ACA Vs Medicare, Is this Fair?

[ShokWaveRider]

I have been researching Medicare as I will be on it next year on my 65th Birthday. I am in an ACA plan now.

I found out the Medicare Part D is Mandatory or there is a penalty. How is this different from the Individual Mandate that was a penalty if one did not have health Insurance in a given year? Is that not a double standard. What is good and OK for Medicare is not good for the ACA.

All the drugs I take a either free or a token copay <$4 at my local supermarket drug counter. Why should I have to pay for a drug plan or a penalty for not having one.

I think the Medicare Part Mandate should be eliminated also. Your thoughts?

 

[MichaelB]

This is a policy discussion, so the thread was moved.

 

[Fedup]

ACA was modeled after Medicare. We don’t have Medicare part D.

 

[ShokWaveRider]

ACA was modeled after Medicare. We don’t have Medicare part D.

But do you pay the penalty? I understand why it is there in order to spread the load, but that was also the objective of the ACA individual mandate. If one is not considered right, then neither should the other.

 

[Fedup]

But do you pay the penalty? I understand why it is there in order to spread the load, but that was also the objective of the ACA individual mandate. If one is not considered right, then neither should the other.

No penalty. We only have part B. We have Fed BCBS as a second insurance so maybe that’s why.

 

[MRG]

My ex-bil opted out of part D. He was diagnosed with a brain tumor and unable to afford the medicines. The tumor was in the part of the brain that controls emotions and low level fight flight responses. He recently beat his current wife to death after a disagreement.

I'd probably sign up, but that's just me.

 

[joeea]

You don't have to enroll in Medicare part D if you have another drug plan.

And the penalty is for those who don't enroll in part D when they become eligibile, but then choose to enroll in part D at a later date.

https://www.medicare.gov/drug-cover...-drug-coverage/part-d-late-enrollment-penalty

https://www.medicare.gov/drug-cover...y/3-ways-to-avoid-the-late-enrollment-penalty

 

[gauss]

^ That sounds familiar. If you wait to purchase the insurance until you need it, like Medicare Pt B, then you will be more.

Helps to thwart adverse selection. But this, indeed, is conceptually similar to the ACA Individual Mandate.

 

[Ian S]

"Why should I have to pay for a drug plan or a penalty for not having one."

As long as you never sign up for Part D, you'll never pay a penalty. What you seem to want is to wait until you need expensive drugs to sign up for Part D and then not pay any more for it than those who bought it all along so they would be covered if and when they needed a costly drug. Do you also believe that you should be able to wait to buy house insurance until it's on fire and the firetrucks are on the way?

I too have only a couple of cheap generic drugs I take but I still signed up for Part D. I pay less than $11/mo for my Part D plan and my generics I take are actually no cost to me in 2019. IMHO, it's a great deal and I can't understand your complaint.

 

[Fedup]

How much is part D cost? I’m sure it depends on the income band, but for the lowest.

 

[ivinsfan]

I have been researching Medicare as I will be on it next year on my 65th Birthday. I am in an ACA plan now.

I found out the Medicare Part D is Mandatory or there is a penalty. How is this different from the Individual Mandate that was a penalty if one did not have health Insurance in a given year? Is that not a double standard. What is good and OK for Medicare is not good for the ACA.

All the drugs I take a either free or a token copay <$4 at my local supermarket drug counter. Why should I have to pay for a drug plan or a penalty for not having one.

I think the Medicare Part Mandate should be eliminated also. Your thoughts?

You have some sort of drug coverage thru you ACA plan which you have told us many times costs you 0. Some people might not think that's real fair but as you have pointed out those are the rules and I just take advantage of them. Sometime the rules take advantage of you that's just the way it works out.

 

[pb4uski]

.... I found out the Medicare Part D is Mandatory or there is a penalty. How is this different from the Individual Mandate that was a penalty if one did not have health Insurance in a given year? Is that not a double standard. What is good and OK for Medicare is not good for the ACA. ...

You are severely misinterpreting the Part D "penalty"... it is a totally different animal from the ACA penalty.

Under the ACA penalty, you had to pay if you chose not to have health insurance... a direct payment... cash out the door.

The Part D penalty only says that if you pass on Part D and later decide to enroll in Part D that your premiums will be higher... no cash out the door unless you later decide to enroll in Part D.

 

[ShokWaveRider]

My guess original point was why was the individual Mandate for the ACA bad, but the drug part D penalty acceptable?


BTW it is the premium that is zero not the max OOP for the ACA, so it in not free at all, it does include drugs to a degree though.

 

[ShokWaveRider]

You are severely misinterpreting the Part D "penalty"... it is a totally different animal from the ACA penalty.

Under the ACA penalty, you had to pay if you chose not to have health insurance... a direct payment... cash out the door.

The Part D penalty only says that if you pass on Part D and later decide to enroll in Part D that your premiums will be higher... no cash out the door unless you later decide to enroll in Part D.

I think you are correct, I did misinterpret it. I thought it was a penalty for not having Part D.

I can see a similarity between Medicare Advantage (Low or no Premium, restricted service/providers etc., as they are subsidized) to the ACA Silver plans.

 

[TwoByFour]

I think the Medicare Part Mandate should be eliminated also. Your thoughts?

Medicare is such a good deal for all us that I am not going to complain about such things. The amount we pay for premiums is peanuts compared to the expenses that seniors pile up.

 

[ivinsfan]

I think you are correct, I did misinterpret it. I thought it was a penalty for not having Part D.

But that Part D penalty levy will continue until you die, it never goes away. I wonder what happens if you switch from Medigap policy to an Advantage because Advantage usually includes part D costs in the plan

 

[Ian S]

My guess original point was why was the individual Mandate for the ACA bad, but the drug part D penalty acceptable?

Actually many of us think the Individual Mandate for the ACA is a good thing. That is the only way you can have protection for folks with pre-existing conditions. No mandate and you are forced to return to the days of medical underwriting if you want to avoid a spiralling increase in premiums and ultimate collapse of the private health insurance system.

 

[Independent]

I have been researching Medicare as I will be on it next year on my 65th Birthday. I am in an ACA plan now.

I found out the Medicare Part D is Mandatory or there is a penalty. How is this different from the Individual Mandate that was a penalty if one did not have health Insurance in a given year? Is that not a double standard. What is good and OK for Medicare is not good for the ACA.

All the drugs I take a either free or a token copay <$4 at my local supermarket drug counter. Why should I have to pay for a drug plan or a penalty for not having one.

I think the Medicare Part Mandate should be eliminated also. Your thoughts?

For the same reason you can't buy fire insurance when you see smoke coming out of the house.

Without the penalty for late sign-up, people will wait until they have really expensive prescriptions and then buy in.

It is the same principle as ACA, but a different mechanism. And, the mandate is also correct for ACA.

 

[pb4uski]

Actually many of us think the Individual Mandate for the ACA is a good thing. That is the only way you can have protection for folks with pre-existing conditions. No mandate and you are forced to return to the days of medical underwriting if you want to avoid a spiralling increase in premiums and ultimate collapse of the private health insurance system.

That is not true... the mandate was principally a talking point to go along with no medical underwriting. In 2019 the penalty will be zero so there is effectively no mandate, yet ACA still exists, insurers are still writing busieness (in fact, some insurers who left individual health insurance are re-entering) and 2019 rate increases have been modest compared to recent years.

Also, some states prohibited medical underwriting long before ACA.

In 2013, five states – Maine, Massachusetts, New Jersey, New York, and Vermont – required all non-group health insurance policies to be offered on a guaranteed issue basis (meaning applicants could not be denied based on health status) with community rating (meaning premiums could not vary based on health status).

 

[samclem]

I

Finding "unfair," inequitable, or inconsistent things in the tax code and other laws/regulations could turn into a full time j*b. To me, it seems more useful to ask two questions about each policy:
1) Is it good for the country?
2) How can I personally benefit from this (or reduce my losses from it)?

 

[ShokWaveRider]

Finding "unfair," inequitable, or inconsistent things in the tax code and other laws/regulations could turn into a full time j*b. To me, it seems more useful to ask two questions about each policy:
1) Is it good for the country?
2) How can I personally benefit from this (or reduce my losses from it)?

I am beginning to think ACA mandates are good for the country. It helps to pay for the subsidies that we try wherever possible to take advantage of. I noticed today that the Deficit is increasing, I think the number was $776b or so. People taking ACA plans seem to be increasing, so more subsidies are being paid. So for 2019 more money will be needed to offset them. I am NOT implying that ACA subsidies are the sole cause of the Deficit rising.

 

[Fedup]

Actually many of us think the Individual Mandate for the ACA is a good thing. That is the only way you can have protection for folks with pre-existing conditions. No mandate and you are forced to return to the days of medical underwriting if you want to avoid a spiralling increase in premiums and ultimate collapse of the private health insurance system.

I don’t think it’s an only way. I think it makes sense to have protection if you previously are covered by any health insurance plan. It keeps the people from gaming the system.

 

[joeea]

My guess original point was why was the individual Mandate for the ACA bad, but the drug part D penalty acceptable?

The individual mandate for the ACA still exists.
The penalty cost has been reduced to $0 recently. Is that bad?

 

[Fedup]

The individual mandate for the ACA still exists.
The penalty cost has been reduced to $0 recently. Is that bad?

It’s largely semantics isnt it. $0 penalty.

 

[joeea]

1) Is it good for the country?

Let's not waste much time on that debate, okay?

Maybe we can just encourage people to cast their votes at the ballot box instead, rather than going down the debate rat hole?