How Badly Does Medicare Suffer from a Neo-Liberal Infestation?

By Lambert Strether of Corrente.

For most of my working life — which roughly coincides with the flattening of real wages and slow, deliberate destruction of the public sector that began in the mid-70s and has continued until the present day — I’ve comforted myself with twin ideas or visions or illusions that FDR’s Social Security would provide me with a baseline of dignity when or if I retired[1], and that no matter the insanity of the health care system for those younger than 65, everything would change, and for the better, when I could enroll in Medicare, a single payer system; out of the stormy seas into the safe harbor, as it were. (Never mind the conondrum that the best way to stretch my Social Security dollars is to leave the country, in which case Medicare won’t cover local care; it’s like they don’t want me to escape, or sumpin.)

Anyhow, I’ve been corresponding with an actual Medicare user, and it seems that, sadly, I haven’t been cynical enough; the safe harbor I had imagined may turn out to be just that: Imaginary. Anonymizing medical and location details, I’m going to excerpt some of this correspondence below, and then comment on each excerpt. (Any misinterpretations are solely my responsibility.) This will not be a systematic treatment or a 30,000-foot view, because I’m not ready to do that, yet; what I’m really looking for from you, readers, is confirmation or disconfirmation of my initial reactions, as well as your own, real-life experiences with the Medicare system.

Medicare Advantage and Supplemental Plans

The Medicare Site describes Medicare Advantage as follows:

A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits.

Which, to my ObamaCare-jaundiced eye, looks like a neo-liberal privatization scam, with the hallmark of all such scams, the rent-extracting intermediary that add no value. Readers, can any of you speak from experience in comparing the two?

AARP describes its supplemental plan:

Medicare has several gaps and doesn’t pay for all of the health care services you may need. If you are in the Original Medicare Plan, you may want to buy Medicare supplemental insurance, also called Medigap insurance. This is health insurance that helps pay for some of your costs in the Original Medicare program and for some care it doesn’t cover.

Medigap insurance is sold by private insurance companies. By law, companies can only offer standard Medigap insurance plans. There are 11 standard plans labeled A-N. Each plan, offers a different set of benefits, fills different “gaps” in Medicare coverage, and varies in price.

You will want to study all the Medigap plans before deciding which is best for you.

Which, still with the same jaundiced eye, reinforces the possibility of a neo-liberal infestation: Like ObamaCare, we have the artificial creation of a phony “market”; after all, the gaps are there because coverage was not legislated, and that’s what created the market; like ObamaCare, we have the standardized plans (with no way to determine the actuarial value of each plan beyond the vendor’s brochure); like ObamaCare, we have the proliferation of plans; and like ObamaCare, we have the tax on time of “shopping.”[2] (“You will want to” is an especially nice touch, since it means “You had better, if you want the slightest hope of decent coverage without being ripped off.”) It’s almost starting to look like Medicare has been the testing ground for “what level of badness can we get people to accept” under ObamaCare. Readers, has this been your experience?

And here is what my correspondent had to say about Medicare Advantage and Medicare Supplemental:

[CORRESPONDENT:] As for the impact on me without either Medicare Advantage or the AARP Supplemental Plan:

I would have had to pay the 20% not covered by Medicare out of my own pocket. Considering my surgery and meds, just a wild ass guess without digging out the records: $30-$40K in 2013, another $15K last year. Plus the tax penalty for early withdrawal from my IRA, because that’s where the money would have come from.

I frankly don’t see how anyone can survive without an Advantage or Supplemental plan. And with the way they keep cutting things, the day will come when many folks won’t be able to survive even with one of those plans. Like Alan Grayson said, “Don’t get sick, and if you do, die soon.”

Yikes. Where ObamaCare forces people into market through the mandate, Medicare forces people into the market by making the public coverage “gappy” and lousy (a standard play in the neo-liberal playbook). Readers, am I being too cynical?

Random Variations in Coverage By Jurisdiction

My correspondent advises me:

[CORRESPONDENT:] What you should try to do is find someone on Medicare in you area who will lend you their plan information booklet so that you can review the plan options in your region. That will give you an idea of the limitations on service/access/choice of providers that you will face come 65. (Assuming, of course, that things don’t get even worse by that time.)

Huh? One of the most unfair features of ObamaCare is random variations in coverage by jurisdiction (see here, here, here, here, here, and here). Is this guy telling me the same is true of Medicare, supposedly a national program? Readers?

And my correspondent goes on:

[CORRESPONDENT:] And BTW, with regional plans, if something happens to you while you’re out of the region visiting the grandkids, taking a vacation, even traveling for work if you’re still employed, guess what? You’re generally automatically OUT-OF-NETWORK, except possibly — depending on the plan — for your Part D medications. The AARP Supplemental plan is not only national, but the one I selected also covers a significant portion of costs if you fall ill outside the country.

Huh? Narrow networks and narrow formularies are one way the insurance companies game ObamaCare, through, as it were, “pre-rescission” (see here, here, here, and here). Is my correspondent telling me the same happens with Medicare?[3]

Why yes. Yes. Apparently they are:

[CORRESPONDENT:] It’s official; for 2015 there is not a single Medicare Advantage PPO plan available in [my] county. Even Aetna’s Medicare Select Plus NATIONAL PPO plan is not available.

Oh well. HMOs ACOs are the wave of the future, anyhow! But that’s some variation. Have other readers had similar experiences?

Bewildering Complexity

Here my correspondent describes what what I can only believe is a sequence of normal, everyday interactions with Medicare:

[CORRESPONDENT:] Therefore, you present only your Advantage card (from Blue Crucifix, United, Aetna, whatever) and your doctor bills that insurer, but never has to bother with billing Medicare itself. You get a statement from the insurer showing what they paid, what (if anything) you owe for co-pays, deductibles, out-of-network charges, etc., and what was disallowed as above Regular and Customary (R&C) pricing for your region and your procedure/treatment.

So you have one card. It’s just that everybody doesn’t have the same card (unlike Canada). And here we go:

[CORRESPONDENT:] At some point your provider bills you. Sometimes it’s just for any unpaid portion not covered by the policy. Other times you get a bill for the whole thing, then a month or so later you get a bill showing the total less insurance payments and the net amount due. This is a hassle. You have to collate the statement from the insurer with the invoice(s) from the provider in order to pay the correct amount and not overpay. Sometimes you can end up having to mail off a payment for a balance due of as little as $5.

Fortunately, elders, especially sick ones, enjoy collating invoices, and anyhow, if they don’t, they can always have their personal assistants do the work. Am I right, readers, or am I right?

[CORRESPONDENT:] With the AARP/United Health care Supplemental (but not Advantage) plan I have to present both my Medicare card and my AARP card and the provider has to bill both.

Oh, wait. Now there are two cards. More useless complexity of benefit only to rent-seekers. We continue:

[CORRESPONDENT:] So far this year I’ve had several doctor’s visits… and have yet to pay an on-site co-pay. I also have not yet received any billing statements, so I have no idea if this new AARP United Health system is going to be better, worse, or the same as my old Blue Crucifix coverage.

And finding out is going to be something to look forward to!

[CORRESPONDENT:] As for you being safe when you hit 65: Hate to be the bearer of bad tidings but, NOT. A. CHANCE. Costs keep going up, coverage keeps getting worse or more limited, co-pays and deductibles keep rising, etc. That’s why I’ve written several comments on NC about how Medicare-for-All is not the answer because it does not really cover the true costs of care.

But wait! [pause] I checked the Medicare website. I did. My plan here, readers, was compare and contrast what Medicare claims to do with what we find that it actually does (“But wait! The Medicare site says….”). And I spent maybe ten minutes clicking around for something like a mission statement, and couldn’t find anything; not the About page, not the FAQ[4]; I even looked up Medicare in the Glossary, but nothing. I even tried “Get Started with Medicare,” because I dimly recall that the first button on the left of the top menu is the hottest spot for clicks… And I can’t find what Medicare is or does! To be fair, you can’t say “Medicare is a program that provides universal health care for U.S. citizens over 65” if you can’t say “Medicare is…” [5] So there’s that. Moving on:

[CORRESPONDENT:] For example, in June of 2013 I suffered a back problem which eventually required surgery (in-network). I also have an annual exam and a tri-annual cancer check-up. (Father died of this form of cancer.) Between the deductibles, co-pays, Medicare insurance premium surcharges, and the $134 a month ($1,608 a year) deducted from my SS check for the basic Medicare premium that everyone on Medicare is assessed, my 2013 out-of-pocket medical costs came to…


With all the post-back op pain meds, doctor’s visits, some dental work, and so forth, this past year, 2014, my total out-of-pocket was $8,605. (BTW, in many plans dental care is an additional premium, as is vision care. And my dentist does not take any Medicare patients, even Medicare Advantage.)

Of course, these expenses were partly because I selected the BC plan which was the only PPO in my region. I could possibly have spent far less by choosing one of the various HMO policies, trading choice of doctors and physical location convenience of facilities for lower costs. I might also have saved more by opting for the AARP United Health Supplemental-but-not-Advantage plan, had I known about it at the time. (Those plans are NOT included in the annual booklet sent to all Medicare beneficiaries.)

Ya know, I think my correspondent is telling me (a) I could go belly up, financially, even with Medicare and that (b) this depends, among other things, on random coverage variations by jurisdictions. Can this possibly be true? Readers?


I don’t have a lot to conclude, here — readers, you’ve seen my questions — except that Medicare has all the signs and symptoms of being infested by neo-liberal rent-seekers in the same way that ObamaCare has, except targeting a far more vulnerable population.

However, one thing that you could do is send me especially egregious documentation — PDFs, scans — of useless complexity; stupid insurance company brochures, stupid invoices, stupid policies, and so forth. You can use the same contact information that people use to send me images of plants, down at the bottom of Water Cooler. Thank you!


[1] Personally, I believe that shuffleboard is a death sentence, so I would prefer to work ’til I drop.

[2] Does anybody know any elders who’ve put “Decoding deliberately obfuscated insurance company policies” on their bucket lists? No?

[3] To be fair, it’s good news that AARP Supplemental might help enable my plan to die in a ditch in the tropics rather than be hooked up to a machine in a “nursing home.” Of course, there ought to be a way that I get health care by virtue of being an American citizen; but there’s no business model for that, so it’s a non-starter under today’s neo-liberal regime.

[4] Hilariously, the top question for the FAQ is: What if I decide to cancel my account? Mission accomplished?

[5] UPDATE After another ten minutes poking around on an unrelated topic, I found what I was looking for like three levels deep in the sign-up material, under “What is Medicare?” In other words, you only see what you’re signing up for after you start the enrollment process.

Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD).

I like my version better. But heaven forfend that the program’s purpose be on the front page!


The political aspect here is the frame “Medicare for All.” When single payer advocates use that phrase, it looks like what they really mean is “Medicare before the neo-liberal infestation,” or rather, “Canadian-style Medicare.”

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.


  1. Kokuanani

    Lambert, there’s another serious flaw with Medicare, one that I’ve experienced during my several years with it: it’s difficult, and often impossible, to find a doctor who will accept it.

    Before moving out of the DC area 7 years ago, my primary physician “kicked me out” of her practice [I’d been with her for over 15 years] by deciding not to accept Medicare for payment. A couple of years earlier she had stopped accepting NEW Medicare patients to her practice; now she was jettisoning all of us who wanted to use Medicare to pay for their treatment. She was a very good and thorough doctor, but claimed that the level of Medicare reimbursements did not cover the cost of the time she spent with patients. [She WAS very thorough.] And, of course, since Medicare prohibits clients from paying doctors for the difference between Medicare’s “inadequate” reimbursement and a “reasonable” fee, there was no way I could continue with her, even if I were willing to make this additional payment.

    For the next several months before our departure, I was unable to find ANY private doctor in the DC area who would accept new Medicare patients. [Remember, this is MediCARE, not MediCAID.] I asked many friends in the DC area to recommend doctors; same result. I even corresponded with a friend in Alaska who told her tale of being unable to find a Medicare-accepting MD.

    Upon moving to Hawaii, I had similar difficulty, but folks I met there almost all seemed to be enrolled in Kaiser, and quite satisfied with it, so I signed up. After an initial shuffle through some ordinary MDs, I found a terrific one. I had surgery there and was quite pleased.

    Now that I’ve returned to the Mainland, I just signed up with Kaiser here. It’s not nearly as good as the Hawaii program, but at least adequate. However, Kaiser isn’t offered everywhere, and does have the drawbacks of an HMO, wherever it is.

    I don’t know how long it’s going to take for folks to realize that their “health insurance” gives them very little, if any coverage.

    1. Art Eclectic

      I have a doctor friend that I get to listen to on this topic and he won’t take Medicare patients because the reimbursement rates are too low. That said, here we have more examples of our economic system at work. As an independent practitioner, my doctor friend is free to not see patients who can’t afford him. He can sell his services only to those with the appropriate amount of money to pay for them. That’s the Free Market at work, folks. Pay up or suffer and die.

      In 10 years we will have a full universal care system but it’s just going to be ugly until then since all the big players have be paid off, they’ve got shareholders to keep happy and CEO retirements to plan and they’re simply not going to stand idly by while their profits are under assault by some hippie philosophy that basic health care is a human right that we’re going to guarantee to all our citizens.

      1. Propertius

        A couple of years ago, while riding home from the airport on an airport shuttle (something I do way too much of), I chanced to overhear a conversation between two ophthalmologists who were returning from a conference. It seems that ophthalmologist A had recently paid for an eye surgery for a beloved dog.

        The fee he paid his veterinarian was apparently somewhat over 10 times the Medicare reimbursement for performing the same procedure on a human being. I do not know if this statement was an exaggeration on his part. I do know that, after perusing the statements for my mom’s cancer treatment, that the level of reimbursement for her chemotherapy treatments seemed ludicrously low. I’m glad I’m not a doc in modern America.

        1. jrs

          By why a doc in modern America? Don’t they still earn more than doctors in countries with functioning medical systems? Granted there are student loans to pay off.

      2. Pookah Harvey

        Dean Baker has discussed physician pay on his blog at the Center for Economic and Policy Research.
        Doctors in the US make triple the salaries found in most other advanced countries because ” they vigorously protect (them) by excluding foreign and domestic competition

        More from Baker on the issue of doctors’ pay here

        His essential argument is the real pay for doctors has increased by 55% since the 1970’s through the ability of protecting themselves from globalization while the middle class was thrown to the wolves and have seen their real wages stagnate.

        1. Beans

          If you imply that globalization of medical services would be a good thing, I think you are quite wrong. See the current thread about H1-B visas and the effect they have had on US IT workers. Perhaps doctors have done a better job of protecting themselves than the rest of the middle class (as plenty of doctors are in the middle class), but you are arguing the wrong position. Better to improve the lot of the middle class than to drag doctors down with them.

          1. Pookah Harvey

            For decent health care for the nation doctors income should stay at a constant level as compared to the national median income to make it affordable.. Either you have to hold physician incomes at levels found everywhere else in the advanced world or you have to increase median income, your choice.
            Average physician income currently is in excess of $200,000, essentially putting a large percentage of physicians in the top 1%, not exactly middle class

  2. Christian Bonanno

    I have been on Medicare and disability for the last 15 years and I have witnessed the rusting of patient care along with higher costs I have to pay out of pocket. I was going to go into a detailed account of all of it but maybe this will sum it up; guck Bush JR., fuck Obama, fuck politics, fuck capitalism.

    Yves, I know you will probably not post this comment but I needed to vent.

  3. Nancy Connolly

    Sorry, Lambert’s post seems quite exaggerated. I have had Medicare for 20 years, with the same Medigap policy (D), no drug coverage (because the way Bush offered this seemed unethical to me). I have had NO problems. Perhaps I would have, had I succumbed to Medicare “Advantage” plans, but they seemed to be waving red flags from the get-go. I am very pleased with my experience with Medicare.

    1. Christian Bonanno

      Hey Nancy, no idea why you are on Medicare but I think it makes a difference. I have had unknown neurological issues which they said was probably MS but that the MRI would cost $900 out of pocket. And the only doctors I can get under Medicare at the ONLY DOCOTORS THAT TAKE MEDICARE in my town are INTERNS at a university hospital. I know more about medicine then these kids.

      Maybe you are lucky, maybe I am unlucky, but lambert does not exaggerate.

    2. diptherio

      So, as with the ACA, it works well for some and not-at-all for others. I’m glad you like your health insurance–it would be nice if everyone could have the same. Your experiences with the system are completely valid, but so are those of others, which is what Lambo is reporting on here. By downplaying his reporting, you’re essentially telling everyone who’s been screwed by this system to shut up and deal. Not helpful. Let’s try looking at things from someone else’s perspective, eh?

    3. jrs

      Many people succumb to Medicaid Advantage plans because they can’t afford Medigap plans and it’s the only other way to plug the gap. Aren’t Medigap plans very expensive? I think it’s desirable to avoid Medicare Advantage if one can as well, I’m just not sure it’s not often a matter of economic necessity.

    4. Yves Smith

      Lambert went to great length to make clear that he was presenting one data point and asked for reader input as to how representative it was. Thus your charge that the post is “exaggerated” is an inaccurate characterization.

  4. DWD

    Last year I became very very ill. Local doctors diagnosed it as “End stage liver disease” and advised my wife that I would be dying sooner rather than later. To my eternal gratitude she refused to accept this and had my family physician duplicate my medical records, enlisted my sons to get me into the Honda, and drove me to the University of Michigan Emergency Room.

    From there I was admitted as an in-patient and I spent the next two and a half weeks having every conceivable test known to man done and treatment prescribed. From there, on the road to recovery, I was placed in an extended/rehab facility near my home. I stayed there for another two weeks or so before being allowed home.

    At home I was given physical therapy, occupational therapy, and a visiting nurse came – initially – three times a week but this was diminished with my recovery.

    Unfortunately at the extended care facility the nurses were so beset with work and obligations that one of the three lesions I had developed from being sick, became infected and from there the infection spread into the bone causing a condition called osteomyalitus. For this I was treated with two different oral medications and a twice-a-day intravenous drip (2 hours in duration each time) and was given my second PICC Line. (The first had been removed when I was discharged from U of M.)

    The infection is gone but part of my foot has been damaged and it is something I will have to live with or have part of my foot removed. I can get along with it as it only causes some minor discomfort.

    For all of this treatment: prior hospitalization in my hometown two times with a three day duration (They could not find what was wrong and were treating me for liver disease, which I did not and do not have) and the five weeks of both hospitalization and extended care, the entire visiting nurses and PT and OT, and the IV costs me a little over 8K in out of the pocket costs.

    I am a retired teacher in the state of Michigan and have BC/BS Supplemental Insurance. (Medigap)

    I don’t know. I am quite pleased that I only had to pay 8K for treatment that was more than 200K all told.

    And Medicare has been wonderful – BC/BS are the only ones I have had trouble with.

    But they raised the deductions to $1500 hospital costs including outpatient services, and $600 for physician care. I am paying the Medicare Premium and the BC/BS $160 a month.

    I am doing better now but still a ways to go.

    So, I believe, in answer to your question, Medicare DOES work pretty well as long as the supplemental insurance is decent.



    1. Christian Bonanno

      This is how they are slowly killing Medicare. Pleased to only pay 8k but had bad treatment while paying for premium services plus BCBS? This is the new normal. Welcome to the slow boil.

    2. Katiebird

      Dumb question…. Which form of supplemental insurance do you have?

      I thought that one of the gazillion supplemental plans (F ?) covered everything, no matter where in the US or what doctor you go to.

      Am I wrong about that assumptions?

      (Clarifying to say that it should not be that way. And that it took me nearly 6 months of research before I understood the differences in the gazillion various forms of supplemental Medicare)

      1. grayslady

        KB, I’ve never heard of a Plan F, and I check the available plans every year. I do know that the number of providers for Medicare Supplemental and Medicare Part D has declined substantially. For Part D, it started out at 1100 providers and is now down to 600. Every state is different as to what type of insurance plans are allowed. I know that in Illinois there isn’t a single dental plan that covers implants, while in PA there is at least one plan that covers 50% of the cost of an implant. The availability of Medicare plans by state seems to be affected by the same state regulatory requirements that govern non-Medicare plans. I think I read that New Hampshire, for example, only has one plan available for Obamacare for the entire state. Don’t know about their Medicare options. If health care is a primary concern (known genetic issues or other serious, continuing medical problems), it is helpful to live in a state that attracts the best providers and insurance companies.

        1. katiebird

          Grayslady, The Medicare research I did was as difficult as learning a new computer language. It was one of the most intense periods of my life. And the fact that they advise us to go through it again every year during open enrollment makes me feel insane.

          Here is the page I stumbled across that helped me to start getting a grip on the details. “How to Compare Medigap Policies”.

          If you scan down the list for Plan “F” (Not the high deductible one) you’ll see that it supposedly covers everything – with no copays or deductibles. …. I’ve been told that the plans are defined by law and that no matter where you live- anywhere in the country …. Plan F covers you.

          This is the plan my parents have had for years and in all the Medical visits from doctors to elaborate surgeries (locally and out of state) they’ve never paid a dime.

          But, I don’t know if they’re just lucky or if that’s how it always works.

          1. grayslady

            Just checked online. You’re correct: there’s not only a Plan F, there are also other letters of the alphabet. However, I didn’t see a plan that covered everything. Looking at the Humana website, you can find plans that will cover co-pays–and even vision and dental–but they won’t cover prescription drugs. They seem to be referred to as Medigap programs–meaning all the expenses, other than drugs, that Medicare doesn’t pay for. Some have PPOs, others have no stated network. Either way, expect to pay an additional $2000 per year for one of these programs, and then you still have to have a Part D (at least with Humana) to cover your prescriptions. That’s probably why I didn’t pay much attention to these plans.

            1. Katiebird

              I should have said thst. Everything but. Drugs. That plan D stuff is a nightmare of it’s own.

            2. JTMcPhee

              Small bit of advice from a nurse: Stay away from (In)Humana. Nothing but limits and trouble. Doctors don’t like it so ones that take it are hard to find.

          2. J Bookly

            Yes, Plan F is awesome. It pays the Medicare Part B copay plus the 20% that Medicare doesn’t pay. If Medicare covers something, Plan F pays; if Medicare doesn’t cover it, Plan F doesn’t pay. On hospitalization (Part A), what they pay and what you pay is clearly spelled out. Plan F is less well publicized than it used to be. Why? The neolibs are trying to get rid of it because with Plan F you are said to have no “skin in the game.” (They love skin in the game unless it is their own.)

            Fifteen years ago, when I was still buying outrageously priced private insurance as a self-employed individual, I became seriously ill. My insurance cost me over $400 a month at the time, and had a $5000 deductible. I thought it was per illness but it was per year. I got sick on December 27 and was hospitalized, so I had two deductibles to pay. Plus my insurance company behaved so badly it shocked even the hospital business office staff who have “seen it all.” It took almost two years to get the insurance company to pay its share. Of course next year I was back to a fresh deductible and had to pay 100% of all doctor visits. My premiums went up and when I turned 65 I was paying $710 a month for the same crappy coverage.

            So Medicare looked very, very good to me. I chose traditional Medicare plus Medicare supplement Plan F precisely because it is simple, it saves you from the stress of endless dunning letters, and it makes your expenses predictable. My Plan F is through USAA. All payment is handled electronically.

            Yes, it’s too bad that we have to have private supplementary insurance, but I would far rather have good reliable coverage for $167 a month than crummy unreliable coverage for $700. It’s a bit European in a way, because the companies offering Medicare supplements have to offer standardized coverage for standardized prices, just like the ones in Switzerland (?) and other countries where they have government-regulated private insurance. The companies make some money, but I don’t think they are allowed to price gouge (yet). Of course they may be charging new enrollees tons more than I am paying; that I don’t know.

            Also, unless you are taking very expensive meds for a chronic illness, plan D is not a good deal. This may be changing as Big Pharma continues to remove generic drugs from the equation.

            I don’t think too highly of Medicare Advantage because it isn’t crisp and clear like traditional Medicare plus a supplement. And they seem to make a big deal out of fringe benefits which look to me like marketing foo-foo.

            Bottom line: uncertainty about one’s solvency is stressful and bad for one’s health.

            1. ks

              Thanks, that was useful.

              Nevertheless, it’s maddening that we should be grateful for a Plan F. Like Lambert, I was living in a dream world until I began talking to people currently on Medicare. One woman told me it took her a year to pay off the $1300 it cost to have basal cell carcinoma growths removed. Another told me she avoids doctor visits for fear of the cost. These are precisely the problems from which elders were supposed to be liberated after a working lifetime of payroll contributions. The same people who pay our children wages too low to live on have their greedy eyes on the things we’ve held sacrosanct – Social Security, Medicare and pensions.

      2. marym

        The 2015 Medicare handbook lists 10 types of supplementary plans “identified in most states by letter” and 4 other letter-plans which have been discontinued. Plan F is said to pay whatever Medicare doesn’t pay on anything covered by Medicare (domestic). The booklet itself in describing the plans as standardized puts standardized in quotes.

        1. marym

          That was a little incoherent. If a service is covered in part by Medicare, plan F is supposed to pay whatever part isn’t covered. If it’s not covered at all by Medicare, it’s not covered by the supplement.

          1. Code Name D

            Maybe you need gap coverage for the gaps left over in your gap coverage. Medicare Plan AA?

    3. diptherio

      If you lived in any other developed country, your cost would have been zero. Still happy with your coverage?

      It’s great that you had an extra 8k lying around for medical care…sadly, many don’t. Glad you made it, but Medicare is still far from a good system. It’s better than nothing, but not nearly as good as what everybody else has.

      1. Jess

        Yeah. The average SS beneficiary receives what, about $14.5K a year? $8 grand is over half the average person’s annual benefit.

  5. Jim Haygood

    Medicare supplemental plans are state-regulated. Example from Vermont:

    The Vermont Department of Financial Regulation reviews and approves rates (also known as premiums) for each insurance company, for each Medicare Supplement insurance policy that they offer. Medicare Supplement insurance policies are community rated.

    Presumably this is because insurance remains state-regulated. But as Lambert correctly infers, this means a minefield of shopping. And if you’re not a highly sophisticated shopper, with advanced medical, legal and actuarial skills, then you might as well just bend over and accept your fate.

  6. grayslady

    This is my third year on Medicare. I’m lucky to live in the Chicago area since it’s known to be one of the best areas for medical selection and services in the country–why, I don’t know; it just is. Every doctor I’ve wanted to see takes Medicare. I can’t afford a Medicare Advantage program, but I do purchase a Part D plan and receive 50% Extra Help from Social Security (Illinois dropped its prescription help program several years ago due to state budget issues). My Part D is through WellCare and is perfect for me. As long as you purchase your drugs through one of their Preferred Providers (Walgreens is the primary one), the prices are very reasonable. I’ve told my doctors to try and prescribe generics, because WellCare typically picks up 100% of the cost of most generics (I receive a 90-day supply of Simvastatin for $0!). WellCare also allows you to pick up a 90-day supply locally rather than have to use mail order.
    The tough part has been the 20% co-pay for every medical service.Here’s what I do: 1) tell the doctor I can’t afford something and to come up with a different treatment that’s less expensive (they always seem to come up with less expensive tests when you say you can’t afford an MRI or CT scan); 2) negotiate extended pay with doctors or physical therapists before even agreeing to treatment if I think the co-pay will be more than I can manage; 3) since my doctors and services are typically affiliated with Northwestern University Medical Center, when I have a problem paying bills, I call accounting and ask for extended terms (they usually come up with something very reasonable) or I explain that I simply can’t pay the bill and need financial help. If I can’t pay, they send me a financial aid form, I fill out the form and send it back in, and they always approve my request; 4) if you need imaging, search for an independent. My MRI cost $600 by using an independent company, whereas the hospital wanted $2300. It pays to shop around.
    One of the more expensive aspects of wellness has been the vitamins I need for two deficiencies (vitamins aren’t covered, even if you have a deficiency that has been shown in blood tests) and over-the-counter medications for routine sinus infections, etc. No Medicare program covers vitamins because they aren’t manufactured by FDA approved companies. If you have a real deficiency, the good vitamins are not cheap.

    Bottom line, forget about being proud. Tell your providers what you can and can’t afford up front. Ask for financial relief when you need it. It’s not how I expected to spend my “golden years”, but it has been manageable, in spite of at least one serious issue.

  7. Jerry Hamrick

    I was part of a small team that developed one of the first Medicare systems. This system quickly became the most widely used Medicare system in the country, and for a time processed all of the Medicare claims in 48 states. Immediately upon completion of the Medicare system the same team of which I was a part developed one of the first Medicaid systems, and it, too, became the most widely used such systems in the country. From 1965 to 1995 I spent most of my working life providing systems and other services to all sorts of health expenses payers: Medicare, Medicaid, HMO’s of several kinds, self-insured employers, association groups, private health insurance companies, not-for-profits of several kinds, and even one company that provided health insurance for animals. This is not all I did, but it was the bulk of my work.

    Medicare and Medicaid as everyone knows by now became a political tool for winning votes and getting campaign contributions. As a consequence these systems have been contorted into systems that are far from their original intent, and, over the long haul, the ACA will also be perverted if it is not expunged.

    We can lambaste the deficiencies of Medicare, Medicaid, the ACA, and our medical systems in general but nothing will change for the better until we change our political systems,

    I am a Medicare user and it pains me to see the ways it has been transformed into a system that gives poor service to patients and providers alike, all in the interests of the politicians.

    1. Carla

      Thank you, Jerry. You described very well everything we can thank Hillary Clinton, GWB, Barack Obama and Congress for. So many well-paid people required to keep Americans from achieving a health care system worthy of the name! Please everyone, remember this in 2016 and vote for the only single-payer candidate running, who will be the Green Party candidate–hopefully physician Jill Stein.

      Lambert, the single payer advocates I know advocate “Expanded and Improved Medicare for All.” We are all aware of the ongoing crappification of Medicare, and I have experienced it myself. The advantage of some “Advantage” plans is that they charge no monthly premium and they also include a Part D benefits of sorts. For those of us who are quite healthy (often the “young elderly”), taking the risk of getting stuck with the costly co-pays and deductibles charged by a no-premium “Advantage” plan can make financial sense, because we hardly see doctors and seldom take prescription drugs. Therefore, we pay only the $134/mo Medicare premium for Parts A and B. The “catch” is — and there’s always a catch, isn’t there? — that after you’ve been in an Advantage plan, a Supplemental plan doesn’t have to take you if you have certain pre-existing conditions, so you have to intuit when your good health will go bust and be sure to get on a Supplemental plan prior to that date.

    2. Beans

      I was a Medicaid provider and can give a BIG AMEN to everything that Jerry Hamrick wrote. Medicaid and Medicare are a slush fund for those willing to rob the system blind. This includes the politicians, claims processors, providers, hospitals, healthcare corporations and insurers. Any patient seeking care under Medicaid/ Medicare is wise to be their own patient advocate – or enlist the help of someone who will advocate on their behalf. Far too many opportunities exist in which a patient can mutate into a human ATM.

  8. Peter Pan

    My 81 year old mother has Medicare and AARP supplemental insurance through the United Health Care insurance company. I should state that everything your corespondent has reported to you is true. However, it’s even worse than set forth.

    First, there’s overwhelming complexity in terms of plan choices from each health insurance company and multiple health insurance companies from which to choose. If your are 81 years old and your cognitive abilities are normally degrading then there’s no way you can make the “right choice”.

    Secondly, open season for selecting a health insurer and a plan does not provide price information, deductions or copays. You learn that information several months later. So there’s asymmetrical information between the citizen-customer and the health insurer.

    Third, plan D prescription drug plans may vastly alter their formulary of drugs from year to year. So a generic drug that was categorized as type1 low tier cost copay may suddenly be placed into type 3 high cost copay.

    Essentially, the idea that there is a marketplace from which someone can make a rational choice about supplemental insurance for Medicare coverage is total fucking bullshit.

    The only way I could truly document all of this would be to gather up all the information my mother has and send a 10 to 15 pound package to you. Unfortunately, I have neither the time or motivation to do so. Sorry.

    1. Peter Pan

      One more story that I just remembered. One year my mother considered switching to the Advantage plan with United Health Care. A salesman from United meets with my mother and her daughter (my sister) and tells her it will be less expensive and she will not have to change her health network or her existing primary care physician. So she elected to switch to the Advantage program based on the salesman’s verbal representations.

      Then when my mother received the official insurance information about the Advantage plan she discovered that the salesman engaged in misinformation/disinformation/bold lies. She could not stay with her current health network or physician. My mother and her daughter contacted United Health Care and complained about the salesman’s lies and threatened to file a complaint with the state’s insurance commissioner. They did switch her back to her original plan but not before the change was enacted thereby forcing my mother to fight the billing process, deductibles and copays that occurred under the Advantage plan.

    2. Brindle

      Sentence of the day…..

      “Essentially, the idea that there is a marketplace from which someone can make a rational choice about supplemental insurance for Medicare coverage is total fucking bullshit.”

    3. marym

      In addition to multiple and changing tiers and other classifications for drugs the prescription drug plans also classify pharmacies. In my area of IL the AARP plan has Walgreens and Walmart n the “preferred” network, Several other local chains are merely “standard.” As far as independent nieighborhood pharmacists, are there any left in mythical free market land?

  9. Eureka Springs

    Since the web page doesn’t make it easy to find perhaps the text of the act itself is the best place to start. Save some room in that tropical ditch for me Lambert.

    Act Establishing Medicare and Medicaid

    Document Text

    AN ACT

    To provide a hospital insurance program for the aged under the Social Security Act with a supplementary medical benefits program and an extended program of medical assistance, to increase benefits under the Old-Age, Survivors, and Disability Insurance System, to improve the Federal-State public assistance programs, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That this Act, with the following table of contents, may be cited as the “Social Security Amendments of 1965”. . . .

    1. sleepy

      An American resident of Mexico can buy Mexican government health insurance through its social security system for $300 per year. I have read some very good things about the healthcare available under that system. This interview seems more mixed:

      “RAY SUAREZ: But, with Americans already consumed by a debate over health care reform, the campaign may have a tough time getting attention in Washington.

      In the meantime, some retirees are taking advantage of the insurance offered by the Mexican government’s social security system, called IMSS, or IMSS. For only $300 a year, Americans who can establish residency are offered an array of medical services with no deductible.

      Susan Wichterman retired to Puerto Vallarta 12 years ago and now teaches yoga here. She signed up for the Mexican social security health plan as a backup, but soon suffered an arm injury, which required multiple surgeries.

      SUSAN WICHTERMAN: All your specialists. I have seen traumatologists. I have seen gynecologists. I have seen psychiatrists. It is all paid for. Too good to be true.

      RAY SUAREZ: But there are limitations to Mexico’s government plan. Anyone with a preexisting condition is excluded. The facilities are not cutting-edge. And if you are not in need of urgent care, the lines are notoriously long.”

  10. redleg

    Are we consumers or people? If we are consumers, then we are commodities to be used until nothing more can be extracted and then discarded.

    1. Carla

      We are only people if we demand to be treated as such. Under the U.S. Constitution, supposedly the rulebook for this country, We the People are Sovereign. We had just damned well better start acting like it. It will take courage, because it’s very dangerous. I guess it all comes down to, is it better to risk dying on our feet, or to live on our knees? All consumers live on their knees…as the U.S. health care industrial complex shows us, as if by design, every day.

  11. Dan Lynch

    Medicare is for-profit delivery. Some things just shouldn’t be for profit.

    I advocate universal public health care — VA Care For All, if you will.

    The challenge with any public program is to keep the politicians from ruining it by strangling funding and appointing political hacks to manage it, as the Brits are doing to the NHS. I suggest the way to deal with that is to make it truly universal — EVERYBODY, including the rich and powerful, should be required to use it.

    As Jerry Hamrick said, real reform won’t happen until we fix our political system.

  12. JTMcPhee

    It’s futile to even ask, the Narrative has long since won this point, but could everyone please pay a little attention to terminology? Is Medicare an “insurance program” or a “health care program?” Many sources refer to it as a “social insurance program,” which is a very different breed of steer than what it is being castrated into by a thousand “ObamachainedCPI-style” “features and benefits.” “Social insurance” reverberates with the resonances of FDR’s comforting disablings of the Gilded Age Gang. But we slurb words and concepts like we slurb our landscapes,, until distinctions and character are lost under the weight of billboards and brands and frankly, proudly, advertisedly dishonest “messaging.”

    Medicare, and the VA healthcare I get thanks to service-connected disabilities from that Vietnam thing, have done very well in my case. I have had one knee replaced (with a lot of problems) at virtually no out-of-pocket costs via Medicare and the AARP supplemental option “F” coverage. I have a lot of neurological and circulatory problems, and looniness from certain experiences, and other than the shitty handoff VA gives to people with mental problems, Medicare and VA have covered most of it. Because of my level of disability, I get a waiver of the usual $8 copay for formulary medications from the VA, for 90-day supplies of prescription meds. Note that VA can and does negotiate, HARD, with Big Pharma for honest pricing of those medications too, part of cost control that seems to work (though there are plenty of contrary anecdotes, from neo-libs who want to trash the VA and benefit recipients like me.) My annual costs, so far, are $2181 for Medicare monthly charge and AARP Supplemental (United Healthcare — should of course be United ‘Medical Insurance Premium collector’) — $181.75 from my bank account. I also get access to VA dental care, again because of my level of disability.

    (Sidenote: VA’s disability program is actually a form of “workers comp.” Like W/C, it only provides treatment, and very limited compensation, for on-the-job injuries and disabilities. W/C is largely a system to screw workers, instituted nationwide in part by lobbying by Johns Manville to defeat the many civil lawsuits that employees were bringing for intentional asbestos harms. (For an interesting history, from The New Yorker, look here,, the original article is behind a paywall.) W/C is all about limiting the business and government liability to workers, and soldiers, who get trashed on the job. PLEASE NOTE THAT A PERSON “AWARDED” 100% DISABILITY BY THE VA, IS “ENTITLED” TO A MAX ANNUAL PAYMENT OF ALL OF $30,000 TO $35,000 A YEAR, LESS IF THEY ARE SINGLE. Try to live on even $35,000 a year if you are disabled. Even with “free” medical care at a VA hospital that may be hundreds of miles away. And the Freedom-Loving Republicans and other neo-libs are always pushing, pushing, pushing to increase the “share of costs” that the damaged GI has to pay. While cutting Our Warriors’ Pay and Benefits on the front side. While messaging to the rest of America that Our Heroes are really just Useless Eaters, who ought “by rights” to be cut right off from ‘entitlements’ that put them in microscopically or at least optically “better” position than the average mopes who are gasping and collapsing as they take yet another lap on the Race to the Bottom.)

    I’ve also worked as a nurse with specialized doctors (in physical medicine and rehabilitation) who do have a lot of both Medicare and Medicaid patients, and continue with them out of a sense of obligation and a willingness not to grasp after the last possible dollar. They provide competent and attentive care, emphasize “CARE,” both in their office and hospital practices. But the “cost control:” crap that the neo-libs are pulling constantly has them thinking about the wisdom or even survivability of continuing as they do. So many docs here in FL, thanks to that Dick Scott and his buddies’ business models and long-term scams, are becoming employees of various corporate scams or early-retiring or just stopping. There are so many tricks one needs to know to honestly and even marginally profitably bill under Medicare and Medicaid. And it helps to have staff who are willing to press back against the people who are trained to say, if you can get past the phone trees and auto-hangup programs, to say something that sounds like “Department of Denial Department, how may I not help you?” as the conversation starter. Press back to get “authorizations” for needed medications and treatments that are part of contracted coverage but you have to fight for them.

    There’s a whole ‘nother screed out there for what happens when one is unfortunate enough to be dumped into one of the many “elder care centers” or “skilled nursing facilities” or “rehabilitation centers” or “nursing homes.” All of the above followed by ‘sic.’ Our governor Scott has been working hard and subtly to push more people out of home care and into the tender hands of his nursing home cronies, among other scams. It’s just one horror after another. But there’s a lot of God-loves-a-profit in it, including the scalping of huge chunks of public money, as Scott did when he ran HCA Columbia as a giant fraudulent ripoff of government “health insurance programs.”

    So, like the man said, the neo-lib corporate advice to the rest of us is “work ever harder, for less and less pay, and when you can’t work hard enough any more, don’t get sick or disabled, and if you do, die quick, and have the decency to do it where we don’t have to look at you.”

  13. Praedor

    Wait…maximize social security payments by living outside the country? Could you please elaborate on that? My retirement depends on social security and military retirement (I don’t count a piddly IRA) so I would be interested in knowing about what you meant by that statement.

    1. Keenan

      They pay out in US dollars. The dollar is king, at least right now, so the currency exchange is favorable for you and the cost of living is less in many foreign countries. More bang for your bucks abroad.

      1. Praedor

        OK, simple enough. I have long had an eye on some lovely Latin American country…if Global Warming or US neoliberal coups don’t render many of the more desireable countries unlivable by my retirement.

        1. Katniss Everdeen

          Just don’t go anywhere that has something the US oligarchy might covet. Like oil or fertile farmland.

        2. jrs

          Yea I know, like one is going to plan on all that being hunky dory in 20-30 years. Global warming might have made much of earth unlivable by then. Of course if it makes it all unlivable I won’t have to worry about retirement at least.

      2. Carla

        Ecuador uses the dollar. Apparently American retirees can live quite well there for $2,000/mo or less per couple. Ecuador’s Constitution guarantees foreign residents the same rights as citizens, and the country offers many 50% off discounts to all seniors. The law also decrees that if you are over 65, you never have to wait in line — you automatically go to the front (where I can just imagine 85-year-olds and 90-year-olds duking it out for the first, second and third positions). Here are a couple of links:

        There are several levels of health care in Ecuador, from free to insured, to entirely private-pay. One might imagine the resulting outcomes could be quite variable.

        1. gardener1

          International Living is a real estate sales website. Well known for selling seminars filled with half truths. Nothing they say is to be trusted.

          BUT, we have been looking at Ecuador pensioners visa for a couple of years, and spent a month in Ecuador looking around.

          Outside of the glowing reviews for cost of living, climate, etc., there are some caveats that need to be considered:

          Ecuador changes their visa requirements constantly. Just this year, January 2015, they added a new required police report to the list of documents needed for visa application. Now each individual must submit an APOSTILLED FBI backround check, *and* an apostilled state police report each going back 5 years. FBI reports are apostilled only by the US Dept. of State and it’s quite time consuming runaround to accomplish that. Both police reports must be submitted for visa application within 180 days of their original issuance. I can assure you that 180 days is a short turnaround for the Federal government. So good luck getting that done.

          AND if one intends intends to use Social Security as the qualifying pension income, it is necessary to have a document of income verification from SS also apostilled by the US Dept. of State. All Federal documents can only be apostilled by the US Dept. of State.

          Sound like fun yet?

          There is also no telling what the Ecuador bureaucrats will come up with next. They often don’t update new requirements to their visa regulations on the government website until years after the requirements changed. That’s even when their website is up and working, which often it isn’t.

          Here ya go –

          1. Carla

            Downsides to using the dollar, huh? Well, we’ve certainly got ’em here, so I’m sure they’ve got ’em there (the downsides, I mean). But other than that, Mr. or Ms. gardener1, how did you like Ecuador?

            P.S. — I didn’t mean to endorse the obvious shill International Living in any way, but simply thought their recounting of senior discounts in Ecuador might be worth sharing. Perhaps I was naive. Apologies. I did not intend to mislead anyone.

            1. gardener1

              That would be Ms. Gardener1. ;-)

              We liked the coast best. Ecuador is a very conservative country and the colonial cities in the Andes plateau valleys roll up the sidewalks at 8PM. Everything closes, I mean everything. There is almost no such thing as nightlife. This was true in both Quito and Cuenca. (La Mariscal district excepted)

              But the coast is almost an odd left out of Ecuador, even though their biggest city is Guayaquil on the coast. The Spanish colonial wealth of Ecuador was largely in the Andes cities and so the 1,400 miles of Pacific coast and coastal towns has been mostly ignored for the last 400 years by nearly all the governments which have come and gone.

              The colonial Catholic lifestyle is mostly absent on the coast. More nightlife, more fun stuff, more free-er and more warmer. More races of people too as the colonial Spaniards brought in Africans in the 19th century to work on the lowland rice and sugar farms. Apparently the high altitude indigenous people survived poorly as slave laborers at sea level.

              But mind you, make no mistake, much of Ecuador is a dirt poor third world country. I do mean dirt. We saw many towns and villages which didn’t have paved roads, electricity, or running water. The coast is especially poor and without infrastructure.

              Most expats seem to end up in Cuenca or Villacamba. I don’t know about Villacamba, but Cuenca is the most first world European style city in Ecuador. Very Euro feeling until you get out in the outskirts where it becomes third world Ecuador again. Cuenca is currently constructing a light rail system being installed by a French company, and they have the cleanest most first world water/sewer system in Ecuador. It’s also the most expensive city in Ecuador. We didn’t like Cuenca much. Too colonial.

              Potential N. American expats should consider that in case of some kind of Ecuador government/economic meltdown, ‘rich’ gringos could be considered a target of dislike. I would recommend that expats adopt as much of the native lifestyle as they can. I suspect that living in a high end condo or a gated golf community would be a bad mistake in the event that something goes wrong in the country.

              Luckily we are already poor, so we should fit right in.

          2. jrs

            so you wouldn’t want to go around doing any protesting near your retirement age. Or during your employment age for that matter either. Too many criminal background checks. Now sit down, bend over, and hope to get out of the country before it destroys the entire world.

    2. grayslady

      Also, in addition to what Keenan mentioned, most countries have health insurance policies for expats that provide the same benefits as locals receive for a modest annual amount. I read awhile back that in France, expats can purchase a policy for $2000 annually that provides everything French citizens receive in the way of medical care. A bare bones Medicare Parts A,B and D package here is going to cost at least $1400-$1500 dollars, so you are only an extra $500 or somewhat more above what you’d be paying here annually. Of course, western Europe is prohibitively expensive ever since the Euro was introduced, and Latin America is a no-go unless you speak Spanish. Still, there are options out there.

      1. Yves Smith

        The Euro is going to parity, so it isn’t as pricey as before….But getting into EU as a US retiree I suspect is not easy. Most advanced economies are pretty hostile to all but rich retirees as far as getting residence status is concerned.

      2. bmeisen

        If you’re thinking Germany you will not get onto a German health plan without registering as an alien. As part of registration they will want proof that you have health insurance. You can say you qualify for MC/MA and I imagine the authorities are ready for that and will give you a deadline for acquiring German insurance. As a non-refugee you would be forced to use the private option – Germany has a hybrid system composed of “public” and private insurers. Doctors get better compensation from the private plans which tend to use deductables and risk penalties. The vast majority of Germans use the “public” plans which have blind admissions, i.e. no risk penalites, and more stable pricing. You will not get on a public plan unless you get a job that provides health insurance or go on public relief but they won’t let you stay unless you can demonstrate that you are not going on public relief. Entering a private plan late in life, you can expect a premium at American levels.

  14. Dennis Byron

    You drew some incorrect conclusions and/or got some bad information from your anonymous correspondent although I am not sure the correct information would change your opinions about how bad Medicare is.

    1. Whether one chooses Original Medicare plus a supplement or Original Medicare plus Part C, you deal with intermediary “insurance plans.” If you do not like intermediary insurance plans, you cannot use Medicare. The advantage of Part C is that there is only one plan but with Original Medicare plus a supplement there could be as many as four or more plans involved (one for Part A and B, one for B Durable Medical Equipment, one for the supplement, one for the drug plan you are sure to want, and one for dental and/or vision and/or hearing and/or foreign travel. The good news is that depending on where you live, if you choose the supplement route, the multiple plans might all be from the same insurance company.
    2. Following up on the last sentence, this is not well publicized but all Parts of Medicare – plus Medigap – are administered by private insurance companies. If you have something against private insurance companies, you cannot use Medicare. (These same companies also sell Obamacare and Tricare and administer Medicaid and large group employee plans. Most even actually sell insurance. Some even sell fire and life insurance.)
    3. Everyone on Medicare is on Original Medicare. You cannot select either a private supplement or a public Part C Medicare Advantage health plan without first signing up for Original Medicare Parts A and B (and paying the A and B premiums; the A premium is typically prepaid by a lifetime of payroll taxes).
    4. Original Medicare has both gaps and many services it does not cover. Those are not the same things. The gaps are simply financial, including lifetime and per-incident limits on how much Medicare will pay on your behalf. The gap insurance might lengthen but not eliminate the lifetime and per-incident limits. And if Medicare does not cover a service, gap insurance won’t cover that service either (there are a few exceptions for travel insurance but none I know of for “some care Medicare doesn’t cover”)
    5. Original Medicare also does not have an annual out of pocket spend limit (unlike Obamacare insurance and most employer group insurance). All Part C Medicare Advantage plans have such a limit (amount differs but can be no higher than $6700). One or two gap plans not available in all states offer an annual out of pocket spend limit.
    6. The standard Medigap plans (I think there only 10) are not all available in all states and some states have different unique gap plans.
    7. You can get all the relevant “plan books” online. And yes, Medigap is totally regional (approved by the state) and Part C Medicare Advantage is effectively regional (approved by the Feds but different county by county). Be particularly careful if you live somewhere near a state line or even a county line.
    8. But apparently by “regional,” your correspondent is referring to the fact that most public Part C Medicare health plans are networked. That’s because they are mostly HMOs or PPOs, nothing to do with Medicare. But if you had an emergency out of your region and had to go to an obviously out of network provider, you would be covered as with all HMOs and PPOs.
    9. The correspondent’s description of how the Advantage billing process works varies plan to plan. My Advantage plan’s billing does not work the way he describes. Either the Advantage plan he or she considered is different or he or she is mixing up billing with the Medicare Summary Notice, a report about what happened that comes way after the fact to Advantage customers. But it is like Canada in the sense that all provincial plans are different. (As for his or her description of how the gap insurance billing process works, it is true that you might present both cards but I do not think the provider has to bill two different plans. I think the plans coordinate that for the provider.)
    10. Nothing to do with Medicare but how can your correspondent by on Medicare but worried about an early IRA withdrawal penalty??? I assume he or she is disabled and if that is the case a whole different set of rules apply. And the fact that he or she is paying $134 a month for Part B means he or she is rich (has a top 10% income); the premium is $105 a month for most of us and higher for the top 5%.
    11. I am not quite sure what a “neo-liberal rent seeker” is but yes, as I said in point 2 above, it is all the same insurance companies. They could care less which option you choose because they get 5% either way. I can choose a non-profit Part C plan in my country so at least the 5% stays in the state and might theoretically reduce my premium next year (actually happened this year; I was stunned but it was partially because they raised some co-pays).
    12. “Working ‘til you drop” might not help. Depending on the size of the company you work for, you could be forced onto Medicare anyways.
    13. The only place you could “die in a ditch in the tropics” using an AARP Medicare Supplement card is the American Virgin Islands or Hawaii (is Hawaii considered the tropics?)
    14. What the Medicare for All people really want is Medicaid for All but that phrase is a political non-starter
    15. Finally, we do not like being called “elders.”

    1. Yves Smith

      Thanks for the detail.

      On 12 and 13, Lambert is self employed, hence not on a corporate insurance plan and plans to be self insured as an expat in a country with low cost, high quality medical care. Ecuador fits the bill, and there are other candidates.

      On 15, I suspect that varies. You actually prefer being called a “senior citizen” or worse, “seniors”?

      1. Dennis Byron

        I think I have a good handle on senior-citizen preferences. Have you ever seen an ad that read “Bingo Wednesday at the Elder Center?”

        1. grayslady

          Totally agree. I have no problem being called a “senior” or a “senior citizen”. That’s what I am. The word “elder” or “elderly” implies infirmity; ditto for “aged”, “old aged” or other ratty synonyms.

      2. Code Name D

        Wouldn’t that be “senior consumer?”

        Ah heck, if you thought slavery was bad, try being just another commodity.

      3. Lambert Strether Post author

        The detail underlines the central point: The insane and obfuscatory system. I’m leaning more and more to the idea that privatizing Medicare was the testing ground for ObamaCare, and not vice versa (as I had thought).

    2. Lambert Strether Post author

      I prefer being called an “elder” to being called a “senior.” The one implies life experience, the other is one of those horrible euphemisms America is so good at inventing that to me translates to “gets a break at the movie theatre.”

  15. McWatt

    My 87 year old mother has Medicare with United Health Care Supplemental. She recently
    received this years copy of the United Health care booklet explaining the policy. It is 436 pages long.

    “They can do anything we can’t stop them from doing.” Catch-22 Heller

  16. Bunk McNulty

    From a friend who has been a Medicare consultant for many, many years:

    I didn’t read the whole thing, but he’s right about Medicare advantage and wrong about Supplements.
    Medicare Advantage plans are different everywhere, and there are as many benefit descriptions as there are companies that sell them, and many sell more than one option. They started as a giveaway to the insurance companies – they made a fortune on them – but now the feds are cracking down on reimbursement levels and so not all are making money.

    Medicare Supplements do just what they say – they supplement Medicare. In most states there are options, but they are prescribed options. Medicare Advantage plans can propose whatever benefits they want and as long as CMS approves them they can sell them. Not so with Supplements. Only a standard package can be sold. (Drugs are different – there are lots of drug packages out there as long as CMS approves the benefit design.) In Massachusetts only two supplements can be sold, because Mass was one of three states that regulated Medicare supplement coverage before the Feds started doing it and so Mass got a waiver from the feds. I think people are trying to get additional benefit designs approved, but I’m not up to date on that.

    Medicare was never designed to cover everything – remember, it doesn’t cover nursing homes and until recently didn’t cover outpatient prescription drugs. The premiums we pay for Medicare (PART A is free if you worked a certain number of quarters under social security) are based on a percentage of the cost. If Medicare costs go up, so do our premiums. And, if Medicare starts paying for additional services, or cuts back on something, if its still a covered benefit our supplemental premiums will go up.

    Another friend adds: “You were always supposed to pay a small portion of your costs. When Medicare first started, paying 20% wasn’t such a burden, because health care cost a lot less then. It costs a whole lot more now.”

    1. grayslady

      Another friend adds: “You were always supposed to pay a small portion of your costs. When Medicare first started, paying 20% wasn’t such a burden, because health care cost a lot less then. It costs a whole lot more now.”

      This. This is what is critical and why we need to demand that Medicare either pay for 100%, or that no out-of-pocket cost can exceed the costs of the treatment/procedure at the time Medicare was instituted. As an example, I had rhinoplasty back in the 1970s. Two nights in the hospital plus a top-notch surgeon cost $1200. The $1200 was not my co-pay–it was the total cost for everything. Since the operation was for a deviated septum, Blue Cross-Blue Shield insurance picked up 100%. Today, a 45-minute ride in a private ambulance costs $5000. Medical costs are simply out of control.

  17. bruno marr

    Interesting, informative comments all. My experience has been similar to many others. While Medicare has been less expensive than my previous state-funded (Nevada) health coverage, there is a steep and continuing learning curve with Medicare. Unfortunately the Open Enrollment period occurs around the seasonal holidays (Oct, Nov.) and staying current on Plan revisions takes time away from those seasonal activities.

    My biggest complaint with Medicare is the eternal “phone jail” one must endure to get a clarification response. (No email for these folks.). Another issue is it takes 90 days or more to get the provider billing statement from Medicare. A recent billing fiasco with a provider (whom I overpaid) took 11 months to resolve and get reimbursement. Paperwork and billing hassles seem to be never ending.

  18. W.A.N.

    Wasn’t Medicare Advantage established by Bush? It seems to me that any attempt by the liberals to reign in it’s costs is met with a conservative cry that they are stripping $700 from Medicare.

    1. Dennis Byron

      The term “Medicare Advantage” first appeared during the Bush administration. The program officially began under the name Choice Plus under President Clinton in 1997, loosely based on a proposal from a guy from Urban Insittute and a guy from Brookings. The concept had been demonstrated by Medicare since 1972

  19. Anon

    I think the following may qualify as to witnessing the Neoliberal Infestation of Medicare which you’re referring to. As someone who fairly recently qualified for SSDI (the process of which applying for was almost more traumatic than my significant health issue) and discovered that despite being accepted [1], it would take two years [2] before I would qualify for Medicare – i.e.: in many cases, the most expensive part of one’s treatment will not even be covered by Medicare. It will likely be covered by Medicaid, in which case many of the States, if you’re in your fifties, will hold a lien on anything you own for the full amount they reimbursed medical providers and “private-public” Medicare scoundrels.

    [1] Being accepted for SSDI, when so many with rightful health issues are stunningly turned down, was a double edged sword which I wholeheartedly believe had everything to due with the fact that my Social Security Pension would have paid out near double what my SSDI payments are and the creeps who preside over SSDI know fully well that the odds of my being able to go back to my prior vocation and earn a livable wage after the [and let alone my damning middle age] corporate employer snoopable IT Med Records indictment. “Heh,” speaking of my insane hope to be able to eventually go back to my ‘vocation,’ I received a soul crushing, fear inducing bot call a while back:

    This is a message about the Social Security Administration’s ticket to work and self-sufficiency program from NTI, a Social Security Contractor[!]. ….

    I would be trained to provide “customer service from my home.” Uh, lemma see wait for that vital “we’ll call back within 48 hours (and then it won’t be the doctor or nurse it will be the front desk who will failingly promise to have a nurse contact me within the next 48 hours), or[!], set up a minimum wage customer service center from my last place of solace, my humble dwelling; and likely ultimately get fired for taking the time to try to extract vital data from my Hospital.

    Have a peek at NTI, “Non Profit” Social Security Contractor, but only if you’re not already traumatized, by your own horrid circumstances:

    Looking to hire staff for your Virtual Contact Center?

    » Visit our Business Services Section

    You need a virtual workforce. We provide virtual contact center staffing.

    There are key advantages to using a virtual workforce of home-based employees to handle many business needs. You can obtain all the benefits of “going virtual” by working with NTI, whether you want to build up a virtual contact center or call center or tech support team. We solve the hardest problem that comes with building a virtual workforce: Staffing.

    By hiring through NTI, you can:

    Improve quality. We recruit, train, and monitor virtual employees who meet the demanding performance standards of employers like the IRS
    Keep costs low while maintaining quality by hiring nationwide
    Hire on-demand staff in response to seasonal and business needs
    Maintain customer satisfaction with American English speakers
    Qualify for unique tax credits of $2400 per individual hired

    [links removed – Anon]

    [2] I suspect the two year rule may not have always been applied, in which case it most likely falls under the Neoliberal Infestation you’re speaking to. To be honest I didn’t have the stomach to even research it (especially after I had discovered that the prick I shamefully voted for twice, let the Medicare Asset Liens take place on his watch over his cronies in crime) as: (a) it would not only make no difference for me, it would further increase my trauma about the hideous low lives who have been running things (b) If I wanted to protest to the powers that be, I would not be able to do it anonymously and may end up finding some chillingly hateful fuck pulling strings about my SSDI qualification despite my horrifying, incurable, billionaire creating disease.

  20. Ed S.


    I managed my mom’s financial affairs for several years before she passed away (@88 in the Summer of 2013). She lived in suburban Philadelphia and had her Part B supplement through Blue Cross and a Part D supplement through a BS/BC subsidiary. Combined cost was about $350 / month in the last year.

    Medicare covered 80% and the B supplement covered the remaining 20%. Prescriptions were a bit trickier but most were covered. She had numerous hospital stays in her final years — beyond a $150 annual co-pay she had NO out of pocket expenses from physicians or hospitals. And in those final years she’d regularly have 5 to 10 day hospital stays that ran regularly into 6 figures. She also had no problems finding physicians (now I will say that she had very long standing relationships with her providers so I can’t speak to taking new patients).

    The more general problem for most seniors is that the $350/month could be a serious financial burden. But beyond that expense, the coverage couldn’t have been more comprehensive (and as well as it should have been – she paid into Medicare for 30+ years).

    For all of the whining by physicians about “medicare doesn’t pay” — fine, then don’t take them. Unless they’re very specialized or have some “moat”, they’ll be out of business soon. Not everyone can deliver concierge medicine.

    1. Code Name D

      You don’t seem to grasp the situation here. Doctors are the ones not accepting Medicare Patents. Those on Medicare seem to have a problem in finding doctors who will accept their policies. Going out and “finding another doctor”, sort of misses the whole point.

      And doctors are increasingly in short supply. I live in Kansas and there are large chunks of the state don’t even have clinics, much less doctor who might reside in them. There are towns that used to have full hospitals with 24 hour emergency services have completely shuttered, even though the population it once served may have grown as well as aged, requiring more care. The next doctor could be several additional hours drive away.

      Now imagine this. On top of any issues you may have to deal with your medicare plan, you also have to drive several hundreds miles, get a hotel room for the night, see the doc the next day for your appointments that might take an hour, then drive back. If you’re lucky, you might be able to get one of your kids to drive you. If you are not lucky, you get to take an ambulance or medivac. Yay, try adding helicopter fuel and runway fees to your medical bills.

      And Kansas is hardly the worst with this problem.

  21. Keenan

    Kudos to Yves for coining the term “crapification” to capture the decay of various products, brands, services, institutions, etc. which, in an earlier time, set the standard of excellence that others aspired to emulate .

  22. Katniss Everdeen

    Both of my parents died in 2011. They had each been Medicare recipients for nearly two decades.

    I’m sure, as with ACA, experiences of Medicare recipients vary and will be well-chronicled here. Over twenty years, both of my parents got tangled up in supplemental/provider disputes and confounding paperwork more than once.

    But what I found most galling was the often overt disrespect accorded them as a result of their being Medicare patients. The universally acknowledged “inadequacy” of Medicare reimbursement apparently justified an inexcusably dismissive attitude on the part of “providers” that I came to think of as abusive. To this day it still infuriates me.

    On more than one occasion, after having gotten up very early for a morning appointment, they were left sitting in the waiting room ALL DAY, ignored by the front desk staff and too intimidated to demand that they be seen at their appointed time. And paying $30 for parking. By the time they WERE seen, they were hungry and exhausted but deferential, as always. Not exactly in a position to be the “informed ‘healthcare’ consumers” of free-market legend. The older they got, the more easily intimidated they became.

    I had to start going with them. Lambert’s “tax on time” writ large, which I paid, for no benefit except “peace of mind.” Just to get the receptionist to pay attention to her own appointment book. Interestingly enough, when I did raise a little hell in the crowded waiting room, my parents were “embarrassed.” The “doctor” wasn’t getting paid enough to see THEM after all. They had MEDICARE.

    The cardiologists and orthopedists were particularly frank. They never failed to mention that they were paid so little by Medicare that “they were considering not seeing Medicare patients anymore” because “it just wasn’t worth it.” My parents were alternately terrified at the thought of having to find a new doctor and deeply ashamed that, as far as these doctors were concerned, they might as well have been on “welfare.” Every once in awhile they let slip that a doctor willing to admit accepting a “cut-rate” fee might feel justified in providing a less-than-optimal service. It both nagged at them and made some sort of perverse sense.

    I always wondered what kind of “healer” would conduct him or herself in this shameful manner. If you don’t want to treat these patients, then DON’T. No one was twisting their arm. But with a quarter of the population soon to be Medicare patients, “discretion” may actually BE the better part of valor. Or the better part of a paycheck, “inadequate” though that paycheck may be. I never said a word. There’s only so much “embarrassment” eighty-year-olds in failing health can take.

    As you may be able to tell, I could go on. And on. But I’m sure you get the picture.

    The fact is that navigating the contracts and coming up with the cash to be “on Medicare” is only the beginning of the limbo that is Medicare. And it is limbo, not nirvana. Not quite “welfare” and definitely not “full fee.” There is clearly a larger price to be paid for the “relief” that is Medicare that cannot be measured in dollars and cents.

  23. Anon

    To (hopefully) clean my initial post up. Sorry, in my comment above, I hadn’t intended all the boldfacing (made an HTML code error) ; and, as specifically regards my last sentence in that first paragraph, had meant to specifically speak to “private-public” Medicaid scoundrels (versus “Medicare Scoundrels,” not that those same scoundrels aren’t also ”Medicare Scoundrels”. Odd, the original copy I pasted from to ‘post’ my comment shows that I used the word I intended, Medicaid, not Medicare):

    I think the following may qualify as to witnessing the Neoliberal Infestation of Medicare which you’re referring to. As someone who fairly recently qualified for SSDI (the process of which applying for was almost more traumatic than my significant health issue) and discovered that despite being accepted [1], it would take two years [2] before I would qualify for Medicare – i.e.: in many cases, the most expensive part of one’s treatment will not even be covered by Medicare. It will likely be covered by Medicaid, in which case many of the States, if you’re in your fifties, will hold a lien on anything you own for the full amount they reimbursed medical providers and “private-public” Medicaid scoundrels.

    [1] Being accepted for SSDI, when so many with rightful health issues are stunningly turned down, was a double edged sword which I wholeheartedly believe had everything to due with the fact that my Social Security Pension would have paid out near double what my SSDI payments are and the creeps who preside over SSDI know fully well that the odds of my being able to go back to my prior vocation and earn a livable wage after the [and let alone my damning middle age] corporate employer snoopable IT Med Records indictment. “Heh,” speaking of my insane hope to be able to eventually go back to my ‘vocation,’ I received a soul crushing, fear inducing bot call a while back:

    This is a message about the Social Security Administration’s ticket to work and self-sufficiency program from NTI, a Social Security Contractor[!]. ….

    I would be trained to provide “customer service from my home.” Uh, lemma see wait for that vital “we’ll call back within 48 hours (and then it won’t be the doctor or nurse it will be the front desk who will failingly promise to have a nurse contact me within the next 48 hours), or[!], set up a minimum wage customer service center from my last place of solace, my humble dwelling; and likely ultimately get fired for taking the time to try to extract vital data from my Hospital.

    Have a peek at NTI, “Non Profit” Social Security Contractor, but only if you’re not already traumatized, by your own horrid circumstances:

    Looking to hire staff for your Virtual Contact Center?

    » Visit our Business Services Section

    You need a virtual workforce. We provide virtual contact center staffing.

    There are key advantages to using a virtual workforce of home-based employees to handle many business needs. You can obtain all the benefits of “going virtual” by working with NTI, whether you want to build up a virtual contact center or call center or tech support team. We solve the hardest problem that comes with building a virtual workforce: Staffing.

    By hiring through NTI, you can:

    Improve quality. We recruit, train, and monitor virtual employees who meet the demanding performance standards of employers like the IRS
    Keep costs low while maintaining quality by hiring nationwide
    Hire on-demand staff in response to seasonal and business needs
    Maintain customer satisfaction with American English speakers
    Qualify for unique tax credits of $2400 per individual hired

    [links removed – Anon]

    [2] I suspect the two year rule may not have always been applied, in which case it most likely falls under the Neoliberal Infestation you’re speaking to. To be honest I didn’t have the stomach to even research it (especially after I had discovered that the prick I shamefully voted for twice, let the Medicare Asset Liens take place on his watch over his cronies in crime) as: (a) it would not only make no difference for me, it would further increase my trauma about the hideous low lives who have been running things (b) If I wanted to protest to the powers that be, I would not be able to do it anonymously and may end up finding some chillingly hateful fuck pulling strings about my SSDI qualification despite my horrifying, incurable, billionaire creating disease.

  24. dw

    medicare has been ruined by those wanted to do that. they dont like people getting health care.

  25. Wayne Harris

    One of the finer ironies of AARP, and the main reason I refuse to renew, is that its exclusive insurance carrier UnitedHealth is a member of ALEC, and UnitedHealth’s CEO Stephen Hemsley has been an active promoter of Fix the Debt. When push comes to shove AARP is more a marketing group than an advocacy group.

    I would echo what others have said about going with plain vanilla guvmint Medicare backed by a Medicap F policy. The coverages of F are mandated, so all you have to do is shop price. Here in North Carolina, the state provides a comparison page. I ended up going with USAA because it was just a few dollars a month more than the least expensive plan, and that is where I do my banking.

    So last year I had $105 deducted monthly from my Social Security check, paid $127 for Medigap F and another $27 monthly for Medicare D. I am fortunate to require only three generic meds (for cholesterol, BP and gout), and those are provided “free” as part of the $27 Medicare D premium. I pay dental out of pocket. I have so many crowns there is not much else that can go wrong.

    Last year I had cataract surgery, and Medicap picked up 100% of the copays. The big gotcha was the cost of the eye drops, which were basically not covered by Medicare D and cost $285. The cost would have been double that, but I opted to participate in a clinical trial on the second eye that made the drops free and paid me $500 for my trouble. (I wouldn’t do it again; based on the incredible irritation associated with the second recovery, I am pretty sure I was in the control group that got the placebo.)

    Counting the clinical trial’s $500 windfall, my total out of pocket last year was $3,874 – not great, but far better than my employer’s group plan, which cost $440 a month and featured gaping holes in its coverage.

    This is just for me. My wife, who is under 65 and suffers from MS, is a different story. She has Medicare A and B owing to her disability but is not eligible for Medigap because she is not 65. She does have D, but her duloxetine (generic Cymbalta) costs $60 a month under the plan. (It costs half that in Canada with NO plan.) And we would be liable for the full amounts not covered by Medicare were she to have a serious illness.

  26. Beth

    Sorry to be so late to post. Things I Wish I Had Known Before Going on Medicare

    Medicare Supp vs Advantage Plan: You chose one of these based on your risk tolerance and which doctors and hospitals are in the Advantage Plan. If you are lucky and your medical bills are light the Advantage Plan will probably do very well. However if you are unlucky and your medical bills are heavy, you will be happy that you didn’t cut corners with the less expensive Advantage Plan. If you decide on a Medicare Supplement Plan and are diagnosed with a rare disease you will want to be in a community rated plan to keep your rates lower. Some of the AARP United Healthcare plans are community rated.

    Folks, none of us can predict the future so select the Med Supp if at all possible. The Advantage Plans give you less expensive choices when you need medical care the most. One of my sisters, the healthiest in the family, was diagnosed with MDS a month before turning 65. I too was diagnosed with a rare disease one year after retiring.

    I too have an AARP United Healhcare plan and have not received any statements after receiving a letter two months ago stating that since I have moved, I may be assigned to a new plan. I HAVE NOT MOVED. When I phoned to ask about the letter, I was told that the letter was a mistake and my plan had not changed. I am frightened out of my gazoo since I have one periodic treatment that is far too expensive and puts me in the 1% of highest cost members. They have selected my name numerous times for special programs to get my costs down. I was diagnosed with a rare disease one year after starting Medicare and would not be eligible for treatment if I had been in an Advantage Plan.

    Note: You DO want to have your monthly payment taken out of your checking account. Many insurers require it. If the insurer sees a very large bill, they will suddenly decide you are not a member. By having the automatic payments, they cannot say your payment was late. Personal experience. They tried anyway.

    BTW there is a law that the company that provides my treatment drug cannot subsidize anyone on ANY government health insurance. So if someone’s private insurance pays 80% of the treatment costs, the drug co in this situation will subsidize your 20% if you prove you cannot afford it. Yet if you have Medicare w/ or w/o an Advantage Plan, they will not assist you. There is a law that says this. REALLY.

    You have heard that some doctors don’t accept Medicare. Most do, sort of. The way it works is this. A doctor decides how many Medicare patients s/he wants to allow per week. When you call in, the scheduler tells you that the first opening is in . . . 3 months. Three months after retiring, I needed surgery. It took three months to see the first doctor, then I decided not to have the surgery with that doctor, so waited two more months to get in to see another doctor.

    One more issue. My doctor ordered an MRI and told me which facility to go to. There is no question that this was medically necessary. Medicare did not pay. The facility refused to allow me to talk to anyone except a clerk who would tell me where to send the check. The facility refused to resubmit to Medicare. I confirmed with a doctor in another city who treats people with my disease that Medicare regularly pays for the MRI for his patients. Appealing to Medicare yourself is a lot of work and useless. YES, SUPERVISORS ALL COGNITIVELY CAPTURED. Please get preapproval from Medicare for everything. To have a procedure done, you must sign that you will pay if Medicare doesn’t. There is nothing that says the facility must fill out the paperwork correctly.

    The monthly cost of my Medicare supplement policy goes up 3x/yr.

  27. jim

    A number of times in my lurking on this site I have wanted to comment.

    I never succeeded in having a comment accepted.

    I got over that in time because I found that the existing commenters and staff would eventually cover my concerns. This site has perhaps the most intelligent and eloquent contributors of any site on the web.

    I had to jump into this subject because in July 2015 I will be eligible for Medicare.

    I find myself looking for answers. I volunteered for military service during the Vietnam war. Ignorant youth with a live forever attitude.

    After I left the military I fought my way up from poverty by using my brains instead of my back. Every corporation I ever worked for cheated me out of a job and retirement.

    Some of the small businesses treated me very well indeed but were in no position to offer a retirement plan.

    The SSA also diminished my retirement assets. There is no effective remedy for age discrimination. By the age of 53 I found myself unemployable. (This was partly due to the offshoring of high tech jobs)

    It is ludicrus to base SS benefits on a relatively good salary that could once buy a decent home and vehicle but is now chump change.

    Anyway I will be recieving about 7200 annualy in SS benefits. Yes that is in the USA in american dollars.

    In the last month companies have spent in my estimate about $100 sending me unsolicited snail mail asking me to consider their insurance. One company even offered me a free steak dinner for showing up for their seminar.

    Prior to reaching medicare age I have recieved excellent care from the Durham NC va clinics and hospital. In spite of the fact that it is a 120 mile 3 hour drive one way I am very satisfied with the care. I’ve already figured out that I will not recieve the care that the wealthy routinely expect but neither will I die from neglect.

    My question for folks with experience in these matters is do I need to worry about medicare parts 0-? or am I good to go with VA and medicare basic.


    1. Carla

      jim, so glad your comment got posted and welcome to what Yves calls the NC “commentariat!”

      Although I have no direct experience with the VA, from the fair amount I have read about the U.S. health care non-system over the years, you would do better sticking with the VA than going on Medicare, if you can. But it’s worth considering that the distance to the VA facility may become more of an issue for you as time goes on.

      Good luck!

  28. Anon

    (hope this isn’t a duplicate post, but upon first post it didn’t appear that the post completed)

    Huh? One of the most unfair features of ObamaCare is random variations in coverage by jurisdiction (see here, here, here, here, here, and here). Is this guy telling me the same is true of Medicare, supposedly a national program? Readers?

    Like Federally Mandated Unemployment Income: States and possibly, to some extent, even counties, etc. (dependent on your particular State’s hierarchy structure), are allowed to “fine tune” Federal Safety Net Mandates, such as Medicare and Medicaid.

    Further, if one doesn’t ‘do their homework’ (and, even when one does, many Government employees are thoroughly under resourced and ill informed and may give you very bad information, happened to me and almost ended up sticking me with a significant bill I couldn’t have possibly paid), they can end up in a horrid situation.

  29. jackiebass

    I’m 72 and have been on medicare for 8 years. My former employer provides my supplementary coverage. The supplemental pays everything that medicare doesn’t cover including my deductable. I pay 20% for drugs but the out of pocket cap is $1000. In my area all doctors and hospitals accept medicare so I guess I’m lucky. I have to pay a $10 copay for an office visit. For me things are about to change. My former employer is trying to force people into a medicare advantage plan. Something I don’t want to do because I’m very satisfied with what I presently have. Also these plans impose limits. Every fall I get the book from medicare listing all of my options if I wish to change my plan. I’m a college graduate with a masters degree and I find it impossible for me to understand and compare the various options. Only a professional consultant is able to help you make an educated decision about what would serve you best. Where I live and I’m sure elsewhere health care is drastically changing. For one thing doctors are quitting their practice and becoming an employee of one of the two health care corporations in our area. This is affecting the quality of care. Now when you go to your doctor he only has 15 minuets to see you. If you are hospitalized your doctor doesn’t care for you. Instead you are assigned a staff doctor and my experience is that the staff doctor doesn’t communicate with your primary care doctor about your care. This results in less quality of car in my opinion. I think this is all by design to get ready for the rush of baby boomers. To solve the problem of too many old people you need to reduce the number of old people. This can be accomplished by having old people die sooner. One way to do this is to have health care quality reduced. I believe that is exactly what is happening now.

  30. Carl

    I’m too young to comment on the issues here, but just wanted to point out how unreal most of these medical “costs” are. When I broke my leg in a vehicle accident last year, the raw medical bills for a three day stay in the hospital including ER trauma and surgery, were 96K or so. When my “insurance” got through with it, and if I recall, paid mostly nothing, the final bill to me was 4k. In the recent past, this ratio of sticker price to final bill has been similar. So what, if anything, do these “costs” have to do with reality? What does a procedure actually cost in this system? I say this because it seems most of the comments here contain an assumption of legitimacy regarding those costs. I suppose it’s one of the weird features of this corrupt system.

  31. phemfrog

    I can attest to many of the problems above. I helped my grandparents and now my parents with these very issues. My parents, luckily, have their supplemental insurance paid for by my dad’s former employer. My mother-in-law is not so lucky.

    How about this situation:
    She has been living in the US as a permantent resident for 8 years. Working LEGALLY for 6. She is now in process to become a citizen. She is 68. Having only worked 6 years, she has not earned enough credits to qualify for Part A Medicare for no premium. You need 10 years (40 credits) work for that. The monthly for part A would be $450/month. She does qualify for Part B (and pays the $110 per month permium). As a relatviely recent immigrant, she was not nnotified of Medicare when she was 64 (like my parents were). So she missed her initial signup and wasnt able to start until age 66. So she pays a PERMANENT penalty of $15/month, making her real bill $125. So IF she wanted A + B, that would be ~$575 per month in premiums only. That does not include the 20% and the other out of pocket costs. Because she is over 65, she does not qualify for ANY private insurance plans or Obamacare plans. She only qualifies for Medicare and any private Medicare-associated plans. As long as she is healthy and independent, she works and makes too much ( a whole $13000/year) to qualify for Medicaid. Only if her income drops below ~$900 per month can she qualify for any State (TX) assistance with her Medicare expenses. That amount is so low that she could no longer afford her apartment and car, so she couldnt work. So she has no options if she needs inpatient care. She will be bankrupt i guess…

    This seems like an unlikely situation, but if we are looking at immigration policy changes, a situation like this could become much more common. The PPACA did not address this at all. There is this huge gap for anyone with less than 10 years work experience.

  32. Gordon Cook

    Medicare advantage used to be a way to insure against the prospect of being billed 20% for a multi-tens of thousands of dollars hospital stay. The Medicare advantage insurer that you sign up with receives every year about $7000 a year from US Medicare — it may be more I don’t think it’s less — to encourage it to become your insurer. If you sign up with Blue Cross, Blue Cross not Medicare is the source of payment for your healthcare expenses. The same thing for Aetna or United healthcare’s deal with AARP. So yes this is privatized medicare and on an individual basis does or at least seems to provide more for less out-of-pocket expense. This now is changing and I expect there will be a calculation to be made when one goes with Medicare alone and prays.

    I have always opted for HMO. Even when as a self-employed independent contractor I was spending 25% of my annual income on insurance before I turned 65 in 2008. If I could get coverage for less than $1200 a month for my wife and myself I considered that Good.

    A few years back I signed up with the AARP United healthcare plan. I mean like they offered a zero dollar a month premium. Seemed like a really good deal. Except if I wanted to see a specialist I would have to travel from the border of Trenton New Jersey within eyesight of Pennsylvania all the way to Manhattan.

    Could I see an orthopod or neurologist in Philadelphia? absolutely not. Philadelphia was not in network. In fact the only neurologist I could see worked out of the worst hospital in Trenton New Jersey misdiagnosed me, left me with $700 of unpaid bills in addition to specialist co-pays for every visit. The only in network hospital under this plan was also the oldest and the one with the worst record in Mercer County. They bulled United healthcare about $25,000 for tests that a year later were redone at the University of Pennsylvania Department of neurology which illed them 1/10 the amount. I learned too late that I needed to find out in advance whether I would have a liability for the test beyond that of my $35-$50 co-pay.

    New Jersey Blue Cross Blue Shield offered an HMO two years ago with a zero dollar per month premium with a $350 deductible for all part D drugs. Co-pays went from $15 to 30 a primary physician visit and from $35-$50 for a specialist. Every physical therapist visit carried the $50 co-pay.

    In summer of 2013 I got a phone call inquiring if I wanted to participate in senior citizen Medicare research a two-hour meeting for which I would be paid $150 in cash. I accepted. Lo and behold as far as I could tell the sponsor was Blue Cross Blue Shield although they hid their effort behind the guise of a Princeton consulting company. At any rate we were shown a video on the advantage of turning a Medicare HMO into Medigap and it explained what Medigap was. In theory something to cover what Medicare did not cover. But in fact with a hefty monthly premium and as I calculated that it would’ve turned the charge for a visit to my primary physician from $30 to over $100. Not surprisingly I said I would not buy such a product. I think most other people said the same although we were interviewed privately one-on-one. They handed me three $50 crisp bills at the end of about an hour and 45 minutes and said you’re free to go thank you very much.

    Two months later horizon withdrew its HMO Medicare advantage plan and offered a Medigap oriented one with the premium which was instead of zero dollars a month – now 123 a month. Talk about sticker shock. My wife and I switched to Aetna which charged a monthly premium of “only” $68 each. But in other respects was similar to the plan that Horizon Blue Cross withdrew. We signed on for that. Of course the hospitalization part is there as well. in 2008 I think it was $150 co-pay per night with a maximum of five nights after which things were completely covered but every year that co-pay went up by about $25 a day and when in late November 2013 I had a lumbar spinal decompression L1 through S1 and fusion L4 through S one with two surgeons a neurosurgeon and an orthopod…. Surgery that has left me worse off after than before. That experience was billled by the providers at about $225,000. I think the insurance company paid them about 65,000. My per night co-pay was 250 and night and I stayed five days. Four 2015 the per day co-pay is $300.

    Add it 2013 I had an MRI of my lumbar spine that cost me the specialist visit of $50. At the end of 2014 I had another MRI to see the outcome of the surgery 11 months earlier that cost me $135. In this case the cost was the medicare cost. They pay 80% I pay 20% . The very reason for spending money on Medicare advantage to begin with. And procedure by procedure apparently they are getting away with turning plain-vanilla co-pays into an 80% 20% formula. that is what stuck me a couple of years ago with AARP United healthcare.

    Now we come to the rates for 2015. The Aetna policy went down from 68 to 38 month. And the Blue Cross Blue Shield from the hundred and 23 to 68. But Aetna roughly tripled or quadrupled required co-pays for part D prescription drugs. What had cost six dollars a month now is 18. And what leaves me most disgusted is that they have decided to discriminate in their formulary against two inexpensive generics, pantoprazole and glyburide. Celebrx is no longer covered at any price so my primary – a really good man I’ve had for 20 years suggested I buy ramitadine at three dollars for one month supply commercially… aetna wanted 12 and he then prescribed nabumentol an anti inflammatory similar to naproxen, something that I have taken for a decade but have developed stomach ulcers from….a known risk The ranitidine is a prophylactic against the acidity.

    But finally listen to this… My wife had been on glyburide to manage her diabetes. In 2014 they covered it with no problems. For 2015 they refused to cover because of undesirable side effects. My wife was fully informed as to what these were and was not suffering from any. But her physician was forced to fill out no less than three appeals to get them to provide her glyburide. And then when finally it was theoretically straightened out the per monthly co-pay was no longer six dollars but rather $18. And to add insult to injury we found out that CVS as do many other pharmacies as a generic discount program where if you pay them a one time fee per year of $15 they will provide her monthly glyburide for 4 dollars month. Note this is a private transaction. Aetna pays nothing Medicare pays nothing and we pay 100%. And her primary physician well over worked was needlessly forced to fill out extra paperwork on three different occasions.

    So yes it’s a horror show and gets worse every year. And companies like Aetna get more and more intrusive calling to inform us of membership meetings in our area where they glad to answer questions. Calling to ask my wife to have a free home check out my visiting nurse to make sure her diabetes management is okay. It is okay. She is extremely conscientious. But can we turn off these calls? no.

    So we are learning as with everything under predatory American capitalism better take out the magnifying glass and read all the fine print very carefully. And under the HMO kind of plan options are getting less and less and less. And oh yes the Aetna billing that is sent every month that details what the plan paid what it didn’t pay what my obligations are blah blah blah damn near requires a tax accountant to interpret.

    So there you are another example of Obama’s gift to the profit-making health insurance industry. My feeling is that the citizen in the United States is no longer free and independent. He or she is a commodity to be used as a resource by private industry to extract profits be they subsidized or not.

  33. TarheelDem

    Here’s the gappy in both Medicare and Obamacare: state insurance regulators, who monitor the plans in their states. But the base nationwide gaps are the co-pays and deductibles, the failure to provide dental coverage, and the failure to provide vision coverage. All of the -gap and -advantage plans are various ways of dealing with those three gaps in base A and B. And then, seniors are charged a premium for base B that is deducted from their Social Security direct deposits. And it runs around $100 a month.

  34. Anonymous II

    “Personally, I believe that shuffleboard is a death sentence, so I would prefer to work ’til I drop.” Sounds like a plan for me. Given all of the holes in Medicare, and then the high cost of filling in the holes (about $350/ for me, plus the cost of Part D copays) it’s not worthwhile even looking at retirement.
    1. The Medicare Advantage plans were a way of shifting wealth from the medicare eligible folks to the insurance companies.
    2. The same is true for the Medicare supplemental plans (that pick up the coinsurance and deductible amounts); but those plans themselves have holes in them so the patchwork of plans leaves retirees making little $20 contributions to their favorite insurance carrier.
    3. The same is true for Part D plans which are often morphed into the Medicare Advantage plans.
    4.Big Pharma is a huge beneficiary of all of the above of course.

  35. Anon

    My mom is now paying $800 plus monthly for her supplemental 20% Blue Cross Plan [no weight, smoking or alcohol issues involved in that obscene price tag (for anyone looking to finger wag!)], which she’s had for at least two decades, and is no longer being offered because it actually offered very good, obscenely priced at this point though, coverage.

    I don’t even want to consider what would have happened if she hadn’t been lucky enough to have found now near extinct senior housing based on income.

    She qualified for Medicaid years ago, but I suspect that: Totally undeserved [Bipartisan] Political Medicaid Recipient contempt; Medicaid having an immediate lien on her few remaining ‘assets’ and not allowing her to leave more then $1,500 for her funeral expenses; and having to beg for the option to take a name brand med when its generic substitute is loaded with toxic fillers; are the reasons she refuses, to this day, to consider the Medicaid option.

    The “United States” Corp/Government [Fascism at this point] is hideously BARBARIC.

  36. Anon


    Thanks for the reminder of Medicare’s barbaric:

    failure to provide [much needed] dental coverage, and the failure to provide vision coverage.


    Who doesn’t remember how excruciatingly painful (and, as it’s come to be revealed, POTENTIALLY deadly) tooth/gum problems can be, and who – with sight – can’t imagine what a nightmare losing their ability to see, while attempting to survive in an increasingly physically isolated from other humans, automated, and unaffordable world, might be?

  37. Anon

    Sounds like there is a lot of pent-up desire to comment on Medicare…

    Since people are still commenting today on a post that went up on March 10.

    I’ll bet the comments above are a dust mote on an iceberg, since there are millions reliant on Medicare/Medicaid (at least 14%+ percent of the US) with no computer access, and, millions of terminally ill computer owning citizens in fear of having their “benefits” denied if they too harshly (to the bone) criticize their faux corp/gov ‘benefactors.’

  38. Gordon Cook

    Hi lambert I noted with interest your remark about Ecuador,

    a year ago I wasted about three full months of my time as an outside consultant to suggest a telecom policy that would befit a new regime that the Correa administration was allegedly interested in. This project was run by the Peer to Peer foundation, whose head I knew and trusted until I found out that he had jumped into the middle of what turned out to be a fraudulent operation.

    All I can say is be careful of Ecuador. The country is deeply in debt, strongly tied to Chinese loans, heavily dependent on resource extraction and Correa’s policies toward the indigenous peoples of the Amazon are absolutely horrendous. when I started my involvement with the project I had no idea of the reality. I published the first issue devoted to Ecuador last May 1. the project blew up immediately thereafter and on July 1 I published a second issue. well documented. both these issues can be downloaded from my website. just Google Cook report Ecuador — I just checked in those three words will get you what you want. Do grab the pdf that came up in my search at least as the first link. all the people involved with the Commons project it turned out worse Spanish citizens not even from Ecuador. and it was all a fraud despite the P2P foundations claims that it was a smashing success. I see that i should be able to provide a link for the report. Hope this works. This is only my 3rd ever reply here. There was enough outrage in Ecuador that a small team of people volunteered to translate my executive summary into Spanish! It iteself was 7,000 words long.

    On Ecuador it may be instructive to check with Bill Black- yes our Bill Black author of the Best Way to Rob a Bank is to Own One. I met him in person for lunch in Kansas City in June of last year. told him of my Ecuadorian experience, gave him copies of my issues on Ecuador and urged him to be careful if he decided to accept the invitation from IAEN – the institiute where the FLOK project that defrauded me was located. He has accepted it and i really wish him luck.

    Vision and dental

    from my experience so-called Medicare advantage plans did include a complimentary vision check once a year. now it seems that a visit to the eye doctor costs a specialist co-pay $50. last year I had cataract surgery on both eyes at a cost of $300 per – surgical outpatient co-pay of $300 per visit. the people I went to managed add-on costs by telling me that the tail end of the procedure would cost me $600. actually when the bill came in they charged me 627. and they said oh sorry Aetna didn’t fully cover one of our charges. well they knew precisely what insurance I had an supposedly checked in advance and still misinformed me. I’ve given them hell about that – they immediately threatened a collection agency- for $27 mind you….. I paid it down to about seven dollars in four installments.

    They also told me I had glaucoma because my eye pressure in one I was 31. treated that for six weeks before the proceedure at an additional cost of nearly 200 before telling me post cataract: oh lucky you you don’t have glaucoma after all. apparently it was the size the cataracts that was causing the increased pressure.

    Dentistry for me is now turning into an additional horror story. I had gone to the same dentist for 20 years whom one year ago went into practice with a colleague….. and lo and behold I found out too late in January of this year, that his practice was now part of the dental chain. and that his charges had doubled or tripled.. that the 10% discount he offered senior citizens was dead. and that the cost for the repair of the mollar would be only $2860. I had them do an extraction. which cost me 290. double what he had charged as a solo practioner in 2013.

    I have been looking for a replacement dentist. and have found so far that general practitioners now seem to be unwilling to do root canals are extractions and refer their patients to specialists….. lord help us all!!!

  39. jayteees

    American physician here. Medicare physician reimbursement rates have generally been falling for many years. And given the cost to run a practice with employees, many physicians don’t take medicare because they would lose money on every patient if they did. This is one reason why private practice medicine is dying and physicians are once again becoming employees of large hospital organizations.

    Physicians are generally not happy with the direction healthcare has gone in the US. What angers many doctors is that for each clinical encounter (physician-patient) that occurs, there are 100-200 administrative encounters that occur within the giant bureaucracy (hospitals, accreditation organizations, insurance providers, medicare, medicaid, legal consultants, business consultants, etc.) that try to micromanage clinical behavior for administrative outcomes. If you are looking at why healthcare is so expensive, you have to consider those 100-200 administrative encounters you are paying for with each clinical encounter.

    Obamacare was a general government subsidization and legitimization of that giant morass of administrative encounters.

  40. Gordon Cook

    I just read through this entire body of comments. Whew!!!

    I would like to ask one question in hopes that someone might have an answer. I am still working and STILL paying the full FICA load of about 14%. everyfall like november december until last fall 2014. I would get a notice saying something like in view of your continued contribution to social security your basic monthly social security payment will increase by the amount would vary but it would be somewhere between $20 and 30 dollars per month. This would be in addition to the COLA. In january of this year i received a monthly COLA of 34 dollars and no still working and paying INTO FICA benefit. I paid about $4000 into fica last year.

    what happened? Did they cancel it?

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