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Health Insurance as Employee Benefit

CalGalTraveler

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When we moved to New Mexico we not only had to find a new doctor, but also one who accepted Medicare. Luckily a doctor that was referred to us by a friend takes everyone. I also needed an OB/GYN. I was told the one I wanted to do to wasn't taking new Medicare patients. I wasn't quite of Medicare age yet so I asked if I was already a patient would they continue to see me after I reached 65. I was told yes. So I made my first appointment with her one month before my 65th birthday and became an established patient. She still sees me. :)

Great plan. I will have to take note of this when I approach 65.
 

Sugarcubesea

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A number of years ago when my Primary Care Physician retired I had to find a new one. When I started inquiring I found that many, if not most, Primary Care Physicians were either not taking Medicare Patients or were not taking any new Medicare Patients. It obviously had to do with the reimbursement rate Medicare pays. The question I pose is where do all the new patients find Doctors if we go to Medicare for All or lower the age for Medicare to 55....

George

That is so true George. I had to find a new doctor for my aunt that I’m responsible for and it took a year to find a doctor for her that would take Medicare. I found a doc just starting out in an established practice and he was only taking 10 Medicare patients and we got in under the wire at #10.
 

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Great question. I was told by someone knowledgeable of the industry that employer plans pay 110% while medicare pays 90% to healthcare and that's why medicare for all won't work.

I had a 70 YO friend who received a bill for late stage cancer treatments and surgery with 8 weeks in the hospital due to complications (she's on the mend now). The gross bill was around $450,000. Medicare authorized about $100k as I recall. Her copay in the end was less than $2000 and she didn't have medigap insurance.

I can see why people with poor or no insurance coverage claim bankruptcy.

so who paid the remaining $350,000
 

bluehende

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so who paid the remaining $350,000


It is like every bill you get when insured. There is a bill and then the negotiated rate. I know a while ago medicare has reimbursements by diagnosis. If there are major complications it does not necessarily mean more money for the hospital. This was probably 25 years ago. Not sure if that still exists.
 

rapmarks

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Disagree on the percentage Medicare pays. Last year, my medical bills were $180000. Medicare paid $18000, I paid $1800. It is roughly the same every year percentage wise.
 

Patri

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A number of years ago when my Primary Care Physician retired I had to find a new one. When I started inquiring I found that many, if not most, Primary Care Physicians were either not taking Medicare Patients or were not taking any new Medicare Patients. It obviously had to do with the reimbursement rate Medicare pays. The question I pose is where do all the new patients find Doctors if we go to Medicare for All or lower the age for Medicare to 55....
George
Yep. There will be a shortage of doctors if they can't earn a good income to compensate for the years of study and residencies. They have large student loans to pay back. Oh wait, education will be free.
 

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Cliff had his first surgery on his HealthNet Medicare plan last month. They knocked him out because there was the possibility they'd have to do a skin graft on his hand after they removed a large squamous cell carcinoma (he's now pissed at HealthNet after being happy for twenty years because between the time he got in to see our GP then the dermatologist then the oncologist then the surgery the thing quadrupled in size). We were both surprised that the hospital collected a $200 co-pay as he was checking in.
 

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I pay through the nose up front using Traditional Medicare paying for Medicare Part B, a Medicare Supplement and a Part D Prescription Drug Plan. After that I don't pay much else. By then I guess they figure they got enough...

George
 

Luanne

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Cliff had his first surgery on his HealthNet Medicare plan last month. They knocked him out because there was the possibility they'd have to do a skin graft on his hand after they removed a large squamous cell carcinoma (he's now pissed at HealthNet after being happy for twenty years because between the time he got in to see our GP then the dermatologist then the oncologist then the surgery the thing quadrupled in size). We were both surprised that the hospital collected a $200 co-pay as he was checking in.
Does Cliff have a Medical Supplement plan or Medicare Advantage?
 

bogey21

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Yep. There will be a shortage of doctors if they can't earn a good income to compensate for the years of study and residencies. They have large student loans to pay back.

My Son-in-Law is a relatively young Doctor. It was a long haul, 4 years undergrad, 4 years Medical School and 4 years Residency. During these 12 years he and my Daughter managed to have 2 kids. I have no idea how much debt they incurred...

George
 

Luanne

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It is my understanding that Healthnet is a pure Medicare Advantage HMO plan at 0 cost premium.
But does 0 cost premium also mean no copays? From the little information I could find quickly, they do mention "affordable" copays.

Also it looks like there may, or may not, be a premium depending on which HealthNet Medicare Advantage plan you choose.
 
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clifffaith

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It is my understanding that Healthnet is a pure Medicare Advantage HMO plan at 0 cost premium.

I'm not up on the terminology yet, but will be by this time next year since I become eligible for Medicare in Dec. 2020. We have to pay $16 extra a month above and beyond whatever it is that comes out of his Social Security. I'm not sure what the $16 does, and he is also clueless. Bill is sitting on my desk now because I pay 3 months at a time rather than fuss with it each month.
 

Luanne

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I'm not up on the terminology yet, but will be by this time next year since I become eligible for Medicare in Dec. 2020. We have to pay $16 extra a month above and beyond whatever it is that comes out of his Social Security. I'm not sure what the $16 does, and he is also clueless. Bill is sitting on my desk now because I pay 3 months at a time rather than fuss with it each month.
Sounds like the $16/month is the premium he pays for what is probably a Medicare Advantage Plan. Usually a Medicare Supplement is more. For example I am currently paying around $150/month for my Medicare Supplement, dh pays a bit more. But, so far we have not had any copays of any kind. I did have to pay for the Shingles shots I got, but in the 3+ years I've been on Medicare, that has been it for out of pocket costs.

If Cliff's plan includes dental and vision it is definitely a Medicare Advantage Plan.
 

clifffaith

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Sounds like the $16/month is the premium he pays for what is probably a Medicare Advantage Plan. Usually a Medicare Supplement is more. For example I am currently paying around $150/month for my Medicare Supplement, dh pays a bit more. But, so far we have not had any copays of any kind. I did have to pay for the Shingles shots I got, but in the 3+ years I've been on Medicare, that has been it for out of pocket costs.

If Cliff's plan includes dental and vision it is definitely a Medicare Advantage Plan.

He is sitting at breakfast with paperwork that came yesterday. I was surprised when he told me he had "some" dental when I asked. Well that's news to me, why aren't you using it and why do I pay Dr. Varwig 4 times per year for you? He went once to the other dentist and didn't like him. He's been on Medicare with Healthnet for 16 years, so that was first I'd heard there was dental included. Got him to agree to try a plan dentist again. He gets a refraction and lenses once a year (although I know he doesn't bother going each year), and sees an opthamologist annually through his plan.

Re: the $16/month he pays, two years ago Healthnet called and was trying to tell him about something new that would be "free". He didn't get what they were saying, so said leave the plan alone. At some point shortly thereafter I saw something in writing (and I don't read his plan stuff, so that was a fluke) and said to him that they were changing his plan unless he opted in/out. He called back two days after the deadline and they said he was too late. That's when he started paying the small extra amount each month.
 

Timeshare Von

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Been awhile since I was employed full time. Wondering what companies provide today.
I would expect a company to provide health insurance to employee at no cost. What are they doing in regard to family coverage? Does employee share the cost?

My experience over the past 20 years is that few employers pay 100% of the premiums for employees (only). You're going to be shocked then . . . as you can expect to pay between 20 and 40% of the single coverage premium.

Some employers use the same percentage for family coverage, but I've also seen where the employee must pay 100% of their family coverage premiums.
 

heathpack

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so who paid the remaining $350,000

No one.

The MO of hospitals is to charge 10x what it costs them to provide services, knowing that they have X percent Medicare patients (who they are forced to treat for less than cost, or maybe barely cost) and Y percent uninsured patients (who will never pay) and Z percent out of network/underinsured patients (who may be able to negotiate a reduced bill).

It’s a pretty irrational convoluted system that pushes some people from categories Y and Z into medical bankruptcy to help keep the system afloat.

Right now I have a friend facing a $268,000 hospital bill for an out-of-network hospital stay for his wife who had a brain bleed. In the emergency of the situation, she was brought to the nearest hospital. Within a day or two, he realized the hospital was out-of-network and when she was stable, he asked to have her transferred to an in-network hospital. He was told not to worry about the money side of things. Now, after his insurance has settled up with the hospital, he’s being told that his share of the bill is $268,000. Money he does not have. If the hospital does not renegotiate, he loses his house.

Basically when dealing with a hospital, not only do they wildly inflate charges but they also refuse to cooperate with a person attempting to be financially responsible. IMO it’s pretty much pure evil.
 

Brett

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No one.

The MO of hospitals is to charge 10x what it costs them to provide services, knowing that they have X percent Medicare patients (who they are forced to treat for less than cost, or maybe barely cost) and Y percent uninsured patients (who will never pay) and Z percent out of network/underinsured patients (who may be able to negotiate a reduced bill).

It’s a pretty irrational convoluted system that pushes some people from categories Y and Z into medical bankruptcy to help keep the system afloat.

Right now I have a friend facing a $268,000 hospital bill for an out-of-network hospital stay for his wife who had a brain bleed. In the emergency of the situation, she was brought to the nearest hospital. Within a day or two, he realized the hospital was out-of-network and when she was stable, he asked to have her transferred to an in-network hospital. He was told not to worry about the money side of things. Now, after his insurance has settled up with the hospital, he’s being told that his share of the bill is $268,000. Money he does not have. If the hospital does not renegotiate, he loses his house.

Basically when dealing with a hospital, not only do they wildly inflate charges but they also refuse to cooperate with a person attempting to be financially responsible. IMO it’s pretty much pure evil.

yes, for many people the health care industry is an "irrational convoluted system" ... maybe 'pure evil'
But I'm on medicare with a supplement plan F ... socialized medicine for seniors !
 

CalGalTraveler

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No one.

The MO of hospitals is to charge 10x what it costs them to provide services, knowing that they have X percent Medicare patients (who they are forced to treat for less than cost, or maybe barely cost) and Y percent uninsured patients (who will never pay) and Z percent out of network/underinsured patients (who may be able to negotiate a reduced bill).

It’s a pretty irrational convoluted system that pushes some people from categories Y and Z into medical bankruptcy to help keep the system afloat.

Right now I have a friend facing a $268,000 hospital bill for an out-of-network hospital stay for his wife who had a brain bleed. In the emergency of the situation, she was brought to the nearest hospital. Within a day or two, he realized the hospital was out-of-network and when she was stable, he asked to have her transferred to an in-network hospital. He was told not to worry about the money side of things. Now, after his insurance has settled up with the hospital, he’s being told that his share of the bill is $268,000. Money he does not have. If the hospital does not renegotiate, he loses his house.

Basically when dealing with a hospital, not only do they wildly inflate charges but they also refuse to cooperate with a person attempting to be financially responsible. IMO it’s pretty much pure evil.

In California in an emergency, balance billing is illegal. We've had to get emergency care out of Kaiser's network in Calif. and were only charged the copay. We did have an emergency in Hawaii with a non-contracted provider but the balance difference was only $60. Hawaii allows balance billing.
 
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Tia

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I started out in 1978 with an employer who paid 100% of health insurance for it's employees. In 1983 my spouse had accident and was in the hospital for over a week with 2 big orthopedic surgeries, total cost was ~$9K. We had two medical coverage policies, back before they all coordinated benefits. We got a $9K check from the second company. Hate to think what the same would be billed for same thing today.

Businesses often have 2 levels of employee benefits. One for the regular employee and one for executives. Have a relative who was an exec for a major corporation, he still has great exec benefits 2+ years after retiring. I went to my employee benefit fair 5 years ago and was told I would be getting FREE long term disability as a benefit now! I had been paying for it. However 20 minutes later HR corrected that saying that was for executives not regular employees. :ponder:

Yes education costs mucho $$$. My own doctor paid off his medical school loans working on an Indian reservation for a few years. My old neighbor did the same working for what was considered an under served rural area in Kansas.

More and more Doctors now days are becoming 'employees' of a hospital, so on the executive level plan for benefits. It was becoming too costly for them to keep up with all the regulations/billing is what I understand.
 

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The MO of hospitals is to charge 10x what it costs them to provide services, knowing that they have X percent Medicare patients (who they are forced to treat for less than cost...

So what happens if we have Medicare for All? Do all hospitals go broke?

George
 

Brett

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So what happens if we have Medicare for All? Do all hospitals go broke?

George

probably like Canada, Australia, England or Japan, etc. Hospitals in those countries don't seem to have gone "broke"
Last year I was on medicare and had a $30,000 out-patient surgery and the hospital collected about half, they seemed satisfied.
But don't worry, there won't be any "medicare for all" anytime soon
 

BarbmC

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I manage the healthcare for our company. Single coverage is $1065.12/month Insurance for a family is $2318.84/month. Part of the ACA is that you can not charge employees more than 9.86% of their gross income for individual coverage. We have a high deductible, and an HRA that is funded by the company to off-set the deductible. It used to be that health insurance was a nice perk you could offer your employees - now its a necessary evil. We cover 60% for employees and 50% for their family (except for those who fall into the 9.86 where are guided by that) I don't have an answer - but it's really hurting small businesses that health care costs go up 10% and more every year.
 

Passepartout

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So what happens if we have Medicare for All? Do all hospitals go broke?
Hospitals all over the world (except in the USA) seem to be doing fine. It's the insurance companies that are in existential danger. There is a HUGE reason that commercials on TV are dominated by drug companies and insurance companies. They are quite simply lobbying the public.
When got my pacemaker a year ago in Germany, the hospital had been in business there since 1425. And on the cutting (bleeding?) edge of technology since X-Ray was discovered there in the same hospital. My bill was a half page long and roughly $10,000. That's about the charge for ONE night in a cardiac care unit in an American hospital without any procedures at all. Don't sweat the hospitals going broke. They'll be fine.

Jim
 
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