Medicare Part D Observations and Dislikes

[mf15]

The push for MA plans, is not our imagination.
Oldmike
https://www.reuters.com/article/us-...ush-from-u-s-government-critics-idUSKBN1O621T

 

[ShokWaveRider]

Yesterday I called Humana about getting a new medigap plan. The rep went on for 20 minutes about MA plans,sending people to my house, could not shut her up. Told her 4 times I only wanted medigap info. For what ever reason they are pushing MA,really hard.
Oldmike

It is very well know HC sales reps get paid more commission from MA Plans than subsidies. Remember the Golden Rule of Sales - "Sales People Maximize Their Com Plans". We wish it said "Sales People Work for the Best Interest of Their Clients" but alas, that is not the case most of the time. So as Usual Buyer Beware. Simple Said it would be better to take the middle man/woman out of the HC acquiring equation, one less cost to pass on to the consumer for something that no one really has a choice in getting, especially for the sick.

The same goes for the Insurance Companies themselves as they are basically in Sales too.

"The companies running (MA) plans are enjoying a boom in revenue - for example, UnitedHealth Group Inc, the nation’s largest seller of Medicare Advantage plans, reported a 15.2 percent revenue jump in its Medicare business during the third quarter compared with the year-earlier period, to $18.8 billion. "

"The jury also is out on the quality of care provided by Advantage plans, Jacobson’s study found, especially for people with serious chronic conditions. These patients are disenrolling from Advantage plans at high rates, according to numerous rigorous research studies. “That is a real concern as Advantage enrollment grows”.

IMHO I think CMS would like to get completely out of Medicare and Elderly Health Coverage, and surmise they would be quite happy if all that was available was MA Plans, and not Basic Medicare at all. It would be a very sad day, when/if that happens.

I also think that while we/Americans are always looking for the cheapest answer to Healthcare, rather than a workable universal solution that covers everyone's needs, it is quite possible that it may happen.

 

[ivinsfan]

It is very well know HC sales reps get paid more commission from MA Plans than subsidies. Remember the Golden Rule of Sales - "Sales People Maximize Their Com Plans". We wish it said "Sales People Work for the Best Interest of Their Clients" but alas, that is not the case most of the time. So as Usual Buyer Beware. Simple Said it would be better to take the middle man/woman out of the HC acquiring equation, one less cost to pass on to the consumer for something that no one really has a choice in getting, especially for the sick.

The same goes for the Insurance Companies themselves as they are basically in Sales too.

"The companies running (MA) plans are enjoying a boom in revenue - for example, UnitedHealth Group Inc, the nation’s largest seller of Medicare Advantage plans, reported a 15.2 percent revenue jump in its Medicare business during the third quarter compared with the year-earlier period, to $18.8 billion. "

"The jury also is out on the quality of care provided by Advantage plans, Jacobson’s study found, especially for people with serious chronic conditions. These patients are disenrolling from Advantage plans at high rates, according to numerous rigorous research studies. “That is a real concern as Advantage enrollment grows”.

IMHO I think CMS would like to get completely out of Medicare and Elderly Health Coverage, and surmise they would be quite happy if all that was available was MA Plans, and not Basic Medicare at all. It would be a very sad day, when/if that happens.

I also think that while we/Americans are always looking for the cheapest answer to Healthcare, rather than a workable universal solution that covers everyone's needs, it is quite possible that it may happen.

People with serious chronic conditions can't really disenroll (is that even a word) from MA plans because they have no where else to go due to underwriting. One sentence like that and I disregard the entire article. SWR I totally agree the insurance companies and the government would like all MA plans and don't think for a minute that "medicare for all" won't be based on the MA model.

 

[nwsteve]

If you want to understand what a Medicare for All plan might be like, you only have to look over what our Canadian neighbors "enjoy". Long waits for non fatal issues, esp diagnostics like MRI & Cat scans. IMHO, you will no longer have a choice of a MA or Medigap options--you will get "The Plan"

 

[ShokWaveRider]

If you want to understand what a Medicare for All plan might be like, you only have to look over what our Canadian neighbors "enjoy". Long waits for non fatal issues, esp diagnostics like MRI & Cat scans. IMHO, you will no longer have a choice of a MA or Medigap options--you will get "The Plan"

That is it, pick the worst you have "Read" about. We actually experienced what our friends next door have for over 5 years and it was never as bad as was made out by those here in the US that oppose anything sensible.

Just like in the USA if you are in a poorly populated LCOL area there can be challenges, but on the whole it works just as efficiently. We lived in Canada for 5 years in a decent sized City and I had 2 surgeries in that time and never has an issue with wait times or quality of service.

If you want better service, you can buy private medical or extra insurance (Exactly as it should be). But for basic and emergency services it is more than adequate, and most importantly no one goes without healthcare.

Besides healthcare success should be measured by how many people are covered and what services they get.

PLUS...… No premiums (other than taxes), No Bankruptcies due to HC costs, much lower drug costs.... Priceless.

 

[Maidensong]

Can I also add a recommendation for BlinkHealth.com? It's a bit like GoodRX, but saves me more on my meds almost every time. You order and pay for your prescriptions online, then pick them up at the pharmacy you choose, just presenting them with the little BlinkHealth print out.

Still don't have a fix for my most expensive med, which has a $40 co-pay now on my Obamacare plan and costs $1600+ per month if we were to pay cash. I switch to Medicare, Supplement G and a Part D plan next February. So far the best Part D has me paying over $500 per month co-pay for this pricey item, which I have to take because I have an allergy to the cheap alternative (Read: about $3.00 per month). I've heard there's a new protocol to "desensitize" people who have this particular allergy and I plan on a trip to Mayo in Minnesota to see if I'm a candidate for the treatment, but if that fails, I'll be paying more than we used to pay for a house payment in order to keep my lungs free of a certain type of pneumonia.

Guess I should warn the DH that I'm NOT a cheap date. But then, after 43 years, he probably knows...

PS. Just read this aloud to the DH and the sweet man says I'm well worth it!

 

[Chuckanut]

If you want to understand what a Medicare for All plan might be like, you only have to look over what our Canadian neighbors "enjoy". Long waits for non fatal issues, esp diagnostics like MRI & Cat scans. IMHO, you will no longer have a choice of a MA or Medigap options--you will get "The Plan"

I have yet to meet a Canadian that would trade their medical care coverage for what we have in the USA. By trade I mean totally give up their system for life and buy into the USA system for life - the entire package from OTC drugs to major medical interventions.

There are probably some wealthy people in Canada who would trade because they have the funding to buy whatever medical care they desire anywhere in the world. But for the average Joe and Jane, I have yet to meet one who would trade.

 

[Animorph]

Quote:

I can't know what drugs are not in the formulary until I have to take them

Can't you get a complete list (or at least a link) to the formulary for your plan? I did.

Sure you can get the complete formulary, but which of those drugs that you don't use now are you going to need next year? Are they on the list? About all we can do is pick the largest formulary. But how much is that worth in extra premium costs if you probably won't need it anyway?

The good thing about Part D is that you can change every year without penalty. The insurance companies can play, but we can walk.