I posted on this subject several days ago under the title 'Heads Up For Anyone Over or Approaching Age 65', but that post was directed more to the subject of TRICARE vs. MEDICARE. TRICARE is military health insurance.
The situation I described of TRICARE vs MEDICARE really applies to anyone who has reached age 65. The comments I received on the previous post indicates some readers may have gotten confused over the issues relating to TRICARE, or I just did a poor job of explaining it. I hope the following is better:
Most people have heard or experienced for themselves, the growing problems with MEDICARE. Health care providers don't like MEDICARE; they actually lose money when treating MEDICARE patients because MEDICARE pays far less for a given medical service than is normal for the medical market.This year I will reach age 65 so I have become interested in health care insurance, MEDICARE and OBAMACARE issues.From what I can tell weather you have an employer sponsored insurance plan after retirement or not, you must enroll in MEDICARE Parts A & B (Part D is another matter) when you reach age 65. If you have a health plan after retirement, when you reach age 65 that plan will require you to enroll in MEDICARE and that plan becomes secondary to MEDICARE or you can purchase a MEDICARE supplemental plan, or you have MEDICARE only; all of which means you must find a health care provider who will file MEDICARE claims for you and any other insurance you have will pay some or all charges not paid by MEDICARE. MEDICARE will pay 80% of the fees they allow, not necessarily the amount a health care provider normally charges, and your secondary insurance plan pays some or all of the remaining 20% of the MEDICARE approved amount.It's my understanding that if the Health care provider is under contract with MEDICARE, he cannot charge more than MEDICARE approved fees for a given service and MEDICARE will pay 80% of that amount as I said above. You are then responsible for the remaining 20% unless you have supplemental insurance will pay that portion.It's going to get worse; the 'Affordable Health Care Act' (OBAMACARE) has opened MEDICAID coverage availability to millions more people and I've seen reports that funding for MEDICAID will, at least partially be taken from MEDICARE funds. I assume this will obviously result in MEDICARE paying less and less until no health care providers will accept a patient under MEDICARE provisions.If we wind up in such a scenario, where you cannot find a health care provider who will accept you has a MEDICARE patient, and will not file a claim with MEDICARE, your supplemental or secondary insurance won't pay and becomes worthless.Here's an example of what I'm afraid will happen: You are enrolled in MEDICARE Parts A & B and have a MEDICARE supplemental policy and receive a medical procedure for which the health care provider charges $10,000.00. The health care provider is not under contract with MEDICARE and will not agree to the MEDICARE allowable charges.
Either you or the provider file a claim for $10,000.00 to MEDICARE. Let's say MEDICARE allows $6000.00 for this procedure, so hopefully, they pay $4,800.00, and hopefully, your supplemental policy will pay 20% of the $6000.00 (not the $10,000.00 your provider charged) which is $1,200.00. That leaves you responsible for $4000.00 if you had a supplemental policy, or $5,200.00 if you did not have such a policy.
How many health care providers are going to trust that you can or will pay the $4000.00 or $5,200.00? They will want that amount or the full $10,000.00 up front. What if it's $100,000.00?They won't need the proverbial 'death panels' in order to get rid of us old folks, they will simply make health care completely unavailable to those over 65 unless they are wealthy.This is an issue being completely ignored by the media including FOX News. We keep hearing how bad the Obamacare web site is, the coverage cancellations, costs, etc, but no one is revealing how devastating Obamacare may be to MEDICARE and potentially leave everyone over the age of 65 with no affordable health care whatsoever.BTW, you may recall AARP was a prominent advocate for enactment of the 'Affordable Health Care Act', and my guess is that they knew the new law would undermine MEDICARE and make their supplemental health plans virtually worthless.If I'm wrong about any of this, please let me know.