I wonder how much medicare costs would be cut if people were allowed to use COBRA?

[tvguy]

It's not likely to be close to adequate for today's healthcare expenses.
And while there are a lot more variables in social security, I'd venture to guess most people receive back more than they paid in.

Well, as I discovered when I had a procedure done 2 years ago, that what hospitals accept as full payment is a lot less than they bill. They billed $225,000. They accepted $30,000 from Medicare, and $1.200 from my Medigap insurer as full payment.
Social Security is a little easier to calculate. I put the same percentage of my paycheck into a 401k as Medicare got from me and my employer. Dividing my Social Security benefit by the total money I have in the IRA I rolled my 401k into, it will take me 16.7 years to get back what I paid in. I will have to live to 83 to get my money back. The average Social Security beneficiary gets 13 years of benefits before dying. Yes, there are people who live longer and draw more, and on the other side are the people who die before they get a penny.

 

[lanejudy]

They billed $225,000. They accepted $30,000 from Medicare, and $1.200 from my Medigap insurer as full payment.

There are so many variables that go into this. The same procedure billed to insurance through an employer might be $100,000, and cost-sharing depends on the plan. Suffice it to say Medicare rates are well below cost and no hospital/practice could survive on that payment schedule alone.

 

[tvguy]

There are so many variables that go into this. The same procedure billed to insurance through an employer might be $100,000, and cost-sharing depends on the plan. Suffice it to say Medicare rates are well below cost and no hospital/practice could survive on that payment schedule alone.

Yet people want Medicare to be able to negotiate even lower reimbursement rates many of the private employer insurance pay even less.

 

[lanejudy]

Yet people want Medicare to be able to negotiate even lower reimbursement rates many of the private employer insurance pay even less.

I’ve had insurance through various companies over the years and none reimbursed anywhere near as low as Medicare. DH is currently on both and I see the rates for exact same visits.

 

[barkley]

There are so many variables that go into this. The same procedure billed to insurance through an employer might be $100,000, and cost-sharing depends on the plan. Suffice it to say Medicare rates are well below cost and no hospital/practice could survive on that payment schedule alone.

Yet people want Medicare to be able to negotiate even lower reimbursement rates many of the private employer insurance pay even less.

it's interesting (and crazy) to see how different a contracted rate can be from insurer to insurer let alone WITHIN insurers. I had a ppo through my private employer so I received statements each month that detailed any appointments/meds/services and how much the billed rate was/their contracted rate/what insurance paid out/my responsibility. my employer started one year to offer an hmo from the same company as my ppo. hmo never sent out statements b/c it was always a flat fee (no share of cost/percentage) so I was never aware of any difference. well...medical group's billing glitched and accidently sent me a copy of the statements covering several months. comparing side by side hmo vs. ppo charges for identical doctors, identical scope of appointments, identical labs and imagings....TREMENDOUS difference in contracted rates.

 

[tvguy]

I’ve had insurance through various companies over the years and none reimbursed anywhere near as low as Medicare. DH is currently on both and I see the rates for exact same visits.

I am waiting for cataract surgery. Lord, talk about a sales pitch. Medicare pays for the procedure and the standard lenses, but the Doctor offers "premium" lenses and services. There are three options, one costs $2,600 extra PER EYE, the next step up is $3,700 an eye more, and top of the line option, $5,600 extra per eye. Had to sit through video presentations on each before even seeing the Doctor. 90% of the patients still opt for the free level, and best I can tell, in the end, other than I might need a pair of $10 reading glasses from the drug store, they give you the same end result. I've worn glasses for 60 years to only need them to read would be amazing.

 

[lanejudy]

My understanding of the cataract lenses is that standard should be fine for most people. Those with an astigmatism need a different lens for best outcome. There may be other issues that recommend the higher priced lens. Your eye doctor/surgeon should have informed you which is best for you. BUT don’t take their word for it that insurance won’t pay — they made me pay upfront but insurance covered it all and it took me 3 months to get that refund back!

 

[tvguy]

My understanding of the cataract lenses is that standard should be fine for most people. Those with an astigmatism need a different lens for best outcome. There may be other issues that recommend the higher priced lens. Your eye doctor/surgeon should have informed you which is best for you. BUT don’t take their word for it that insurance won’t pay — they made me pay upfront but insurance covered it all and it took me 3 months to get that refund back!

Yeah, I'm more concerned with just getting rid of the cataracts, even if I had to continue to wear glasses full time. I can buy a lot of glasses for the $12,000 the top of the line option costs.

 

[Mirabell Rose]

OK, they do not pay for it themselves they get carried onto COBRA by family or spouse coverage just like the original coverage is extended through spouse or parent coverage.

Lets say a family of 5 has coverage with some adult in the household and either a dependant child or spouse is on SSDI with the Medicare Part A they can't refuse. If there is no Medicare involved everyone in the group slides onto COBRA with the one premium payment but because of the rules if there is a SSDI recipient everyone slides to COBRA with the exception of the person on SSDI. Then that family needs to not only pick up the COBRA but also pick Medicare plan and pay for it for the SSDI person and at the expense of taxpayers. Same thing if the insured adult chooses to work at a smaller business, regardless of how wealthy that business may be.

Everyone can have their own opinion, I just wonder if this is the best way to spend tax dollars, maybe letting people choose is sometimes better and can save taxpayer money.

A person who is on Medicare is not prevented from being on their spouse’s or parents plan simply because they have Medicare. The same goes for Medicaid. An employer can not refuse to provide them coverage simply because they are on Medicare or Medicaid. If the employer becomes eligible for COBRA, the family members being covered before COBRA on the person’s employer coverage are eligible for COBRA.

Where the size of the employer comes into play is in regards to which plan pays first in the instance of both Medicare and employer coverage. For smaller employers, Medicare pays first. For larger employers, the employer coverage pays first. In the case of employer coverage and Medicaid, Medicaid is always the last payer.

There are people who continue to carry disabled spouses and children, adult or not, on their employer coverage. For disabled individuals on Medicare, 22 states do not have Medicare supplement plans available to purchase, so those without also having employer coverage through a spouse or parents, or Medicaid coverage, can be left with huge out of pocket costs.

Medicare determines a cost formula and reimburses what they calculate cost to be. So, theoretically providers wouldn’t ’go under’ on Medicare reimbursement. Some providers, such as those that qualify as rural hospitals, or federally qualified health centers, get reimbursed higher if they show their costs to be above what the Medicare determined rate costs to be. Employer insurance averages 110-140% of Medicare rates overall - although there is great variance by individual bill code. So, the overall cost of care for an individual would be higher to pay through employer insurance than Medicare.

The question was why not COBRA? Answer, up to individual to decide. Our current law helps supplement the cost of care for the aged and disabled in our country through the federally funded Medicare program. For those that drop off employer coverage this shifts the subsidization of their care from the employer to a shared society cost. Does our country have to exist under a law that does it this way? No. Laws can change. How do other first world countries do this? All other first world countries have a system of universal healthcare coverage that manage this. The U.S. does not yet have universal coverage, but it has subsidized coverage for those eligible for most employer, Medicare, or Medicaid coverages.