 percent. That means you and others on Medicare will receive the $135 a month now deducted, while federal income tax increases by 20 percent on those working. So, you will have $135 more per month, but I’m afraid the cost of living will increase so those making big bucks can makeup for the 20 percent income tax increase.

      Like

  2. Oh, wow. I wasn’t aware about that when it came to Medicare. Sure, I knew it wasn’t free, but I didn’t know about the numbers though.

    Liked by 1 person

    • Ospreshire,
      Ignorant me thought it was without cost. My mom was on Medicare and received Medicaid with a spend down. I thought she only had to pay the spend down — didn’t know that she was also paying for Part B Medicare. After she died and I settled her Estate, there was a significant hospital bill that I had to pay because Medicare did not cover all of her medications.

      Liked by 1 person

      • Oh my goodness. I’m really sorry to hear that about the additional medical expenses.

        Liked by 1 person

        • Thanks. Thankfully I was able to pay it after selling my parent’s house. The hospital filed a lien against the Estate in 1989 and I didn’t put the house on the market until 1994. It just goes to show that even with Medicare, they don’t pay full hospital bills for patients who die in the hospital.

          Liked by 1 person

          • You’re welcome. At least you were able to pay it off, but it must not have been fun. It’s a shame that there is all this red tape with Medicare and Medicaid.

            Liked by 1 person

            • Ospreyshire,
              “Red tape” is right!

              Liked by 1 person

            • Thanks. There shouldn’t be so many addendum or hoops to go through for getting health insurance. Don’t other countries consider it a human right?

              Liked by 1 person

            • Ospreshire,
              It appears that America also thinks it’s a human right. It’s a human right like property — you get what you can pay for. This country was rooted on humans being property and that mindset still exists in the systems. It’s subtle.

              Liked by 2 people

            • Wow, that was a brilliant, yet morbid subversion of the term human right. I couldn’t have said it better myself, Xena.

              Like

            • Ospreyshire,
              When the day comes that all Americans stop putting value on the lives of human beings, this country will make leaps and bounds on real, positive human rights. Dehumanization is rampant.

              Liked by 1 person

            • Exactly and I wish it would happen. I do my best to treat others with dignity, but I’m only one person.

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            • Ospreshire,
              I know exactly what you mean. The problem is massive among some who have authority and their gatekeepers.

              Liked by 1 person

            • Yeah, it gets really hard when you expect others to have the same level of humanity and equality as you. Definitely learned that the hard way in my life.

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            • Ospreyshire,
              At my age, I’m still learning. The breast cancer journey placed me on a path of communicating with healthcare professionals. When calling their office, I always get a nurse. There is one who is very condescending. In one phone call I asked if the doctor would correct an order because my diagnosis is incorrect. Know what her response was? “How do you know?” That stunned me, and I responded, “Because I can read.”

              Would she really think that a patient who has been in treatment since Sept. 2018 doesn’t know her diagnosis? Give some folks a little authority, and they think the entire world is stupid.

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            • My goodness. I’m sorry to hear about how the medical personnel were condescending to you while you had breast cancer. What a huge shame.

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            • It probably made her feel real important. She’s always that way.

              Liked by 1 person

            • I guess so. People who think they are self-important turn me off.

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            • She’s the gatekeeper of my surgeon’s office, which means I have no choice than to talk with her when I call. My patience has worn thin with her. And, the social worker who says it’s the job of her department to advocate for patients between their care team, says calling my surgeon’s office to coordinate is not what do. :-(.

              Liked by 1 person

            • Ouch. That must be a huge bummer especially when you have to talk to her.

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            • Ospreyshire,
              What can I say? 🙂 It gives me more chances of disciplining myself in patience and being kind under the circumstances.

              Liked by 1 person

            • I can see that. It’s something I can work on when it comes to dealing with people in less-than-desirable circumstances.

              Liked by 1 person

            • There are times I ask myself what am I to learn from an experience. There are also time when I ask if others involve are suppose to learn from the experience. LOL!

              Liked by 1 person

            • Sure thing. I’m slowly starting to wonder about that if I’m the only one who learns from an experience or if others are supposed to as well.

              Liked by 1 person

            • Ospreyshire,
              I know what you mean. There have been situations where people with controlling nature think they are right so they are never open to learning. In fact, they try to justify their attitude and actions by blaming it on the person they abuse. They end up learning the hard way. Learning patience while dealing with them is the easy way when we don’t communicate with them. That’s my goal now. Between hospital programs’ social workers, the insurance company and nurse advocates, some one must step to the plate. That is what I plan on working on this coming week.

              Liked by 1 person

            • That’s good advice. There are times where I wanted to be right, but I hope I haven’t hurt people because of that need or want. I’m just sorry to hear you were a scapegoat in that situation.

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            • Ospreyshire,
              I trust that things will work out in the end. It’s a matter where I have to take my time, step by step. I know what you mean about wanting to be right, and in so many situations, you probably are. When others disrespect our knowledge, especially based on our experience, my tendency now is to walk away and leave them to their ignorance.

              Liked by 1 person

            • That’s good. That’s something I really need to try more often. There’s a quote I’ve heard from Neely Fuller Jr.: “No contact, no conflict.”

              Like

            • “No contact, no conflict.” I like that! Thanks for sharing it.

              Liked by 1 person

            • Thanks! I’ve been getting into his books and some of his podcasts on YouTube.

              Like

            • turn her in the the state nursing boards. what she said, and her condescending attitude is grounds for sanction. and this comment is from George the registered nurse in the family who was disgusted to the point of cussing (he never cusses).

              Liked by 1 person

            • Suze,
              There is much on my plate right now, and I also lack the energy to write a report to the state’s licensing agency. First, I would need her license number and all I have is her first name. Hopefully, I won’t need to have contact with her until the end of the year, if she’s still in the position then, that is.

              Liked by 1 person

  3. Medicare is not free. This is not a socialist country, this is not a compassionate country. Look at the billions of dollars Trump wants to waste on a wall, yet we can’t provide caged children with toothbrushes or blankets (we are now no better than than the countries we accuse of crimes against humanity) nor can we provide universal healthcare free of charge to the elderly who have paid into it all their working lives. It’s a disgrace. The wealthy are riding high on the backs of the poor.

    Liked by 1 person

    • Hands Clapping Applause

      A blogger on the breast cancer journey lives in Canada. There is a chemo drug that the government will not pay for, but she is convinced it is the drug she needs, but will have to pay out-of-pocket. If the U.S. gets universal healthcare coverage, I want to know if citizens will still receive all the drugs for all medical conditions available before universal healthcare.

      Liked by 1 person

      • So many essential for life drugs are not covered by Medicare, not on the formulary of many insurance companies. We are talking thousands of dollars for a single dose of some Cancer medications. This means bankruptcy for many people or death.

        Like

        • My first chemo treatment with 4 drugs was $37k. One of the targeted drugs I now receive costs about $7k per treatment. The other targeted drug runs around $5k pr treatment. Treatments are every 3 weeks. Some pharmaceutical companies have programs to help patients. If anyone who is on the cancer journey has the energy, they can fill out forms for hours. Of course, the Cancer Center does not tell patients about the programs. Actually, I’m unsure if they know about them. The nurse navigator was unfamiliar with grants that breast cancer patients can apply for. We have to be resourceful and find the information on our own, then get the oncologist to fill-out and/or sign their portion of the papers.

          Liked by 1 person

          • And this, in one of the worlds wealthiest countries. Shame.

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            • Yes, it is shameful. Treatment doesn’t end with chemo drugs. Lots of money is spent on prescriptions to address the side-effects and damage caused by chemo drugs, not including ER visits and hospitalization. The hospital I’m associated with has an entire floor for chem patients admitted because of chemo damage.

              Liked by 1 person

            • It’s a very disturbing situation we are in, and now our Rep government is trying once again to eradicate the no preexisting clause to appease their insurance lobbyers.

              Like

            • Under the ACA I had Blue Cross who denied a claim on the basis that it was for a preexisting condition. The rep must have been embarrassed by my knowledge that I threw at her like a hot potato. It took some back and forth, but they finally paid the claim. People had better wake up about preexisting conditions because they include diabetes, C-section deliveries, and a host of other things.

              Liked by 2 people

            • There are so many ways insurance company can use the preexisting clause in contracts. With the ACA , as you state, there is no basis for denial for preexisting, they want to take that away, and do away with ACA yet the REPS have no alternatives to offer us.

              Like

  4. Great information, thanks. I’ll be on Medicare next year.

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    • Robert,
      You are most welcomed. After I got over the initial shock that I had to pay for Part B, I needed a road map for the rest. The main thing I give credit to Humana’s Advantage Plus for is not having a co-pay for my primary care doctor. Before I qualified for Medicare, I was paying $20 to see my PCP who did nothing but refer me to a specialist. The copay for specialists was $40. At least now I get to save $20.

      Liked by 1 person

  5. I’m on SSD/SSI & I get Medicaid with my Medicare. I live in Buffalo, NY. Having been in other states, I know that Medicaid isn’t as good in other states. NY is really the best. I think that the combo I have is PERFECT. But I happen to be poor enough to get this combo. Dental would be a problem if I didn’t have perfect teeth … I have NEVER had a cavity in my 59 years. I get free cleanings from the dental school at the local university. I never pay co-pays to ANY doctor. I have had bouts of thyroid cancer & have had radiation & biopsies & other procedures. I do pay co-pays for my meds but I don’t take many. & I only have co-pays for the first six months of the year. I think EVERYONE should have this deal.

    Like

    • Sounds like Buffalo, NY knows their stuff. I have friends who receive social security disability and they have no problems getting accepted in certain programs or with out-of-pocket expenses. Medicaid is run by the states. In Illinois, they determine if a person qualifies based on the poverty level for the county where they reside. They placed me on a spend-down that is more than my monthly mortgage payments. That’s what I and my late husband get for working and earning a decent living. It’s a circular issue — if you are above the poverty level, you are either denied or they place requires that put you under the poverty level before they give any held. Not only is the spend-down program confusing, the IL Dept. of Human Services that run it do not answer their phones nor return voice mails. Even social workers with the hospital think it means one thing, while the hospital’s financial dept. thinks it is something else. I’ve come to the point of not tasking my brain any longer.

      Like

  6. Xena, not only is Medicare not free if you have private insurance as I do with Medicare, you pay two premiums and still have deductibles, copays, and significant out of pocket expenses. Foolish me, thought whatever Medicare did not pick up my private insurance would. That is not the case. Quite frankly, I don’t know what my private insurance covers.

    In our predatory capitalistic society, any type of universal healthcare will need to find a way to replace the profits of private insurance companies, big pharma and of course hospital administrators and researchers, who financially benefit from the status quo. The ACA did very little to change that. If anything, it boosted those profits while lowering the quality of healthcare and increasing the premiums of those who had excellent insurance coverage.

    So your point of taking care of those already on Medicare is an excellent one. If that cannot be done then the cry for Medicare for all is just another political ploy to eat away at social security.

    Like

    • Angela,
      I think it is big pharma that calls the shots for healthcare. Since Oct. last year, I’ve learned and heard much about how pharma companies make deals with healthcare networks and hospitals. They also make deals over the price of drugs with countries that have universal healthcare.

      ACA worked well for me the first year. The second year, Blue Cross increased their premiums. The first year, the premiums were covered by tax credits. The second year, they increased the amount by almost $300 a month. Since I knew I was qualifying for Medicare in 2 months, I chose another provider within the tax credit limits. The coverage was awful and the copays high. Thankfully, I did not need to see a doctor for those 2 months.

      The cry for Medicare for all needs to include what is expected from those covered. Will there be any out-of-pocket expenses?

      Candidates also need to talk about if pre-existing conditions will be covered under Medicare for all.

      Now, I’m really concerned about women under the age of 45 and mammograms. If mammograms are not covered for women and men regardless of age, then it falters in what one contender said about keeping Americans healthy.

      Another point about keeping Americans healthy is having available healthcare providers. Procedures are not the same across the country, or even from one city to another in the same state. If the system does not allow for “specialist” services without needing to see a PCP first for a referral, then it’s not keeping Americans healthy. No one should have to wait more than a week for a visit to their PCP, to then wait another week for a referral, to then wait another 2 weeks of longer before seeing the specialist. Proponents against universal healthcare bring up the long waits for citizens in countries that have universal healthcare. I don’t live in another country and that situation has been a current condition in my neck of the woods for decades.

      Liked by 2 people

  7. Medicare is also very useful for the individuals.. Medicare Part D covers prescription drugs. Great post!!

    Like

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