Now thats fine and all but the part I don’t like is that obamacare will be run like an HMO. I will have to go see a primary doctor (which will be hard to find as few will accept obamacare) and then they will have to give me permission to see a specialist (which I have seen without permission before) and maybe after the headache and lost time at work I will be able to finally get seen. And maybe even treated if I am lucky.

What do I have now… a great medical package that I walk into whatever doctors office I want and get treated costing me and the insurance company less money.

I know what is available. . .under plan F, you pay ZERO.

ThackerAgency on June 25, 2009 at 1:25 PM

There is a NON-ZERO premium for every Plan F: $88-$264/month for my area of the country with various copay arrangements. Medicare estimates my AVERAGE total annual cost for this type of plan to be $5250, which includes the $1122 I pay for Medicare B as well as my total annual out-of pocket cost for copays and the extra insurance premiums. This means my out-of-pocket cost would be $4128 under a Plan F: far from ZERO, and well in excess of the $3642 MAXIMUM out-of-pocket cost (=$1122 Medicare B premium + 2520 maximum out-of-pocket copays) I am guaranteed with my present Medicare Advantage plan.

And $4128 is more than double what I actually paid last year under my Medicare Advantage plan including all of my co-pays for two hospitalizations and a mixture of in-network and out-of-network doctors (my MA plan is a PPO). In addition, Drug coverage is INCLUDED in my plan, whereas it would be extra with a Plan F Supplemental.

Does this mean that Medicare Advantage is best for all patients? Of course not!!! But there is no reason to throw away a valuable choice of plan as long as it works for any group of people.

And did my Medicare Advantage plan “cost” the government more than your plan? NO!!!! It actually cost the government LESS because government routinely cheats Medicare Advantage plan insurance companies by paying less than would be paid if the government had administered the plan: less than the sum of my premiums plus the pro-rata per capita proceeds from the Government’s Medicare Insurance Reserve (maintained by Keebler elves and Barney Frank). Despite that, my MA insurance company makes a PROFIT!!! They should be PRAISED for leading the way in reducing costs: not damned for showing up the inefficencies in the government-administered Medicare!

You do know that prescription drugs through the VA is better than any other private plan, don’t you?

You do know the VA rations medication, and often uses older, less effective drugs instead of newer, more effective drugs, don’t you?

that’s why you get to easily change plans once a year in order to adapt to your changing situation.

I know you don’t know this, but this is what causes a LOT of fraud in the industry. There are agents that switch their clients without them knowing it because it is ‘easy’. They pocket the money and few people know because it’s ‘free’.

you would pay (in 2009) $175/day for days 1-7, and $0 for days 8-90, with out-of-pocket costs capped at $2450 per year.

isn’t that what I said?

I know what is available. . .under plan F, you pay ZERO.

When they start charging a fee, it won’t be as good. They will start charging a fee.

I’m not against profits. That’s why I’m against a government plan. They can run a insurance plan without worrying about profit. That causes a monopoly.

Earth to ThackerAgency… time to wake up and face reality…

…Big Government is NOT a viable solution.

dominigan on June 25, 2009 at 1:13 PM

Why is it that I get questioned here so heavily? This is how I eat. I don’t generally talk about what I don’t know. If this were about cooking, I’d just read. But insurance – HEALTH INSURANCE – I KNOW.

I’m not suggesting ‘big government’. I’m proposing this in horror of the concept of a ‘government insurance plan’. If you want to ‘reform health care’, it’s best to do something OUTSIDE of what is currently available.

I’d rather big government not provide money to people to buy insurance. That would help me because if they make it mandatory like auto insurance, I’d make more sales, and I’d get government money to butter my bread.

I don’t want to see the government in insurance. Do I want people to not have access to affordable coverage? NO. I want people to have access. The government is going to do something.

What can they do to help?

They can set up General Practice offices like Urgent Care facilities all over the country. They could staff it with doctors trained through the MILITARY. . . military spending.

The system could be considered VA, but it would be available to EVERYONE WHO DOESN’T HAVE INSURANCE. If you get sick, go there and pay an out of pocket fee.

I think that solution ‘fixes’ a gap in health care without destroying what exists. It keeps government OUT of insurance, but provides a solution to ‘people who are not insured’.

I in no way want a bigger government – EVER. In fact, I’d be happy without the government. . . but I don’t want to have to fight on my own against invading international forces.

Tell me. . .under Coventry – if I am hospitalized for a week, how much would I have to pay?

Med Supp, plan F I pay nothing. . . what would Coventry charge me under the ‘free’ plan with ‘better’ benefits?

ThackerAgency on June 25, 2009 at 12:34 PM

With a Medicare Supplement plan, you pay the Insurance company for the “Supplemental F” benefit whether you use it or not. It may or may not be better for you, depending on how often you are scheduled by your Creator to be hospitalized in a year. Other supplemental plans and “Advantage” plans offer better or worse deals for a given situation: that’s why you get to easily change plans once a year in order to adapt to your changing situation.

For a week in the hospital under Coventry (in the PPO plan in my area: additional cost over Medicare A+B = $0), you would pay (in 2009) $175/day for days 1-7, and $0 for days 8-90, with out-of-pocket costs capped at $2450 per year. This is a great deal if your situation is such that hospital costs are likely less than the Supplement premiums offered in your area.

Eliminating Medicare Advantage programs would simply increase costs and eliminate a valuable choice.

The “excess costs” which Liberals whine about are simply the profits which private companies manage to earn over and above the costs they pay for providing the same or better care for LESS money than it costs Medicare to service the same patient directly. So why should the Advantage provider be punished because the government can’t figure out how to cut its own costs by the amount of the profit? What is wrong with private enterprise showing government the way?

Liberals seem to hate private enterprise and can’t stand the thought of anyone making a profit (except them, of course). And they are greatly threatened when a private company is being rewarded for out-performing the government.

Are you claiming that the VA (with all the resources of the government) CAN’T be a solution? You don’t think they can be made better?

ThackerAgency on June 25, 2009 at 12:16 PM

First of all, anything provided by the Government is not free… it’s paid by taxpayers through taxpayer revenues, which ebb and flow with the free market.

Second, point out one Government-run entity that is managed efficiently. Do I think they can be made better? YES! Do I think the Government can do it? HELL NO! (Otherwise they would have done it for dozens of other agencies, and hundreds of other programs.)

Earth to ThackerAgency… time to wake up and face reality…

…Big Government is NOT a viable solution.

You may or may not be a liberal, but you have (perhaps without realizing it) swallowed their line.

landlines on June 25, 2009 at 12:50 PM

I’ve never heard most of what I’m saying. Since you aren’t in the industry, I’ll answer the question you can’t concerning how much a week stay in the hospital costs under the Coventry ‘better benefits’ MA plan.

A week in the hospital will be a dollar a day benefit. . . I don’t know the exact number, but it’s generally around $200/day in the hospital. If I’m hospitalized for a week and have a ‘free’ MA plan, I have to pay 1400 dollars (7×200)

If I’m hospitalized for a week and have regular Medicare and a supplement plan F, I pay ZERO, NADA, ZIP, NOTHING. Medicare and plan F pays EVERYTHING.

Again, you really can’t go wrong with any Medicare product. But for my money, traditional Medicare beats MA plans. . . and when they start charging a fee form MA plans, it will be even more of a no-brainer.

Yes you can breathe in as much as you want, but unless you pay the carbon tax… this will do wonders for health care as you have to stop breathing if you can’t pay the tax…

We were warned about this:

In what manner then will you be eased, if the expences of government are to be raised solely out of the commerce of this country; do you not readily apprehend the fallacy of this argument. But government will find, that to press so heavily on commerce will not do, and therefore must have recourse to other objects; these will be a capitation or poll-tax, window lights, &c. &c. And a long train of impositions which their ingenuity will suggest; but will you submit to be numbered like the slaves of an arbitrary despot; and what will be your reflections when the tax-master thunders at your door for the duty on that light which is the bounty of heaven. It will be the policy of the great landholders who will chiefly compose this senate, and perhaps a majority of this house of representatives, to keep their lands free from taxes; and this is confirmed by the failure of every attempt to lay a land-tax in this state; hence recourse must and will be had to the sources I mentioned before. The burdens on you will be insupportable-your complaints will be inefficacious-this will beget public disturbances, and I will venture to predict, without the spirit of prophecy, that you and the government, if it is adopted, will one day be at issue on this point. The force of government will be exerted, this will call for an increase of revenue, and will add fuel to the fire. The result will be, that either you will revolve to some other form, or that government will give peace to the country, by destroying the opposition. If government therefore can, notwithstanding every opposition, raise a revenue on such things as are odious and burdensome to you, they can do any thing.
-Cato, Cato No. 6, 13 DEC 1787

Yes, warned about this and greatly. America has decided not to listen to the constructive criticisms from the founding and end that dialogue.

So ‘Progressive’.

And now we shall pay until we are numbered slaves of despotic government.

You do know that prescription drugs through the VA is better than any other private plan, don’t you? Isn’t this your industry? Don’t you know all this stuff? Is it time to call me a liberal again?

ThackerAgency on June 25, 2009 at 12:16 PM

No, I am a health care consumer…not “in the industry”. But my profession affords me ample oppportunity to become skilled in reading and understanding laws, government documents, and various legaleze.

The best prescription drug plan in the country which is available to every man, woman, and child is to shop at Walmart: they have, almost single-handedly, largely solved the prescription drug cost problem…without government help. Walmart competitors provide even more convenient and highly cost-competitive access to most prescription drugs.

You may or may not be a liberal, but you have (perhaps without realizing it) swallowed their line.

Maybe you focus too much on YOUR plan. When it first started I was excited and gung ho about it. I got signed up with 6 different plans (which is why I spent so long explaining the differences in plans to my clients).

But EVERY YEAR you have to go through a regulatory meeting with EVERY COMPANY you represent. Also, United was spending money putting out novice agents (probably like yourself) and setting up appointments for them to just go out and get as many signatures as possible.

The MA products only work because you sign over your Medicare benefits to the insurance company. That’s why they get the money that they get. It’s the money that was allocated to the government providing your Medicare coverage.

It has been obvious to me that if insurance companies weren’t doing well with it, they wouldn’t be marketing it as heavily. Watch the AARP United medicare ads now. They no longer market their MA product (the most popular and one I represented – they bought out another one I represented ‘Pacific Life’).

United now markets their traditional supplement plan F instead of their MA plan. Why? Because the government is going to cut the payments that they will make to the insurance companies for providing those benefits. That will make it impossible for them to make a profit giving something away free.

Their first step will be charging a fee. . . then they’ll reduce benefits.

Tell me. . .under Coventry – if I am hospitalized for a week, how much would I have to pay?

Med Supp, plan F I pay nothing. . . what would Coventry charge me under the ‘free’ plan with ‘better’ benefits?

Tell me what I don’t know. . . please.

ThackerAgency on June 25, 2009 at 12:01 PM

I can’t explain why you are so wrong. Maybe you focused your research too narrowly on the company you represented. Check out Coventry Advantra for a counterexample.

And I cannot fathom why you think that you “give up Medicare” when you sign up for “Medicare Advantage”. Nothing in the CMS documents says this in any way. You still get every single benefit and every single protection spelled out in Medicare…plus MORE (and yes, I spent MONTHS reading ALL the public and private literature).

The ONLY thing you “give up” with a Medicare Advantage plan is the opportunity to be put on hold for an hour every time you call the national Medicare number for health care support: you call your plan’s administrator instead. My Medicare Advantage plan answers the phone immediately 24/7/365!!

And you can STILL call the national Medicare number if you have a problem or complaint, because you are STILL IN MEDICARE!!! Medicare Advantage is simply an alternative administration and delivery system.

(1) Thanks for your service. Far as I’m concerned, any expenditures we incur addressing your medical needs are simply what we owe you.
(2) We can cover everyone through the reforms being proposed, but the public option doesn’t need to be government-run. We can have nonprofit co-ops, nationwide nonprofits receiving an initial loan at market rates (there may even be private capital willing to flow to set them up) and able to operate across state lines, etc.

I ask again — if the public option is “non-negotiable,” do you think they’ll ever let it fail? And if not, can it ever compete fairly?

Dude, they don’t need to be in the insurance industry.

Are you claiming that the VA (with all the resources of the government) CAN’T be a solution? You don’t think they can be made better?

I’d rather the government propose a better system that they currently control than they propose to create a better system from scratch.

The VA system can be expanded and improved and offered to citizens. It is a solution OUTSIDE OF INSURANCE for the government to create a parallel health care system available to everyone.

But whatever. . . throw stones at our military veteran systems.

You do know that prescription drugs through the VA is better than any other private plan, don’t you? Isn’t this your industry? Don’t you know all this stuff? Is it time to call me a liberal again?

I think that the solution to ‘health care reform’ has to be in the VA system. The government shouldn’t be looking at the insurance system to ‘reform’ health care.

ThackerAgency on June 25, 2009 at 11:54 AM

I can’t believe that anyone would seriously propose the VA hospital system as a model.

See the following examples of VA care:
Walter Reed scandal:
http://www.sfgate.com/cgi-bin/article.cgi?file=/c/a/2007/03/06/MNG71OG4NQ1.DTL
Rogue cancer unit:
http://www.nytimes.com/2009/06/21/health/21radiation.html
Safety problems with colonoscpies:
http://www.wbir.com/news/health/story.aspx?storyid=90713&catid=3

…and there are many, many more RECENT stories of poor care and scandalous administration in the VA.

THE PROBLEM…NOT THE SOLUTION…IS GOVERNMENT INVOLVEMENT!!

An official with the American Legion who visits and inspects VA health centers said complacency, poor funding and little oversight led to the violations that failed the cancer patients in Philadelphia and possibly infected 53 veterans with hepatitis and HIV from unsterilized equipment at three VA health centers in Florida, Tennessee and Georgia.

Systemic.

But the VA exemplifies the debate in other ways — the Government obviously found it cheaper to fund VA hospitals for our veterans to give them treatments specific to their battlefield injuries (horrific battlefield injuries, in some cases).

I just went through an incident in which my son needed medical care in another state — and my employee health plan doesn’t cover him in that state. I tried to arrange fee-for-service with several area GP doctors, only to be told that they couldn’t treat him because they had full patient lists and even treating him once for cash on the barrelhead (to give him a tetanus shot) would be taking him on as a patient forever. Eventually, one of the doctors told us to have him go to the emergency room of the local hospital — which cannot turn him away. He did, and they didn’t. It was expensive, but it turned out to be far less expensive than the doctor visit would have cost, because we discovered that, through a loophole, our California-only plan DOES pay out of state visits to hospitals in Connecticut — to the emergency room. Cost turned out to be $75 out of pocket (or 1/10th what the hospital billed the insurance company).

As for the concept of $750 for a tetanus shot — well, that’s the type of healthcare system we have right now, and a prime reason why the Government has a VA.

Dude, you are WRONG.

I am not a liberal. I know Medicare Advantage plans because I SOLD THEM. I spent HOURS going over the benefits with clients of mine to make all of 25 bucks to give them something free.

I went to EVERY SINGLE REGULATION MEETING that CMS forces agents to use.

What do you know about MA? What is your connection?

You DO give up your Medicare when you go on an MA plan. MA plans are HMO’s. The CMS rule is that you have to have AT LEAST as good of benefits as Medicare. You have to go to certain doctors and hospitals when you get on a MA plan. Didn’t you even say you ‘choose your doctor’? You don’t have to do that on regular medicare. You have to pay for copayments and you have to pay dollar a day amounts for hospital stays that you don’t with regular supplements.

My DAD has voted Republican all his life. He has sold insurance (including Medicare) for 40 years. When he turned 65, he CHOSE PLAN F instead of Medicare Advantage. He’s a prostate cancer survivor and couldn’t be happier with his insurance.

I’m not a liberal. I don’t ‘hate’ MA because it works. I know the only reason it is popular is because the insurance companies make money off of it. I stopped selling it because it was obvious that the feds were going to stop supplying as much money to the plans and so the insurance companies would cut benefits.

Wait until insurance companies start cutting benefits. People will be running to Supplements. I’m in perfect position because I offer Mutual of Omaha plan F.

Tell me what I don’t know. . . please.

I think that the solution to ‘health care reform’ has to be in the VA system. The government shouldn’t be looking at the insurance system to ‘reform’ health care.

Any ‘reform’ would need more access. Urgent Care facilities (doc in a box) are popping up all over the country and are very successful.

In my opinion, the government could set up ‘urgent care’ facilities through the VA and increase doctors and VA facilities through the military budget.

train doctors and establish new and better facilities through military spending. . . and allow everyone to go there for a fee subsidized by the government. That’s how you should reform health care if you really wanted to do it.

The insurance angle is merely a power and money grab by the federal government. They want all your premium dollars to go to them so that they can distribute it. That’s 3 T a year. They want that.

the Medicare Advantage plans are a disaster. The only reason that they are popular is because the government pays insurance companies to provide them.

Medicare Advantage plans were set up to get people OFF OF Medicare. When you go on MA plans, you give up your Medicare. MA plans cause you to see certain doctors.

ThackerAgency on June 25, 2009 at 10:23 AM

This is complete BS: simply a regurgitation of the Liberal line.

1. The “Medicare Advantage” insurance companies are paid the money which otherwise would go to Medicare administrators because they can provide the same or better care cheaper!!! To make it sound like these companies are getting an extra pile of money is completely disingenuous: these plans actually consume LESS money per insured person than vanilla government-run Medicare!!!

2. “Medicare Advantage” plans do NOT force you to see certain doctors. As with other plans, you can select from your choice of a variety of Managed Care or PPO (Preferred Provider) plans. Neither one forces you to use a certain doctor, although you may have some financial incentives to use plan doctors.

3. “Medicare Advantage” plans DO NOT force you to give up Medicare: they are covered under the same rules. You can change plans easily once a year (or other times for cause) …back to original Medicare or to another Advantage plan…just like vanilla Medicare. All services provided under any of these plans are provided under Medicare rules and must be as good or better than the minimum standards established by Medicare (and the Advantage plans are always better).

The reason the Liberals hate “Medicare Advantage” plans is that these plans are stark, irrefutable proof that the best way to cut health care costs is to take the government out of health care administration. They are an embarassment to government because they do all that Medicare does…and more…for less money!