Basically like making everyone use Medicare Advantage (which 31% currently do; the other 69% choose traditional Medicare). But not having traditional Medicare means that there is no longer a tie-in between the voucher amount and actual traditional Medicare costs, so that the voucher amount would be purely based on the politics and lobbying of the day.
I’m not totally up on Medicare, but isn’t this the high income premium surcharge? And this is nothing about Medicare costs, but everything about Medicare premiums for higher income people.
@“Cardinal Fang”
My basic Medicare cost went up…as well as my high income surcharges…for both medical and RX.
And the RX and medical deductibles increased as well.
I have no issue with my high income surcharge going up. But it’s all based on my 2015 income…for,the 2017 calendar year of payments. Reality check…in 2015 I earned 25,000 more than I’m currently earning.
As an aside…my SS benefit increased for 2017 as well…based on my 2015 earnings…but not enough to cover the increase in my Medicare costs.
I guess Medicare uses prior prior year to determine costs.
I won’t be considered a high earner a year from now…and I’m not NOW…even though imget to pay the higher costs.
How many insurance companies will want to compete to insure all those 70 year olds out there? How about the 85 year olds? Are there companies out there just drooling to compete for a market of old and often sick seniors in this country?
@thumper1-.if you complete SSA form 44 , cite work reduction, and bring to SS office with documentation ,it is possible to have the IRMA reduced or not charged for 2017.
Hayden, I don’t know. But it amazed us how some family members’ rates went down when they moved to AZ and switched to Medicare Advantage plans. Certainly, lots of older folks there. Everything the needed was covered and they liked their docs.
The IRMA is based on my 2015 earnings.
What documentation would I bring? I’m not working! I was a long term replacement worker in 2015 full time for 5 months.
I did the same, but only 2 days a week for 4 months in 2016.
I’m not working at all now…work ended May 1.
To be honest. My SS benefit is only enough to cover my Medicare anyway. I would net an additional $53 a month…but I don’t have the patience to deal with the SS office.
I will wait until we file our 2016 taxes, and if the income is below the threshold to trip IRMA, then I’ll deal with it.
Obviously, some do compete for the current Medicare Advantage business.
I believe you can get a refund if you overpay IRMA, but have no personal experience with any refunding. H is fine with paying whatever Medicare bills us and it is deducted directly from his pension, so there’s no chance of lost payments.
I think some of you are misunderstanding Medicare Advantage plans. They do not replace or compete with Medicare. They act on behalf of Medicare, and behind the scenes Medicare reimburses them for any payments which Medicare would have paid for if the person hadn’t bought the Medicare Advantage plan. They depend completely on the existence of Medicare.
In particular, Medicare Advantage plans depend on negotiated rates for Medicare reimbursements for doctors and hospitals. If there were no Medicare, there would be no Medicare rates, and insurers and providers would have to figure out ab initio how much things would cost.
For example, it is currently illegal for any doctor who accepts Medicare to bill the Medicare patient for more than what Medicare pays for the procedure. That is, if the doctor performs zoopodectomy, say, and the Medicare reimbursement for zoopodectomies is $5000, the doctor is prohibited from saying that his fee for zoopodectomies is $6000 and requiring the patient to pay the extra $1000. This is called balance billing, and is illegal. [Currently. Incoming HHS Secretary Price wants to allow Medicare doctors to balance bill, but currently it is prohibited.] If Medicare disappeared and was replaced by coupons, this protection would also disappear.
Medicare.gov
“Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. You’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.”
"Medicare pays a fixed amount for your care each month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare.
However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non-emergency or non-urgent care). These rules can change each year."
@“Cardinal Fang” - thanks for the correction i.e. it is not being proposed that Medicare be block granted it’s Medicaid. I still have questions about how that saves $ and appreciate the discussion.
As for Medicare going with the “coupon” method and administered at the state level…again it seems to go back to how your individual state will handle it, what rules they will put in place for insurance plans to follow, etc. Some states could allow certain procedures be reimbursed while others don’t. But if you have insurance in NY for example but on a trip to FL get hospitalized for something not covered by your NY insurance it’s just your bad luck? And you’re on the hook OOP? That’s the kind of thing national plans gives you that individual state plans don’t. How much of an issue that could be remains to be seen… Would something like balanced billing be allowed in some states but not in others?
@JustGraduate, moving from current Medicare to block grants does not save money overall. It saves money for the immediate federal budget. But will shift costs to individual consumers while at the same time eliminating the strength of the federal government in reducing cost and fraud.
How is this different than our insurance today, some able to go to any doctor, even in another state, and some not? Some getting a fixed credit from ACA, then choosing their plan.
Miles to go, to see what’s pushed and what push back.
@lookingforward the nice thing about Medicare…it goes across state lines. So much nicer than private insurance which is so state dependent.
@hayden:
You are correct, but I think when they talk about saving money those pushing vouchers are talking about the outlay from the federal government, not what people pay. Like any proposal to ‘fix’ medical care, the problem with this plan is it doesn’t address the costs of healthcare going up, it is designed to get the federal government out of direct exposure to medical costs, which are what is really rising along with insurance premiums. Without getting into the whole discussion about health insurance and such, the rise in premiums has been driven by the increasing cost of healthcare, and basically those vouchers are a subsidy to buy private insurance, but the reality is that people on medicare will face what people on private insurance are facing, paying more for the premiums if the employer has it (or themselves, if individual policies), not to mention risiding deductibles and copays, and with vouchers they likely will find that health care costs go up geometrically, while voucher increases likely will be arithmetic. I have heard voucher proponents say that if people want to save money they will be able to shop around for insurance and more importantly, for health care, but the only people who realistically can shop around for health care are those doing elective surgery not paid for by insurance, like nose jobs and the like, you can shop around and get the price for a breast reduction or enhancement, but can you do that if you get cancer or heart disease?
What privatizing Medicare means is getting rid of Medicare, getting rid of Medicare Advantage (which piggybacks on Medicare) and going to a system like the subsidized exchanges that we now have for the ACA. Seniors would have a voucher, in other words a subsidy, and they would use it to buy insurance. So, we kinda know how it would work.
The difference is that the current subsidies under the ACA are based on income. Low income people are guaranteed not to have to pay over a certain amoun, no matter how much insurance costs where they live. Medicare coupons would not be based on income, and there would be no guarantee that the coupon would be enough to buy the insurance. Indeed, the whole design of Medicare vouchers, the reason to go to vouchers instead of keeping the current system, is to make vouchers cover less and less of the cost of insurance every year.
That is how vouchers would save money-- by not paying for the care that seniors get.
Wow–scary that the idea is to shift costs from Medicare to poor elderly patients. 
8-} [-(
@cardinalfang:
Yep, obviously no plans have been officially proposed yet (since Trump is not in office until next month), but I have heard some numbers floated around, like 7500 bucks a year, and shook my head. Given that seniors as a group are the most costly to insure, I suspect they will find they are paying a huge amount themselves to get coverage…and others are right, the proposals I have heard floated (again, not official proposals) would be a flat voucher, not adjusted for income, so a poor elderly person might end up paying the same as someone a lot better off.