Well, I knew my medical insurance was expensive, and now it's official

[SmithOp]

My birthday is December 30th; I turn 62 this year. Anyone know if my first SS payment starts that month, or does it start the next? (Cliff is 18 years older so we have always figured I'd take SS ASAP; then back issues that often render me unable to walk without a cane and the slowdown of our business pretty much have forced our hand that way anyway). Same with Medicare three years after that-- does it start in Dec or Jan? I remember my dad crowing that he got to count me as a dependent the whole year I was born, even though I was born two days before the end of the year.

SS at the end of one full month AFTER your birthday month. My wife turned 62 in Oct, first check was Dec 1st. You should get one Feb 1st.

Medicare is different from SS.

PS, don't forget to cancel ACA when you go on Medicare, I did taxes for a person that assumed it would be canceled automatically, now owes $750 refund of PTC.


Sent from my iPad using Tapatalk

 

[VacationForever]

It's ironic but to some extent, Medicare has a rule against preexisting conditions. As I understand it, along with Basic Medicare, you can get either Supplemental or Advantage coverage. Medicare Advantage is significantly cheaper and is a good choice for the "younger seniors" who are not very sick.
But I was told that if you are on Advantage and want to transfer to Supplemental because you are now sick, the insurer does not have to accept you if you try to transfer with a preexisting condition.

Advantage plan can only throw one out if the entire plan goes away but an alternative plan within the same provider will be provided, unless the medical network shutsdown entirely. Most remain on their Advantage plans even when they get very sick. Yes, 2 years after one starts Medicare and not already on Supplemental, then insurer can reject the applicant or raise rates. The worst thing about Supplemental plans is that they can also bump one's rate the following year when the person gets sicker.

Advantage plans are HMO plans. They are not necessarily inferior to Supplemental plans.

 

[isisdave]

"USA health insurance system is broken"
"This cannot continue for much longer"
"I agree the system is broken"

This NY Times best seller book details why Americans pay significantly more in health care costs than other developed countries

https://www.amazon.com/American-Sickness-Healthcare-Became-Business/dp/1594206759

unfortunately it's going to get worse before it gets better

Also, An American Sickness

 

[rapmarks]

Medicare begins on the first of the month of your birthday month.


Sent from my iPad using Tapatalk

 

[funtime]

Run, don't walk! over to Kaiser Permanente. Blue Cross jacked my mother around for 6 months and I called Kaiser for her and they had her insured in 1 day on their Senior Advantage Program for 1/3 the cost we used to pay. We love Kaiser. They give great service, are affordable, are convenient. They were there for my mother when she broke her hip. You owe it to yourself.

 

[VacationForever]

Run, don't walk! over to Kaiser Permanente. Blue Cross jacked my mother around for 6 months and I called Kaiser for her and they had her insured in 1 day on their Senior Advantage Program for 1/3 the cost we used to pay. We love Kaiser. They give great service, are affordable, are convenient. They were there for my mother when she broke her hip. You owe it to yourself.

A prime example of an Advantage plan being superior..Kaiser gets 5 star ratings in CMS Comparehealth.

 

[artringwald]

My birthday is December 30th; I turn 62 this year. Anyone know if my first SS payment starts that month, or does it start the next?

My first SS check arrived exactly one month after my birthday. If you want to claim it in December, you'll have to start you paperwork in September. If you can wait until you're 70 to claim it, your monthly check will be 64% higher. Financially, the worst case scenario is living until you're 100, and not having enough monthly income, so wait if you can.

 

[artringwald]

Talk about the crazy costs of medical care, DW occasionally gets severe migraines. We were on a Mediterranean cruise, and she went after hours to the ship's urgent care, and got charged $316.76 for IV drugs and a couple hours of observation. When the same thing happened while on a trip with a stopover in Seattle, the ER did almost identical treatment. After they buggered up the insurance billing, they sent us a bill for $4410.35.

Fortunately, our total cost for both was $0. Travel insurance covered the former, and Medicare with supplemental covered all of the later (after reducing it to $518.13).

 

[WinniWoman]

Now to put a third edge on the sword. Americans are paying for all of this innovation by the price we pay. I am not sure how much more innovation we can afford. We pay twice as much for our healthcare and our outcomes are not as good. If we do not change soon the price we will pay long term is going to be ugly.

"To some questions there are no answers."

We can't afford health insurance. We can't afford medical care. We can't afford to be on waiting lists for health care. We can't afford the innovation to cure more illnesses. We can't afford higher taxes.

 

[Talent312]

My b-day falls mid-month, which meant my 1st month of SS eligibility was the next ensuing month, and my 1st benefit would be paid in the 3rd week of the following month. IOW, a little more than 2 months after my b-day.

BTW, I didn't wait becuz my break-even point at which waiting would begin to yield more $$ was about age 84. Before then, waiting would'a cost me $$. Sure, if I lived that long I'd have shorted myself but who knows... Besides, I'm getting a pension with a built-in 2.65% COLA.

.

 

[artringwald]

My b-day falls mid-month, which meant my 1st month of SS eligibility was the next ensuing month, and my 1st benefit would be paid in the 3rd week of the following month. IOW, a little more than 2 months after my b-day.

BTW, I didn't wait becuz my break-even point at which waiting would begin to yield more $$ was about age 84, and while yes, I'd be nice to have the additional amount, at that point, I doubt I'd be active enuff to need it. As it is, I'll be getting a pension with a built-in 2.65% COLA.

.

A pension with a built-in 2.65% COLA? Wow! I have a nice pension, but I don't think they've increased anybody's pension in years. Most companies are working hard to eliminate pensions.

 

[lizap]

The rising cost of health care insurance will continue until people have had enough. This has been politicized, but really providing decent, basic healthcare should not be a political topic. Why does the cost continue to rise at the level it does? Because it can; there's no system of checks and balances, no controls. It will continue to rise until people have had enough..

 

[GregT]

This is indeed an interesting topic, and I thank the TUGgers who have personalized it -- we all read so much crap in the papers, and this is the real world experience here on TUG.

From the perspective of the corporate world, I do have a balancing view. I am the CFO of a healthcare company here in San Diego. We have several cardiac diagnostic tests that are widely utilized, and I would bet that any TUGger who has had open heart surgery or a stent implanted has been tested with our product. It is a life saving product and I am proud to be CFO of this company. I would without hesitation have our products used on me, my brother, my children, my parents, and know that they would have a better outcome because of these diagnostic tests.

In the United States, we sell our product directly to the hospital (and we have a U.S. sales force that we hire and pay to support those sales). Internationally, we sell through distributors, who in turn re-sell to the hospitals at a marked up price.

On average, we charge about 33% more from the products that we sell directly to the hospital in the United States than a hospital in Europe will ultimately pay for the same diagnostic test. The difference is because of the reimbursement amount that the hospital is paid by the insurance company. European insurers (ie, their governments) pay less to the hospital than a U.S. insurance company. Because of this, many European hospitals do not buy our products, preferring a cheaper (inferior?) product from a different source, purely for cost reasons. We've seen situations where sales in November and December dry up in the U.K. -- because the NHS ran out of budget for tests like ours and so procedures get canceled. Tough stuff if your open heart procedure is in November.

But why do we charge 33% more in the U.S. than we know is being paid in the rest of the world for the same test?

It's not greed -- this is part of the business model -- and although it is unfortunate, this is the reality of the situation: the United States subsidizes the rest of the world's health care systems. We spend ~$10M in R&D every year (about 25% of our Operating Expense budget) to try and create better tests. We hope to be successful, but it takes time and is uncertain. And that U.S. price premium funds it -- and the rest of the world will still get to buy that next generation test -- and pay less for it than the U.S. consumer.

There is alot of interest in a single payer system in the United States -- if every other country does it, why can't we? Well, this is a glimpse of what I believe would happen. The United States government, like every other government (and like Medicare) would reimburse less for the usage than current private insurers pay. There really would be decrease in new products, and budgets really would -- even more than today -- determine what treatments are available. Finally, fear of litigation is pervasive in the medical world -- we all recognize the need to protect our patients, but we need to recognize the significant related compliance cost that this brings from doctors and hospitals that fear litigation.

So I hope we fix what is currently broken, continue to protect those that are most vulnerable, reward those who have maintained coverage even if not sure they needed it, and manage the unnecessary costs that burden our products.

Sorry for the rambling message, and my thanks to my fellow TUGgers for sharing their experiences above.

Best,

Greg

 

[b2bailey]

Did you ask him how much was his cell phone bill monthly?
Is he driving a newer car? And does he have insurance on the car?
Could he get a part time job?
Has he cut out primo coffee and lattes?
Did he look for a cheaper apartment?

His premium is less than $85 per week.

At $85 per week -- it's more than his weekly grocery allotment. That doesn't seem right. He works in food service for min wage plus tips. Drives his mom's hand me down car which is 20 years old.

 

[moonstone]

I find it sad that Americans have to pay so much in health care insurance. Nobody should have to choose between eating (or paying their rent/mortgage) or paying for heath insurance or medical treatment. I have family in Calif. who pay more in health insurance (family of 4 with 2 pre-teens -all healthy) per month than what their mortgage payment is!

Many years ago we met an elderly man camping in the next site to ours who was a professor at the local university and presumably making good money. He was forced to sell his home when his wife was diagnosed with cancer so he could afford the treatments. I don't remember what, if any, insurance he had from his work. His wife eventually passed away and this poor old man was left with nothing -no home (lived in a 22ft trailer), no savings & no wife! He worked quite a few years after he should have retired just to build up his SS income for his retirement.

Not to get political but I am so glad to be a Canadian with our health care system and coverage. My Mom spent over 5 months in hospital a few years ago and my Dad's cost was $0.00!!


~Diane

 

[Bucky]

This is indeed an interesting topic, and I thank the TUGgers who have personalized it -- we all read so much crap in the papers, and this is the real world experience here on TUG.

From the perspective of the corporate world, I do have a balancing view. I am the CFO of a healthcare company here in San Diego. We have several cardiac diagnostic tests that are widely utilized, and I would bet that any TUGger who has had open heart surgery or a stent implanted has been tested with our product. It is a life saving product and I am proud to be CFO of this company. I would without hesitation have our products used on me, my brother, my children, my parents, and know that they would have a better outcome because of these diagnostic tests.

In the United States, we sell our product directly to the hospital (and we have a U.S. sales force that we hire and pay to support those sales). Internationally, we sell through distributors, who in turn re-sell to the hospitals at a marked up price.

On average, we charge about 33% more from the products that we sell directly to the hospital in the United States than a hospital in Europe will ultimately pay for the same diagnostic test. The difference is because of the reimbursement amount that the hospital is paid by the insurance company. European insurers (ie, their governments) pay less to the hospital than a U.S. insurance company. Because of this, many European hospitals do not buy our products, preferring a cheaper (inferior?) product from a different source, purely for cost reasons. We've seen situations where sales in November and December dry up in the U.K. -- because the NHS ran out of budget for tests like ours and so procedures get canceled. Tough stuff if your open heart procedure is in November.

But why do we charge 33% more in the U.S. than we know is being paid in the rest of the world for the same test?

It's not greed -- this is part of the business model -- and although it is unfortunate, this is the reality of the situation: the United States subsidizes the rest of the world's health care systems. We spend ~$10M in R&D every year (about 25% of our Operating Expense budget) to try and create better tests. We hope to be successful, but it takes time and is uncertain. And that U.S. price premium funds it -- and the rest of the world will still get to buy that next generation test -- and pay less for it than the U.S. consumer.

There is alot of interest in a single payer system in the United States -- if every other country does it, why can't we? Well, this is a glimpse of what I believe would happen. The United States government, like every other government (and like Medicare) would reimburse less for the usage than current private insurers pay. There really would be decrease in new products, and budgets really would -- even more than today -- determine what treatments are available. Finally, fear of litigation is pervasive in the medical world -- we all recognize the need to protect our patients, but we need to recognize the significant related compliance cost that this brings from doctors and hospitals that fear litigation.

So I hope we fix what is currently broken, continue to protect those that are most vulnerable, reward those who have maintained coverage even if not sure they needed it, and manage the unnecessary costs that burden our products.

Sorry for the rambling message, and my thanks to my fellow TUGgers for sharing their experiences above.

Best,

Greg

Great post Greg. I can almost guarantee you that I have had your product used on me. More than once!

I would assume and always have, that the hospitals always bill astronomical fees because they know they are only getting a certain percentage back from the insurance companies and Medicare. No different than the drug companies that overcharge to fund research and development.

 

[Brett]

I find it sad that Americans have to pay so much in health care insurance. Nobody should have to choose between eating (or paying their rent/mortgage) or paying for heath insurance or medical treatment.
.
Not to get political but I am so glad to be a Canadian with our health care system and coverage. My Mom spent over 5 months in hospital a few years ago and my Dad's cost was $0.00!!

~Diane

taking pity on Americans is OK as long as you realize the $0.00 cost for staying 5 months in a hospital was paid through your taxes. Google
"Canada health insurance taxes" and you will find many believe Canadians are the ones paying more for their health care!

 

[Talent312]

... There is a lot of interest in a single payer system in the United States -- if every other country does it, why can't we? Well, this is a glimpse of what I believe would happen. The United States government, like every other government (and like Medicare) would reimburse less for the usage than current private insurers pay...

Not to politicize, but to interpret... What you are saying is that health care costs would go down, but that's a bad thing becuz your company, drug companies, and others who game the system would spend less on R&D...

My take: So be it. Let your shareholders and overseas customers pay the price.
But then, hospitals don't mind becuz they can soak insurance companies for new equipment and new buildings.

The health cares system awash in money being taken out of the hides of consumers, in which insurance companies are complicit. Insurance companies, who should emphasize cost-control, won't do it becuz they don't want to be blamed for choking the system and besides, most of their money comes from employer-group plans in which employees are captive audience.

.

 

[lizap]

taking pity on Americans is OK as long as you realize the $0.00 cost for staying 5 months in a hospital was paid through your taxes. Google
"Canada health insurance taxes" and you will find many believe Canadians are the ones paying more for their health care!

I suspect there is a large portion of Americans who would be willing to pay more in taxes for guaranteed healthcare.

 

[moonstone]

Yes as lizap says, I don't mind paying a relatively small amount (I'm retired on not a large pension) of income tax (with health care costs in there) so that no matter if I am in the hospital for 5 hours or 5 months my cost will be the same. People should not have to go bankrupt to pay for their (or family members) cancer treatment. I know that if I am in a really bad health situation my husband wont have to sell our house to pay for my treatment. It doesn't matter if your income is 20K a year or 200K a year you get the same treatment and at the same cost. Although there are private treatment options available for those who can afford it but you aren't necessarily getting better healthcare, but maybe faster.

~Diane

 

[dominidude]

This is indeed an interesting topic, and I thank the TUGgers who have personalized it -- we all read so much crap in the papers, and this is the real world experience here on TUG.

From the perspective of the corporate world, I do have a balancing view. I am the CFO of a healthcare company here in San Diego. We have several cardiac diagnostic tests that are widely utilized, and I would bet that any TUGger who has had open heart surgery or a stent implanted has been tested with our product. It is a life saving product and I am proud to be CFO of this company. I would without hesitation have our products used on me, my brother, my children, my parents, and know that they would have a better outcome because of these diagnostic tests.

In the United States, we sell our product directly to the hospital (and we have a U.S. sales force that we hire and pay to support those sales). Internationally, we sell through distributors, who in turn re-sell to the hospitals at a marked up price.

On average, we charge about 33% more from the products that we sell directly to the hospital in the United States than a hospital in Europe will ultimately pay for the same diagnostic test. The difference is because of the reimbursement amount that the hospital is paid by the insurance company. European insurers (ie, their governments) pay less to the hospital than a U.S. insurance company. Because of this, many European hospitals do not buy our products, preferring a cheaper (inferior?) product from a different source, purely for cost reasons. We've seen situations where sales in November and December dry up in the U.K. -- because the NHS ran out of budget for tests like ours and so procedures get canceled. Tough stuff if your open heart procedure is in November.

But why do we charge 33% more in the U.S. than we know is being paid in the rest of the world for the same test?

It's not greed -- this is part of the business model -- and although it is unfortunate, this is the reality of the situation: the United States subsidizes the rest of the world's health care systems. We spend ~$10M in R&D every year (about 25% of our Operating Expense budget) to try and create better tests. We hope to be successful, but it takes time and is uncertain. And that U.S. price premium funds it -- and the rest of the world will still get to buy that next generation test -- and pay less for it than the U.S. consumer.

There is alot of interest in a single payer system in the United States -- if every other country does it, why can't we? Well, this is a glimpse of what I believe would happen. The United States government, like every other government (and like Medicare) would reimburse less for the usage than current private insurers pay. There really would be decrease in new products, and budgets really would -- even more than today -- determine what treatments are available. Finally, fear of litigation is pervasive in the medical world -- we all recognize the need to protect our patients, but we need to recognize the significant related compliance cost that this brings from doctors and hospitals that fear litigation.

So I hope we fix what is currently broken, continue to protect those that are most vulnerable, reward those who have maintained coverage even if not sure they needed it, and manage the unnecessary costs that burden our products.

Sorry for the rambling message, and my thanks to my fellow TUGgers for sharing their experiences above.

Best,

Greg

Greg, I really like your post, it seems honest.
I'll tell you what is wrong with the system in our great country and how to fix it in a much shorter posts than yours.
The current US system rewards cures such as those provided by your company, but it does not do anywhere near enough to prevent people from needing those cures in the first place.
Imagine a world in which fire prevention officials didn't exist, and in which you and I had to pay every time a fire truck came to the front of our house.
The more fires, the more loses; the more loses, the bigger the insurance premiums; the bigger the premiums, the higher the profits from insurers; the higher the profits from insurers, the higher the incentive to put out those fires quickly if expensively (see the pattern).
So, to conclude, while I do not necessarily agree that a single payer system would be the end of all problems health related, a single payer system does have strong incentives to prevent disease in the first place, something that our current system desperately needs. If there is a substantial reduction in disease, sorry to say, your company would not need to exist in the first place.
1st Note: if your business depends on US insureds subsidizing the rest of the world, that's not a sustainable proposition. I hope all of the employees of your company have a back up in case that stops.
2nd Note: While it's "Tough stuff if your open heart procedure is in November" in the UK, it's tough stuff 365 days a year here in the USA for Americans who are either uninsured or underinsured and cant afford your company's product. I bet the US population here that is either uninsured or underinsured is about the size of the UK.
3rd Note: It is really cheap to live healthy to old age. The list of what to do is really short. 1) Eat 1200-1600 calories a day, depending on your height, and no more, about half those calories need to come from veggies 2) get enough sleep 3) eat a good amount of fish (about 4oz twice a week). Notice exercise doesnt even make it to the list. What is not easy is having an environment where most people adhere to those three things. Imagine how many fast food restaurants would go out of business, and how many customers would balk at paying $8 for a meal with 300 calories.

 

[Brett]

I suspect there is a large portion of Americans who would be willing to pay more in taxes for guaranteed healthcare.

sure
but a whole lot of political changes must occur for something like that to happen

 

[DeniseM]

Folks - I know it is really difficult, but we can't go down the "political" road.

 

[taffy19]

I know that political discussions are not allowed on TUG and I am so glad about it. I get sick when I read the nasty comments on Facebook to each other because people do not agree instead of having a civil discussion with each other about what the problems are and how to solve them.

This is fact. I received a PM yesterday on FB from a Dutch friend who lived in California first and then moved to Canada after her husband retired because that is where their children live.

He needs a knee replacement and has difficulty walking and kneeling but he has to wait six to eight months before it is his turn (her words). I am sure that he wouldn't have to wait that long here in the USA. It is the same in Europe too from what I understand.

Our neighbors in Mexico are from the same area in Canada where my Dutch friend also lives. They spend their winter months in Mexico too. She has therapy three times a week and she tells me that it is so much better than her far and in between therapy treatments in Canada.

The hospital over there butchered her back operation and she ended up in a wheelchair because they injured her nerves in the spinal cord. She can hardly stand up but when she goes home again she can walk a few steps on her own with a walker but will have lost all her strength again when she'll come back a year later. Very sad.

There are several modern or up to date hospitals in Puerto Vallarta ready and eager to receive foreign patients once people will rather go somewhere else than wait for treatment at home if they have to wait so long.

There are some very good dental clinics too in Mexico from what I hear. One is owned by a Canadian dentist in Bucerias in Nayarit close to Nuevo Vallarta near Puerto Vallarta. I even read it here on TUG how much cheaper the treatments are in Mexico.

It is becoming a bigger problem the older the population gets and this is fact too.

 

[WalnutBaron]

I'll echo what others have said about how interesting and engaging this thread is. And thanks to many of you for personalizing your experiences and the truly shocking costs of healthcare in America today. I'm blessed--60 years old and never with a major health challenge for either me or my DW. I'll offer my two cents on how to get this runaway train under control:

1. This is an industry that is inherently immune to the laws of supply and demand. Good old-fashioned competition just doesn't work--and here's why: right now DW and I are shopping for a new refrigerator. Since it's a major purchase, I've checked Consumer Reports to see which are the best-rated. We've shopped online, gone on the message boards and review sites to see what others who own the brand and model we're looking at say about it, and are now checking various retailers to see what their delivery costs and service capabilities are. But when I have a medical emergency--whatever it may be--I not only have no time to do my due diligence, but time is of the essence, especially if it's a life or death kind of issue. Literally the only factor keeping my healthcare provider(s) from charging whatever they darn well please is the pre-negotiated rates for products/services by my insurer. If it was just me, the doctor/hospital/specialists/drug and medical supply companies could and most likely would hang me out to dry. Competition is out the window because my insurer directs me to which provider and hospital I'm allowed to see. The invisible hand of Adam Smith is not just invisible in the healthcare industry in America, it's non-existent.
2. The tort attorneys are killing us. I'm old enough to remember when attorneys were not allowed to advertise--until a Supreme Court ruling in 1977 changed all that. Even forty years later, that ruling is controversial because it allows so-called "ambulance chasers" to pre-dispose people to sue doctors and medical companies for so much as a hangnail. One organization has estimated that the passage of federal tort reform would lower healthcare premiums by about 3.5%. It's doesn't sound like a lot, but every little bit helps.
3. There is no doubt in anyone's mind that greed runs rampant in the healthcare industry. This particularly egregious example comes from an article published just today in Bloomberg BusinessWeek about a drug company--Alexion--which charges an almost unbelievable $500,000-$700,000 per year for a drug called Soliris. The drug companies will often trot out the old saw that they need this kind of pricing flexibility to offset massive R&D costs, especially for drugs that help a relatively few patients, like Soliris does. But the BusinessWeek article contends that so-called "orphan disease" drugs are in fact highly profitable for the drug companies. The article itself is pretty damning.
4. Thanks to the overly-extensive lobbying strength of the AMA in Washington, bad doctors are not only able to continue to practice despite substance abuse issues, questionable training, and other things, but their patients have no way of knowing they have been disciplined. This is yet another example where the patients are hampered from being able to conduct simple due diligence. Bad doctors should be exposed and then at least let the free market determine their eligibility to continue to practice. But free market principles don't apply since these doctors are shielded by laws advocated by the AMA.
5. Greg's earlier comments about the effects of a single-payer system ring true. By its very definition, healthcare gets allocated and healthcare availability decisions get made by government bureaucrats and not healthcare providers.

So what's the solution? Of course, there is no easy answer and this issue is incredibly complex. But I would offer a few suggestions that would at least have a positive effect on the outrageous costs in the American system:

• Pass federal tort reform that limits jury awards.
• Repeal the ability of tort lawyers to advertise their "services" in a way that encourages frivolous and costly lawsuits that we all end up paying for. Ultimately, the only winners in the current system are the tort lawyers themselves.
• Substantially shorten the time period for drug patents, allowing generic imitators to come on to the market much sooner. The drug companies will tell us that this would completely undercut their incentives to conduct the R&D necessary to develop drugs, but I think that theory ought to be tested by allowing the free market to have a greater hand in controlling drug costs.
• Remove the veil from bad doctors and bad hospitals. Expose the bad ones, and allow the free market to laud the exceptional ones.
• Require doctors and hospitals to post their fee schedule for routine medical procedures and make these fees available online such that online consolidators such as esurance.com can immediately show consumers what those costs are. Yes, some will say that this is impossible because every patient is different and every situation is different. Fair enough. But that doesn't mean something like this could not be done to at least provide some level of price comparison to see the light of day.
• Substantially shorten the inordinately long and costly drug testing and approval process by FDA. Many will say that this process protects us, but the recent experience of the expedited process for approval of Zmapp to respond to the Ebola crisis shows it can be done--and should be done much more often and with greater dexterity.

Not being in the medical field, I am sure some of my prescriptions (pun intended) for fixing our broken system are short-sighted. But we've got to start somewhere, because what we've got is not only unconscionable, but unsustainable in the extreme.