Medicare for all … or … Medicaid for all…

There is a lot of talk about “Medicare for all”… but they seem to be talking about is Medicaid for all… because they seem to be inferring that what they are talking about is national health insurance paying from FIRST DOLLAR…

Medicare now… only Part A has no premiums but has a $1200- $1400 deductible each time a person is admitted to a hospital… deductible is “forgiven” if the pt is readmitted to a hospital within 60 days of being discharged.

Medicare Part B has a monthly premium of $135.50 and a $185 annual deductible and 20% copay

Medicare Part D ..which is a policy offered by a FOR PROFIT INSURANCE COMPANY… and has various premiums, copays, deductibles.

One of the people who is floating around as a 2020 Presidential candidate has claimed that the whole insurance industry should be eliminated but what this candidate doesn’t seem to know is that both Medicare Advantage policies and Part D policies are provided by FOR PROFIT PRIVATE INSURANCE COMPANIES

All one has to do is look at what is going on with the VA medical system and what is going on with chronic pain pts and their pain management as being dictated by HHS/CMS to get what a national health insurance program may look like…

Here is a article about how the 70 million Medicaid pts are having trouble finding a physician to treat them…

 

You’ve Got Medicaid – Why Can’t You See the Doctor?

https://health.usnews.com/health-news/health-insurance/articles/2015/05/26/youve-got-medicaid-why-cant-you-see-the-doctor

Medicaid insures more than 70.5 million Americans, according to the most recent report from the Centers for Medicare and Medicaid Services. Largely low-income health care consumers, these patients have had a notoriously difficult time finding physicians to treat them, and in a reasonable amount of time.

With an influx of people qualifying for the public insurance and changes to providers’ reimbursement rates, it’s difficult to say if these troubles will improve or worsen. So it’s crucial that Medicaid beneficiaries know what they’re up against.

In an effort to make it easier for Medicaid patients to see the doctor, the federal government increased Medicaid reimbursement fees in 2013 as part of the Affordable Care Act. When 2014 came to a close, so did that program, and fees once again fell in many states – though some states chose to continue paying higher rates on their own.

It’s too early to say with certainty how the fee changes – both the rise and subsequent fall – have affected patients, but even prior to the fee bump and before the ACA expanded Medicaid to include millions more Americans, these patients sometimes struggled to get in to see the doctor, had worse health outcomes and found themselves holding a good insurance policy with nowhere to use it.

“There are certain aspects of Medicaid, particularly for low-income populations, where it is really almost superior to private [insurance] coverage, with very low copays and no deductibles,” says Stephen Zuckerman, co-director and senior fellow with the Urban Institute’s Health Policy Center. “But at the same time, Medicaid beneficiaries are significantly more likely to report having difficulty finding a provider or delaying care because their health care coverage isn’t widely accepted.”

A 2011 nationwide survey of doctors found 31 percent were “unwilling” to accept new Medicaid patients, with acceptance rates across states varying widely. Across the nation, the study estimated 69 percent of doctors were accepting Medicaid, but state acceptance rates ranged from a low of 40 percent in New Jersey to 99 percent in Wyoming, according to the study published in Health Affairs. This was pre-ACA expansion and prior to any reimbursement fee changes.

Why Some Doctors Won’t Accept Medicaid

When comparing reimbursement rates among health insurance plans, Medicaid is the lowest payer, meaning it’s not a moneymaker for doctors’ offices. Paired with the administrative requirements of accepting public insurance, doctors sometimes just don’t want the hassle

The fee bump of 2013 to 2014 sought to make Medicaid acceptance more enticing by putting those fees on par with Medicare reimbursement rates.

“We don’t know if physician participation in the Medicaid program really increased as a result of the fee increases,” Zuckerman says. But a study he worked on with colleagues from Urban Institute and the University of Pennsylvania did find one way the fee bump helped.

Evaluating wait times for appointments in two periods – November 2012 through March 2013, and May 2014 through July 2014 – the study, published in the New England Journal of Medicine, reported Medicaid patients found it easier to make appointments after the fee bump, and those states with the biggest changes in wait time were those with the largest increases in reimbursement rates.

It’s this study that may have motivated some states to continue reimbursing doctors at higher rates after the federal bump expired on Dec. 31, 2014. According to the University of Pennsylvania, 16 states have elected to continue paying at least partially higher rates than they had pre-bump, to continue encouraging doctor participation in the Medicaid program. In the other states, fees have dropped.

Given that states have wildly different acceptance rates, different reimbursement rates and various state-set nuances, the effects of all this remain to be seen. But it stands to reason that beneficiaries may struggle again for their appointment times.

“You would think if there were access problems that the fee bump dealt with for a couple of years, that those access problems could reemerge,” says Zuckerman, who reiterates the lack of data backing this hypothesis. On the other hand, Zuckerman says, doctors knew the fee adjustment wasn’t permanent, and those who increased their participation may not make major adjustments in light of any changes.

What Does It Mean For You?

If you’re on Medicaid, this may be more than you care to know. The bottom line: You need a doctor, and you shouldn’t have to wait an unreasonable amount of time for an appointment. How you navigate your state’s Medicaid system likely hasn’t changed, but finding a doctor may require some legwork.

If you had a doctor prior to receiving Medicaid approval, call the office to discuss staying on as a patient. If the doctor accepts Medicaid, you likely won’t have to look for a new provider.

If you need a doctor, check your state’s Medicaid website for a provider directory. If your state doesn’t offer one, contact the doctor you’re interested in and ask if he or she is accepting new Medicaid patients. Ask what the average wait time is for a new patient appointment, and use that answer to compare a few different providers in your area. You can also use tools such as the Medicare.gov Physician Compare, Healthgrades or the U.S. News Doctor Finder to see how doctors stack up.

If you live in a state where Medicaid doctors are in short supply, you may find using a health center or community clinic is your best option. And before you turn up your nose, know that the ACA-funded major improvements and the expansion of health centers across the country in part to help deal with the influx of new Medicaid patients. Further, a Kaiser Family Foundation study found these centers to largely be on par (or even better) than other Medicaid managed care organizations in terms of quality, even before the ACA-funded improvements.

It is possible to get high-quality medical care under the Medicaid system. Navigating your way through the system, however, can be difficult. Regardless of how doctors are getting reimbursed or who is accepting the public insurance, your health should remain a top priority. So don’t delay medical care out of frustration, and remember to stay flexible with your provider choices.

 

One Response

  1. Some of us have a 7,000 out of pocket,,soo 1500,,,does not sound bad at all…and that’s a government employee by a county type insurance..I remember the days of 250 deductible and 1,000 out of pocket,,,,That would be nice again,,,,U know ,”we were just talken about this health care for all,,,including payments for all Doctors,,,meaning restricting what they get paid.That would take the money corruption out of medicine jmo,,,For example,,,in England,,,all Doctors get paid by the government,,,Their 1st year,,,their salaries are 1 million a year,,,thats it,,,They interveiewed a doctor on that c.d. ”sicko” a doctor from England,,,He and his wife were both Doctors,,,1st years,,,soo they both made 1 million a piece,,,He stated in his interview,,,that was enough for their 1st year..They lived in a very well-off condo,,,both drove mercedes,,,The doctor went on to say,,,1 million a piece is enough for us ,,,is just fine,,we live a good life,,now,,,if we wanted 4 Mercedes,,a condo in the south of france,,and a condo in Coloradoe,and a million dollar home,,,we would move to America,,,were doctors can/will make what -ever they want….but,,,,we are just fine w/1 million a piece,,,it kinda allows them to practice medicine for the real reason,,,to truly help people,,,,its not about money then as it is in America,,Now,,,someone pointed out to me,,,,,how are doctors schooled in England,,and who pays for that education????My understanding is,,,if the stay in England their is some sorta drastic cut in what they have to pay back for their schooling….I kinda like that idea,,,1 million a piece for a year,,,takes the money incentive out of medicine,,thus the current corruption happpening to some doctors I have witness myself,,,,,just sayen,,,jmo,,maryw

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