ObamaCARE & MediCARE | revolvingdoor

ObmaCARE & MediCARE

President Obama's structuring of the Patient Protection & Affordable Care Act, affectionately known as ObamaCARE, following the Medicare model was pure genius - keeping the best features of Medicare & restructuring some of the worst.

With the 2020 Presidential Primary well underway I thought it important to step up my efforts to get this out there on WHY "MediCARE For All" is a TERRIBLE IDEA.

While Medicare For All may seem like the Gold Standard in Health Care, massive Gaps in Coverage in Original MediCARE as written created the need for Supplements.

So while "MediCARE for All" sounds good on paper, THIS is what people are asking for. Please read below:

Original Medicare has some TERRIBLE PROVISIONS such as Lifetime Limits on Inpatient Hospitalization under Medicare A - & keeping the best features, like prohibition on discriminating against people with PreExisting Conditions as I mentioned yesterday here and Subsidies like the LIS "Extra Help" for Medicare here.

Signed into law on July 30, 1965 in the Johnson Administration, as written, Original Medicare is an 80/20 Plan - intended to HELP WITH THE HIGH COST OF TREATMENTS, & therefore creating the need for Medi-Gap Supplements in the 1980s.

In 2003 George W. Bush, recognized that Low-Income Senior Citizens were struggling with these huge Gaps in Medicare Coverage. During the Gaps in Coverage, Seniors had large Out-Of-Pocket Expenses that they had to pay - forcing Seniors to make difficult choices: "Do I buy food, or do I buy my Prescriptions?"

The 2003 Medicare Modernization Act (MMA) created Medicare Advantage Plans & Medicare Prescription Drug Coverage that included a provision in the Social Security Administration to help these low income senior citizens pay for their drug coverage: LIS.

These Low Income Subsidies ARE EXACTLY THE SAME as what Barack Obama did for the rest of us who are Under the Age of 65 & unable to afford insurance. This is what Healthcare Marketplace did for Obamacare.

So why the Republican HYPOCRISY with the Democratic Good Idea to do the same for the rest of us?

Supplements for Original Medicare were created when Congress passed the Omnibus Reconciliation Act of 1980 known as COBRA. This act expanded home health services and brought Medicare Supplemental Insurance (also called Medigap) under federal oversight.

These Supplements help cover those 20% Out of Pocket Deductibles, Co-insurance & Co-Payments that Original Medicare does not.

One of the WORST features of Medicare A, & why I disagree with proposals of "Medicare For All" is the question of Life-time Reserve Days for Inpatient Hospitalization.

As a US Citizen, I find it INFURIATING. As an Insurance Professional, it find it mind-numbingly incomprehensible to explain. It is tied to the concept of Benefit Periods & goes like this

Excerpt from WebCE

Cost-Sharing on Inpatient Hospital Coverage

Even though Medicare provides substantial coverage for an inpatient hospital stay, it includes many costsharing provisions that may leave the patient with a large part of the hospital bill to pay. The hospital costs that the patient is responsible for under Medicare are:

 deductible—Before Medicare begins paying for hospital care, the beneficiary must first pay a deductible. The deductible amount increases each year to reflect increases in health care costs. As a point of reference, the deductible was $1,340 in 2018. The deductible applies to each benefit period. A benefit period begins on the day a Medicare beneficiary enters the hospital and ends 60 days after he or she is discharged. If the patient is re-admitted to the hospital within 60 days of
discharge, the second stay is considered to have occurred during the same benefit period; therefore, another deductible is not triggered. However, if the patient returns to the hospital more than 60 days after being discharged, that hospital stay is considered to have occurred during a new benefit period, and another deductible must be paid before Medicare begins paying for covered costs.

 coinsurance on days 61 through 90 of each benefit period—For the first 60 days of each benefit period, Medicare pays all covered costs of an inpatient hospital stay after the deductible. Except for the deductible, there is no cost-sharing with the Medicare beneficiary during those first 60 days. However, if a hospital stay continues longer than 60 days, the Medicare beneficiary must begin paying a daily coinsurance amount starting on day 61 of the hospital stay. As with the
deductible, this coinsurance amount increases each year. In 2018, the daily coinsurance amount that applied to days 61 through 90 of each benefit period was $335.

 higher coinsurance amount on “lifetime reserve days” that may be used after day 90 of an inpatient hospital stay—Every Medicare beneficiary is given 60 lifetime reserve days that may be applied to help pay for inpatient care costs if a hospital stay lasts longer than 90 days. Lifetime reserve days are not renewed each benefit period—once a lifetime reserve day is expended, it is gone. If a Medicare beneficiary uses up all 60 lifetime reserve days, the reserve is depleted and cannot be renewed or reinstated. At that point, the Medicare beneficiary will be responsible for paying the full cost of each day of inpatient hospital care that exceeds 90 in a benefit period. The coinsurance amount that applies to lifetime reserve days increases each year. In 2018, the daily coinsurance amount on lifetime reserve days was $670.

 all costs after 150 days—Costs associated with a hospital stay that exceeds 150 days (or exceeds the 90th day, if all reserve days had previously been used) are the patient’s responsibility.

Medicare pays nothing.

A Life-time Limit on Care.

So, understanding Medicare Supplements provide the basis for understanding how ALL Medical Plans work in the US.

Insurance Supplements are GAP FILLERS to protect us from those 20% of Out of Pocket Costs that could potentially bankrupt a family should a hospitalization due to accident or illness occur.

Most people can afford to pay for a Doctor's Office visit out of pocket, but an unplanned Hospital stay could be a potentially bankrupting event.