the cavalry may be coming over the hill! read first and last sentences!

Lani · 05-05-2009, 01:22 PM

Kaiser Health News/Philadelphia Inquirer examines proposal that would allow people ages 55 to 64 to buy into Medicare

Tuesday, 5-May-2009

Kaiser Health News/Philadelphia Inquirer on Monday examined a plan being touted by Senate Finance Committee Chair Max Baucus (D-Mont.) that would allow people ages 55 to 64 to buy into Medicare. The plan would target people who purchase insurance on the individual market or have no insurance because of unemployment.

About four million people between ages 55 and 64 are uninsured, according to the U.S. Census Bureau. While people in that age group are less likely to be uninsured than others, they are more likely to have serious medical problems and difficulty finding affordable coverage, according to Kaiser Health News/Inquirer.

Most states allow insurers to reject applicants who have pre-existing medical conditions. A 2006-2007 survey by America's Health Insurance Plans showed that individual insurance plans rejected 17% to 29% of all applicants ages 50 to 64, compared with 10% of those ages 30 to 34. In addition, people in their 60s often pay as much as three to six times more for coverage than people in their 20s, according to Georgetown University Health Policy Institute research professor Karen Pollitz.

The Baucus plan would allow people to buy into the program until comprehensive health reform legislation is approved. Complicating the debate is the "tricky question" of whether federal subsidies would be provided for people enrolling in Medicare early, according to Kaiser Health News/Inquirer. Baucus' current plan would not provide subsidies for younger beneficiaries. His proposal does not include cost estimates, but a similar plan analyzed by the Congressional Budget Office found that premiums would cost $7,600 per year for those ages 62 to 64.

Republicans who oppose the early buy-in plan say that rather than expanding Medicare -- which the federal government estimates will run out of reserve funds by 2019 -- the government should promote private sector ideas. AHIP spokesperson Robert Zirkelbach said the insurance industry opposes expanding Medicare because it "underpays providers," who then charge private insurers more to make up the difference. He cited an industry pledge to accept all applicants if all people are required to obtain coverage.

Baucus also has proposed allowing adults with incomes of up to 100% of the federal poverty level to enroll in Medicaid and eliminating the requirement that disabled people younger than age 65 wait two years before enrolling in Medicare

Rich66 · 05-06-2009, 04:52 PM

Mixed feelings on this one. Knowing that some docs are opting out of Medicare and especially Medicaid arrangements already, what happens when there is no private sector payments to, albeit unfairly, cover the difference? Rationing a la NICE? Even less doctors when there is already a shortage of GPs? Of course, I wonder about the cost of visits. Eg. Requested payment for a 30 minute onc vist: $320?? Medicare knocks that down severely(around half) and pays 80%. Not sure if Medicaid pays less. But I imagine private sector insurance, like mine, pays the full price. I guess I feel conflicted about this because I appreciate the flexibility my folks have but wonder whether it would be sustainable in similar fashion if this was extended to all. Even with them, I have already encountered invisible rationing in the sense that things weren't offered simply because the doc assumed they weren't covered by Medicare. First off, they turned out to be wrong..it was covered. Secondly, they only looked into it after a meeting was held with multiple specialists and I made it clear that if it was medically advantageous, "do it" and it would be paid for out of pocket if need be. I wish doctors would stay out of the finances and just present medical options/opinions. I would like to see a national examination of nationalized health care around the world and see what does and doesn't work...and seriously consider the dynamics of our own country relative to that. Some countries have NH but most folks there have supplemental private insurance. I think Australia is like that. And furthermore...(blah blah blah)

Nancy L · 05-06-2009, 05:08 PM

I am a retired US benefits manager from a fortune 25 company. $7200 for the 62-64 age group is a bargain. I have been retired for awhile but I believe the real cost for a PPO plan is closer to $1K/mo. Look at your EOBs and add up the payments made by you and insurance. I live in a retirement community and those in the 62-64 age group have other expensive health care so it is not just cancer---heart stents, heart bypass, knee replacements, cataracts, etc. If the government gets involved in more health care, you can count on rationing.

Lani · 05-06-2009, 06:37 PM

those with cancer had to wait two years after they qualified for disability to become eligible for Medicare and when they become disabled they may lose their employer provided health insurance, leaving them in the lurch.

I never understood why that was.

Joan M · 05-10-2009, 05:12 PM

Lani,

Thanks for this post.

I sent an e-mail last week to my local congressman about the 2-year wait to receive Medicare for advanced cancer.

Currently under the law, kidney disease patients and ALS patients get Medicare automatically without having to wait two years.

Joan

hutchibk · 05-10-2009, 08:39 PM

The worrisome part is that advanced breast cancer could well end up a "rationed" condition in the not too distant future, when bureaucrats (like NICE in UK) are tapped to pick winners and losers due to cost vs. statistical benefit. I worry day in and day out about when my treatment plan might be "opted" out of the system in order to equalize the system to pay for the 16% who allegedly don't have access. I am reasonably certain that in the not too distant future, "cutting medicare payments" (as has been touted by the folks running things as a way to cut deficits) means exactly that... picking winners and losers.

Rich66 · 05-11-2009, 09:25 AM

If one qualifies for disability, isn't that an SSI or medicaid issue for health insurance? (If not Medicare age)

hutchibk · 05-11-2009, 09:40 AM

No, if you qualify for disability and you are under 65, you currently qualify for Medicare, with a 24 month waiting period. You don't have to take Medicare, but you only have a 6 month window to decided whether you want it or not... after that, you don't get another chance to opt in.

Rich66 · 05-11-2009, 10:04 AM

Hmmm..."qualify for Medicare, with a 24 month waiting period."

I'm trying to imagine an analogous situation that would make sense:

"You got the job! You start in 2 years."

Nope.

How long does COBRA last?

hutchibk · 05-11-2009, 10:38 AM

Can't tell you anything about COBRA. I always carried my own individual PPO insurance, as I never liked the employer offered options. And I was self employed much of the time as well. I had 2 very short periods under employer provided ins. - first was an HMO and I got out from under that stranglehold quickly. The other was a PPO with one of the biggest providers, and they were so heinous, questioning almost every claim I submitted, that I fired them and went back to individual coverage. I was always of the mindset that I would rather carry my own chosen plan and work a little harder to pay for it than have my care rationed and dictated by an employer based plan or a sub-par carrier.

StephN · 05-11-2009, 11:00 AM

A couple of thoughts on this one.

First, Lani is right to point out that some legislators have decided that the 2- year wait for poverty level people under 65 may should go by the wayside. But what about the REST of us??? I was just able to manage it!

I am trying to decipher the "buy-in" part.
I know that Fauxgypsy has been having a hard time keeping coverage, due to qualification restrictions. This may help those in her situation.

About the cost reaching $1,000/mo for a individual PPO. That sounds much higher than average. I had lunch last week with a college friend who is now 62. She had a stroke and can no longer practice law. BUT, she does not qualify for disability! She has numerous health issues and carries her own individual preferred provider insurance (the same one I had, BTW), which now costs her in the $700/mo range for full coverage.

Like Brenda, many of us budget our lives to have security in our health coverage. Means I did not have a new car, or redo my kitchen, but I had the coverage when it counted.

I now have a Medadvantage Plan using my old carrier's plan as my supplement. So far not a peep from them for any of my care in two years.

I don't want to have to change what I have and I will find a way to keep paying the lower premium.

hutchibk · 05-11-2009, 11:45 AM

Once I decided to opt in to Medicare, I also researched for a good medigap supplement. Per month I pay $96 for Medicare, $150 for supplement, and $65 for prescription part D, all totaled = $311 per month. When I dropped my private insurance I was paying $400 a month.

The only thing I gained by opting in was protection from rising monthly premiums...

What I gave up was:
1) surgical pre-certification so I would know what would be covered and what might not be covered. With medicare they don't tell you up front, you have to wait for determination and "surprises" after the fact.
2) a somewhat simple appeal process for denied claims with consumer protections under the state board of insurance. With medicare, it is a tedious and arduous process to figure out their rules, restrictions, coverage codes, etc. and even then, you have no consumer support. You have to live with their decisions.
3) restrictive rationing decisions like it is not medically necessary for a woman over 50 to see the GYN yearly for annual checkups, even if she is a breast cancer patient.

DanaRT · 05-11-2009, 12:48 PM

A 24 month waiting period--I would be in serious trouble. This is very interesting. We have had a private policy for several years. My husband never wanted to be tied to a job because of benefits. Our premiums are about $700. a month with a very high deductable. It has worked well for us, especially with now having had breast cancer. I am sure our premiums will continue to rise.