Medicare Blues

As I approach 65, I have Medicare in my future. The more I learn about it, the more I want to become an expat. Because Medicare is a horribly complex and half privatized, it’s a sign of Stockholm Syndrome that Medicare for All is the preferred branding for single payer when Medicare is no such thing. The reason that many look favorably upon Medicare is they have crap coverage now, say no insurance at all, a non-subsidized Obamacare plan (often meaning high premiums and high deductibles) or a not-very-good corporate plan (I know a big Pharma exec who reports that Obamacare will be an improvement on his company’s insurance). In other words, Medicare looking less bad is simply another proof of how crappy our health care, or more accurately, health insurance system is.

I am particularly dreading going on Medicare because I am in the microscopically small minority that has good and cheap private insurance. Some are lucky in love, some are lucky with investments, yours truly is lucky with insurance.

My insurance is a legacy policy. It’s a plan from the late 1980s. What was a mediocre plan then looks gold plated now, particularly it being an indemnity plan, which means I am not in an HMO or PPO. I can see any doctor in the world, no GP gatekeeping, and have submitted claims from the UK, Australia, and Thailand.

Rather than an overview, which I hope to eventually be able to produce, we’ll be tackling Medicare more deductively, working through issues and cases and hopefully to some bigger observations. So we’ll only set forth a few of the major features and then describe issues.

Medicare consists of a dizzying number of parts: Medicare A, which is hospital coverage. Proponents like to say it’s free if you’ve paid Medicare taxes for 40 quarters but it isn’t, since you are pretty much obligated to sign up for Medicare Part B (doctors outside hospitals) and Part D (drugs) because the penalties for joining Medicare B after you have started with Medicare A are draconian, and not having drug coverage if you take any is generally not a hot idea. So unless you are rich enough to be confident you can afford concierge services or pay out of pocket, you’ll wind up needing to pay for Part B and Part D coverage. Oh, and Medicare A is so skimpy that it’s preferable if you can afford it to buy a private Medigap policy too.

You can’t opt out of Medicare unless you give up your Social Security too. From E-Health Medicare:

In fact, if you don’t pay a premium for Part A, you cannot refuse or “opt out” of this coverage unless you also give up your Social Security or Railroad Retirement Board benefits. You’d also have to pay back your previous benefits to the government.

The only exception is you may be able to delay starting Medicare until after you are 65 if you are in an employer group health plan.

Let us look at some of the issues regarding Medicare.

Some doctors don’t take Medicare. Despite the efforts of some Medicare defender to deny it, it’s. None of my current physicians accept Medicare, while my current insurance covers them. I don’t look forward to having to find new doctors, particularly through the confines of an HMO or PPO, where I will be subject to its gatekeeping and won’t be able to go freely to specialists.

One of my friends plans to leave New York at 65, and the timing is driven by Medicare. None of her current doctors will take it. Rather than pay for them fully out of pocket, or have to get new NYC doctors (and she does not like the look of the choices), she will move to a biggish city in Flyover that had a good medical center and sign up for its HMO via Medicare Part B.

Having Medicare can seriously impede procuring medical services. Medicare prohibits medical providers who accept Medicare to take direct payment from patients for “covered services”. Note that most private plans allow patients to “self” or “cash” pay and then submit for reimbursement. 1

Medicare has made it virtually impossible for me to get a nurse out to draw blood from my mother to get it tested. I spent a full three months at it with no success, contacting five different services, and only recently understood what the obstacle was.

For an annual MD exam, the bloodwork is arguably the most important single set of inputs. My mother’s doctor is in an enormous clinic that is difficult for her and me to navigate; it’s a lot to ask an aide to do what would in the end be close to half a mile of wheelchair pushing to get her to the test area and then to her doctor and then back to the car. Plus with Covid, why should she get risk getting infected by coming in when the clinic’s nurses are working remotely?

Her doctor did a telephone check up (telephone as telemedicine is acceptable under Medicare) and clearly still wanted her to come in for a blood test (he is very controlling). I finally got him to understand “no is no”. His nurse, who was not willing to put much effort into contacting private nursing services, rang up one that this clinic deals with, and which at one time sent out some physical therapists for my mother.

The nurse e-mailed to say that the nursing agency would not do a blood draw. I said we’d be willing to pay directly. I was told we could not do that.

I then tried calling two other agencies on my own. Both said they would not take a direct payment from or on behalf of a patient. The fourth said that there a way to code the visit as skilled nursing and include other tasks, like assessing my mother for physical therapy, and the blood draw could be bundled into that. She said she would talk to the doctor’s nurse about that. I thought we had this worked out, only to have this agency call back and say they didn’t take my mother’s Medicare Advantage plan, and they wouldn’t let her direct pay either.

The next route was that one of my mother’s home health care agencies had a nurse with a phlebotomy license. Note that home health care agencies often don’t provide medical services, only home aide services, and so the only insurance they might take is a long-term care policy, not Medicare. I thought we had worked out a price and that agency’s nurse was to call the doctor’s nurse to determine when she could pick up and drop off the vials. I heard nothing and called the agency. That nurse had quit and they didn’t have anyone else qualified.

I then tried calling a nurse I knew at one of the local hospitals to see if she had any friends who could do this on a private duty basis. No luck.

Then my mother went to the ER on a false alarm, so she got bloodwork plus poked and prodded and was given a clean bill of health.

When I grumbled to my doctor in New York about this mess, she said it was probably because it was considered Medicare fraud for a Medicare provider to take a direct payment from a Medicare patient rather than billing CMS.

Only then did it occur to me to go poking around, since no one I had dealt with even hinted that my difficulties came from Medicare, as opposed to weird policies of medical organizations run by MBA beancounters (like the one discussed last week, which insisted on taking a copy of my driver’s license, as opposed to just having a look to verify my identity, to take an image, even though I had already paid for the service via credit card and hence there was no insurance fraud risk). My assumption had been that these nursing agencies must have decided that self pay customers were too few in number to bother serving.

Nope. From under Home health services. See the bold and italicized gotcha!:

How often is it covered?

Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) cover eligible home health services like these:

Part-time or “intermittent” skilled nursing care
Physical therapy
Occupational therapy
Speech-language pathology services
Medical social services
Part-time or intermittent home health aide services (personal hands-on care)
Injectible osteoporosis drugs for women…

Who’s eligible?

All people with Part A and/or Part B who meet all of these conditions are covered:

You must be under the care of a doctor, and you must be getting services under a plan of care created and reviewed regularly by a doctor.

You must need, and a doctor must certify that you need, one or more of these:

Intermittent skilled nursing care (other than drawing blood)
Physical therapy, speech-language pathology, or continued occupational therapy services.

These services are covered only when the services are specific, safe and an effective treatment for your condition. The amount, frequency and time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively. To be eligible, either: 1) your condition must be expected to improve in a reasonable and generally predictable period of time, or 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition, or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition. The home health agency caring for you is approved by Medicare (Medicare certified).
You must be homebound, and a doctor must certify that you’re homebound.

You have to be so “homebound” that you pretty much never leave (for church is OK though). So that works, but you can see that a blood draw is specifically disallowed! That seems bizarre since some meds, like the anti-stroke Coumadin, require very vigilant monitoring of blood levels, meaning monthly or more frequent blood tests.

But the fact that bloodwork is explicitly disallowed would make it a non-covered service, and thus legal for a Medicare provider to take a direct payment for it. But none of the nursing agencies I could find would even consider the question.

Honestly, if I weren’t needle-phobic, this would be enough to make me get a phlebotomy license, so as to never have to deal with this run-around.

Medicare is a huge tax on time. I am regularly working in a room with Old People TV on (ME TV and Ion, which has crime shows). The drug company ads were displaced in the last month with close to non-stop Medicare ads urging oldsters to call to “review” their benefits with “no obligation” to see if they might qualify for a cheaper/better plan. As readers pointed out:

Jeremy Grimm
December 7, 2020 at 9:08 am

And every year you have to re-examine all your policies to see how they’ve changed and compare with other similar policies as the relative prices for policies shift around.

December 7, 2020 at 11:46 am


You have to check your part D plan each year to see what drugs are covered (or not covered).

When picking a plan, you have to decide what drugs you MIGHT need, whether they are on the formulary or not, and what tier they are in.

And the formulary can change at any time.

I cannot believe the time tax we have paid looking into all of this.

juno mas
December 7, 2020 at 1:13 pm

The tax on ones time goes beyond research. There is the interminable “phone time” waiting to connect with a Plan representative. I’ve spent HOURS waiting to talk to someone who knows anything substantive about the various plans. This year I simply let last years Plan roll over, so as not to have to endure this tax on my time!

But hey, neoliberalism says shopping is fun and a consumer benefit. So we all have to get with the program, right?


1 I do this mainly for privacy and not economic reasons, since my insurer’s right to have access to my records is much weaker when I pay for services than when the doctor or lab bills them. I have found that the “cash pay” rate is often better than my insurer’s best negotiated rate, and so my co-pay kicks off of that. Since I am not in a HMO or PPO with my insurer, it looks like a violation of the insurer’s contract with the doctor to force a network discount on them when they aren’t entitled to it. I’ve pointed this out to my doctors who’ve been subject to it (as in having me pay their cash price and then having my insurer they need to reimburse or credit me for some of it) but they spend so much time fighting with insurers already that they don’t seem to have the strength for it, and my taking it up with the state regulator years back got nowhere

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  1. Amfortas the hippie

    interesting and depressing.
    i’ve never had health insurance…but i was on medicaid, via SSI, for about 6 years.
    remarkably…and based on conversations on NC in just the last few days…medicaid appears much better than medicare. I had always assumed that the opposite was the case, and have looked forward to getting on medicare(11 years to go, i think–i’m 51)
    medicaid has it’s issues…like increasing numbers of doctors not taking new medicaid patients(my regular doctor said that if i had been a new patient when i finally obtained medicaid, that he wouldn’t have taken me)…and specialists are even worse(not a single ankle guy in texas takes medicaid, including the 35 or so listed on the bit of paper given me by my medicaid ‘provider”…i cold called all the rest)
    but it sounds like medicare is even worse.
    …and not being able to pay cash, and not being able to opt out…and with all these flaming hoops…well, what have i been paying for out of every paycheck all these years?
    more importantly, why do the masses continue to submit?
    is it because it’s been crapified incrementally?
    no alternative?
    or are we all just beaten dogs, hiding under the end table?

    i’ve essentially given up on ever having healthcare again, aside from routine things i can pay for(with money, eggs or fresh green beans(I love my regular doctor))….anything more than that may as well not exist, as far as i’m concerned.
    I had sort of high hopes for medicare, but not any more.
    back when i was waiting for a hip(6 1/2 years), in desperation, i considered robbing a bank, stealing a boat, and going to cuba for my hip(and ankle)…the “medical tourism”(run out of canada) was even out of reach.
    i suppose that’s teh last resort, still, for anything really large and serious.

    I hope the bosses enjoy their yachts and mansions gained from this rapine and plunder…perhaps it will comfort them when the hoi polloi have finally had enough, and the lamp post looms.
    Thanks, Yves, for filling out the terribleness,lol.
    clarifying, indeed.

    1. jackiebass

      Medicaid like Medicare is health insurance. You need to be 65 to be on Medicare so at 51 it will be 14 years before you can get Medicare. The exception is if you are disabled. Then after 1 year on disability you are eligible for Medicare.

      1. Selwyn

        You must be disabled for two years after being on Medicaid for disability, not just being impoverished, before Medicare MIGHT kick in – which means you have enough full time work credits (quarters) to get Medicare before 65 years of age.

  2. Cocomaan

    Your mother’s blood draw story is incredibly aggravating. I had a blood pressure spike reading it.

    Some are lucky in love, some are lucky with investments, yours truly is lucky with insurance.

    I was laughing out loud reading this on my phone this morning, thank you.

    1. hoonose

      My wife’s experience was aggravating as well. We both had Covid back in March. Nearly killed her as the virus turned off her stem cell transplant. So after hospital discharge she needed frequent blood draws. But with her recent Covid, no one wanted her in the labs. And due to her immune system she should not travel. In a small town, and me being a doc, I did find a nurse to come in and do the blood draws. As I recall $30 a pop. But after 4 tries, no Obamacare coverage for the >$500 bills.

  3. jackiebass

    I’m 79 and have been covered by Traditional Medicare Part A and B. since I became 65. My wife is also covered by medicare. Our drug plan is through our supplemental policy. We have a supplemental policy that picks up most of what Medicare doesn’t pay for like copays and deductibles. Mt wife has serious health problems and has been in hospital several times. It seems like she is always going to a doctors appointment. We have never had a problem with medicare but our private insurance is a different story. They deny treatment or don’t pay for out of network services. Where we live in upstate NY we have never found a doctor that refuses to accept Medicare. I think it depends where you live on how good your medicare is. We are fortunate to live in an area where Medicare is good. It does have it’s short falls. One being long term care limited to 100 days per year. Home health care is another story. Private providers are poor and undependable. The exception is if you are lucky enough to be able to get the county health department to serve you. Another weakness in medicare is after a hospital stay rehab services in a skilled nursing facility. You don’t have much choice. You need to go where you are accepted to to go and not necessarily where you wish to go. I think the reason for Medicare being accepted where I live is because all providers are employees of one of the two health care systems. I suspect Medicare is a lot like the VA. Where it is located determines quality. We really need a one payer universal coverage system like Canada or other foreign countries. I know in rural Canada the elderly person we rented a cottage from receiver in home care water being hospitalized. In the US that won’t happen.

    1. ChiGal in Carolina

      Many factors go into which nursing home accepts which patient, but Medicare is not one of them—unless you have a Medicare Advantage plan, which features that classic cost-saving mechanism of narrow networks.

      Traditional Medicare allows you to go to any doc that accepts it, no referral required from a PCP. Medigap policies pay the 20% that Medicare proper doesn’t pick up. So if you go traditional, the premium is higher and you don’t get dental and vision, but you get better medical care with no copays etc at point of service.

      My mom had Medicare and loved it, but she could afford to pay those premiums. And from the thread on this topic the other day I got the impression that Medigap the way it used to be may not be available to newcomers after this year.

      Medicaid is great if you can find a provider (in Will County, IL where I worked at a foster care agency there were NO private docs that took Medicaid, which is the insurance available to kids in the foster care system). Usually you will be limited to county facilities, where notoriously every appointment turns into a day-long event due to wait times.

      Medicaid started earlier on the path to privatization and is further along. Most of what used to be state programs are now run by insurance companies. Medicaid pays for long-term care, which Medicare does not, but you have to “spend down” your assets (used to be they let you keep $2000 and your home if it was still the residence of your spouse or other caregiver).

      And talk about narrow networks! In IL Medicaid went private when I was working in hospice, and suddenly certain LTC facilities were off limits for certain patients, which was never the case when the state was running the program.

      And, as marym noted in that previous thread, proponents like PNHP and Margaret Flowers of HOPE always referred to the clumsy “New and Improved” Medicare For All (to include LTC as well as dental and vision and be free at the POS).

      Oh, and we can’t call it a National Health Service like the Brits because the proposal isn’t that the government owns the hospitals and docs, just that it insures their services.

      1. Anonymous

        Yes, here in Florida, Medicaid is now under the name ‘managed care’ which is a better name than that ugly word ‘privatization.’
        They were touted as being cheaper, money-saving, having more specialists and keeping people out of the emergency rooms; nope, nope, nope and nope.
        Even providers who used to bitch about Medicaid’s reimbursement rate are finding the hoops to jump through with the competing plans are costing them more time and money than whatever greater reimbursement they receive is worth.
        But what’s the big deal the state touts?
        Better HEIDIS data (!) and greater satisfaction reported by the recipients (really?).
        Too bad half the plans have great on paper provider networks that rarely are true.

  4. Yoghurt

    Another data point: remember how Obamacare allows you to keep your kids on your insurance until they turn 26? Well, that’s not true if your insurance is Medicare. As an older parent, I can never retire.

      1. Pat

        You have apparently never had to shop for insurance in a gig economy. For many young people who work full time but with multiple part time jobs that have no benefits, you don’t make enough for rent and food AND insurance even with the subsidies.

        1. Bakes

          You have apparently never had to shop for insurance in a gig economy.

          Perhaps we are living in the wrong state. I am 63. I have only had 1099 “gig” employment since 1992. If I was single, I could get a Bronze Obamacare plan for free. Silver would be $250 per month. I only get screwed out of a subsidy because my spouse has income in excess of 4X poverty level.

          A good friend who is a widow and only works 8 hours per week gets bronze insurance for free as well.

          Obamacare works.

          1. Bakes

            Lest I be misunderstood…

            My self-employed father found Medicare to be the best thing that ever happened to him. His 63 year old son, self-employed as well, looks forward to the day he can sign up.

            Medicare… Not great, but better than any policy I have ever had.

          2. Al Deutsch

            Obamacare like medicare doesn’t work.
            Every year with Obamacare and medicare, unless you have medigap/supplemental, you have to review your plan and alternatives; you, or someone on your behalf, pretty well needs to be detail oriented, sane and have an MBA to figure anything out.

      2. ambrit

        The theory seems to be an extension of the anthropological observation that as a species becomes more “intelligent,” the length of “childhood” extends to match the required training and educational needs of attaining said “higher intelligence.”
        YMMV Trined.

        1. ChiGal in Carolina

          Advances in brain research have shown that myleination (the coating that enhances signal transmission between neurons) is not complete until about age 25.

          There’s a reason adolescents struggle with executive functions like planning, impulse control, insight, judgment, etc.

          Children are not small adults, as used to be believed for centuries!

      3. bob

        It’s hard to find an employer who offers health insurance that is A) offered B) any good and C) affordable.

        A lot of young people go without it because of these thing. Obama care starts at $500 a month here for a ‘bronze plan’ (read VERY HIGH deductable, over $10,000).

        Parents will just add them on their own policies for less than $500. A group rate, which is only allowed for families, not countries.

        We’re forcing the youngest and most healthy people to pay (A LOT) into private insurance companies for coverage they will likely never use. We then cover large parts of the most expensive people to care for (older) with government programs, that the youger people are also paying into, but not seeing any benefit from them.

        1. Offtrail

          Bob, the reason for the very high deductible Obamacare plans for the young has to be that that the individual mandate has been removed, skewing young Obamacare purchasers sicker and more expensive. My wife and I didn’t have deductibles anywhere near that two years ago when we were on Obamacare.

          It is really a shame that things have come to this.

          1. bob

            It’s not the guys driving the yachts and flying around in private jets. It the guy working at mcdonalds who just won’t use money he doesn’t have to buy health insurance he can’t ever afford to use.

            It’s not that “medicine” these days is all about money, on every single level. The reason the deductible is so high is that young people aren’t paying enough. Just say that out loud a few times.

            They really make you believe that don’t they? It’s part of their grift.

  5. The Rev Kev

    Out of curiosity, are medical brokers a thing in America? I mean companies and professionals that can advise people on what plan would be last hideous for them and who could update them on any changes annually? You already have tax agents so this would be something along the same lines.

    1. Carla

      @The Rev Kev — SHIP (State Health Insurance Assistance Programs) are available in every state to provide the service you are talking about free of charge to all Medicare beneficiaries, including those about to turn 65 and enrolling in Medicare for the first time.

      No human system will ever be perfect, but the Expanded and Improved Medicare spelled out in H.B. 1384 would be an incredible improvement over the criminally inequitable non-system we in the United States have now.

      It’s truly unfortunate that Yves’ mother has an “Advantage” plan. It is my understanding that no one over age 80 who can possibly afford a good Medi-gap policy and drug plan should ever be enrolled in Medicare “Advantage.”

      1. The Rev Kev

        Thanks for that. It is a case of the more I learn of the American healthcare system, the less I want anything to do with it. Some of our politicians sometimes think that it would be a good idea if we adopted your system but as 1.3 million Aussies (out of 25 million) use to go to America annually, I am sure they there they learned how that would work out in practice and brought that lesson home. As far as I can see, the whole thing should just be burned down to the ground and then started off from scratch. It really is horrific.

        1. juno mas

          …it works fine, as long as you don’t get sick.

          (One of the reasons that non-group-practice doctors avoid Medicare patients is that payment usually takes 90 days. And, of course, the tax on their time from interminable paperwork when there are “alleged anomalies” in their medical coding practices.)

          1. Selwyn

            90 days? Maybe with ‘advantage’ plans? Medicare must ‘pay and chase’ which means most care can be billed electronically.

      2. Chuk Jones

        I’ve heard it referred as Medicare “Dis-advantaged” Yes, it has all the problems of employer health care plans. Stick with traditional Medicare. More and more people are signing up for Advantage plans, looking only at the upfront price, and getting a shock when they see the co-pays, time used to contest non-covered services and looking for a new plan every year. I understand the allure of these plans, and living on a fixed budget it can be tough to make the medi-gap payment affordable. However, if you can, go traditional, because just like commercial insurance, these advantage plans will go up in price and provide lower benefits every year. You’ll probably end up on Medicaid eventually.

        1. run75441


          You are correct. Also if you transition to an Advantage Plan from Medicare and your Supplementation Plan and desire to go back to Medicare Original, you may not be able to get Supplemental insurance due to pre-existing conditions that were incurred while on an Advantage plan. Or the price for the Supplemental may be higher.

          Supplemental Plans G & F are not available for new Medicare enrollment either.

          There is also an issue with the over payment of Advantage plans which has to be resolved and is in the $billions.

          1. flora

            Private insurance Advantage Plans are a govt subsidized Trojan Horse designed to destroy traditional Medicare through enrollment attrition over time, imo.

            1. flora

              also: traditional Medicare gap plans are called “Plan” [C or G or N] for example. Advantage plans are called “Part” [C or whatever]. “Plan” vs “Part” are close enough in name to be confusing. The name confusion is deliberate, imo.

          2. John Steinbach

            I retired at age 70 from a hands on children’s recreation position. I unretired last December & then had to retire again because of Covid concerns. Found I was ineligible for any medical insurance because of pre existing conditions (Mild retinopathy)

            Had no idea about this before hand,

          3. GF


            As part of a settlement with the over payment in AZ the state pension fund is offering free Advantage plans through United to all Medicare eligible pensioners.

        2. Phacops

          I have also seen scams perpetrated by Medicare Advantage insurers. They call a member asking if they would like an at-home nurse visit. Once in the home they are trained th look for and exaggerate hazards. These are used to upcode reimbursement without adding any health benefit to the insured.

          A feature of American health insurers is that of looking for every advantage for profit without actually delivering any tangible benefit. Sociopathy all the way that one wonders at the people who voluntarily work for such organizations.

    2. Rick in Oregon

      Yes, there are agents who take a cut from the insurance companies.

      I use one for my supplemental and drug policies. They seem reasonable and it avoids the horrific time tax in going through the details. If anything, Yves understates how difficult this is.

      I get angry every time I think about how absurd it is to place bets on what your health will be in the next year, as nearly all health insurance in the States expects you to do.

      As Mike the Mad Biologist says, “Anger isn’t the appropriate emotion, rage is.”

  6. Howard Beale IV

    Medicare would actually be an improvement for me, given how my employer’s self-funded plan is administered by United Healthcare. Case-in-point: both my mother and I have had to call the ambulance to go to the same hospital. Her Medicare rate was $400; my self-funded plan’s charge was $1300. Fortunately, my healthplan’s administrator subscribes to a service you can use to submit your bills to and they negotiate the rate down (which they successfully did).

    What’s worse (at least for me) is that I live in an area where it’s basically a one-hospital town, and my administrator has few contracts with providers up here. When I needed cataract surgery, my opthamologist was in plan, but the anesthetist (from the only practice in town) was not – and the actual injections were done by their PA.

    And heaven help me if I need a joint replacement: I would need to travel to one of the plan’s ‘Center of Excellence’ to get that done, which would wind up being a 4+ hour drive to the largest city in the state.

    1. fresno dan

      Howard Beale IV
      December 9, 2020 at 7:59 am

      I only bring this up because I started seeing a number of Medicare appeals about 2 years ago, as Medicare started enforcing or interpreting the provision about transportation in any other vehicle (other than an ambulance) could endanger your health about Medicare covering ambulance transportation. Ambulance transportation is covered ONLY when any other transportation can harm you. I have seen cases where broken limbs are not reimbursed because Medicare believes that you should hobble to a car or taxi, and someone you know or pay should drive you to a medical provider. I think its outrageous, but Medicare does have a point that ambulances are too expensive too use as taxis.

      So there is an appeal process if your ambulance claim is denied. Most people don’t have the patience, knowledge, or because of age, the sharp mental faculties to deal with the Medicare appeal process, even when a HICAP advocate is advising a beneficiary what to write. Lawyers are so expensive that usually it is a money losing proposition to hire one to appeal a medicare ruling. One thing to remember, if you believe in good faith that you are having a stroke or heart attack, that should be accepted * as justification for ambulance rides.
      And besides the 20% medicare deductible, ambulance rides are reimbursed under Part B, so you have to be up on your yearly Part B deductible.
      For those who enjoy reading government guidance and policy documents

      The below is from the wesite on ambulance services
      Medicare Part B (Medical Insurance) covers ground ambulance transportation when you need to be transported to a hospital, critical access hospital, or skilled nursing facility for medically necessary services, and transportation in any other vehicle could endanger your health. Medicare may pay for emergency ambulance transportation in an airplane or helicopter to a hospital if you need immediate and rapid ambulance transportation that ground transportation can’t provide.
      In some cases, Medicare may pay for limited, medically necessary, nonemergency ambulance transportation if you have a written order from your doctor stating that ambulance transportation is medically necessary. For example, you may need a medically necessary ambulance transport to a dialysis facility if you have End-Stage Renal Disease.

      And this is even more guidance on ambulance services

      * Finally, one thing that most people don’t get about government programs is that the law, rules, and regulations are written in such a way as to be applicable to a broad range of circumstances. The law against murder does not specific with a gun, knife, or hammer. You have an outcome, and it is simple enough to understand to be in compliance with the law.
      But I recently started researching the question of whether someone who is self employed is “employed for purposes” of Medicare. If you are employed by an entity past 65, IF your are still employed and IF your employers insurance meets the standards of qualified health insurance OR minimum acceptable coverage (I still have not figured out which term is THE term to use when talking about employer’s health insurance used past age 65 that allows the Medicare beneficiary the right to delay enrolling in Medicare WITHOUT PENALTY. It is gonna take a lot more research to figure out the applicable term, but I suspect I will never get a definitive answer.
      But what if your self employed? I don’t know – a LOT of Medicare questions people have are simply not definitively addressed – one has to do a LAWERLY analysis, and one can’t know the definitive answer until one applies for Medicare and Medicare decides to apply the penalty or not. Who could advise a person that their insurance meets the standard of qualified health insurance and/or minimum acceptable coverage? Other than asking the insurance provider, I am unaware of how it can be done.

  7. Pat K California

    I took a little gentle flak for my comment in yesterday’s Links where Medicare was brought up. But I feel the need to reiterate what I said. Getting on Medicare meant everything to me. I’ve been self-employed for most of my career … and have been royally soaked by private insurers during most of it. The instant Medicare hit, I wound up with an extra $1,000 a month with which to pay other urgent bills, not to mention my ever increasing debts. It was a godsend.

    Yes, I know. Not everyone finds Medicare to their liking. But I sure do. Every one of my 10 doctors accepts it. I didn’t have to change a single doctor. In fact, I can go to any doctor or hospital that I want to in the entire country as long as they accept Medicare. I also thoroughly enjoy waltzing into any doctor’s office and not having to even think about copays. (Mind you, I am on Original Medicare; Medicare Advantage is a whole different kettle of fish, complete with the dreaded copays and deductibles.)

    I’d also like to give a shout-out to the SHIP counselors that Carla mentioned above. Honestly, more people should use this FREE service. My Dad was a volunteer SHIP counselor for years and years and thoroughly enjoyed sitting down with people for as long as it took to walk them through the ins and outs of the Medicare program … passing along all of the tips and tricks he’d learned over the years. In fact, when my time came to sign up, Dad sat me down at his kitchen table and passed along everything he could think of … what to watch for when picking an insurance company for a supplemental plan, how to do a thorough annual review of your Medicare Part D drug plan to make sure you are getting your money’s worth, etc. etc. These days, Dad has handed over the oversight of his and Mom’s Medicare to me. And I’m actually thinking of becoming a SHIP counselor myself.

    The hardest part of Original Medicare to me is dealing with the private insurers who are involved with the Part D drug plan. Dealing with the government only for Part A & B is a walk in the park compared to that!

      1. antidlc

        I am not Pat, but I will answer:

        From above:

        December 7, 2020 at 11:46 am


        You have to check your part D plan each year to see what drugs are covered (or not covered).

        When picking a plan, you have to decide what drugs you MIGHT need, whether they are on the formulary or not, and what tier they are in.

        And the formulary can change at any time.

        I cannot believe the time tax we have paid looking into all of this.

        The formulary AND THE TIERS can change at any time.

        1. Big Tap

          When you say tiers and covered drugs can change “at any time” is that true? I would think they can change annually from one year to the next but also during the same year too? I will be on Medicare starting late next year and all I’ve heard about it is its complicated. Seems most people here at NC prefer Medicap policies vs. Medicare Advantage ones.

          1. Janie

            I prefer medicare advantage. It depends on your health status and your locale. Medigap is expensive compared to medicare advantage, and medicare advantage may offer dental and vision. Many other variables…

            Ask everyone you know of that age what plan they have and why they like or dislike it. It pays to get as many opinions as you can and sort through them. Good luck. And yes, our system is crummy; Cuba’s is way better.

    1. Selwyn

      Totally agree with you, Pat.
      Stay away from Advantage Plans.
      Part D is utter garbage in many situations. Seriously, try GoodRx.
      Be careful when signing up for Part D only plans because they may try to sign you up for their related Advantage Plans.
      Finally, under Federal Law, every state must have an ADRC per region. These are Aging and Disability Resource Centers that may be named something else by the state they are in – and many free Medicare counselors often originate from within.

    2. fresno dan

      Pat K California
      December 9, 2020 at 8:54 am

      For a lot of people, Medicare is a Godsend. And as to the problems Medicare has, I can’t say it any better that Carolinian’s comment at 9:56 am.

    3. antidlc

      “The hardest part of Original Medicare to me is dealing with the private insurers who are involved with the Part D drug plan. Dealing with the government only for Part A & B is a walk in the park compared to that!”

      It took me all of about five minutes to sign up online for part A. For part B, I had to go to the Soc Sec office to sign up because I was on an employer plan after I turned 65. Had to wait a while, but the appointment went rather smoothly and I got signed up for part B. The government parts of Medicare (A and B) were fairly easy to sign up.

      You are correct. It’s the PRIVATE INSURANCE part of Medicare (Medigap, Advantage, part D) where the time tax gets you.

      1. juno mas

        As Yves mentioned at the top, Medicare Part A and B is a swift negotiation, because there is NO negotiation. You’re in it or your not.

        However, Part A & B leaves you so exposed to large out of pocket expenses (it only covers 80% of a hospital stay—I had one that ran $750K) that the private insurance “Gap Plans” are essentially mandatory if you own a home, or have any wealth whatsoever.

        After years of enduring “open enrollment” one does get better at assessing what private plans will best accommodate anticipated medical needs. But it is still a crapshoot; and the insurers are better at it than you are.

        1. antidlc

          “But it is still a crapshoot; and the insurers are better at it than you are.”

          Yep, that’s why the insurance companies have actuaries.

    4. Jason Boxman

      Indeed, a had a family member that ran a small business, and the annual premium at 64 was about $26k or $30k for the small group medical plan; getting on Medicare was huge financial relief. I haven’t looked, but the ObamaCare plans are probably similarly awful for lower deductible plans at that age.

      Getting older in America should not be a terrifying experience financially or medically, but because markets, go die. Each of us must fulfill our role as a wallet to be sucked dry until death.

      1. tegnost

        Look at the bright side! If “we” can drive down life expectancy for the working class down below 65 the social security can be turned into citizen rent,at the same time subsidizing the old age of the punishing class! All’s for the best in the best of all possible worlds!

  8. Peter Pan

    I’m going to Medicare from Medicaid in January. Medicare is a POS compared to Medicaid. There are significant out-of-pocket expenses (co-pays, deductibles) such that I’ll probably have to incur debt in order to pay for coverage/co-pays/deductibles.

    It’s a total time suck that leaves me with a crappy healthcare plan & a path to bankruptcy.

    Under 18 Medicaid for All !! (Under age 18 provides more services).

  9. Petter

    Health insurance and Medicare is the main reason my wife and I decided not to move back to the USA (I lived there from 1958 to 1997, my wife is a native New Yorker). We actually thought about it but half way through reading one of those helpful advice pieces in the NY Times titled something like How to Choose the Right Medicare Plan, my eyes glazed over and I thought no way, I’m not going through that.
    I’m 75, have emphysema, my wife is 68 and has heart issues. We’re both on several medications. Here in Norway there is an annual deductible of about 300 dollars and the deductible covers doctor’s visits, medications, hospitalization, home health care, mental health services – just about everything except dental care and even that is partially covered depending on the dental problem. Once you’ve paid the deductible, everything else is no cost. You’re on a Free Card.
    And no paperwork. Identification consists of name, birthdate and persona number (like a SS number). If you’re referred to a specialist, the receptionist might ask for an ID, and then again, might not.
    The system isn’t perfect by a long shot but compared to what’s described in this post and other posts on health care in the USA, it’s heaven. And even though we had very good health insurance when we lived in the USA (employee plans) it can’t compare to the simplicity of Norway’s universal health care.
    The bottom line for us is – we don’t think about health care coverage, it’s a non issue. So we’re staying here. We’re not moving back.

    1. run75441

      Between Part B and Plan N Supplemental, you will pay $300/month per person. Part D is about $30 per month per person with Tier 1 drugs at no cost and Tier2 at $6/month. Medicare Deductible is ~$200 this year.

      I had my first Rituxan infusion on Monday which I will not pay anything for it. I have 3 more coming (ugh!). Rituxan was rated the 2nd most expensive drug by the World Health Organization. Hopefully, it works this time also.

      Single Payer would be nice as we could gain control of the costs of pharma and hospitals, and eliminate ACOs. That I am afraid is a long ways off.

      1. Carla

        Single payer (H.B. 1384) would be better than nice as it would cover everyone in the country with care that is free at the point of use. Including vision, dental and long term care.

        Then we could actually have a functioning public health system — think of it!

      2. juno mas

        BTDT with Rituxan. Ten years ago it cost $20K per infusion. It’s essentially a controlled dose of poison applied by medical professionals. It saved my life.

  10. C

    This personal narrative regarding the failures of Medicare are exaggerated and does a real disservice to a government program that daily helps millions of Americans. I have had several cancer-related surgeries, immunotherapies, four different- highly qualified physicians and numerous tests- all of which have been paid for by “Traditional Medicare.” I count my lucky stars everyday!

    1. juno mas

      Actually, “Traditional Medicare” covered only 80% (max) of your hospital stay. (That benefit cost you about $100/month–taken from your SS benefit). The last 20% of your hospital stay was likely paid for by a private insurer who you likely paid MORE than $100/month. Where is the risk parity?

      1. Yves Smith Post author

        Exactly. My point is my formerly mediocre, now very good private sector plan is way better than Medicare. That demonstrates that that the typical private sector plan 30 years ago was way better than Medicare, and back then, a higher percentage of the workforce was in traditional employment. Americans are blind to how poor our health system is, both over time and relative to other countries.

  11. grayslady

    Medicare works fine if: 1) you don’t have Medicare Advantage, 2) you have private insurance in addition to Medicare, or 3) you are income limited and can receive financial assistance. Every doctor takes Medicare but they don’t all take the various Medicare Advantage programs. MA is just like a PPO, except a PPO is better if paired with Medicare since Medicare is always billed first and the PPO picks up the balance. A Medigap program is about double the cost of regular Medicare–nice if you can afford it. For low income, you can combine hospital/medical financial assistance with drug financial assistance–both through Social Security Low Income Subsidy and individual drug assistance programs. For blood work I always use Quest since they accept regular Medicare as complete payment, regardless of the so-called stated cost. Part D is the worst of the programs: those with reasonably priced premiums may have great prices on one of the medications you take but not on others, and the forumlaries are geared toward generic, popular drugs, not branded drugs (although I suspect that’s the case with all health insurers these days).

    The best thing about regular Medicare is that they will really help you out if you’re having a problem. Their Special Resolutions area is first rate–they fight like tigers to get you what you’re entitled to.

    1. sam

      +100. Compared to private insurance original Medicare is very good. Obviously too good as evident from the massive, government subsidized effort to con seniors into “Medicare Advantage” plans. Like any government program it’s got its faults but let’s get everyone up to the original Medicare level of care before we start carping about them.

    2. Yves Smith Post author

      It is absolutely false that “every doctor takes Medicare.” Many doctors in NYC don’t. None of my current MDs (my GP, three physiatrists I consulted, one of which I am using, my chiro and my opthalmologist) take Medicare. I mentioned my friend (who sees more specialists than I do) who is in the same boat, none of her current doctors take Medicare.

      There are specialists I have consulted in other parts of the US that don’t either. The best gerontology practice here in Birmingham doesn’t take Medicare either; they provide a concierge service. The can send nurses to people’s home without the nonsense I ran into with the blood draw issue above (you need to be homebound, as in really truly barely leaving the house, for Medicare to cover a home visit from a nurse, and then it has to be set up for particular intermittent services).

      And you also seem to have missed that I am not in a PPO. I find the whole HMO/PPO system to be an abomination, as I am sure non-US readers would agree.

    3. Janie

      Grayslady. Every doctor does NOT take medicare. In the Dallas area it is difficult to find any doctor who accepts it, from my experience.

  12. Alan K

    I live in New York and all my doctors and all my wife’s doctors whom we have had for over 30 years take traditional medicare. What they will not take is “Medicare Advantage” plans – that is, private plans mimicking medicare. They do not want to have to deal with private insurance companies. Most employer-based healthcare insurance limits the number of doctors available on the plans offered to their employees and worse many employers change plans every few years with the result that the average employee must find new doctors. Medicare could, of course, and should be much better – tell Congress, but compared to the average private insurance, which I previously got through my employer – it’s great. Medicare D, the Drug Plan, is a private plan and has all the problems of private insurance – drugs that the doctor orders are not covered, and, as some of the comments have pointed out, every year the company issues a new formulary (list of covered drugs and drug tiers). Suddenly your drugs may not be covered or they may be on a new (typically) more expensive tier.

  13. philnc

    Thanks to Yves and everyone on this thread for the bit of education about Medicare. I’ve still got a year to go, so this has been on my mind. Having two kids in college and a wife who is several years away from eligibility means that I’m also going to continue paying for my company’s ACA-style plan for a few years to come. I think that means my premiums are going to be substantially higher for at least a few years. Going to have to look into MediGap.

    It really is time to start calling out the political class for their b.s. on this. Individually. By name. Doing it by implication with tag lines like “Expanded and Improved” really doesn’t cut it. I consider myself pretty well informed about a lot of things, but until I began researching how the existing Medicare system works last year, I had no idea how much it has been crappified in service to the false god of privatization.

    I get that many in my generation “have no empathy” or sense of responsibility to anyone other than themselves, and most of them think they’re pretty well set (the statistics on retirement savings and income don’t bear out that smug attitude), but young people like my kids really need to know the truth, and be encouraged to make themselves heard.

    Thanks again to Yves and the crew here at NC for giving these issues some space.

    1. Carla

      “until I began researching how the existing Medicare system works last year, I had no idea how much it has been crappified in service to the false god of privatization.”

      Kinda like student loans, university educations, any product you buy, the legal profession (arbitration substituting for justice), agriculture, food manufacturing, medicine itself… I could go on all day.

      But it’s easier for us to imagine the end of the world than the end of capitalism so… aren’t we really getting what we deserve?

    2. flora

      By name? I’ll start. Billy Tauzin D/(R) and Medicare Part D.

      Central to this effort was PhRMA president, CEO and top lobbyist Billy Tauzin, a longtime Democratic member of Congress who switched party affiliations after Republicans gained control of Congress in 1994. By switching parties Tauzin was able to maintain his influence and even rose to be Chairman of the House Committee on Energy & Commerce. Tauzin became the poster child of Washington’s mercenary culture. He crafted a bill to provide prescription drug access to Medicare recipients, one that provided major concessions to the pharmaceutical industry. Medicare would not be able to negotiate for lower prescription drug costs and reimportation of drugs from first world countries would not be allowed. A few months after the bill passed, Tauzin announced that he was retiring from Congress and would be taking a job helming PhRMA for a salary of $2 million.

      1. flora

        Not forgetting Joe Lieberman (D). From 2011.

        Leave it to Connecticut Sen. Joe Lieberman to speed along the process of making seniors on Medicare pay more for their care—the cost control method of choice at the moment, since it doesn’t disturb the profits of major stakeholders. After all, it was Lieberman who sealed the death warrant for the public option during the health reform debate.

        And not forgetting Richard Neal (D) who last year killed the bill that would end surprise billing .

    3. Lex

      I’m with Phil.

      We’re right behind you, Ives. I’m 63 and hubby is 62 (next month). We have Aetna through his employer; it comes with a high yearly deductible. We also get dental and vision. I set up an IRA years ago that we contribute the max to every year, just to pay our future medical bills. It will be our single largest expense in retirement.

      I have to wonder how many jobs would be freed up if old folks could actually afford to retire.

      1. ambrit

        Times have changed friend.
        Now, many “older” ‘consumers’ are not given an option about ‘retiring.’ They are forced into some semblance of the condition by the business class. Jobs are offshored, qualifications are ‘strengthened’ so as to deny older people jobs they have performed for years beforehand, H1B visa holders are imported to replace long term employees for ‘cost containment’ purposes, etc. etc.
        Unless you are fortunate enough to have a Degree or Certificate allowing you first access to a position, you are now ‘officially’ screwed.

  14. Edward

    Maybe you should start a meth lab to pay your medical bills. I have read about frustrations people had with the Soviet system and I wonder how we compare these days.

    1. GM

      I am someone who grew up in the old communist system, and basically in a hospital too (my parents worked in one, so I spent lots of time there when there was nobody to babysit me).

      Watched the way it changed after 1989 first-hand too.

      There was really nothing wrong with the communist healthcare system, it provided healthcare to everyone who needed it, and also, which is always forgotten, it avoided having to do so in the first place to a maximum extent by being an single integrated system, encompassing all of society, which made it possible for prophylactics and constant screening to be a core feature of it. There were doctors and nurses in schools, factories, etc. Can’t have that under a for-profit system that is fundamentally based on payment for services received.

      But even when services were needed, you just went to the hospital and received care. And that was it.

      The horror stories you hear are from when the system was falling apart in the late 80s, and even then that is from the USSR itself. In the rest of Eastern Europe that wasn’t the case until the early 90s.

      Then it got bad, but that was because the system was funded at 10% of what it needed due to the overall economic collapse.

      That underfunding plus the sudden lack of control over what doctors were doing made it possible for it to become a common practice for doctors to extort patients for direct payments. But that was in no way a common practice prior to that. Again, you just went to the hospital and received treatment. No GPs to serve as a barrier between you and treatment, no “codes” and “pathways” to follow, no administrative BS, you just went to the hospital.

      Of course, the bad times were then used as justification for implementing “market-based reforms”, because they were supposedly a proof that this was a system that can never work, but the reality is that there was nothing wrong with the system, it just needed to be funded at the necessary level, which would have been eminently possible once the economy recovered (and really, even when it was in freefall, in retrospect, they were just playing by the neoliberal rulebook of defund-crapify-privatize).

      Now healthcare in those countries is a complete disaster.

      P.S. The reason Soviet-style healthcare works well is something that tells you how much of a failure Medicare-for-all will be if ever tried. Soviet-style healthcare works because it is a fully integrated system. Doctors are government employees under direct governmental control. Hospitals are government-owned, all of them. Private practice is outlawed, which means that generally everyone has to rely on the same services, including the party officials (this changed in later years with the establishment of special hospitals for the very top of the party bureaucracy, and in retrospect that should have been a warning sign that it was all going to be eventually dismantled; but at the local level this effect still held). All drug and medical device manufacturing is under direct government control. Medical school is free. And, as I said, there is this massive network everywhere for monitoring, prevention and prophylactics. All of this combined minimizes the incidence of disease, while eliminating all the rent extraction from the system, and makes it work financially.

      And, of course, there were all the other aspects of life that improved people’s health — no far-flung suburbs and car dependence, and no fast food industry, this much lower level of diabetes and cardiovascular problems, etc.

      All that Medicare-for-All would do is to make the government pay for insurance, which will eliminate only a small fraction of the rent extraction, and will add none of the benefits in terms of improving people’s health before ending up in the hospital. And it will not eliminate the elite level of services reserved for the rich, So even if you implement it, costs will keep skyrocketing, the rich will not use the system and will have no incentive to keep it in working order, and it will come crashing within a short period of time, which will eliminate any hope for proper socialized medicine for generations after that.

      1. Rod

        P.S. The reason Soviet-style healthcare works well is something that tells you how much of a failure Medicare-for-all will be if ever tried. Soviet-style healthcare works because it is a fully integrated system….Medical school is free. And, as I said, there is this massive network everywhere for monitoring, prevention and prophylactics. All of this combined minimizes the incidence of disease, while eliminating all the rent extraction from the system, and makes it work financially.

        thanks for the first hand insight–my bold on what jumped at me–and some of the solutions I think are necessary.

  15. Carolinian

    So perhaps it should be called Moneycare since that’s what all these problems seem to boil down to. The doctors who refuse to take it will probably say that can’t run their businesses on Medicare reimbursement rates (perhaps true in NYC?). The opposition to Medicare for All much less single payer is all about money. Surely there’s no cure for any of this until the illogic of the medical industrial complex is somehow addressed.

    Having once taken care of an aged parent myself I’m familiar with the whole runaround that pressures families to uncomfortably transport the elderly for routine doctor visits and that would often prefer to have them institutionalized altogether–which can be even more of a death sentence than usual given the advent of Covid. All of this will be justified under “standard of care” even if it’s not what’s best for the patient. As long as nobody gets sued they are happy. It’s the system that is the problem, not just Medicare.

  16. Keith Newman

    I am always stunned when I read just how bad the healthcare situation is in the US. I had mistakenly thought that US Medicare wasn’t bad if not perfect. How wrong I was. In Canada our public systems (provincially run) for doctors and hospitals are certainly not perfect but “heaven” by comparison, to quote Petter. No cost, no paperwork at all. However we do not have public dental care. Prescription drugs are provided at no cost if you are over 65 or poor, or, in Quebec, to everyone with up to $1,000 of co-pays and deductibles plus a $600 premium (unless you have a private plan in which case you are covered by that as are 60% of people). It does look like, finally, a universal public plan to fully cover drugs will be phased in by the federal government soon (with the provinces) as long as the federal Conservatives don’t get elected next time around.
    The public system allows doctors to opt out. HOWEVER once doctors are out they are all the way out – they can’t take any public medicare patients. Very few doctors opt out. I had one – he opted out for a couple of years, worked part-time, charged triple what the public system paid, then came back into the public system. This safeguard makes the public system much more secure than elsewhere where doctors can take both public and private patients, as in the UK.

    1. Sub-Boreal

      One vignette of U.S. healthcare has stuck with me.

      On a southern California holiday about 30 years ago, I was visiting a childhood friend who was now a Canadian expat in Pasadena. One evening, he had a bunch of friends over, and in the course of mingling, I got chatting with a lady who was marketing some new personal software. Its purpose was to enable consumers (I hate that word) to make more accurate comparisons between competing health insurance policies, with all of their differing deductions and fine print.

      So here was an overgrowth of entirely superfluous activity made necessary by the complexity of the underlying system. And this lady’s living depended on it.

    2. Felix_47

      Most of those who opt out in Canada move to the US to make bank. The US is a magnet for doctors from the rest of the world because they can bill a ton and do unnecessary treatment at will. There are medical schools in India and Pakistan that train doctors to emigrate who have no intention of working in their native countries. The only solution is to put all doctors in the US on salary with no bonus for production and no bonus for giving patients what they want (they can decide what they want when they go to med school) and combine that with tort reform. We have a system like that already in the US. The firemen paramedics are on salary and provide critical medical care in the US. Why should the payment system change the moment the patient hits the ER swinging doors. I grant that many fire departments are working to monetize that work but it is not fee for service to enrich the provider. Firemen don’t put extra splints on or extra IVs to just be able to bill more. I can’t say that for all cardiologists. The government would have to determine allocation of doctors just like in England. And I say this as a doctor who has been horrified at what the profession has become.

    3. Rtah100

      I don’t see how the bar on mixing public and private practice makes the system more secure. In the UK, consultants had to work a certain fraction (I think famously 7/11ths) for the NHS. They may pursue private practice or clinical research or more NHS work in the bslsnce. I think the percentages have been renegotiated but the system is broadly by he same. Bevan stuffed their mouths with gold and they have yet to spit it out.

  17. Dave_in_Austin

    I’ve been a member of Mensa for 40 years and I can’t understand any of this, which is a bad sign.

    At 76 I’m in a Medicare Advantage plan- free swimming at the YMCA pool-;5 miles/week- probably does me more good than anything the medical profession gives me.

    If I really have a big problem I have one more ace-in-the-hole; an Irish passport.

  18. Alex1

    As someone who has interacted with single-payer systems in two countries I should say that things like being able to go to the doctor you like or going to a specialist directly without visiting a GP first are usually not covered and are are at best partially reimbursed, thus requiring private insurance or cash payments

    1. GM

      GPs are not a necessary feature of a healthcare system

      The old Soviet system had no GPs to serve as a barrier between people and getting treatment.

      You just went to the hospital, a general specialist doctor would see you and immediately send you to a specialist if necessary.

      If you have GPs in the system, it has already been crapified to a certain extent.

      The argument that having a personal physician care for you is somehow better is just BS — no country has that many doctors, it is always something like 5,000 patients per GP, and no human being can even remember the names of that many individuals, let alone keep track in his head of their medical history.

      The primary purpose of the GP is to ration care.

      1. Alex1

        The word immediately does a lot of work here. You might be sent to a specialist immediately, but you certainly would not be received immediately. And of course if you want a certain doctor, as in the original post, the waiting time can be very long, or this doctor might only have a private practice.

        Btw only one of these systems I interacted with is post-Soviet. I think that in general single-player is still better than the US system, the country I live in now manages to get life expectancy better than the US, so the system does work. I just think it’s important to realise trade-offs and not expect unrealistic things.

      2. Rod

        no country has that many doctors,true–but how much could be provided by LPN/RN/PAs/NPs
        In the Military, your unit Medic was your first Point of Contact with severity referencing you further along the system.

  19. antidlc

    While we are on the subject. could someone PLEASE explain GoodRX? Why can you get prescriptions cheaper through GoodRX than you can through a prescription drug plan? Who is behind GoodRX?

    I know people who have part D plans but don’t use them because they can get their drugs cheaper through GoodRX.

    Why should we pay for a part D plan that we don’t use?

    Are the insurance companies behind GoodRX? (They take your part D premiums but you don’t use your part D coverage?)

    Seriously, I want to know what the deal is with GoodRX. (And there is another coupon program that advertises on TV but the name escapes me.)

    1. hoonose

      Get a cheap Part D plan and use the GoodRx app if and when it’s cheaper. But you need the Part D plan in case you end up on really expensive meds. Most likely those won’t be available through GoodRx. And even if they are, many thousands a month for those meds is too high a risk to take withut Part D.

      1. antidlc

        That doesn’t answer the question.

        Why should we pay for a part D plan that we don’t use?

        Why does GoodRX exist at all? Why do you pay less for drugs under GoodRX than you do under part D?

        1. hoonose

          There are huge variations in retail medication costs. Many times it is cheaper to not even use your Part D plan. Like with GoodRx. Especially if you have deductibles to meet.

          Part D is needed in case you suddenly need very expensive meds. My wife’s are over $20K/mo. Retail. Probably lower with negotiation, and we have no idea what her insurance actually pays for the meds.

    2. grayslady

      GoodRX is just a drug discount program like those dental discount programs. It would probably be more accurate to describe GoodRX as a marketing program for pharmacies–the pharmacies that participate are willing to give a discount for not using traditional insurance. The GoodRX discounts are not nearly the lower prices you pay with a drug insurance program (GoodRX is much more expensive), but there are times when it can be useful. Example: Due to a spinal injury I very occasionally need to take a muscle relaxant, cyclobenzaprine. None of the Part D carriers are willing to support this drug once you reach 70 years old unless your doctor is willing to submit a reason why you should receive special approval. Cyclobenzaprine is a relatively cheap generic so I just use my GoodRX card when I need to purchase it to make the bottom line cost less expensive. I still need the drug; I just don’t need the medical hassle with my insurance company.

    3. Pat

      SingleCare, it is the one with Martin Sheen in the ads.

      Not on Medicare but have used GoodRX a few years ago before it made enough to afford ads. It is/was essentially a shopping app that lets you know the cost of your drug at various outlets plus provides any drug company coupons or discounts. It doesn’t necessarily make all drugs affordable.

      To give you an idea, at the time, I was purchasing insulin for my cat (my vet used human time release insulin glargine aka Lantus as it had been show to jump start insulin production). After using their coupon a 10mg vial still cost over a hundred dollars. For numerous reasons not just cost I had to go strictly food control, which apparently worked well enough as he is still going strong over six years later. But to give you an idea of how this wasn’t an answer, my vet informed me of a method to try to order from Canada, but you had to order three months ahead, transport took that long. But it was a third of the cost. I actually asked both the vet and a contact if people used this for human use. Neither said Yes, but there wasn’t a no either. And this was before insulin cost got any media attention.

      Glargine was supposed to be eligible for generics soon after this, I know they held it off. Not sure it has ever happened. But I am pretty sure after limited coupons or purchase plans most insulin is still too expensive even with GoodRX or SingleCare.

    4. judy2shoes

      >>antidlc “Why should we pay for a part D plan that we don’t use?”

      That was my question, too, until I found out about the late enrollment penalty for not having part D. We are supposed to enroll in Medicare part D when we first become eligible, unless we already have what Medicare refers to as “creditable prescription drug coverage.” The ins and outs of that coverage and penalty are discussed on the following page:

      Once incurred, the penalty never goes away; it’s always included included in the premium you pay for part D. Even though at 69, I am not on any prescription drugs, that may change in the future.

      The fourth way to avoid the penalty, which wasn’t covered in’s fact sheet, is to die now. /s

      1. antidlc

        Yes, there a late enrollment penalty for not having part D.

        But the question remains: If I have a part D plan which I pay for each month, how can GoodRX provide drugs cheaper than a part D policy?

        I know people who have part D plans but don’t use them — they use GoodRX. So they are paying for part D plans which they don’t use.

        1. judy2shoes

          antidlc, I answered a specific question that you asked (“Why should we pay for a part D plan that we don’t use?”), so please don’t move the goal posts on me.

          Personally, I’d much rather pay a small premium (one plan I looked at was less than $7/month) than pay an ongoing penalty added to that premium for not having coverage when I was *supposed* to. That’s why I have coverage I don’t need (yet); YMMV. Ostensibly, having everyone in the pool spreads the risk out for those wonderful, altruistic private insurance companies (sarc alert) who provide the part D coverage.

          1. Elizabeth

            That’s what happened to me – I didn’t sign up for Part D because I wasn’t taking any drugs, so I figured why should pay for something I don’t use. I really do think it’s unfair to impose a penalty on people who don’t use prescription drugs. That’s my biggest beef with Medicare, otherwise original medicare works ok – but it certainly could be improved. One of the best things I like about it ts that you can see any Dr. you want – even if he/she is in another state.. Medicare Advantage plans are mostly a scam.

            When I read comments from people living in other countries which have universal health care, it really makes me wish I didn’t live in “the most exceptional country in the world.”

  20. EMtz

    At 65, I rolled the dice. Had not seen a “conventional” MD for 12 years. TCM only. Crap insurance in case I got hit by a bus. Went for Medicare Parts A and B only ‘cuz I take no pharmaceuticals.

    5 years later I left the US permanently. When I requested release from Part B, I was asked why. “Personal reasons,” I said. Apparently, that was good enough. Kept the free Part A ‘cuz why not?

    I could buy private health insurance here in México but at my age the premiums are absurd so forget that. Instead, I get very inexpensive public health care on demand if I should need it. If I wish, I can pay cash at a top notch private hospital and the cost is a small fraction of US fees. I don’t have to sign up for anything or be part of any network to do either of these things.

    Instead, I focus on prevention with an acupuncturist and Chinese herbalist. It’s all very simple, affordable and devoid of red tape. I’m healthy and happy – and the stress reduction, especially compared with what I hear about in the US, helps to keep me that way. This is what happens when the driving need for profit is taken out of the picture.

    1. Arizona Slim

      Taking care of myself is my default health care mode. Glad to know of another NC-er who does the same.

  21. antidlc

    While I’m on my soapbox, let’s talk about “choice”.

    The insurance companies say “consumers” love “choice”. (I hate being called a health care “consumer”.)

    Yes, you have a “choice” of Advantage plans, part D plans, Medigap plans. But as was explained the other day, once you pick a Medigap plan you are not free to move to another Medigap plan without undergoing underwriting (unless you live in one of the few states that allow you to switch.)

    I don’t want “choice”. i want ONE POOL — everybody in, with comprehensive coverage. Sign people up at birth and be done with it.

    1. savedbyirony

      “I don’t want ‘choice’. I want ONE POOL….” Oddly enough, we do not seem to be given that choice! (Maybe because that is not a choice a “consumer” makes -i detest that term too- but a human being.)

    2. Sue inSoCal

      I couldn’t agree more. The privatization of Medicare from Part A now through D disgusts me. I have a plethora of medical issues and had a wonderful policy through my spouse’s former employment. When I was forced on to Medicare, I had to prove that I had no interruption in coverage from when I became ill and qualified for Part A but two years later declined Part B. The coordinator who phoned me to explain that my benefits were approved (three months after I applied) stated that the current price for a PPO gap B policy would be frozen at $50/mo when I wanted B. (I should have requested this in writing!)

      My bit of research has brought to light that in certain areas of the country all parts of Medicare are run by third party administrators. Even Part A. If it feels strangely familiar haggling with these people, it should. This amounts to private insurers and TPAs that just say no, require preauthorizations, you’ve posted the improper codes and similar foot dragging nonsense.

      Here in the desert, I’m convinced that Medicare scams are legion, but worse, there are many physicians who opt out. We need to get TPAs out of the picture. Stop the tax dollars paid to these middlemen and have the government administer Medicare directly as it used to. (I noted there are some midwestern jurisdictions that do not have administration via TPA.)

      Opt for Medicare Advantage? You’ll never get out of it to a gap plan if you become seriously ill.

      Medicare D if you need serious medications? AARP’s is through Tenet Health (who is constantly trying to push Medicare Advantage) that simply uses a huge pharmacy benefits manager. This is a huge windfall for pharma.

      Please, just give us old government Medicare.

      1. Janie

        All traditional medicare is run through third party intermediaries. It was necessary to keep it from being rejected as socialist, commie pinko stuff.

        Your medical provider sends the claim to the fiscal intermediary for your state/region. The FI handles the part about did you need the care, was it appropriate, how much do we pay, etc. Social Security Medicare department verifies your eligibility. Then the FI pays the provider and you pay the balance, if any.

        The FIs are the big insurers, like the Blues. In California, when I was in the industry, it was Transamerica. They bid on it.

  22. Kathy

    For those who can afford it and are reasonably healthy, traditional Medicare with an AARP Medigap Plan F provides good outpatient and hospital coverage. It is otherwise pretty shitty (no dental, vision, hearing, long term care). Sanders was always pretty clear that, under his plan,, M4A would include coverage of dental, vision and hearing.

    1. Yves Smith Post author

      Readers in comments on another thread said that Medicare F is done. If you aren’t already in, you can’t get in now. Closed to new patients.

  23. David Mayes

    My wife and I are Americans who have been living as retirees in South Africa for over 16 years. We live in a leafy suburb at the edge of Cape Town next to one of the best networks of private hospitals in the country. We pay less that $500 per month for private health insurance. Between the two of us, we have had six major surgeries since we have been here. Our expenses were covered over 95% by the insurance company. We pay less that $100 for an annual physical from our GP which normally takes over an hour. We pay perhaps $100/ month for about 20 different medications. Our doctors and specialists are excellent, caring individuals and inexpensive.
    However, the public health care system is a mess and the government wants to expand it to cover everyone in the next xx years— without the money or administrative talent to make it work. We are fearful that many doctors in the private system will leave the country as this process unfolds.

      1. Sub-Boreal

        Back in the ’90s there were lots of South African docs in rural and northern parts of British Columbia. I had one of them as my GP for a few years before he sold his practice and moved south to Victoria.

        In hinterland areas of Canada which are chronically short of docs, I’m sure they’d still be welcome.

        I recall that they all seemed to drive Range Rovers. If you were at a social event and saw one of those parked, it was guaranteed that you’d hear the telltale accent in the crowd.

  24. Ron Grissman

    Speaking as a lawyer that does work on occasion for the state I live in, regarding Medicare & Medicare. First as to docs that do and docs that don’t accept Medicare mostly that is (not accepting) very rare not to, with an exception I’ll get to. Any md (or similar) that ever received a loan for school or business has to accept Medicare. Further as in at least the last 25 years, residents are by paid by the centers for Medicare/Medicaid they have to accept patients, basically forever. If your practice receives any federal funding or grants for anything you have to accept Medicare/caid patients. If you refer to other doctors that you are in a group with you have to accept patients if they receive feds funds (e.g., for escripts). Certainly, the same for any hospital, research center, or medical school. Some doctors may not know they have to accept Medicare patients but they do. If you want your to keep your DEA registration read the fine print. One has to of “high moral character”, to have one.

    The rate of reimbursement is tricky, because there are programs a md or group practice can signup for that increases the rate. One can, have a higher rate, but in this case it is better to file a claim directly, and then pay the md the difference. Some practices help with this some not. It is tricky, fraud is a real problem with Medicare.

    Medicare which used to be ‘poor peoples’ insurance is not anymore. The coverage has to the same or better than Obama care. And it covers dental & eye care. The RX benefit is excellent and accepted everywhere. To show how screwed up things get, Medicaid reimbursements are usually higher as that is how the ACA law (ObamaCare) is written. It is possible to have both. It is possible to have both plans to have both. All depends on your circumstances. Regarding Medicare indeed most of it is outsourced, but your insurance card nor the name of program indicate it is the ACA extension of Medicare.

    Medicare is a generally a means tested program, but not in all cases. The Ryan White program for HIV isn’t, (well you do have to prove you have HIV), before ACA Medicaid states had a separate program to pay for insurance and other costs. But ACA covers everything in Ryan White as well. That’s one reason most states need to be obtuse about what is or isn’t a state Medicaid program, because revealing the fact someone has HIV is a crime, usually a felony and they do prosecute. Sadly, in the US there are still around 50k cases a year.

    Lastly, most docs involved in chronic pain relief, certain kinds of surgery, and mental health care do not take any insurance from any entity including Medicare/caid. One can usually submit claims directly but it is not always wise to do so. HIPPA is full of loop-holes most occurring at the insurance and RX boundaries. When you have a ‘war’ against drugs, on any given day there may be no one to fight so people go looking. Got to keep the pay check coming in. If we are to have a better world we need to make it.

    1. flora

      Medicare which used to be ‘poor peoples’ insurance is not anymore. The coverage has to the same or better than Obama care. And it covers dental & eye care.

      Medicare is a generally a means tested program, but not in all cases.

      I think it’s Medicaid that you’re referenced here, not traditional Medicare. Typos?

      1. miningcityguy

        I agree. There was a lot of useful information in Ron’s post but the failure to distinguish between Medicare and Medicaid left me confused. Medicare was never “poor people’s insurance and is not means tested.

    2. Yves Smith Post author

      The CMS site shows that your claims are wildly inaccurate. CMS describes how MDs can opt out of Medicare. It says absolutely nothing about not being able to if you took a loan, etc. The limits are based solely on your type of practice (MDs can opt out, weirdly chiros and occupational therapists can’t). See here:

      Now admittedly it appears that a doctor in a group practice can’t but many top MDs still operate solo. My GP left a group practice and has successfully operated on her own for a few years now.

      And one of my physiatrists is with a top NYC hospital (his office is located there) and he accepts no insurance at all. Everyone pays at the time of service, disproving your sweeping claim that doctor affiliated with hospitals must accept Medicare. He bills in the name of his own practice, and has his own billing clerk, suggesting that it’s not unheard of for MDs to operate what amounts to a storefront in a hospital.

      Making Shit Up is a violation of our written site Policies. You are treading on very thin ice

    3. kareninca

      It is nearly impossible in eastern CT or SW RI to find a doctor who takes new Medicare patients. I have a family friend who is a retired MD who has run out of chips for getting a Medicare doctor for friends who need one. It is NOT TRUE that it is easy or even always possible to find a Medicare doctor.

  25. lordkoos

    At 69, my Medicare experience has been positive for the most part but I haven’t really had to use it for anything too serious other than prescription drugs and regular check-ups. I feel very lucky to live in WA state which has pretty decent public health — I’m able to get dental care at a reduced cost at our community clinic. It also helps to be in a small town, I can see an actual doctor easily now, whereas when I lived in Seattle I saw physician’s assistants or nurses 90% of the time.

    After I turned 65 I had a bicycle accident in a neighboring state (Idaho) and went to a local rural hospital for x-rays and treatment. Although some of it was covered I still ended up on the hook for about half of the bill ($400 worth) which seemed like a lot for a quick exam, 3 x-rays and some pain meds. I’m on the lowest tier of income so most things are paid for but there are occasional surprises. Here in WA state the implementation of the ACA was very good (WA “Apple Health”) and the plan was much better than medicare, I was sorry to see it go when I turned 65.

    A surprise for me when turning 65 was that I had not realized that medicare payments are subtracted from social security benefits. Seems idiotic to provide a program like SS which is supposed to help seniors stay out of poverty, and then take from that program to offset the costs of medicare, but hey this is America.

    1. flora

      A surprise for me when turning 65 was that I had not realized that medicare payments are subtracted from social security benefits.

      I believe you mean the Medicare Part B premium payment. Yes, it’s subtracted from SS monthly benefit.

      1. Rod

        Surprise on those Medicare Payments–paid in Quarters for those turning 65 BUT not drawing the SS.
        Me–excited to sign up a year ago then I had to out of pocket more than 700$ for the Quarter i was signing up for and also the first ‘next Quarter”.
        I have paid an additional ~1200$$ in three payments over the past year(all this was a big surprise and budgeting for this 145$ monthly has been a laughingly absurd eye opening challenge.)

    2. crittermom

      My son (age 44) was also surprised to learn money would be taken from his SS for Medicare when he retires saying, “But…but… they already take it out of my check!”

      All I could say was, “Honey, you’re dealing with the government, so they get you both coming & going.”

    3. Big Tap

      Is it true that if I was on Medicare and travelled to Canada or any other country and had say a leg injury I would have no medical coverage paid for? My understanding is Medicare is only good within the United States and possibly some U.S. territories. Again is that the case?

  26. Leftcoastindie

    My wife and I are both on Medicare she has Medicare Advantage and I have traditional Medicare with supplemental coverage. I love my coverage as I have had to go through a few procedures and another next week and I have not seen a bill and don’t expect to. I have had no problems finding a doctor and none of them have expressed any concerns about me being on Medicare. In fact the surgeon who is doing my surgery next week was discussing my insurance with his PA and expressed delight in my coverage.
    My wife on the other hand has had many of the issues described here. However due to where we live, in San Diego, the clinic she deals with is all over the county. It took a while to get doctors near our home and now her doctor is no more than a mile away. She had to jump through a few hurdles to get there but nothing insurmountable.
    A lot really depends on where you live as to how well Medicare works.

  27. VP

    Thank you for this post. Very informative and I now understand what I have to put up with in the future.
    It’s just disheartening- more like a gut punch to see how many hoops one has to jump through – There is so much friction in this system. I am not able to believe that this is the same society that once put a man on the moon.

  28. Jeremy Grimm

    As Yves states “Medicare for all” is horrible branding for “single payer” … but I doubt that horrible branding was instrumental in assuring the political failure of any kind of single payer plan. It has qualities of the branding “Global Warming” or “Climate Change” promoted to describe the Climate Chaos and Climate Crisis portended. Medicare is just the far lesser evil on offer for the moment. But Medicare is a rotting carcass — so enjoy it while you can.

    But Medicare and other medical insurance is only only one facet of the miserable Neoliberal deconstruction of Medicine. I can only attempt a partial gloss of the desolation of Medicine accomplished and worked in progress by the Medical Industrial Complex:
    — Candidates for medical school are selected for horribly ill-suited personality traits and motivations.
    — Medical schools extract their increasingly exorbitant rents on top of the rents charged for entering the pre-med lottery/contest, and Finance enjoys rents on top of both.
    Hospitals respect their physicians based on the number of profitable patients they bring in.
    — Medical equipment providers charge high markups on the equipment they sell to hospitals, physicians, and clinics. Monopolization drives up the rents charged for certain kinds of medical equipment and supplies — like dialysis machines and supplies.
    — Laws crafted by the Medical Industrial Complex keep nurse practicioners from undercutting physician charges for routine medical services, and control patient access to drugs, and certain tests and treatments.
    — Hospitals, clinics, and private practices are being sold to Finance enabling consolidation and monopsony control of new physicians starting practice weighed down by heavy debts incurred for the costs of their schooling. A most ancient of professions is being turned into cadres of dependent employees and contract workers.
    — The ancient Guild of Physicians — the AMA — controls the licensing and fees that physicians, especially specialists can charge through a state-by-state systeme of professional boards. The ancient Guild of Physicians keeps out foreign competition through licensing restrictions. How nice to set your own fees for a service like medical care!

    As Bender says: “We’re bone!”

  29. crittermom

    Yves, my roommate requires monthly blood draws but since Covid they now have him call from the parking lot of the hospital at his appointed time, & they then go to him, taking his temperature & drawing his blood while he sits in his car.
    Can’t/won’t they do the same for your mother, due to the virus? Or is that just a perk of going to a hospital in a smaller city (population 6,373)?

    Thankfully, I’ve yet to find a Dr either here or in N.M. that doesn’t accept both Medicare & Medicaid.

    I call myself ‘perfectly poor’, as I qualify for both (I’m 69 & poor, since losing my home to the banksters & now renting).

    In the state of New Mexico I never got one bill for any of the cancer treatments & surgeries I endured over 3 years, as my Medicaid covered what Medicare didn’t (in addition to the money that would be taken from my SS for Medicare). My meds only cost me $1.25 for a 3 month supply there, with Medicaid paying the rest.

    Now in Colorado, it cost me $7.60 for those same meds, but I’m certainly not complaining! I know I’m much more fortunate than most in that respect.

    However, weeks ago I had to have a blood draw once again after being treated for a vitamin D deficiency. I’m awaiting a bill, as it seems Medicare only covers them every 4 months, & it had only been 3 months since my last one. Not sure if Medicaid will pick up the difference but I’m sure I’ll soon find out.

    Medicaid is the only good thing about now being poor, I suppose.

    Yes, our healthcare system is a disgrace.

    1. Yves Smith Post author

      I’m glad you have had a good experience with your insurance and am very sorry that you’ve had enough health problems that you’ve needed to rely on it.

      Thanks for your suggestion but

      1. Neither my mother’s clinic nor any local lab like Labcorp would have someone come to her car

      2. Even if they did, she really is housebound. It takes 2 people to get her and her wheelchair to a car.

  30. lobelia

    I’m surprised Global, For Profit, Publically Traded™ Maximus, Inc. (which, per current wiki: Maximus won its first contract for social welfare in 1987, under the 2nd Reagan/Bush Reign, in Los Angeles; and “Went Public”™ in 1997, during the 2nd Clinton/Gore reign) hasn’t been brought up in the comments. Also per the current wiki, emphasis mine:

    Maximus Inc., trademarked as MAXIMUS, is an American outsourcing company that provides business process services to government health and human services agencies in the United States, Australia, Canada, Saudi Arabia and the United Kingdom. Maximus focuses on administering government-sponsored programs, such as Medicaid, the Children’s Health Insurance Program (CHIP), health care reform, welfare-to-work, Medicare, child support enforcement, and other government programs. The company is based in Reston, Virginia, has more than 34,000 employees and a reported annual revenue of $2.39 billion in fiscal year 2018.[2]

    Then again, who searches for information on a company they don’t even know exists, yet it oversees the healthcare of countless, international millions? It seems to have been kept a great secret by our lovely mainstream newspapers and news networks for over four decades. The 1 800 MEDICARE call center is actually answered by Maximus employees ( ). Having called the 1-800 number countless times for years before I knew the call center had been outsourced, not once was it clarified that the responders weren’t government employees; no wonder they can’t send you written verification of the information they provided you in that phone call, nor their phone extension or last name.

    I had no clue how deeply outsourced Medicare was to Maximus until I filed a very careful and detailed (including numerous medical reports) Part A Appeal for Skilled Therapists on behalf of a relative. Maximus oversees early Appeals regarding Medicare Parts A, C, D and Durable Medical Equipment [DME] ( ). That Medicare Part A Appeal was a horrid, soul sucking nightmare, and the excruciatingly painstaking appeal was denied. I remember reading at the time (less than two years ago), from a reliable source which link I can no longer find anywhere in a search, that around 98% of such Part A Appeals were being denied; also, that those denials were a long standing pattern (i.e. certainly during Obama’s reign and earlier).

    Maximus also ‘oversees’ many States’ Medicaid programs, much to the horror of their increasingly impoverished populous. This site, MAXIMESS, tracks the horror of the decades long US State and Federal Maximus Medicare/Medicaid privatization:

    Gotta run.

  31. lobelia

    Re my above Maximus Inc.comment, oddly the Maximus Durable Medical Equipment [DME] appeals are not noted on that Maximus appeals page I linked to, but they are noted on this page: Medicare Durable Equipment (DME) Appeals , in case anyone was wondering.

  32. Jack Parsons

    About your friend is moving to Flyover Country? I strongly recommend Kaiser. They’re in a lot of cities now.

  33. Janie

    All traditional medicare is run through third party intermediaries. It was necessary to keep it from being rejected as socialist, commie pinko stuff.

    Your medical provider sends the claim to the fiscal intermediary for your state/region. The FI handles the part about did you need the care, was it appropriate, how much do we pay, etc. Social Security Medicare department verifies your eligibility. Then the FI pays the provider and you pay the balance, if any.

    The FIs are the big insurers, like the Blues. In California, when I was in the industry, it was Transamerica.

  34. Dick Swenson

    Do any Doctors or their kin (i.e., medical bretheren) ever explain why they don’t accept Medicare?

    Do their explanations make sense? Are their answers “I don’t get paid enough?

    I am 83, iin reasonible health and have never known any medical professionals who did not accept Medicare.

    My younger brother had a blood disease from which he died. Just before that death, he visited Canada. He had some severe difficulties, went to a hospital, was cared for (he received blood), and returned to the US. He never received a bill nor was he refused service. The doctors suggested that he stay and let them provide full-time care..

  35. jrkrideau

    Did Rube Goldburg design the US medical system morass?

    I live in Ontario, Canada and the health system is not the best in the world but I show up at my doctor’s or a hospital, hanh someone my health card, get treated, and leave.

    Last year after a bad accident I had 7 weeks in the hospital, the services of neurologists, physios and occupational therapists and then a home visit from a nurse for two weeks and weekly visits from a physio and an occupational therapist for 10 weeks.

    This month, 18 months after the accident I have my third follow-up appointment with my rehab doctor.

    Total out-of-pocket expenses were $45 for the ambulance.

    Oh yes, the hospital asked if I would mind leaving a day before my scheduled release day. They offered a taxi chit when I casually mentioned I’d need a taxi because my chauffeur was out of town that day.

  36. gerry

    Why not VA For All? No need to abolish private healthcare. Just compete. Open hospitals and clinics. Hire doctors nurses, etc. Select staff for public service motives and establish esprit de corps. Free care for the poor and sliding scale to the general public. It also provides competition in services, not just price. Naturopathy, body work, lifestyle as opposed to the body as a machine.

    It’s also on the glide path for universal, free service unlike ACA.

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