Healthcare insurance and retirement - again!

[Senator]

I don't understand this comment, if you get VA healthcare, you get VA healthcare...A disability rating my reduce your co-pay to zero. Yes if you have any type of other insurance, the VA will bill your insurance. As a matter of fact, VA encourages you to use the healthcare to stay in the system, they recommend a visit every 12 to 18 months so that you stay qualified as a regular user.

Exactly. As soon as I got my disability rating, I scheduled an appointment for a physical to get in the system. If you have any disability rating, it's 100% free. If you use the VA because you cannot afford anything else, there is a co-pay based on your income. There are 8 levels of priority, with 1 being the highest. I am a priority 3. The same as a person with a purple heart.

I have been seen quite a few times since the first visit, for basic follow-ups. I did use the VA back in 1983 as I was a student without health insurance, and has my appendix removed. Since I was low-income, that was free too.

When I also had a corporate policy, the VA billed BCBS. I saw the EOB forms, and it was treated as in-network. They still cut the costs down from the original charges, and applied my deductible. And I never received any bills, but the deductible was closer to being met.

I gave the government a blank check, made payable to ‘The United States of America’ for an amount of ‘up to and including my life.’ I do not feel guilty at all about getting my healthcare. I hope that I can eventually go to any medical facility, not just the VA.

 

[NW-Bound]

I am a layman, but have read that some of these fancy new and expensive drugs are not that great. Why are the prices so high then if they are not effectual? Is it simply because desperate patients want them at any cost, if the drugs give them a glimmer of hope?

I have read about sick and desperate patients traveling to other countries to try all kinds of dubious alternative treatments. For example, there was a clinic in China that used chlorophyll to treat cancer. Does it do anything other than turning the patients green? Well, that clinic makes good money regardless.

Anyway, I can see that we will always have a tough problem of deciding how much some medicine should be worth. The drug company has the right to not sell if it does not like the price. I don't like the state to confiscate somebody's work.

And then, there's the problem of who should be paying for it.

 

[Senator]

I am a layman, but have read that some of these fancy new and expensive drugs are not that great. Why are the prices so high then if they are not effectual? Is it simply because desperate patients want them at any cost, if the drugs give them a glimmer of hope?

I have read about sick and desperate patients traveling to other countries to try all kinds of dubious alternative treatments. For example, there was a clinic in China that used chlorophyll to heal cancer. Does it do anything other than turning the patients green? Well, that clinic makes good money.

Anyway, I can see that we will always have a tough problem of deciding how much some medicine should be worth. The drug company has the right to not sell if it does not like the price. I don't like the state to confiscate somebody's work.

And then, there's the problem of who should be paying for it.

From the various cannabis websites, I hear that smoking pot will do everything, including cure cancer. Maybe we can free up a lot of hospitals when doctors prescribe pot rather than chemo...

 

[NW-Bound]

Darn! Many states have just allowed recreational use of MJ. No need for prescription. Watch out for healthcare costs to plummet next year. I love it.

 

[Katsmeow]

Since you want to go down this road . . .
It's no secret that there was considerable light between Speaker Ryan and Donald Trump during the runup to the election. This was nowhere more evident than in the area of entitlement reform. So >perhaps< it's a bit over-the-top at this point to declare "Medicare won't survive unscathed." In truth, Medicare >can't< continue on its present path. The Medicare Part A fund will be insolvent in 11 years. Doing something about it now, rather than when the last penny in the fund has been spent, is the responsible course of action.

Doing something about it and privataizing it (AKA doing away with Medicare as it is now known and converting it to a voucher type program where your premiums are partially paid but the risk of price increases is on you and may require you to use narrow networks) are two entirely different things. Of course, there need to either be reforms to Medicare or the Medicare tax needs to be increased (it's funny how those who say something needs to be done never consider the possibility of increasing revenue rather than cutting benefits). That does not at all mean that the Ryan plan is the right plan.

And, we are talking about his plan because he is the Speaker of the House and his buddy also just got appointed COS and I'm sure will be talking up his proposal.

60 Minutes interviewed the President-elect and one of the questions related to repeal and replacing the PPACA. The President-elect indicated he would continue to support the idea that pre-existing conditions will not impact eligibility for health care insurance. He also indicated the new law (if enacted) will not force anyone to be uninsured but rather allow individuals to transition from PPACA plans to the new plans. Yes, the discussion was vague - there are lots of details to be considered - but it was interesting to hear his comments.

And, on Sunday, Ryan proposed that instead pre-existing conditions be handled through high risk pools....

 

[lawman3966]

I read an article linked to earlier in this thread about Massachusetts preserving some form of the ACA at a state level. I didn't see much detail, and it's possible that nothing has been really decided yet.

Nevertheless, on the chance that someone knows about this, I am posting to ask whether how closely the proposed Massachusetts substitute resembles the current Medicaid expansion/ACA subsidy eligibility criteria.

I ask because, at first glance, Masshealth appeared to be limited to those 19 or under, 65 or older, and to people with some specified disabilities (such as mental health issues).

Since I'm eligible for expanded Medicaid for 2017, I would of course be interested in knowing whether any equivalent to expanded Medicaid (or to ACA with subsidies) is being contemplated in Mass.

 

[eta2020]

Majority of us with 7 digit net worths and 2700 Social Security checks waiting for us in a future will have variety of options available no matter what happens. (Including gutting Medicare)

Things like emigration to Spain is not an option for somebody with no savings and 1300 SS check. (Such people are unlikely to get residency permit)

But no matter what camp you are in take good care of yourself if you want to FIRE because good health is very valuable asset.

I see this discussion is politicly polarized so I am leaving it.

 

[NW-Bound]

I am concerned about Medicare too, though it will be 5 more years till I get there.

Instead of talking about cutting benefits or raising taxes, how about reducing costs and using the same money more efficiently? We already spend more than other countries. Maybe we just need to spend it differently than we do now?

 

[exnavynuke]

Exactly. As soon as I got my disability rating, I scheduled an appointment for a physical to get in the system. If you have any disability rating, it's 100% free. If you use the VA because you cannot afford anything else, there is a co-pay based on your income. There are 8 levels of priority, with 1 being the highest. I am a priority 3. The same as a person with a purple heart.

I have been seen quite a few times since the first visit, for basic follow-ups. I did use the VA back in 1983 as I was a student without health insurance, and has my appendix removed. Since I was low-income, that was free too.

When I also had a corporate policy, the VA billed BCBS. I saw the EOB forms, and it was treated as in-network. They still cut the costs down from the original charges, and applied my deductible. And I never received any bills, but the deductible was closer to being met.

I gave the government a blank check, made payable to ‘The United States of America’ for an amount of ‘up to and including my life.’ I do not feel guilty at all about getting my healthcare. I hope that I can eventually go to any medical facility, not just the VA.

VA healthcare is only 100% "free" for service connected disability treatments unless you have specific rating percentages. At 50% rating, all treatment copays are waived. Below that, there are copays for non-service connected condition treatment/prescriptions.

For instance, I was rated at 30% so I had copays for all my medication for conditions that weren't service connected at the time. My rating is now over 50% and I no longer have to pay those copays. At 100%, VA dental becomes available as well (not offered below 100% unless you have service connected dental conditions).

 

[ivinsfan]

VA healthcare is only 100% "free" for service connected disability treatments unless you have specific rating percentages. At 50% rating, all treatment copays are waived. Below that, there are copays for non-service connected condition treatment/prescriptions.

For instance, I was rated at 30% so I had copays for all my medication for conditions that weren't service connected at the time. My rating is now over 50% and I no longer have to pay those copays. At 100%, VA dental becomes available as well (not offered below 100% unless you have service connected dental conditions).

Sorry but this is inaccurate in the present day. At 10% my DH has zero copays and it's not income based. As for meds their is an 8 dollar copay per 30 days.This would also be what persons just in the VA system with no rating would pay.

 

[exnavynuke]

Sorry but this is inaccurate in the present day. At 10% my DH has zero copays and it's not income based. As for meds their is an 8 dollar copay per 30 days.This would also be what persons just in the VA system with no rating would pay.

Priority groups 7 & 8 have copays for everything (if means testing doesn't preclude it). Priority groups 2-5 have copays for some things and not for others. Priority group 1 (>50% rating) have copays for nothing. https://www.va.gov/healthbenefits/resources/publications/IB10-431_copay_requirements_at_a_glance.pdf

The only people who have no copays at all (without a means test excluding them or other special circumstances) are >50% rated.

 

[donheff]

Children would be covered under CHIP if their parents were ignorant enough to forgo health insurance.

If someone is unemployed then it is likely that their lack of income would qualify them for continued coverage on Medicaid... they would just need to take the responsibility to sign up for Medicaid. Also, the solution that I envision would include some mechanism to make health insurance affordable low income people do not qualify for Medicaid similar to ACA subsidies.

Just like today:

What about kids of irresponsible employed families who forgo insurance because they conclude it is too expensive? As I understand it to qualify for CHIP you need to have a very low gross income. All the talk about no mandate includes speculation that young millennials who think they are invulnerable should be able to assume the risk and go uninsured. Those families would put their kids at risk by doing so. The replacement plan could, of course, provide some mechanism to cover such kids but that bit of moral hazard would just increase the number of yutes electing to forgo insurance driving the costs up for the folks with bad health markers.

 

[ShokWaveRider]

Banning All Drug Advertising in the USA would reduce costs too. I know some countries do that.

 

[samclem]

Banning All Drug Advertising in the USA would reduce costs too. I know some countries do that.

Nooo! Now they spend all their money on TV and print, where I can easily avoid it. If that dough gets forced onto internet popups (govt bans even possible there?) and radio, there's no way I'll be able to escape it. Their money and available tech will swamp any technological defenses we might mount.
As far as banning advertising--I'm thankful we have some strong protections against the government getting involved in what people say to each other. Sure, we've gone down that road before, but I don't think we should make it a habit.

 

[Fermion]

Banning All Drug Advertising in the USA would reduce costs too. I know some countries do that.

Probably should then ban advertising for alcohol, fast food, candy, soda. Maybe we could just have a agency that approves all advertising based on some of this criteria.

 

[ShokWaveRider]

Probably should then ban advertising for alcohol, fast food, candy, soda. Maybe we could just have a agency that approves all advertising based on some of this criteria.

We are not complaining about the price of those and they do not save lives, for the most part they take them. You may not like the idea, but it does curb costs. Some things just need regulation, whether we like it or not, or we should NOT keep complaining about the prices.

 

[pb4uski]

What about kids of irresponsible employed families who forgo insurance because they conclude it is too expensive? As I understand it to qualify for CHIP you need to have a very low gross income. All the talk about no mandate includes speculation that young millennials who think they are invulnerable should be able to assume the risk and go uninsured. Those families would put their kids at risk by doing so. The replacement plan could, of course, provide some mechanism to cover such kids but that bit of moral hazard would just increase the number of yutes electing to forgo insurance driving the costs up for the folks with bad health markers.

Had you read the thread you would see that the topic was maintaining continuous coverage to avoid pre-existing conditions exclusion in lieu of the current mandated coverage and what might happen if someone lost their job and presumably if they were unemployed their lack of income would qualify them for CHIP.

The question you pose is a difficult one. If you extend the exclusion to pre-existing conditions to children then you increase the incentive for these young parents to maintain coverage at the risk you describe. OTOH, extending coverage to all children would protect the children from the situation you describe at some moral hazard but at the same time I would not think a program protecting children would be particularly costly.

I would lean to the former in that there should be natural consequences of parent decisions ... the consequence would be draining their savings if their children had a serious illness at which point they might qualify for public assistance.

 

[ivinsfan]

Priority groups 7 & 8 have copays for everything (if means testing doesn't preclude it). Priority groups 2-5 have copays for some things and not for others. Priority group 1 (>50% rating) have copays for nothing. https://www.va.gov/healthbenefits/resources/publications/IB10-431_copay_requirements_at_a_glance.pdf

The only people who have no copays at all (without a means test excluding them or other special circumstances) are >50% rated.

I think the statement I was referring too was that you have to make co-pays when you are treated for a non-connected disability issue. In fact your disability rating carries through for all treatments you need for anything. Your group number can be based on the % of disability you have.

 

[bmcgonig]

Here's the Paul Ryan plan for healthcare. Page 30 or thereabouts deals with Medicare. What pops out at me is that he is planning on starting the switch to exchanges in 2024. And that the switch will be optional for those already enrolled.

Also he wants to do away with Medigap policies in 2020 as he says they prevent people from having skin in the game.

https://abetterway.speaker.gov/_assets/pdf/ABetterWay-HealthCare-PolicyPaper.pdf

 

[Senator]

Priority groups 7 & 8 have copays for everything (if means testing doesn't preclude it). Priority groups 2-5 have copays for some things and not for others. Priority group 1 (>50% rating) have copays for nothing. https://www.va.gov/healthbenefits/resources/publications/IB10-431_copay_requirements_at_a_glance.pdf

The only people who have no copays at all (without a means test excluding them or other special circumstances) are >50% rated.

True. I am a priority 3 with a 10% service connected disability rating. My only co-pay is an $8 per month, per prescription. No matter what the retail cost is, if it is not service connected. It is free for service connected drugs. If I can get the prescription at any other pharmacy cheaper than $8 for 30 days, I can get it there instead.

All medical care, in and out patient, is free. Including long term care. Service connected or not. I can live with that expense.


Dental insurance is available too. Subsidized.
https://www.va.gov/healthBenefits/vadip/

 

[Senator]

Probably should then ban advertising for alcohol, fast food, candy, soda. Maybe we could just have a agency that approves all advertising based on some of this criteria.

If a doctor would prescribe diet and exercise, rather than meds, it would go a long way towards reducing healthcare costs.

It could even be mandated before any major surgery is required, like knee surgery.

 

[neihn]

Instead of talking about cutting benefits or raising taxes, how about reducing costs and using the same money more efficiently? We already spend more than other countries. Maybe we just need to spend it differently than we do now?

Then it makes too much sense. No can't do that.

 

[exnavynuke]

True. I am a priority 3 with a 10% service connected disability rating. My only co-pay is an $8 per month, per prescription. No matter what the retail cost is, if it is not service connected. It is free for service connected drugs. If I can get the prescription at any other pharmacy cheaper than $8 for 30 days, I can get it there instead.

All medical care, in and out patient, is free. Including long term care. Service connected or not. I can live with that expense.


Dental insurance is available too. Subsidized.
https://www.va.gov/healthBenefits/vadip/

Yeah, I have Delta dental through VADIP myself (cheaper than my work plan for the coverage provided).

The one thing to note that some people may not know is that the "cost" we're talking about is only for VA provided (or referred) care. They won't pay for you to go see any doctor of your choosing in general, it's either through the VA, their referrals, or the Choice program (if you qualify). The exception is emergent care received in an ER or similar (though the VA has been fighting that and trying not to pay if you have any outside insurance, but have been losing with their argument in courts recently).

That can be a significant downside in some areas and for some people who really want to see a particular doctor/specialist etc.

 

[MRG]

If a doctor would prescribe diet and exercise, rather than meds, it would go a long way towards reducing healthcare costs.

It could even be mandated before any major surgery is required, like knee surgery.

Very true. I was amazed at how many medications I didn't need. All of them! Just by changing my diet and walking.

I had tachycardia last May, among other conditions. My doc suggested weight loss(again), I was convinced that this was the end. Fear! Good old fashioned fear was good for 50% of the loss. Then my heart rate was lower and my BP lower. Pretty amazing that I'd been on meds for years.

I met into a guy I've known for 30 years, we barely recognized each other. He's become very obese, barely could walk, waiting on his second hip replacement. Guys not 55 yet.
Prescription weight loss, what a notion.

 

[pb4uski]

.... It could even be mandated before any major surgery is required, like knee surgery.

Not sure if it should be mandated or not, but you make a good point... anecdotally I have seen significant outcome differences between friends and acquaintances who have done a lot of PT prior to knee replacement surgery and those who have not.