There are HMOs and then there are HMOs. Kaiser out here in California is a good one, I think. It does Medicare Advantage in 2008 for $74. Health Net did it for $18 in 2007, not sure for 2008. These are catastrophic, comprehensive programs that pay for it all, plus dental, to boot.
I know that some of the HMOs have not paid for catastrophic costs. I'm not sure how that can happen. And I know the arguments against paying premiums to HMOs, as opposed to the fee for services model, but I think that is just one part of the story.
Health care, of course, will be a HUGE issue from now through November 2008. I like what I see of Hillarycare so far. We'll see how the details begin to emerge. Out here in CA, there is trouble with the Governor's universal health care proposal right now. If about 70% of all who have private health care get it from their employers and are happy, and if about 15% are poor enough to get it from Medicaid, that leaves about 15% that are the 47 million uninsured. Getting them to pay for a decent product via a reasonable premium is the trick. We're not that far away! Good that you are covering the subject. Keep it up. George Fulmore
***
Great information re: Medicare and AARP. And of course, Bush. I begin to think Bush is a pyromaniac amongst other things. (I am joking, I hope.) But AARP is not a friend to seniors. They do give out some information, usually self serving. I am well oversuddenly 55. Bob Hertz
***
What would happen to the system if everyone ignored all the other plans and just signed up for good old fashion "Original Medicare"?
I am training to teach classes to show people how to use the Internet to access Medicare insurance information (Medicare Matters). The theory is something like you "teach a man to fish" rather than provide the service for them, we are suppose to teach them how to use the reliable information that is out there on the Internet. Even having a little more information that the average person, I find the system so ridiculously complicated, I would love to say forget it all and just sign up for Original Medicare. Thanks for your wonderful and helpful columns. Lois Beaudrie
***
Thanks for the informative article on Medicare Advantage. Do you advocate taking regular Medicare vs. Medicare Advantage if one can afford the costs? Also, Medicare D? I turn 65 in January and consider myself fairly intelligent, but it appears the entire system is a mess and most difficult to understand. Many thanks. Keep the articles coming! They help a great deal. Gerry Price
***
My aging husband has survived 2 brain operations several bouts of manic depession and a stroke over the past few years.Hospitals have tried to force him into nursing homes repeatedly! The first requirement is for me to sign over our home! The doctors who see his recovery when I refuse have nicknamed us the energuizer bunnies,.The visiting nurses and therapists are awed with his in-home recovery. Our closest child lives 300 miles away. He has had short stays in nursing homes.They all put him in diapers and confined him to a bed, They all fed him by tube and denied him food by normal means due to early dysphasia. At home he enjoys a soft or pureed diet, He has normal bowel and urinary habits,I have a lot of unused diapers should he need them. He enjoys his pets and tv. I may be an old broad, but I am a tough one. I refuse to give up all that he hasd worked for all of his life until absolutely necessary, and even then I will accept a nursing home tht will accept us both!
My biggest gripe with all plans is formularies. my husband was on a medication until it reached phase 1. Despite tests that showed that all was well trhe hospital changed him to a new medication claiming that it was unsafe. The new medication was $450 a month. I was forced to go to Canada where 100 days supply was only $70. Jeanne Gorleski
***
You and others are beating this horse to death. You should have been able to pick wisely but you got suckered. I made the right decision for me going with Humana and I have never looked back. Just because you did not do your homework, like others, does not mean that everyone feels that way. Richard Sams
***
I found your Medicare reporting interesting and the best way I can describe medicare is don't bend over in the shower!!!
Most of my life was taken care by military health providers (Navy Hospital Corpsman and Doctors) and the their Champus/Tricare for LIfe Programs.
You may consider this socialized medicine, and if you do, I am all for it.
How often have you heard of staph infection in military hospitals or on ships? You know the Corpsman are all well trained and receive continuous training. The Corpsman are evaluated quarterly, and complete performance factors and take a competitive test for promotions. Many of my friends who were Corpsman have gone to higher paying position in both gov't and civilian medical fields. It is not unusual for a Corpsman to leave the service, enter medical training and go on to be a doctor.
I know most of the military doctors are good because my son was one and he graduated in the upper 5% of his medical school class. Of course, he went on for bigger and better things after is active service. The military did have some bad doctors, BUT they were weeded out and discharged from the service and went to work in the civilian field. Military doctors are evaluated by both medical and non-medical senior officers continually and not treated as if they walked on water, but respected. So there is a health system with checks and balances set up, all you have to do is expand on it. It should be noted that a pure military facility, like on a ship, field unit or a completely manned hospital have done very well; however, were they mixed with civilian bureaucrats there have been some difficulties. The only bad thing about the program is that it is now attached to Medicare were you must pay part 'B', (a bummer) and its administered by bid to civilian firms, many of which are HMOs. The VA Health System is another, but could use some tweaking.
I am sure you have noticed that the law was changed to increase the medicare premiums according to income. If people don't watch themselves, they can increase their premiums from several hundred to thousands without to much effort. For example, if you are buying and selling on the stock market. Let say you want to buy a car or house, so you cash in a goodly share of your stocks or withdraw from investments, when you take your profits you may zoooooom up your medicare premium. Or let say you get a nice size inheritance, ka boooooom goes your medicare premium. Forget about the lotto or Vegas. So the average guy may continue to live the average life but suddenly pay the "well to do tax" while still NOT being well to do. On second thought, the "well to do's" accountant will probably have them at the no tax level. Like I said, don't bend over in the shower room. Dick Dornblaser
Right on! I had two very bad experiences with Advantage plans, one of them Humans. I'm a nurse and retired from a Humana Hospital. They were better at that. I finally took out a plan F supplement, and have had no problems with it at hospitals or doctors offices. But the premiums have gone up about $20.00/mo every year. This year, I'll be paying more than $200/mo. The part D puts me in the doughnut hole by late February and as November approaches, I'm still in the hole. Of course, it's much better than paying 100%, but prior to part D, I was receiving most of my maintenance drugs through Prescription Assistance programs through the drug companies free. I really don't want to go "Advantage." They are touting a new PFFS plan that seems too good to be true. Do you know anything about these? Bonnie Wilson
***
This article is especially timely to me. I've been retired since 1983 with a company provided medical and prescription coverage. Several years after retiring, a major US corporation who continued to provide my wife and I with the same medical coverage purchased my company. In the fall of 2006, they advised they were switching to a new "Medicare Advantage Private Fee For Service Program" for a limited group of retirees. While I cannot say for sure, I believe the limited group happened to be only people from my old company.
In our case, our plan has no restrictions on which we see for medical needs and has worked well for us this year with no problems until this week. I had made an appointment at Mayo's in Jax where I've been before. They do not recognize an Advantage program, but I've worked with them trying to get info as to at what level they would bill me on my visit. I called this AM to have another conversation and the young lady advised me she didn't know why I was given an appointment as their policy was to refuse treatment to any person with an Advantage program. So...I had to cancel my appointment. What really got my attention in your article was the side reference article about Carolyn being refused by Moffitt. I was at Moffitt in 2002, and with my wife perhaps facing the need for a trip to either Mayo's or Moffitt, looks like we are both screwed but good. And the frosting on the cake for us is that yes - you can go back to Medicare but you will no longer be covered for prescriptions or for any Medicare balance by your company.
Enjoy your weekly articles very much. Bob Curtis
***
You just ruined my day...in a good way...I suppose. I went with Humana Gold for several reasons, one being they believed in preventive maintenance and I could join the Silver Sneakers program and go to my gym absolutely free. Another, my meds are a lot cheaper...mainly because I am so poor...hate to admit that.... that I got on Bush's poor people plan for drugs.... probably could get that thru Medicare, huh?
So, by reading your informative article...I need to change back to Medicare.
New subscriber and already love it. Martha Tuttle
***
Very good one again, Frank. My AARP Medicare RX is gonna issue free generics in 2008 thru mail order and I am gonna take advantage of this...that would be $43 a month less for me to pay...As for the tranquilizer, until my new family dr. changes me then I will still have to pay for it...Medicare does not pay for any tranquilizer, like valium, or Librium (sp) so we are doomed...I tried withdrawing from this drug, slowly, just gave up one pill and got where I was having some withdrawal pains but evidentially I will find something new I am sure. Take care and good health to you and Carolyn and God bless you...Love your newspaper! Betty Culp
***
I found your Medicare reporting interesting and the best way I can describe Medicare is don't bend over in the shower!!! Most of my life was taken care by military health providers (Navy Hospital Corpsman and Doctors) and the their Champus and Tricare for Life Programs. You may consider this socialized medicine, and if you do, I am all for it. How often have you heard of staph infection in military hospitals or on ships? You know they are all well trained and have continuous training. The Corpsman is evaluated quarterly and tested for promotions. Many of my friends who were Corpsman have gone to higher paying position in both Gov't and civilian medical fields. It is not unusual for a Corpsman to leave the service, enter medical training and go to be a doctor. I know most of the doctors are good because my son was one and he graduated in the upper 5% of his medical school class.
Of course, he went on for bigger and better things. They did have some bad doctors, BUT they were weeded out and discharged to work on civilians. BUT, they did evaluate the doctors and did not treat them as if they walked on water. Non-medical senior officers did parts of the evaluations. So the system is set up, all you have to do is expand on it. The only bad thing about the program is that it is now attached to Medicare and you must pay part 'B', the bummer.
I am sure you have noticed that the law was changed to increase the Medicare premiums according to income. If people don't watch themselves, they can increase their premiums from several hundred to thousands without to much effort. For example, if you are buying and selling on the stock market. Let say you want to buy a car or house, so you cash in a goodly share of your stocks or withdraw from investments, when you take your profits you may zoooooom up your Medicare premium. Or let say you get a nice size inheritance, ka boooooom goes your Medicare premium. Forget about the lotto or Vegas.
So, the average guy may continue to live the average life but suddenly have the well to do taxes while still not being well to do. Like I said, don't bend over in the shower room. Have fun while you can afford it...or if you lucky to afford it. Dick Dornblaster Not only do we not get increases but are forced to carry high supplemental insurance to cover our health needs. Leigh
***
I have been quiet for some time, but have not missed any of your wonderful "writings."
Today's missive re: medicare's "advantage" program is a wonderful piece of work, as is the case with all of your writing.
I spent a good deal of time getting information on the "advantage" program and quite simply, it is too costly for the ridiculous coverage, which I will go into another time. BUT I THINK AARP IS USELESS IN THE HEALTH CARE ARENA!!!!!!!! We need to give AARP proposals for presentation to Medicare or have a REAL AND INFORMED committee to deal with AARP. I dropped my membership for 3 years and wish everyone else would do likewise. Money talks in every arena!
Whatever, during my call re: AARP and Medicare supplemental health insurance, I learned that my coverage with state farm, which was just increased 100.00/mo., still remains some 80.00 less than what AARP offers for same Medicare supplemental plan F - to date, I have paid nothing for professional services from doctors of my choice. As for medication, I am fortunate enough to not need much, but get a discount at Walgreen's and CVS, and samples from doctors - friends or doctors who have treated me long term and those with whom I have worked.
While talking with AARP, I inquired about auto insurance and learned that I would save 90.00/year by leaving state farm and going to AARP—but one's driving record plays a big roll here in these costs.
I am in the process of writing about serious issues (fraudulent billing; kickbacks, etc. in the health care system) and although it will, hopefully, be available as a manual and helpful, it takes time and courage to do this. Illinois has a huge crisis for persons age 0 to death, with regard to obtaining health care—in fact, Illinois has serious - very serious problems state wide due to a pathetic governor, and Chicago is no better, with mayor Daley and his staff being exposed re: fraud, etc., we are in living hell.
I will write more regarding health care issues ASAP, but must take leave now. I did close both of my health care businesses as there is soooooooo much fraudulent billing and many "providers" who
will do anything to fill a bed and many who own huge numbers of facilities (which should be "outlawed")............we did not want to be part of the "dirty docs" scene. Lastly, for now, are you aware of the fact that doctors are being paid up to 1000.00, by pharmaceutical companies, to push various drugs, at expensive restaurants where doctors dine at the cost of the pharmaceutical companies, while they listen to a well-paid doctor talk about the drug that the pharmaceutical co. is "pushing" at the moment?
The system stinks! Shirlee Dwyer
***
Going on Medicare next year...who has the best policy? Henry Peyton
Keep with Medicare for Parts A & B. Compare your drugs to prices of various Part D drug providers at www.medicare.gov. To keep it complicated, the drug companies and insurance companies made certain that prices and services vary from county to county throughout the US. Good luck, Henry!
***
Most of what you say in your article is just so much gobbledygook to the average layperson and to those that try to stay current it's so much, I hate to say it CRAP. You know and I know it's not going to change until we get someone in Washington that's got the people forefront on their mind, and they have to have the ability to look to the future (after their stay in office) and say EVEN if I have to raise taxes, I've got to show the people what their getting for their money.
I really don't think we've had anybody in there since FDR that looked out for our money, if the poor man had lived to be a thousand he would still be there in the same seat he give up to Truman, and as hard as Truman tried he could not get people on his side where money was concerned.
It's got to be someone who has never given a DAMN where money is concerned, like a gambler, MONEY his a tool to him, if they have money they play high stakes, no money he doesn't play, it's just that simple and you'll not find one of them in the Oil Business or any other business.
The last person that to be in the driver seat (TO MY ESTIMATION) was Vice President Rockefeller, I joined his side when he ask his aid " what's take home money ", I begin to look into his back ground, did you know he had 33 million in savings accounts, any body that got that much money laying there doing nothing but getting what little they give you in a bank has my blessing, he doesn't give a DAMN about money.
And yet he would of given his aid's their heads who handles money and to make it work for them, not running around in the Oval Office waving his arms saying HOW MUCH is that...Bob Fansler Sr.
