Facts And Numbers Medicare For ALL

Facts and Numbers Medicare For All

Some people are for it and some people are against it. This is sometimes a very sensitive issue, but this article ” Facts And Numbers Medicare For All” will explain everything to you so that you can have an intelligent conversation about it. 

What Is "Medicare For ALL"

Facts and Numbers Medicare For All EXPLAINED

When most people talk about “Medicare for All” they typically refers to a single-payer health care program in which all Americans are covered by a new version of our Medicare program.The current Medicare health-insurance program currently covers about 60 Million people who are 65 or older and some younger people with certain disabilities.

Under a single-payer Medicare for All program, it would cover essential treatment with no premiums or deductibles. It would also expand the categories of benefits under the current Medicare system to include areas such as dental and vision coverage, as well as long-term care.

There are several different versions of Medicare for All, the one I just mentioned is the most popular while others would expand access to Medicare and Medicaid without ending the private insurance system. Most of these alternatives involve allowing individuals or employers to purchase a Medicare-like “public option,” a government insurance plan that would compete with private plans rather than replace them.

What Was then the point of Obama Care?

President Barack Obama’s Affordable Care Act focused on covering people who were unable to get insurance through their job or existing programs due to preexisting conditions.

Under the ACA, the government offered subsidies for individuals and families to buy private plans through a government exchange. It also expanded Medicaid, the program for low-income people, to cover more Americans.

While the law broadened coverage to millions, about 27 million people are still uninsured, according to the Kaiser Family Foundation, and that number is growing.

The problem with ACA was that if you did not qualify for a government subsidy, you premium would be much more then before. 

I’ll give you an example: I did not not qualify for any subsidy under the ACA, so the lowest priced plan for me, my wife and our two kids was $1200 per month with a $12,500 deductible. So I would have to pay $26,900 per year before anything big would be covered. 

If you qualified for full government subsidy, you can find a very good plan (On the shoulders of others who have to pay much more because of you). The ACA’s exchanges also struggled to attract insurance companies to offer plans because not a lot of companies wanted to risk associated with insuring people who are already sick, leaving many areas with few choices. 

Most people who make too much money to qualify for subsidies have found the plans to be unaffordable, while others have complained that deductibles, while capped under the law, are still too high.

Medicare Is Not FREE!

When I talk to people about this subject, most please believe that Medicare is Free and it covers everything. Let me clear that up for you because it’s far from that.  

Original Medicare

Original Medicare which 60% of people use that are Medicare Eligible is made of Part A & B. 

Part A is your Hospital Insurance. When you are admitted into a Hospital Part A helps you covert that bill. Most people do not have a premium for Part A because they have been paying Medicare taxes during their working years. 

The Part A premium is calculated based on “Work Credits“. You get 4 work credits for every full year of full time employment. You need 40 credits for Premium-Free Part A, so if you work and pay taxes for 10 full years you will get Premium-Free Part A. 

If you don’t have enough work credits, you can buy Part A. If you paid Medicare taxes for less than 30 quarters, the standard Part A premium is $458 per month. If you paid Medicare taxes for 30-39 quarters, the standard Part A premium is $252 per month.

When you are admitted into a hospital, you do have to pay a deductible. In 2020 you have to pay $1408. This deductible covers your hospital expenses for 60 days from when you are admitted. If you go back to the hospital after the 60 days, you have to pay that again. In a worst case scenario you can pay up to $8,448 in just hospital deductible per year.

Part B is your Doctors Insurance. It helps you pay for medical bills when you go to your doctors, do x-ray’s, blood work or when you go to the ER and so on. Everyone has to pay a premium for Part B, in 2020 that amount is $144.60 per month. Some people pay more based on there income (IRMAA – Income Related Monthly Adjustment Amount) up to $491.60 per month. 

We are not done yet with Part B! Part B also have has a deductible, (it’s a small one) only $198 per year as of 2020. But here comes the fun part, Part B WILL ONLY PAY 80% of your medical bill. You are responsible for the other 20%. It get’s even better, Medicare does NOT have a maximum-out-of-pocket amount. So if you get a bill for $250,000 you will have to pay $50,000! 

Medicare Does Not Cover Prescription Drugs

2020 Part D cHANGES

Medicare does not cover prescription drugs, the government introduced Part D in 2006. Part D is not included in your Medicare coverage, you have to buy a plan from a approved private insurance provider. The monthly premium for Part D ranges widely but most plans are between $13 to $60 on average based on the benefits. 

You will also have a deductible with Part D. Your deductible is the amount you may need to pay per year before your prescription drug coverage benefits begin. This Medicare Part D cost is a set amount that is limited by Medicare. In 2020, Medicare prescription drug plans can’t charge any more than $435 for the annual deductible. Not all plans charge the $435, you can find plans with where the deductible is $0, $25, $50 or another amount up to $435. 

You will also have a co-payment. A co-payment is an amount that you have pay every time you pick up a prescription at the pharmacy.

To understand this cost, you’ll need to understand how plans price their medications. Each drug plan has a list of covered prescription drugs called a formulary. Formularies are usually divided into “Tiers,” where your basic generics are Tier 1 or 2  more costly medications are in the higher Tiers.

You’re co-payment for a Tier 1 or 2 medication might be $5 to $20 but a Tier 4 or 5 might be $50 or more. Again this all depends on the plan you choose and the drugs you’re taking. 

Your Medicare Part D cost isn’t always a co-payment. Sometimes you pay a coinsurance amount. Coinsurance is a percentage of the cost of the prescription drug. This amount varies based on the Tier which the drug is in and the plan you have. 

For example, let say your doctor write you script for a drug that cost $200 and your co-payment is 25%, that means you have to pay $50

If you and your plan spend a combined $4,020 on covered prescription drugs in 2020, you reach the coverage gap called the DONUT HOLE phase. During this phase, you’ll pay 25% of your plan’s cost for covered brand-name and generic drugs during the coverage gap. You will pay the 25% until you and your plan together reach $6,350

Facts and Numbers Medicare For All DONUT HOLE

If you and your plan together spend $6,350 in 2020 you will reach what’s called the Catastrophic Coverage phase. At this point and until the end of the year you will only pay a small co-payment for your drugs.

Covering The Gabs

60% of people who are Medicare Eligible keep Original Medicare the way it is. To cover the gabs they buy a Medicare Supplement Plan which is also know as a Medigap plan. 

A Medigap plan covers some or all of the gabs that Medicare does not cover. The plans average between $100 to $250 per month

So, let’s break it down. The average Medicare Beneficiary spends the following per month. 

  • Part A$0 ( up to $435)
  • Part B $144.60 (up to $491.60)
  • Part D$13 – $60 + Deductibles, Co-pay’s & Coinsurance
  • Medigap$100 to $250

The average person will spend between $250 to $450 per month per person. Of course that number can be higher based the medications your taking and other income based premiums. 

NOT COVERED

While Original Medicare covers a wide range of care, not everything is covered. Original Medicare Does NOT Cover:

  • Dental Care
  • Eye Exams
  • Hearing Aids
  • Acupuncture
  • Cosmetic Surgeries
  • Long Term Care

If you want coverage for any of these, you have to buy a private insurance plan that covers them. 

Back To "Medicare For All"

Next time when someone tells you that they want “Medicare For ALL” ask them if they mean what we just went over. It’s funny what kind of reactions you will get. 

What Options Do We Have?

Many people have suggestions, let’s review a few of them.  

Sanders Plan: The most well know suggestion is Bernie Sanders options of “Medicare For All”. Here is his key points on how he want it to be:  

Medicare for all
  • Create a Medicare for All, single-payer, national health insurance program to provide everyone in America with comprehensive health care coverage, free at the point of service.
  • No networks, no premiums, no deductibles, no copays, no surprise bills.
  • Medicare coverage will be expanded and improved to include: include dental, hearing, vision, and home- and community-based long-term care, in-patient and out-patient services, mental health and substance abuse treatment, reproductive and maternity care, prescription drugs, and more.
  • Cap Prescription drug out of pocket limit to $200 a year.

To fund the program the Sanders plan would impose extra taxation on the corporate world. Don’t take my word for it, here is the link to his own breakdown of how he would finance everything. Click Here

His program is great and it’s something we want for everyone. Unfortunately the real world requires money to run. His own plan says It is projected that if we do nothing and maintain our current system that we will spend $49 trillion over the next decade on health care.

I added up all the Trillions in his plan and the problem is that I come up with only $16 Trillion over the next 10 years if you add everything up. We are currently spending almost double that on healthcare, and this plan wants to remove premiums, deductible and copay’s and wants to add other very expansive coverage such as Long Term Care. It wants to do all of that but the plan would cut the money to pay for it in almost half.  

And this is assuming that all the big companies are OK with being taxed over 50% and that they are OK with limiting how much profit can make. And since we are eliminating private insurance we just have to find new jobs for millions of people that work in that industry. 

If everyone agrees to change the very fabric of our structured economy and embrace a socialist form of government then this would be possible.   

I would love to have his plan but the money just does not add up to pay for it and the american people hate being under more and more government regulations. You can make up you own mind. Here are the links again. 

Public Options

The idea is that along with the private health insurance plans that you might have access to through your employer or through the individual insurance exchanges, there would be an option to buy into a government-run insurance program, like Medicare. Private insurance would still exist, but people could choose to get a government insurance plan instead if they want to pay for it.

There are many kinds of public option proposals, and different presidential candidates have their own ideas on how it would work, whether it’s lowering the age for Medicare access or creating a new program that’s not Medicare or Medicaid that people could buy into, among others. The idea is that the government might be able to offer a more affordable option for people, which could push down prices in the private insurance world.

I like these options because they simple create competition in the market. The one that offers the best option for the lowest price get the money. Not to many details are available for me to state here because everyone has an options they think will work best.

Universal Health Care

Universal health care is a system that provides medical services to all citizens. The federal government offers it to everyone regardless of their ability to pay. I consider Universal Health Care to be the same as Medicare for All (It’s the same concept) but with 100% control over everything by the government. In most countries where they have Universal Health Care, the government runs the hospitals and all doctors work for the government. The Health care costs overwhelm government budgets. For example, some Canadian provinces spend almost 40% of their budgets on health care.

How it would work:

    • Lowers overall health care costs: The government controls the prices through negotiation and regulation.
    • Lowers administrative costs: Doctors only deal with one government agency. For example, U.S. doctors spend four times as much as Canadians dealing with insurance companies.
    • Forces hospitals and doctors to provide the same standard of service at a low cost: In a competitive environment like the United States, health care providers must also focus on profit. They do this by offering the newest technology. They offer expensive services and pay doctors more. 
    • Creates a healthier workforce: Studies show that preventive care reduces the need for expensive emergency room usage. Without access to preventive care, 46% of emergency room patients went because they had no other place to go. They used the emergency room as their primary care physician. This health care inequality is a big reason for the rising cost of medical care.
    • Early childhood care prevents future social costs: These include crime, welfare dependency, and health issues. Health education teaches families how to make healthy lifestyle choices, preventing chronic diseases.
    • Governments can impose regulations and taxes to guide the population toward healthier choices: Regulations make unhealthy choices, such as drugs, illegal. Sin taxes, such as those on cigarettes and alcohol, making them more expensive. 

Disadvantages:

    • Healthy people pay for others’ medical care: Chronic diseases make up 90% of health care costs. The sickest 5% of the population create 50% of total health care costs, while the healthiest 50% only create 3% of costs. 
    • People have less financial incentive to stay healthy: Without a copay, people might overuse emergency rooms and doctors.
    • There are long wait times for elective procedures: The government focuses on providing basic and emergency health care. 
    • Doctors may cut care to lower costs if they aren’t well paid by cost-cutting governments: For example, doctors report Medicare payment cuts will force them to close many in-house blood testing labs.
    • The government may limit services: with a low probability of success. This includes drugs for rare conditions and expensive end-of-life care. In the United States, care for patients in the last six years of life makes up one-fourth of the Medicare budget.

Final Thoughts

When you have a conversation with someone about this, you should know first what you believe. Ask yourself if these questions:

  1. Would you be willing to pay more so that someone else who does not have as much money as you get’s the same coverage for less or free.
  2. Are you OK with the government controlling your healthcare choices?
  3. Are you OK with the government forcing Hospitals, Doctors, Nurses, Dentist and everyone else in the healthcare industry to accept less money for their services.

If you answered “Yes” to these questions then Universal Healthcare or Medicare For All would work for you and you believe in socialism. 

If you answered “NO“, then you would not be OK with it and you believe in a open market when success and services are based on the value you provide.

Our healthcare system is nowhere near perfect and nobody claims that. But our system develops all the medical technology which is making everyone life better. Our system is based on if you bring value to it you will be rewarded. That’s why we have people coming here from all around the world to be treated.

This conversation will continue and we will keep on trying to make it better. It might not be fair to everyone right now, but neither is life in general. 

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