My ACA reimburse rates are same as those for the equivalent policy directly via the insurer. I’ve been looking under that hood for years. What can differ are diffferent insurance companies, how they negotiate rates.
The ACA reimbursement rates for individual policies are lower than the payment rates for non-individual policies. These are the people having problems. These are the policies with narrow networks and shrinking providers. These are the folks seeing massive increases and decrease benefits.
A provider can not afford to ‘carry’ Medicare patients and ACA individual policy patients. Choices are being made.
Are you telling me that what reimbursement was in 2013 is not what it is today, now that I’m under ACA? Because that’s not what I see in my billing/payment summaries. My docs get paid based on negotiated rates. An exam, a procedure, lab tests, are not lower than before. And we were previously on an amazing Cadillac plan. Nor has my network diminished.
Again, it’s tough to generalize across the country and among insurers.
I am going to bow out of this conversation. You can review the threads started years ago and see what was predicted. Judge for yourself if the predictions came true.
That’s not true, in the general case. And we know it because there are plenty of doctors most of whose patients are Medicare patients, and yet they’re still in business. A lot of us at CC have elderly parents. We see that our parents see lots of doctors. We look around the waiting room and notice that everyone there is a senior, and we look at the hospital patients and see everyone is a senior. Our parents’ doctors are doing fine.
dietz, I think you may be confusing Medicare and Medicaid. Most doctors take Medicare. Most doctors don’t take Medicaid because the reimbursement is too low.
However,
He wouldn’t when he discovered how much it would cost, assuming we could buy in at cost. Here’s the dirty secret: as expensive as our ACA policies are, those of us 55-64 are subsidized by younger subscribers. By law, a 64-year-old can be charged no more than three (3) times as much as a 21-year-old. Yet 64-year-olds cost five (5) times as much as 21-year-olds on average.
A reasonable guess is that Medicare would be 8-10% cheaper than insurance, if you factor in the Medicare supplemental the person would have to buy. That still means health insurance would be a better deal for people in their 60s.
I made a little spreadsheet to play with this. Medicare buy-in doesn’t look like a good deal. I assumed that health care costs rise exponentially with age, that there are five times as many 64-year-olds as 21-year-olds in the risk pool, and that the Medicare buy-in price would be regionally adjusted like Medicare reimbursements are. People who are 64 in this model pay about 16% less than their cost share. Even though Medicare is (by assumption) cheaper than private health insurance, it’s not enough cheaper.
Where I am, BCBS has annually shifted around around their offerings. One year, one may be the lowest deductible. Another year, they wanted to try to move as many to an HSA as they could, that was the sweeter plan, overall.
So presently, I have a nice plan with a low premium and reasonable deductible. Medicare will cost me more, though still lower than previous ACA years. But, what I did with the supplement was pick one that meets as many of my personal preferences as possible. I could have chosen among some supp options costing next to nothing.
LF, are you saying that you have private health insurance that costs less than what you’ll be paying for your Medicare premium plus your supplemental premium when you reach Medicare age?
CF, I’m on the exchange. And I was lucky to get a low cost Silver (2nd lowest/HSA) this year, with a reasonable deductible (2k is higher than I’d like, but beats others. And I did max it.) It’s a matter of how my MAGI is reported. And some luck that the insurer wants people on HSAs, is trying to make them somewhat attractive, for now.
My Medicare, including supp will cost about 25% more than my current plan. Still reasonable. (Medicare Advantage. HMO, but where I live, and at this point, it functions like a PPO.)
Anyone who remembers the old threads, knows I feel lucky about ACA. But my point is all this can be very much a matter of where you live and how your state controls. Or not.
Maybe I misunderstand Medicare, but it looks to me like if I were old enough for Medicare, I’d pay something like $400 a month, counting the Medicare premium plus the supplemental. My health insurance premium next year will be $1100 a month.
Are you subsidized, LF?
Yup, subsidized. (You may remember the circumstances.) You aren’t, right? That’s the difference in this detail. Remember, my official MAGI for ACA purposes is low. It’s increasing just when I turn 65, as a mandatory retirement plan amount kicks in, but then I’m off ACA.
The basic choices are Original Medicare with optional Medigap supplements or Medicare Advantage. The latter works for me, in my area. The idea is you shop the various offerings, pick what works for you.
adding: I see the confusion. Yes, Medicare will cost you much less than $1100.
Medicare with excellent supplement costs me @$500 a month. Prior to this, I paid over $1200, which basically covered nothing. My deductible was only 1000, but it didn’t cover mammograms, colonoscopies, without symptoms. I rarely met the deductible.
I know many people chose a low cost supplemental or an HMO when they reach Medicare age. Over 5 years or so, they save money, and then increase their plan.
My recent experience with MRSA made me glad I had great coverage.
My husband is on medicare. I am not. I would be thrilled to be covered under medicare. Have to wait five years. His premiums are far lower than mine including the supplement for better coverage. Also more efficient with fewer problems. I’ve been fighting my insurance company for the last six years about what they will cover and what they won’t and their mistakes.
Let’s remember why Medicare premiums are so much lower than private health insurance premiums: because Medicare is massively paid for by the federal government. Medicare spending by itself makes up about a fifth of the entire federal budget. Premiums do not come close to covering your Medicare cost.
Also, if you are 64, your private insurance premium does not cover your risk to your insurance company, even when we subtract out insurance company profits. That is, as a group, 64 year olds cost more than their premiums bring in, even when we allow for insurance company profits. If you are 64, you are a loser to your insurance company.
If we allowed 55-64 year olds to buy into Medicare at cost, they’d be paying more to the government than they pay now to insurers.
Indeed. Part A (covers hospitals) is essentially "free’ to the Medicare beneficiary in that it is supported by the payroll taxes of today’s workers and their employers. (Of course, that assumes that you paid into the hospital trust fund as a worker earlier.)
Part A does come with a hefty deductible, however.
Per a recent Kaiser report, its ~15%, net, but point still stands: heavily subsidized by the government.
http://kff.org/medicare/issue-brief/the-facts-on-medicare-spending-and-financing/
We are in Illinois. 40-something % increase in premiums over last year, and boy, those networks are getting very, very narrow. It’s turning into Medicaid.
I wish we had the option for major medical, high deductible, with lower premiums.
I agree with the sentiment upthread that it’s going to get worse before it gets better. OUCH.
Your premiums would be lower, but not very much lower, unless your deductible was tens of thousands of dollars.
I wish my one kid had more than one choice…but he doesn’t…so there you go.
Thanks for the link to Kaiser, bluebayou. The 15% figure you cite for federal government Medicare payments is net of premiums. If you look at the gross spending, it’s bigger.
That chart on the Kaiser page is strange. It shows a pie chart for federal spending, with one of the slices being net Medicare outlays. Where in the chart are the rest of the Medicare outlays? It’s still government spending even when it’s supported by a premium.
Yeah but the premiums are paid out of user’s pockets, so it is not part of the federal expenditures, net. Yes, you would add them together to get the total cost of the health care, but still not a federal payment – just a pass-thru.
I have not read all this posts here but their seems to be a lot of misinformation that I would like to clear up.
Under ACA, your out of pocket costs are going down.
Under ACA, your premium payments are going down.
Under ACA, the quality of your care is going up.
Under ACA, your satisfaction with care provided is going up.
Under ACA, if you like your doctor, you can keep your doctor.
Under ACA, your choices and freedoms are increasing.
I am mystified that people refuse to accept these self-evident truths.