Medicare for All?

(you are definitely going to want to read this blog in its entirety)

I recently met with a group of women.  All are working because their jobs provide the health insurance needed by their families. It startled me when one of the women said: “I can’t wait until I am 65 so I can get Medicare and retire.”    

“You know only Part A, hospitalization, will be free; the rest you will have to pay for.”  

There was stunned silence.

Medicare for All does not mean free healthcare – NO ONE on Medicare, unless they are in jail or covered through Medicaid, gets their healthcare for free. 

What Medicare is is an insurance product, just like the policies you can purchase through the Affordable Care Act. Just like in the Affordable Care Act, the Federal Government covers some of the cost. Part A generally covers certain hospital costs, certain skilled nursing facility costs, a portion of home health costs, and nothing else.  Part B may cover doctor visits for Medicare-approved services, tests, screenings, limited mental health services, physical therapy deemed medically necessary, and additional coverage for durable equipment.  Drugs are not covered under Part A or Part B. To cover the gaps not covered by Part A and Part B, you can purchase additional coverage. 

You May Pay Premium Costs For Part A

The government typically covers the cost paid to the insurer of Part A; but this isn’t always the case.  Those that Pay for Part A must pay either $240 or $437 per month in 2019, depending on how many years they paid Medicare taxes.  Like most policies, Part A has a deductible. Even if you don’t pay for your premium, you typically pay the deductible, plus coinsurance and/or copayments.

You Always Pay for Part B

The standard Medicare Part B premium for 2019 is $135.50 per month. Though relatively small, Part B also has a deductible.  Anyone that earned more than $85,000 per year must pay a higher premium than the $135.50 base. The amount you pay is based on your income.  People earning more than $107,000 pay premiums of between $189.60 and $460.50 per month, depending upon their income.  How do they know how much to charge? The federal government looks at your tax return and sends you a bill for the additional costs based on the tax return you filed in the prior year.  Want Medicare, remember to do your taxes!

In addition, in most cases, you also pay 20% of the Medicare-approved amount for each item or service you receive covered under Part B. 

Part D Covers Drugs.  You Pay for That, too!

In 2019, Part D premiums generally started at $41.00 per month, and like Part B, increase based on income. Increases start at $12.40 per month and top out at $77.40. Many people find that they pay more for their drugs once they are on Medicare than they did for routine medications taken before they signed up for Medicare that were covered by private insurance.  Under the Affordable Care Act, the federal government gave away its ability to negotiate drug prices.

First, of course, you have to reach your deductible.  Then you pay a co-pay and co-insurance.  When out of pocket limits reach  $6350 in 2020, $4,020 for 2019, the co-pays and co-insurance payments are reduced.  

Remember, NOT all generic drugs are covered.  Remember, only certain brand name drugs are covered.  Remember only certain types of treatments for cancer, hepatitis, kidney disease, etc. are covered.  

If you get really sick, you can count on spending at least $6350 for your drugs, excluding brand name drugs and drugs that are not covered by Medicare.

And Now The Fun Begins!  You Must Buy Insurance, too!

These policies help pay for out of pocket expenses, such as co-pays, co-insurance payments and, up until 2020, deductibles. They also help pay for Medicare-approved procedures, doctor visits, etc., that are not fully covered under Parts A and B. 

Whatever type of supplemental plan you choose, be it a Medicare Advantage Plan, PPO plan or other, you are buying insurance.   AND REMBER, when they say these are supplemental policies, they mean these insurances are supplemental only.  They only cover balances due for Medicare-approved expenses. 

If Medicare does not cover a specific treatment, you must pay for that treatment yourself.  If you are over 75 and get prostate cancer, breast cancer, or want a mammography, you are not covered by Medicare.  All expenses associated with that treatment are on you.   Surprisingly, restrictions are in place limiting access to many types of treatments.  There are also restrictions on heart procedures, cancer treatments, joint replacements, and other things. With each passing year, as a way to reduce costs, more and more limits are being imposed.  Better save up!

Part A Payments + Part B Payments +Part D Payments + Supplemental Insurance + Co-Payments+ Co-Insurance + Deductibles + Uncovered Expenses  DOES NOT EQUAL FREE.

Based on your income, you could end up paying more for healthcare costs on Medicare than you did before you turned 65, especially if you get sick.

 

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