November 7, 2017

Healthcare Marketplace Strikes again


This will be Betty's last year to endure the swampy water of the Healthcare Marketplace. Ever since 2011 she has had to put up with the same crap....misinformation, provider lists that are wrong, fewer choices. and higher prices.  In 16 months she will be Medicare-eligible....we can hardly wait.

Like last year, there is one company in Arizona offering plans for the individual market through the marketplace. Predictably, prices went up 20%. That included a higher deductible, lower hospital cost coverage and a switch to a different hospital system. Whether her primary care doctor or any of the specialists she sees will be under contract for next year is impossible to know until sometime in January, or too late to do anything about it. We do qualify for a monthly subsidy from the government that keeps the total affordable, even with the large monthly bump in price. But, this turmoil every year is taking its toll on my wife.

With lawmakers in Washington unable to either kill the ACA outright or come up with a viable bipartisan alternative, the approach now seems to be to let it slowly twist in the wind, becoming more unattractive and workable until....who knows what? The Republicans don't have the unity to repeal and replace; the Democrats don't have the power to fix it or present an alternative with enough support. Frankly, both parties share the blame in this mess so if there is any finger-pointing it has to cover everyone.

The insurance companies have no idea what to expect, meaning the customers are left to guess what their future holds. It is hard to imagine a scenario where the American health care system could be worse than it has been...well, welcome to the jungle.

At the moment Betty has decided to postpone a needed foot operation until she has Medicare coverage. While we certainly could handle our share of the costs, she refuses to give into a system that is deeply flawed and has made her health care coverage such a painful experience (pun intended). 

What about you? Are you stuck between whatever coverage you had while working but don't yet age-qualify for Medicare? How are you handling the health care problem? Have you explored the H.S.A. option?

Have you finally entered into the safety of the single-payer system after 65? Did you delay medical treatment until then? 

We can't do anything about the mess our system is, but sometimes it helps to vent. 



44 comments:

  1. I am lucky since I am still on my husbands group insurance at work. He is retiring soon and we will both go on Medicare. I just wish they would agree on a single payer system for all but the way things are going in this country, that will never happen.

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    1. Single payer has developed an evil image, even though Medicare is just that and those of us covered by it love it.

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  2. Yes, it helps to vent so here goes. If Trump and the radical fringe of the GOP stay in power long enough they will start handing out vouchers and close down Medicare. "Here's a hundred bucks, now go away" will the the mantra. If you don't like what the GOP or the Dems are doing then move over to the Centrist Project to see some real change. With a small core of centrists positive change can happen sooner than you think...

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    1. Both political parties are failing us at the moment and not just on health care. They are thinking small and being led by their wallets.

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  3. We have had to change insurance companies three times in a row on the ACA plan.vEvery year a new plan.. But, As you know, in Az. last year's only choice is still this year's only choice. We never did "establish" with a new doctor on the Ameribetter plan last year, we did not need a doctor all year, thank goodness.I have my yearly check up with A Naturopath I've worked with for years. On the same plan this coming year-- I am going to try to get us "established" somewhere..which means waiting a few months for an appt. we don't really need, but we should have a Doc on hand in case we do need one I suppose. I am Medicare eligible half way through 2017.Ken has another year and a half to go. So whomever I choose,I will try to be sure they are on Medicare also. Yes, system is a mess. Single payor would make America great again in my opinion!! I have friends in their 60's who still are self employed, not Medicare age, they have to pay close to $2000 for a policy!!!Luckily Ken and I are also eligible for some subsidy. American citizens deserve better than this!!!

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    1. One of the very nice features of Medicare is that virtually every doctor accepts it. If they didn't they would have no patients over 65. It is nothing like trying to find someone who is in network.

      The only exceptions are places like the Mayo Clinics and hospitals. They use a Medicare Plus system. The patient pays a certain percentage extra charge above what Medicare will pay.

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  4. Medicare is complicated, but it works. The individual marketplace, as you say, is a mess. I think some kind of universal insurance is the answer ... but you know, somebody has to pay for it. By my figuring, people should be willing to pay, either directly or indirectly, about 15 percent of their income for medical care.

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    1. When I retired in 2001 and for a few years after that we were paying almost 30% of our gross for all of our yearly medical expenses. As much as some people hate the ACA it has cut our medical expenses quite dramatically.

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  5. I will start Medicare next year as well (if it still exists). I am currently part of a large retiree pool insurance plan, and although premiums have spiked, it is still reasonable coverage. I am lucky.

    I have no faith that this mess will be solved anytime soon. With the corporate takeover of the government we now are essentially at their mercy, with both political parties bought and paid for. Profit and shareholder benefit are seemingly the only merits considered. Voters now approach government like entertainment or sport. There has to be drama and a "winner and loser." There is no compromise on the football field or in mixed martial arts, so why should we compromise in congress or legislatures? "Winning" is more important than working together to solve a problem.

    My own feeling is that in just a few years the challenges of climate change will be increasingly evident to everyone. The wildfires and hurricanes of this summer were just the beginning. The problems we will face will loom ever larger, hammering the budgets of federal, state and local governments. I see nothing but hard choices ahead, with healthcare competing with many other pressing problems.

    In response, I am trying to invest effort in my own health and well being, making more changes to my habits and practices when I can see a benefit. I am going for "healthspan" rather than lifespan. I can only truly change or influence the things I can control, and I try to enjoy my life as much as I can in the here and now, because I don't see much light on the horizon.

    Rick in Oregon

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    1. I am afraid I tend to agree with most of what you say, Rick. I am the least optimistic about government's ability to heal itself as I have been in my lifetime. Our citizens only seem to wake from a collective stupor when something touches them directly, unless it has to do with mass shooting. Then, we seem to be incapable of any action (think bump stocks).

      The oceans will have to cover Miami, Boston, New York, San Diego, and parts of L.A., hurricanes destroy the deep south, and wild fires denude most of California and the desert southwest before enough people say, "why didn't you tell us? Why didn't you do something?"

      I am following your plan....doing everything I can to protect my health without ruining enjoyment of life and some of its pleasures. I don't believe Medicare will be turned into a voucher system, but I have been proven wrong before!

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  6. Hi Bob! Congratulations to Betty. My husband Thom turns 65 in exactly 1 year and we are seeing that as a GREAT birthday present. We have both been self employed our entire lives so never had employer insurance. We started doing the HSA High Deductible Health Insurance about 10 years ago and in the beginning it was kind of reasonable. But just like every coverage it continues to go up every single year. I guess we are lucky our rates only went up 8% for 2018 ??? We are fortunate that we live completely debt-free, except for that growing bill. And yes, while we are optimistic about hitting medicare--Thom next year and me a year and a half later--I think every single one of us needs to be actively involved in pushing for change. I'm in the camp that says Universal Medicare for all people is the only humane solution to this growing problem. ~Kathy

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    1. Like you, except for 5 years when i worked for large companies, I was on the individual health insurance market for my entire working career and 14 years after retirement. Medicare lifted a giant weight from my shoulders.

      Medicare is set up and works. With everyone covered, included younger, healthier people, the system would be able to work even better. One of the jobs of government should be protecting the health of its citizens, not supporting a system that only works for the well-off.

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  7. In Canada we have universal health care which has some problems regarding affordability through the tax system but includes all our citizens. And unfortunately, all the loafers from other countries taking shelter here at our expense. Does universal healthcare appeal to Americans, it's expensive, but can't be more expensive than insurance. As an aside, with the current system. It would make sense for Congress to mandate all insurers who wish to participate in any health care insurance in any part of the country to pool into one universal system and split profits according to their overall investment. You would have one provider and lower costs through shared risk. Just a thought.

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    1. Americans have a strong streak of resistance to government, even when it is helpful. Universal care is the obvious end result of our broken system, but that will require many more years of sick and under-covered people before the public will demand a change.

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  8. In defense of the ACA, yes I can imagine a scenario in which the health care system would be worse, and that would be the pre-ACA scenario, when insurance companies could deny coverage to people with pre-existing conditions and charge higher premiums based on a person's health status. The ACA needs some fixes, but that is obviously not going to happen unless the Democrats control both Congress and the Presidency. In my rural low-income county, both the subsidized insurance available on the exchange and the Medicaid expansion have led to an expansion of health care services, with new facilities opening up to serve the newly insured. If the ACA is repealed, I could still get coverage through my state's plan for retired state employees, but it would cost me a lot more, and I would worry about continued availability of health care services in our area.

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    1. Betty is a good example. She had so many pre-existing problems, at one point she went 7 years without a doctor visit so everything was wiped off her medical records. Then, she could buy coverage again. That was a scary time.

      The ACA has allowed her a safety net of coverage and the yearly subsidy has made it affordable.

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  9. I will be going on Medicare in Feb and my husband 18 months later. We have been on the ACA since it started and I have kept our income low enough to receive the subsidy. While the insurance is far from good, it is better than before when the only insurance I could get was the Oregon High Insurance Pool (for people who could not get insurance anywhere else) and in most other states I would not have been able to purchase insurance period....I have sleep apnea, which used to be an automatic reject in 48 states, and something very common and not an issue as long as one uses a cpap machine.

    I agree with all that has been said. If we did not have the subsidy, we would have to pay $1530 per month for a bronze plan that does not pay a cent until $6310 deductible is paid.

    So here is my solution. Currently, you can get a medicare supplement plan or an Advantage plan. I prefer the advantage plan as it is in the financial best interest of the insurance company to keep you healthy. They receive a monthly amount regardless of whether services are used. Whereas traditional Medicare is a fee for service, and the incentive is to provide more services. Currently, insurance companies providing the Advantage plans receive more money if they maintain a 4 or 5 star rating, making sure that they maintain customer satisfaction (and eliminating the incentive to cut services for more profit).

    If we were to provide Medicare Advantage for all, it would get the government out of the insurance business other than to collect and distribute funds and allow individuals to pick the plan that best suits them. Medicare taxes would increase for individuals (who no longer have to pay some even if their employer covers most of their insurance) and even more for employers as they would no longer have to provide health insurance for employees. There would need to be at least one plan available that costs 0 dollars as many advantage plans do now. There would be more expensive plans available with different benefits, and individuals would be free to purchase an upgraded plan.

    Everyone in the US would be on these plans....no other options allowed. That would include young, old, politicians, etc. It would get the government out of the insurance business (for the Republicans) and cover everyone regardless of employment, age, etc. (Universal care for the Democrats). The government would oversee collecting and distributing the amounts to the insurance companies and enforce basic benefit requirements. It would promote competition as it would be the only game in town, but does not put them out of business. The insurance companies could then negotiate with the drug companies (the largest cost right now). It would also promote preventative services, as once again, it is in the insurance companies best interest to keep you healthy....many provide gym memberships, vision care, hearing care and optional dental care. Healthy alternatives would also become more attractive.

    All doctors and hospitals would have to be in at least one network or be out of business.

    I could go on, but this is all ready too long! Unfortunately, the Advantage plans are currently in jeopardy because part of the funding is tied to the ACA, and given what is currently going on, may alter or eliminate this option in the future. So I will be selecting a supplement plan until this mess is eliminated....but not really what I want to do.

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    1. That is a very interesting idea. I don't think I have ever read of that being an option for expanding traditional Medicare to all while maintaining private insurance. It makes all sorts of sense, which may be why it hasn't been mentioned before.

      Thank you, Donnine. That gives us something to to discuss.

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  10. My brother put off foot surgery for 16 months until he turned 65 this summer. He had a big pot luck for his birthday party. He said he was celebrating no longer having to pay $20000 for health care. He laughed with me-since he used to tease us about socialized military medicine. "Never thought I would be rejoicing at joining a single payer program!"

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    1. Medicare is a blessing. We both hope Betty's foot will hold together until February of 2019! She can't believe there is no paperwork, no copay, and no extra costs (if you have Medigap and Part D) and no need for referrals.

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  11. Hubby and I were just talking about this very subject: medical coverage! He is newly diagnosed with a cancer tumour. So far he's had a visit with his GP, an MRI, a visit with a Radiology Oncologist and his resident, a biopsy of the tumour is scheduled as is a visit with a cancer surgeon. There will be weeks of radiation treatments before, during and after surgery. He has health issues: epilepsy, diabetes, asthma and MS. We are worried about his diagnosis but never have to worry about paying for it all! We don't have to wonder if we will be dumped by a healthcare institution or insurance company. We don't have to worry if our house will be repossessed because we can't pay the medical bills on my retirement pension and his $20 an hour job. We don't have to tell our kids that they will be responsible for paying our bills after we have died. We live in Canada. We pay for universal healthcare through our taxes. Sometimes I wish we paid fewer taxes and got to keep more of our money for day to day living. But we gladly pay and are privileged to be able to pay so that we and others can have healthcare coverage without worry. With his other health issues he probably wouldn't have qualified for any health insurance in your country. We also have a friend whose son recently was paralyzed due to aggressive cancer tumours on his spine. He had a day long surgery on his back, is currently recuperating in a rehab hospital getting physiotherapy every day and is waiting to start both radiation and chemo. He's 18 years old. His parents can put their energy into being with him, supporting him, helping him instead of worrying where they are going to get the money to pay for it all. Yes, some people take advantage due to a flaw or two in the system but I think that ours is a program that works for the good of the majority of the population. I can't fathom the cost of my husband's care or my friend's son's care in your system.

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    1. Every time someone who lives in Canada shares stories like yours, I feel like forwarding it to the U.S. Congress. The cost of treatment for your husband or friend's son in the U.S. would be well into the hundreds of thousands of dollars. You wouldn't pay that full total, but the out-of-pocket costs would bankrupt many people.

      Personally, pass on my very best wishes for treatment and recovery to your husband and your friend's son. They have a long road ahead of them.

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    2. Thank you for your kind words! Very much appreciated!

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  12. We are in a slightly different situation than most. Deb worked in the public sector specifically for its benefits, such as medical coverage as a worker and retiree, while I worked in the private sector to make more money. Even though Deb retired at 57, she and I have been covered by her insurance all this time, while as an IBM retiree I was able to cover us for the two parts her retiree insurance did not, including eye and dental. To be honest, our coverage has been great and we both dread going on Medicare in 2018. Maybe it will be fine but we still think it might cost us more than we are currently paying for premiums, with less coverage.

    The only thing I would say on the political front, and it appears this puts me on the outs with many posters here, is that why would anyone think the Republicans that were kept completely out of the obamaCare negotiations and voted 100% against it, should jump in and fix the problems that they did not create? We can all talk about how both parties should do everything they can to help the country, but expecting the Democrats and Republicans to do anything other than what is in their best interests ranks up there with believing in the tooth fairy. No, I think that with how the atmosphere was poisoned by the lack of bipartisanship when obamaCare was enacted with insure that it limps along until it either implodes on itself, or Americans demand a change that appeals to both sides. Appealing to only half the country, either half, has been proven not to work over these last nine years.

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    1. I would add that no Republican tried to work on Obamacare and no Democrat will bail out the GOP now that they want to gut the ACA. Refusing to even interview Obama's Supreme Court pick and then rushing through Mr. Gorsuch strictly along party lines only hardened the line. Frankly, I have no idea where this will end. I don't see an issue that will bridge these gaps. I hope I am wrong.

      You and Deb have a great deal with your private insurance. You are probably right, Medicare will likely be a step down for you. Certainly the eye and dental coverage isn't available through regular Medicare, though Advantage policies often offer those extra benefits.

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    2. You can be excluded from participation in legislation, or you can refuse to participate and just say "NO" to everything. I will leave it to history to make the judgement as to what actually happened in the case of the ACA, although history has already spoken loudly to me.

      When do we stop blaming and demonizing into a persistent state of inaction? There is enough poison that has been distributed from all sides. I am tired of the "who's fault was this?" game. If your neighbor's house is on fire do you say, "well, I was not included in its construction, so it is not my problem"? Unfortunately, many appear to agree with that sentiment. Very disheartening.

      We need some compassion, vision, cooperation and action. Soon.

      Rick in Oregon

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    3. Bob, you might check your facts. No Republican was allowed to work on Obamacare. Even leadership did not know what was in it (" we will read it after we sign it into law"). Obama signed it in, but he did not advocate for most of the parts. He wanted single payer but his party negotiated with the insurance companies to kick it down the road until this year. I know you are of the party of resist everything, but do you not see how that is hurting everyone ?

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    4. Anonymous, please note that 13 Republican men met in secret to work on the replacement bill this year. The ACA was debated in both the House and Senate and there were public forums. I don't believe that occurred with the replacement bill offered by the Republicans. At any time the party of no could have proposed amendments to the ACA and worked together to bring forth a bill.

      Sheila

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  13. I know the Meidcare Advantage plans vary a lot from state to state.I am gong to begin goingo to their informational meetings in January so I have 6 months to figure out if it's a goo didea.From what i know so far the Blue Cross and the Aetna and the United plans have many Doctors on them.. but I do have to do more due diligence on this. Many of Ken's patients in our Chandler chiro office had Medicare Advantage Plans and were happy--I want complete coverage, not 80/20, if I can get it.

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    1. I researched the Advantage plans and I made my decision to avoid them mainly because I was sick of being screwed over by private insurance companies for so many years. Yes, I know these plans have to meet certain government standards, but still, I didn't want to support them in this way. I do buy Medigap and drug coverage from private companies so I know this is kind of silly.

      Quite importantly, they often don't work outside your home area. A policy you buy in Phoenix may not provide coverage if you travel outside the local area. They do have to provide emergency care anywhere in the U.S. but nothing else is mandated. It is policy-dependent. That isn't true for regular Medicare. Be sure to check this carefully if you plan on doing any travel anywhere in the country.

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  14. I can certainly sympathize with Betty's problems of dealing with the Healthcare Marketplace. We retired a couple of years before we turned 65 and had to rely on it until we could get medicare this past summer. ACA was a lifesaver at first for us because we were able to get an affordable insurance plan that our doctor accepted. We saw a difference overnight the January after Trump was elected, even before he was sworn in as president. From that point until we turned 65 we went through multiple different insurance plans none of which were accepted by our doctor of 35 years. By 2017 there was such a limited choice of plans that we essentially were paying more money for what was no more than catastrophic coverage. As a result we both fell behind on our medical checks and I even had to turn down some testing my doctor wanted to do when I went through a diverticulitis episode. We could barely afford an insurance that was not doing much for us.

    Thankfully we are now 65 and covered by a medicare advantage plan. We are still working on catching up on many long overdue medical appointments and tests. I know there are many different opinions on the advantage plans but so far we love the one we are on. It is much more affordable for us to go this route than medicare + a supplement. It was easy to find a good plan that was accepted by our regular doctors. Our coverage is very good and our out of pocket is very low. The majority of our prescriptions are 100% covered at no charge to us and the few we do have to pay for are affordable. We especially love that we now have Silver Sneakers and have free gym membership to multiple gyms. We both take Silver Sneaker classes twice a week and love them. My biggest concern now is that we are able to maintain what we have without our government destroying everything!

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    1. Thanks for mentioning Silver Sneakers. My Medicare Supplement plan included SS which the gym near my home accepted. I don't attend the classes but have full membership for everything the gym offers.It saves at least $20 a month, which is more than the Medigap policy costs.

      An Advantage policy can be a good deal if extensive travel is not planned. For us, that was the ultimate deal breaker. It made no sense to be gone for 2 months at a time in the RV and have no regular medical coverage. Of course, Medicare doesn't work oversees, either.

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    2. What AARP Medicare Supplement Plan do you have that includes Silver Sneakers? I know that the Advantage Plans do, but was not aware that the supplement plans do? Is it an Add-On?

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  15. Lordy, I do not want to go thru what you are going thru. My personal gray matter doesn't work anymore. Both my wife and I are now under Medicare and United Health Care/AARP. Why do I have this? I have a neighbor who was in the health insurance business and told me I should be in this plan-- better than the others. He would tell me when/if/why I should change in the event another provider was better/cheaper etc etc. He has a p/t job in his home office where he handles nationwide calls regarding retiree health insurance. We also have the same Part D coverage. Total for the 2, $500/mo.

    BTW your health care article of several years ago was the BIGGEST source of good info prior to our neighbor. Thank you!

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    1. I will have to look through the archives for that post. Maybe it should be run again! I'm glad you found it so helpful.

      I also have the AARP Supplemental and Part D from Humana. I am paying close to $300 a month and have been very pleased. I did need to see a doctor on one of our RV trips and had no problem using traditional Medicare.

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  16. I realize attitudes are different in the U.S., but those of us in Canada continue to have a hard time understanding why you would not want to emulate an excellent (but admittedly not perfect) healthcare system like ours or any number of other single payer systems around the world. The constant refrain is that "costs will skyrocket once government runs the system and we lose the competition", but the facts don't bear that out, as we and all the other single payer countries pay half of what you do per capita, and we never have to worry about choosing a plan or provider, and we never go bankrupt from treatment for cancer or even a broken leg. I truly hope you folks can figure out something that works for everyone there.

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    1. The red herring argument about the loss of competition equals higher rates is obviously untrue. Prices increased rapidly in the decade before Obamacare and continue to do so. All the while, Medicare premiums have increased by about 5% over the last several years.

      The problem is there are too many companies and too many drug manufacturers making way too much money to want to lose a captive market. So they use lobbyists and fear to prevent a common sense solution.

      It makes no sense to have a for-profit system determine who gets treatment and who doesn't.

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  17. I have been lucky in going straight from a high-quality employer health care plan to Medicare and haven't had to deal with either the political-compromise complexities of the ACA or the Trump administration's policy of destroying it through induced uncertainty. I think one of the unintended consequences of the latter approach has been increased support for a single-payer plan like Canada's. In Maine, there are now two initiatives for a state-wide single-payer plan, one grassroots push and another one among healthcare providers. -Jean

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    1. And, Maine just passed an initiative to expand Medicaid coverage. The Governor says he won't do it, but with a citizen-passed ballot measure he doesn't have that power.

      I spent virtually my whole working life in the individual insurance market. For most of that time pre-existing conditions could leave you with no insurance. Show me any person over the age of 35 without some medical condition!

      Medicare was a tremendous weight lifted off my shoulders after all those years.

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  18. Just catching up on posts after a vacation. DH is on Medicare and I am six months from it. I can't wait. I'm buying insurance through Healthcare.gov and paying $500/month for it with a $6K deductible. The only good thing I can say is we have good h/c in this city and I purchased a plan that would let me keep my doctors that I've had for years. That said, I really hope and pray I don't need it before I hit 65. I have a couple of nagging health issues that I won't deal with (god willing) until I'm on Medicare and I completely understand where Betty is coming from.
    --Hope

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    1. She is quite determined to wait on her foot operation. She is concerned about the cost, but also the possible effect on our European river cruise next spring if she doesn't heal in time. I understand her concerns, though I have made it clear we have the money and the cruise can be rescheduled. I don't want her in pain for the next 15 months.

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  19. Medicare and Medigap policies are no great cost savings. Think of all the money me and my employer has put into the system over my 42 year career and still now pay $7800 per year for us for "insurance" and still have to pay for copays, deductibles, dental, and vision care. Also, many providers do not take medicare, so always need to hunt for a specialist. Imagine the cost of a "medicare for all" if it applied to everyone and not just for those 65 or older where people pay in for 47 years before they can get a benefit....and the system will go bankrupt.

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    1. That is a little unusual. The reason to have a Medicare supplemental policy is to cover what Medicare doesn't. I have never paid a deductible or a copay. You are correct that dental and vision are not part of Medicare, but they are usually included in a Medicare Advantage program. or, you can purchase discount programs or separate insurance for each. In three years I have never had a GP or specialist not accept Medicare.

      When my wife is covered we will probably pay about $7200 a year for the two of us. Before I went on Medicare we were paying over $1,200 a month for the two of us, plus copays and deductibles. $7,200 for medical coverage sounds quite good to us.

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  20. To clarify my wife has an Advantage type medical insurance as a retired teacher and the plan is not available to the general public. She has to pay $18 copay for any doctor visits and a recent emergency room visit for stitches had a $200 deductible. We also have Part B deductibles of $183 each, plus copays on prescriptions drugs.

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