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Posted by pomegranate-man on November 1, 2007, 2:28 pm
Thank you for the thorough and thoughtful response.
Unfortunately, I'm still puzzled over some details.
> As a trained SHIP (or HICAP as we call it in California) counselor...
> ...
I'm in California too. My knowledge of Medicare details is probably
faulty, so please correct any errors below.
> While 20% of an office visit (about $12 in my area) is reasonable,
> the $1024 or 20% of a heart bypass surgeon may be hard to deal with.
> ...
> In this area a decent MediGap (Plan C through Plan J) will cost you
> about $150/month ...
MediGap is one of the plans I'm trying to get my head around.
Surely you aren't suggesting it's sensible to pay $1,800/yr ($150/mo) to
protect against a possible loss of $1024. I'm in good health, but even
sickly people don't typically have major surgery every year. (My guess is
there's a typo in your surgeon dollar amount; plus, there are other
costly specialized services are involved in major surgery; plus, ...)
So typically, if somebody had severe episode like a heart bypass, how
much would MediGap pay in total dollars? And how much would the patient
pay after Parts A, B, D, and MediGap? Maybe there are a few examples from
experience. Is there a maximum dollar figure MediGap would pay?
It also seems that MediGap shields us from the first dollars of expense,
but (like Parts A and B) cuts off when the expenses pile up. I'm
referring to the limits of 150 hospital days and 100 skilled-nursing-
facility days per benefit period. As far as I can tell, nothing in the
Medicare menagerie extends these limits. Even Medicare Advantage plans
that tout "unlimited days" qualify it by saying "Medicare-covered"
charges -- I've asked, and this qualifier means that the "day" limits
still apply. Am I wrong to be concerned about these limits? There's got
to be some kind of really low-cost supplemental medical coverage outside
the Medicare system that kicks in when the limits are reached, but I
haven't found any. Nothing from my employment history applies. (I'm aware
that long-term-care insurance for custodial nursing-home or assisted-
living stays is a separate topic outside the scope of a Medicare
discussion.)
Parts of Medicare (including Parts B and D, if I'm not mistaken) are
subsidized from the taxes we've paid. So an individual can expect to
receive more in benefits than he pays in premiums, on average over time.
Is this true of MediGap?
Thanks again!
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Posted by Avrum Lapin on November 2, 2007, 11:34 am
>
> Surely you aren't suggesting it's sensible to pay $1,800/yr ($150/mo) to
> protect against a possible loss of $1024.
I have no idea of what a bypass surgeon charges but I expect that 20% of
that charge is in excess of $1024.
> So typically, if somebody had severe episode like a heart bypass, how
> much would MediGap pay in total dollars? And how much would the patient
> pay after Parts A, B, D, and MediGap? Maybe there are a few examples from
> experience. Is there a maximum dollar figure MediGap would pay?
Providers who agree to accept MediCare agree to accept the MediCare
approved amount for the procedure as payment in full (there is a
provision for a provider to charge and receive 15% above the MediCare
approved amount but in this area none of the providers do this).
MediCare then pays 80% of the approved amount and MediGap will pay the
rest. In larger MediGap plans the payment occurs seamlessly.
If MediCare does not cover something (say you exceed the 100 days in the
nursing home or have a tummy tuck) there is no product that I am aware
of that will cover you other than long term care insurance. MediCare
does not cover work done by a provider who does not accept MediCare.
So if you have a "vegetative" coma in your future you will be expected
to spend down your income and assets (less an amount for your spouse and
dependents still at home) and go on MedicAid (welfare)
For what it is worth the MediCare pends an average of $1000 per month
per person on the over 65 crowd. Memory suggests that MediCare still
takes in more than it spends but that trend is due to reverse in the
near future.
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Posted by Ron Peterson on November 2, 2007, 5:08 pm
> For what it is worth the MediCare pends an average of $1000 per month
> per person on the over 65 crowd. Memory suggests that MediCare still
> takes in more than it spends but that trend is due to reverse in the
> near future.
http://www.medpac.gov/publications/congressional_reports/Jun06DataBookSec2.pdf
states:
"Per capita expenditures increased by about $2,000 for each age group
over 65: Per capita
expenditures were $5,042 for those ages 65 to 74, $7,789 for those 75
to 84, and $9,243 for
those 85 and older. Per capita expenditures for Medicare beneficiaries
under age 65,
enrolled due to disability (both end-stage renal disease and non-
ESRD), were $6,513. On
average, Medicare spending per beneficiary was $6,602."
--
Ron
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Posted by Avrum Lapin on November 3, 2007, 6:56 am
>
>
> http://www.medpac.gov/publications/congressional_reports/Jun06DataBookSec2.pdf
> states:
> "Per capita expenditures increased by about $2,000 for each age group
> over 65: Per capita
> expenditures were $5,042 for those ages 65 to 74, $7,789 for those 75
> to 84, and $9,243 for
> those 85 and older. Per capita expenditures for Medicare beneficiaries
> under age 65,
> enrolled due to disability (both end-stage renal disease and non-
> ESRD), were $6,513. On
> average, Medicare spending per beneficiary was $6,602."
>
> --
Thanks for the reference.
Those numbers are for 2003. For CY 2008 Medicare will pay
$885.55/mo/enrollee ($10626) to MediCare Advantage plans ($54 less/mo
for the under 65 disabled) for San Bernardino County (60 miles east of
LA). They pay more in LA county and slightly less in Riverside County.
This excludes ESRD.
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Posted by Ron Peterson on November 3, 2007, 11:26 am
> Those numbers are for 2003. For CY 2008 Medicare will pay
> $885.55/mo/enrollee ($10626) to MediCare Advantage plans ($54 less/mo
> for the under 65 disabled) for San Bernardino County (60 miles east of
> LA). They pay more in LA county and slightly less in Riverside County.
> This excludes ESRD.
There are large differences in Medicare costs per state. See
http://www.cms.hhs.gov/MedicareFeeforSvcPartsAB/Downloads/HHAst05.pdf
Part of the cost differences are due to the general health of the
population (LA, MS, OK, TX, etc.), and part due to the cost of the
services (NY, CA).
--
Ron
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