General Discussion

1. Part B Medicare is essentially non profit. It is allowed a small % of override per year to accomodate raises, rent, supplies, etc. Last time I read anything about it that over ride was 3 % increase from the prior year's budget.

2. Advantage plans are sold by commercial insurance plans and are designed to make money for them. Remember the CEOs and other senior officers of these companies are paid obscene amounts of money.

3. Advantage networks are tight. You may have to change doctors depending on the plan you choose. Ask your primary MD which plans seem to work best for their practice. Their office staff with be very familiar with the good, the bad and the ugly.

4. Part B has no networks.
5. You do not need a PCP visit before you see a specialist. The specialist has to document the consult.
6. Hospital based lab, radiology, anesthesiology and ER are usually billed under Part A although there are exceptions.

7. Medicare B does not pre X.

8. Traditional Part B has one deductible regardless of where you are when you need care. There is a national databank which every claim hits before the claim is finished to check how much deductible you already have. That has been working like a charm since 1976.

If traditional Medicare is tweaked a bit it would be a godsend for so many people.
If I were in charge there would be an annual cap on out of pocket costs, carryover deductible (meaning that if you did not start building your deductible until the 4th quarter of the year that amount would roll to the following year) So if I accrued $75 of my deductible in 2020 it would roll over to 2021. Medicare had this when I was a claims examiner; the system we were using way back in 1976 handled that just fine.

Children could be included, with coverage for well child care.

It should start out a public option on every employee benefit plan, and be available to anyone who does not have access to employee insurance.

It would need to be phased in because adding that size of a member base to a plan is a logistical nightmare. There are many ways to do this.


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