Medicare - Too Many Hands in the Pot

Reading an article about Medicare costs next year - or should I say the potential costs since nothing yet is set in stone.

Seniors May Pay More for Medicare Plans

Senior citizens may pay more for their health plans next year, as the Obama administration tightens terms for insurers offering Medicare Advantage plans and cuts payments to them, The Wall Street Journal health blog reports. Some 10.5 million seniors are enrolled in the plans, up from 5.4 million in 2005.

Simple terms it works like this. You have an ear ache and go to the doctor. He cleans out the impacted wax and you go home --everything just fine. Now Medicare will pay that doctor for an office visit and a procedure. Lets say Medicare pays $75.00 but the doctor bills $200.00.

You pay your co-pay - say $20.00. That leaves $105.00 for the doctor to write off. In previous years perhaps the doctor only had to write off $85.00 so he sees it as a loss of income. And rightly so.

But the big problem here in my opinion is that the whole billing fees rate is based on a pulled from thin air cost of operating. Medicare bases their payment rate on the area of the country and the facility in question. The idea is the cost of living or doing business in one area vs another area. Don't be mistaken - medicine is a business.

It comes down to what the market will bear. Doctors and hospitals bill for cost plus profit plus write off. If every doctor bills $200 for cleaning out your ears, then Medicare will pay a higher rate than if some bill $100 and some bill $150.

The end of the story is that if your insurance plan can't make the same profit with Medicare payments - it will raise the cost of that plan to the patient -- YOU.

Ever wonder why your doctor rushes out of the office as soon as possible - they get paid a set fee for some visits such as first time or follow up. And those visits have a time frame. If the visit time frame is 20 minutes and he/she stays with you for 35 -- those 15 minutes are free. Those 15 minutes could have been billed to the next patient.

That's why I always recommend that you have your questions written down - the rushed feeling may cause you to forget something important. A good doctor will stay until all your concerns have been addressed. They may not be answered without another appointment but they have been considered.

Special treat. Video
Please take a few moments to watch this. Inspiration can come from the strangest places.

until next time --- smile
Sharon
Answers For Your Health