<p>Apparently, this oncology group makes no profit on Medicare patients because Medicare pays so poorly. $120 for an initial visit by a cancer patient. $51 for a follow-up visit. He says his profits are made on private insurance patients. So private insurance essentially has to cover both the private insurance client but also the Medicare and Medicaid patients. (He was talking about 2013 before ACA kicked in, but since the ACA reimbursement rate is low, in the future private insurance rates will have to make up for the reimbursement deficiencies there also).</p>
<p>For anyone wondering why doctors limit their Medicare, Medicaid and now ACA patients. </p>
<p>$120 to evaluate a cancer patient on the first visit? The plumber and the appliance repairmen charge more than that. </p>
<p>So the total you could possibly spend for the Bronze plan is $25,200, if you got very very sick and spend your max out of pocket.</p>
<p>And the least you could possibly spend for the Platinum plan is $23,580, if you never got sick and never set foot in a doctor’s office. But if you thought you would never get sick, you would be way better off buying Bronze.</p>
<p>In other words, people who think they won’t get sick should pick the Bronze over the Platinum, and people who think they will get sick should also pick the Bronze over the Platinum. Explain again why anyone would ever buy the Platinum? For which person would the Platinum be better? I don’t think there is ever a case where the Platinum works out better; essentially, the Platinum buyer is paying their entire deductible up front in their premiums.</p>
<p>@calmom: on the individual market the only plan that has the same network is offered by the most expensive insurance company. It would be closest to what we have now…which we like.</p>
<p>“ps. GP why not give us your detail so we can check?” </p>
<p>go to covered covered ca and you can price a bronze plan for a couple in early 60’s. As for the premium for my pre-Obamacare plan, the plan doesn’t exist anymore. Although I am not sure why you think I am not telling the truth since you seem to think I got a great deal, which I just debunked in my recent posts.</p>
<p>To be honest, I am getting tired of arguing with people who don’t think logically and have closed their minds to factual information. </p>
<p>@tating: I tried to explain the cost shifting math several hundred pages ago. Medicare/Medical reimbursements rates are not attractive to providers. When the ration was 4 private pays to 1 Medicare/Medical pay…the system worked. As evidenced by my recent phone calls to providers whose first volley was - sorry no ACA (and by default no individual insurance from 2 of the 3 providers) patients, holding the magical insurance card is not a key to getting care.</p>
<p>GP, what factual info? We have NO idea if you are analyzing this correctly.<br>
I looked at Anthem and see better options than Platinum and Bronze. Don’t know where you live, guessed 50. And frankly, are you now saying you are in high need for medical services, will meet those high deductibles? You and your wife? </p>
<p>That article about the Salem oncologist put me off. He whines that he only gets $120 for an initial patient consultation from Medicare. Maybe, but he rakes in $326 for the average billable event, and most patient visits result in multiple billable events. I’m not bringing out the violins for this dude.</p>
<p>Also, “our profit margin in 2013 was 14.8 percent” sounds pretty damn good to me. Definitely no violins are necessary.</p>
<p>“I looked at Anthem and see better options than Platinum and Bronze. Don’t know where you live, guessed 50. And frankly, are you now saying you are in high need for medical services, will meet those high deductibles? You and your wife?”</p>
<p>“Our coverage cost $1279 a month for the two of us. We had a lower deductible, but on the other hand, that price is comparable to the price for a pair of 35-year-olds, because it was the same price for everyone at Mr. Fang’s company.”</p>
<p>Do you remember saying this, CF? Please get your story straight about what is your premium. </p>
<p>As I read it the ‘profits’ were how the doctors who owned the practice got paid. Not as in other businesses in which the pay for workers would be overhead with profits going to investors. He didn’t say how much he made, but given that it took him 20 years of training to become a medical oncologist, and given that his expertise means life or death, I would hope he makes more than a comfortable salary. They certainly do more good for society than investment bankers, and their ilk. </p>
<p>LF: The whole point of insurance is to cover the unanticipated. I HOPE not to never need the full blown network…but since I do not know what tomorrow holds…I want this network available to me if tomorrow is unkind.</p>
<p>Don’t know because my old plan doesn’t exist anymore. This 35-year-old example is a distraction. The bottom line is I paid more for my plan (using your criteria) than your husband’s employer paid for your plan. </p>
<p>Well, GP, Silver looks a lot better than “Huh!” considering we don’t know your details. The right analysis has to account for how much in med services you are likely to use- which you haven’t revealed. Silver 70 PPO via CovCa has a 2k ded pp and Anthem mid silver is a 1750 ded with 25% co-insurance. Even if I am wrong in my guesses re where you live, this leaves open a need for you to run various numbers accounting for predicted medical expenses- not just wide loops. Do you expect about 20k in med billing outside premiums? </p>
<p>LF, with all due respect, I don’t understand your posts. I told you in a previous post what a bronze and a platinum plan costs on Covered CA for my wife and me. I would like to answer your question but am having a real hard time trying to understand what you’re saying.</p>
<p>GP, I’m asking you why not Silver? Lower ded, lower co-insurance %. CovCA or Anthem. Yes, the max oop is 6350, but if you do remain healthy, you don’t come near that. I don’t know your health. Or Mrs GP’s. </p>
<p>If you need me to explain some decision strategy, I would. (This stuff isn’t easy. I needed help from another poster.) Look at Silver on CC and Anthem. Not just premium, family ded and max OOP. You need to look at premium, individual ded (yours applies for you, hers applies for her- if it’s like mine,) co-insurance %, and max OOP. That’s just a start. (I’d say OV, too, but the differences seem relatively small.) You can project for yourself, and then as a couple. </p>
<p>(Btw, I’m not able to see if someone and I are x-posting, until I come back to the thread later. Sorry about that.) </p>