a Medicare hmmmmm...

[madamesilverspurs]

Having been on Medicare for many years, I’ve been listening with considerable interest to the back and forth conversation about Medicare in general and the prospect of Medicare For All. Reflecting on the mailed regular notices listing what was paid for — what was billed, the approved amount, the little notations that explain such decisions — the question came to mind, who sets those rates of reimbursement.

The Google provided numerous sites that outline the process of rate setting, but I couldn’t find any mention of who implements that process. What is the pool from which they are selected? More, what are the job experience requirements, and who chooses those employees?

I don’t know, maybe I’m just getting cynical in my dotage. But there is a discernible whiff of machinations to maintain the highly profitable insurance industry by making Medicare untenable for practitioners and hospitals. Admittedly, my perception might be somewhat influenced by the vestiges of the stench of congress refusing the testimony of doctors and nurses while hastening to give insurance executives a seat at the healthcare discussions table.

The how (which I didn't ask) is readily available. But the question I did ask, Who?, remains unanswered. For now, anyway.

[Hoyt]

1. The government -- Centers for Medicare and Medicaid Services -- sets the rates each year.

The rate setting is based upon laws enacted by Congress. MediCAID rates are set by states, but largely funded and somewhat controlled by feds.

It's a complicated system that utilizes relative values for thousands of health services.

Whether rates go up or down, especially over several years, is a political issue (that could have seniors in nursing homes, etc., being treated like the poor migrant children are right now if cuts are severe enough).

[hedda_foil]

2. The Center for Medicare Services sets uniform reimbursement rates by service/procedure/treatment

Under regular Medicare Parts A and B, the Medicare Beneficiary (you) pay 20% of WHAT MEDICARE PAYS -- not what the provider billed. If you have a Medicare Supplemental policy in addition, all or part of that amount is paid by your private insurance company -- depending on which of several government determined levels of coverage you choose. Different companies offer EXACTLY the same levels of Medicare Supplemental coverage at wildly different prices. You can price shop these policies because by law, their coverage levels are identical. AARP/United Healthcare is usually by far the highest priced.

Sorry for supplying extra info but it pisses me off how some companies rip off seniors who don't get the full facts.

[emmaverybo]

4. With M4All, those on Medicare Advantage or Medicare supplemental plans will lose the second plan.

That fact will greatly concern seniors, half of whom buy the other plans in addition or get them
provided at no cost in their retirement packages,

Vested state employees in California, for example, pay for Medicare out of SS, but are reimbursed that monthly cost to their pension, pay zero premium for the supplemental, get drug coverage, 100 percent hospital, small co-pays for out-of-hospital costs.

These “extra” plans also allow for emergency and urgent care coverage on extended out of country
visits, even in retirement in countries all over the world.

Despite that the senior vote is often discounted in Dem proposals, we exist in great numbers and we do vote.

[hedda_foil]

9. Even Bernie wants to substantially improve Medicare in the process.

I think it makes a great deal of sense to shoot for the end result you want and negotiate from there as necessary than start in between your true goal and where you think the sold out opponent's bottom line is and negotiate down. That's one of the the so called centrists' consistently failed ideas.

[emmaverybo]

10. Then supporters should make it clear that they will negotiate, not mandate their way into

Medicare4All. They need to anticipate resistance, which is going to come from many voters we need to win the GE. They need to make the case you are making.

[dlk]

3. Medicare Reimbursements Are Abysmally Low

This is why many providers limit the number of Medicare patients they will treat or refuse to take them at all. However, there’s no reason the reimbursement rates can’t be raised.

[Wounded Bear]

5. And that goes back to Congress...

and especially Repub led congresses of the last couple of decades. Rates have not grown with inflation.

Medicare reimbursments will never be 100% of average rates, but they should be high enough so that more civic minded doctors and clinics/hospitals can afford to offer services.

[dlk]

6. Even More Reason to Elect Democrats

[Wounded Bear]

7. Ab-so-lutely!

Though I can't help much there. My House Rep and both Senators are strong Dems.

[Hoyt]

8. They limit them because they have higher paying options. If Medicare

is only option some might quit, but most will just adapt.

A doc can make a decent income on Medicare, even Medicaid, they just don’t like it. Cardiologists, urologists, etc., do fine with a high Medicare patient base.

But, there is no question that those who have done very well under or healthcare system might have to tighten their belts.

Not all commercial plans pay significantly more than Medicare.