What's up with Mediacre reform?!

Discussion in 'Fibromyalgia Main Forum' started by Jeramy, Apr 19, 2011.

  1. Jeramy

    Jeramy New Member

    I am 48 and on Medicare... I'm not clear about what I'm hearing and reading n the news. Am I at risk of loosing my coverage?
  2. Jeramy

    Jeramy New Member

    I really don't know. I've been away the past 10 days...not following news.
  3. mbofov

    mbofov Active Member

    It is confusing. I do know that if enacted, the Republican plan is supposed to double the cost of healthcare for people on Medicare. Also, they have some sort of voucher plan, to enroll in I think private insurance (which of course will cost more!)

    Here's a link to one article. I really couldn't find something which succinctly states what the Republicans' proposal is, although I have read that a majority of Americans oppose it:


  4. Mikie

    Mikie Moderator

    One good thing is that the govt. decided not to make cuts to the Medicare Advantage plans which cover 20-25 percent of people on Medicare. These plans are what Medicare should and could be if the govt. were more efficient and stopped the fraud. I am on a good Advantage plan and I only pay co-pays when I use it and there is no premium.

    Obama says he will veto any "voucher" plan so I don't think we have to worry about that. There are a lot of ways to cut the waste in Medicare without going crazy. I also don't think they will make changes to those on SSD nor anyone older than 55. I worry about my kids, though; they are in their 40's.

    Love, Mikie
  5. Waynesrhythm

    Waynesrhythm Member

    Hi Jeramy,

    Just wanted to mention that this is not something you need to worry about. The Republican controlled House passed a budget bill which included eliminating Medicare as we know it, substituting it with nominal vouchers for people to use to buy private insurance. Any House passed bill would have to be reconciled with a Senate passed budget bill.

    The Democratically controlled Senate would NEVER, EVER agree to this, so there's no chance this could become law. Also, Obama would NEVER, EVER agree to it either, and would veto it. It would take a 2/3 vote in both the House and the Senate to override a Presidential veto. If the coming elections somehow brought Republican majorities to both the House and the Senate, they would still never be able to override a Presidential veto if Obama were still President.

    I suspect this issue could become a major topic in the coming Presidential election. I also believe it's an issue that the Republicans could pay dearly for. There is nowhere near a consensus in this country to abolish Medicare as we know it. As I see it, about the worst thing that could happen is there would be somewhat less reimbursement for Medicare recipients to try to control costs. But they would most likely not be draconian.

    I hope this clears things up a bit, and also helps you differentiate betweeen Republican and Democrat positions on Medicare.

    Best, Wayne[This Message was Edited on 04/20/2011]
  6. Jeramy

    Jeramy New Member

    Thanks, Jam, Wayne et al.
    I really did not know what was going on. I knew it was a ridiculous proposal, but being on SSDI, with two young kids, I need my medicare because I can't afford any othet health care. (And though my icome is very low, apparently not low enough to qualify for any medicaid.
    I LOVE my medicare coverage. it works great.
    You are all right that we should have concern for it's future though. I'm 48. Hopefully I'll be around another 40-50 years. Will I still be able to have medicare then? Will my kids have it when they are older?
    But why not? That's why we have medicare tax deductions on our paychecks!
  7. rosemarie

    rosemarie Member

    i am on an advantage plan and i love it. So I agree with Mikie on what was posted, about the politics I thought that we were not to discuss it here. I don't know that much about politics and I am not thrilled with some of the desisions that have been made. I hope that one day we can agree on what is promised us during an election time.

  8. AuntTammie

    AuntTammie New Member

    there's nothing in the forum rules re not posting political stuff on here, and since many of us are on medicare this totally affects us and makes sense to discuss here
  9. bobbycat

    bobbycat New Member

    watch msnbc especially, The Ed show, Rachael Maddow, The Last Word, Chris Matthews, Etc they are keeping up on what is going on. Obama has decided not to go after Medicare advantage. The Republicans want to privitize it. They must be stopped or they will do it as they do not care what their own constituants want as more then 80% of the american people are against what they are doing. They are for the coporations period. If they take over the senate and the house they will do it.
  10. AuntTammie

    AuntTammie New Member

    it depends on income and which plan you choose.....for straight medicare (the part that you still also have to have if you get an advantage plan), if your income is low enough you don't have to pay, and for the advantage plans if income is low enough a portion of the advantage plan may also be covered by the govt and I think a few of the advantage plans can even be no cost if income is low enough; however, they are really really bad coverage

    I am on SSDI and have an advantage plan and I do not have to pay the 96 or whatever it is per month that covers the main medicare part, & i get a small amt off of the advantage plan that I chose, but I still wind up paying about 100 a month.....I could have gone with a cheaper one but it wouldn't cover what i need it to...and even the plan that I have is not accepted by one of my docs, and it still has a co-pay that I have trouble affording

    I also have medicaid bc my income is so low, and it would cover stuff that medicare doesn't (co-pays, etc), but I have not been able to find Drs who will take it....the main reason I have it is bc it does cover the hospital and I have wound up in the ER at least once a yr for many yrs now
  11. Mikie

    Mikie Moderator

    Even if one is on SSD, the Part B Medicare must be paid, except in the case of those who qualify because of low income. Part A, hospitalization, has no premium unless one didn't work the required quarters and didn't pay into it. It can be purchased in that case but it is expensive. Part D, drugs, must also be paid for unless it's included in ones supplement plan or a Medicare Advantage Plan. One can have only Medicare but that can leave a lot of out-of-pocket expense if one gets sick.

    Supplements to Medicare are expensive if one is on SSD. Medicare Advantage Plans make more sense in that case if one can find a good one. Once one turns 65, one can qualify automatically for a supplement with no underwriting.

    The Medicare Advantage Plans take a monthly amount from Medicare and then, the plan, and not Medicare, pays all the bills. Most of these plans are HMO/PPO plans. Co-pays and co-insurance is cheaper when one uses network docs and facilities. There is no underwriting for these plans but one cannot be in renal failure nor living in a hospice situation.

    In all cases, Part B Medicare must be maintained, either through deduction from one's SSD or SS monthly benefits, except, as noted above for low-income individuals. Many of us might qualify for this benefit except that, not only is income included but, assets are included. You cannot qualify if you have much in the way of assets.

    There is no monthly premium for my Medicare Advantage plan but I pay $15 when I see my PCP. I pay $35 when I see a specialist. I pay $10 for labwork. For other procedures and tests, I pay a percent. My two knee surgeries cost me about $200 each in co-insurance. I like this because I only pay when I use it. The plan has a huge network of good docs. There is a maximum out-of-pocket expense cap of $5,000 a year. This is the worst-case scenario if I were to get something catastrophic. My Part D Medicare is included at no cost. I pay $4 a month for my Rx's and, if I were to use mailorder drugs, it would be less.

    Hope this helps.

    Love, Mikie
  12. Mikie

    Mikie Moderator

    Wants Medicare to be able to bargain with the big pharmas on meds for people on Medicare, like the VA does. Part D Medicare law was written by pharmaceutical and insurance executives and they designed it to maximize their profits. We could save a bundle if just this one step were taken.

    Love, Mikie
  13. AuntTammie

    AuntTammie New Member

    one thing I forgot to mention is that the plans available vary a lot depedning on were you live, so there may be more advantage plans with no monthly premium in different places....where i live there are very few of those and they are HMOs with practically no docs in the network (so they are actually pretty worthless)

    it sounds like where Mickie lives there are better free advantage plans offered
  14. Mikie

    Mikie Moderator

    Are not everywhere. Most are HMO/PPO plans so you can see anyone you want. It's just cheaper if you stay in network. There are more plans in more populated counties in which there are more people older than 65. I live in FL, aka, God's Waiting Room :) I used to work for Medicare Advantage plans in CO and here in FL. There are good ones and not such good ones. Like everything else, one should beware before signing up for anything.

    Only 1/4 of people on Medicare are on the Advantage Plans. They aren't the best fit for everyone but mine works beautifully for me.

    Love, Mikie
  15. Aberlaine

    Aberlaine Member

    I'm on a Medicare Advantage plan through where I used to work. The premiums went up $30/month this year and my prescription co-pays tripled. I'm going to look around next year. I don't need the "Advantage" if it's going to cost me so much.

    Also, as far as politics is concerned - as long as we have Democratic majorities in the Congress (lost it in the House last year) and hold the White House, we seniors are okay.

    If we lost the Congress and the Presidency (they go to the Republicans), we are doomed. Medicare, Medicaid and Social Security will disappear as we know it. So let's try to keep at least Obama in the White House.
  16. Mikie

    Mikie Moderator

    You might be better off going out on your own to get an Advantage Plan; however, be careful before leaving an employer plan. Be sure that if you opt out of the current plan, you could get back in if you ever wanted to. Also, be sure that you would not lose other benefits provided by your former employer.

    Love, Mikie
  17. Mikie

    Mikie Moderator

    It is better that it is privatized. The insurance companies take the money Medicare spends, on average, and provide more benefits and monitor for fraud far better than Medicare. Medicare virtually does no fraud prevention.

    Love, Mikie
  18. herbqueen

    herbqueen New Member

    The republican plan is a joke. It is great if you are blessed with no health problems! But what elderly person has no health problems? That is why medicare exists in the first place. No one who is old or ill can get affordable private healthcare coverage. This is why we need a national health care plan for all. The private insurance model doesn't work and and health care costs are bankrupting our nation. No easy answers. But continuing to feed the insurance companies is not it. Healthcare also goes hand in hand with what we eat. We need to eliminate fast food, toxic , gmo and processed food if we are serious about keeping our nation well.
  19. Mikie

    Mikie Moderator

    As I mentioned, private insurance company Advantage Plans (at least, the good ones) are doing a better job than Medicare. It's just that they aren't everywhere. With Advantage Plans, there is incentive for the patient to live a healthier lifestyle and for the docs to prevent illness. Medicare just pays and pays and pays providers who over test and do unnecessary procedures. Also as mentioned above, Medicare does virtually no fraud prevention.

    I've heard so many Seniors who have a "who cares how much it costs; Medicare and my supplement will cover it all." Now that many are in danger of losing Medicare for themselves and/or their children, they are starting to question the charges from their providers. Good for them.

    The overwhelming majority of Medicare payouts are in the last months of life. They recently OK'd an expensive drug for terminal prostate cancer patients which gives, on average, another four months. That's crazy. "60 Minutes" did a segment on this. There was a man dying of liver failure insisting on a liver transplant. He was very elderly and even a liver transplant wouldn't give him much more time nor any kind of quality of life. I know people are afraid to die but I find that just selfish and unrealistic. He died before a transplant could be done. We have to be willing to limit some treatments with little chance of positive outcomes. I've told my children that I never want a transplant. I've lived my life. Any organs should go to someone who has his or her life ahead or to a parent of young children.

    Of course, any attempt to limit care will be portrayed as "Death Squads" or "Killing Grandma." Well, there comes a time when it makes no sense to artificially keep Grandma alive when all hope of life is gone. By then, Grandma is probably ready to go anyway. Remember Terry Shiavo? The same people in our govt. trying to keep her alive are the very ones who say the govt. should stay out of our private lives. People need to be allowed to die when it's time. If there are treatments which are viable, that's another thing and not what I'm talking about here.

    Medicare funds would be much better spent on prevention, education and incentives for Seniors to do their part in their own healthcare rather than on hopeless, desperate efforts to keep terminal patients alive a little longer.

    Love, Mikie
  20. Mikie

    Mikie Moderator

    To help ensure we won't be artifically kept alive with heroic measures is to have a Living Will or Advanced Directive. We also need to inform loved ones of our wishes.

    A neighbor had a stroke at one of our condo mtgs. and later died. No one had any info on him--his meds, his wishes, his emergency contacts. I now have a sheet on the front of my fridge which lists all this and is attached to an envelope with my ins. card and my Living Will. A lot of us old folks in FL live alone with children in other states. We depend on one another and keep keys to each others' condos. If anything happens to me, a friend will have the key to my condo to get the info.

    When we are terminal, we can have a Do Not Resusitate Order posted on our walls in our homes, hospital or Hospice room. This keeps them from rushing in to shock us back into a life we are ready to leave.

    Love, Mikie

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