Medicare Advantage is an all-in-one managed care plan, typically an HMO or PPO. Advantage plans provide the benefits of Part A and B, and most also include Part D, or prescription drug coverage. Some offer extra benefits not available through Original Medicare, such as fitness classes or vision and dental care.
If you opt for Medicare Advantage, you typically continue to pay your Part B premium as usual, but you will pay little or no additional premiums for your coverage. You generally have copays or coinsurance, but once you reach your out-of-pocket limit, the plan will pay 100 percent of your medical costs covered under Medicare for the rest of the year. The out-of-pocket limit does not apply to prescription drugs or extra benefits.
To keep premiums low, Advantage plans generally require you to get your care from a network of doctors, hospitals, and other providers, and you typically need pre-authorization for specialized care.
Here’s a question that’s been on my mind and perhaps yours: Is the US healthcare system expensive, complicated, dysfunctional, or broken? The simple answer is yes to all.
Below are 10 of the most convincing arguments I’ve heard that our system needs a major overhaul. And that’s just the tip of the iceberg. Remember, an entire industry has evolved in the US just to help people navigate the maddeningly complex task of choosing a health insurance plan.
Financial burden. High costs combined with high numbers of underinsured or uninsured means many people risk bankruptcy if they develop a serious illness. Prices vary widely, and it’s nearly impossible to compare the quality or cost of your healthcare options — or even to know how big a bill to expect. And even when you ask lots of questions ahead of time and stick with recommended doctors in your health insurance network, you may still wind up getting a surprise bill. My neighbor did after knee surgery: even though the hospital and his surgeon were in his insurance network, the anesthesiologist was not.
Access is uneven
Health insurance tied to employment. During World War II, healthcare was offered as a way to attract workers since employers had few other options. Few people had private insurance then, but now a layoff can jeopardize your access to healthcare.
Healthcare disparities. The current US healthcare system has a cruel tendency to delay or deny high-quality care to those who are most in need of it but can least afford its high cost. This contributes to avoidable healthcare disparities for people of color and other disadvantaged groups.
Health insurers may discourage care to hold down costs. Many health insurance companies restrict expensive medications, tests, and other services by declining coverage until forms are filled out to justify the service to the insurer. True, this can prevent unnecessary expense to the healthcare system — and to the insurance company. Yet it also discourages care deemed appropriate by your physician.
Please refer to the DWWR Posting on “concierge doctors” for my rant on the current healthcare system, which I will not repeat.
The truth is more nuanced. All countries are having trouble of one sort or another with their healthcare systems. This is due to the inherent expense of today’s top flight medicine. The very best care requires costly high technology and drugs that are intrinsically hard to produce. And you have to know where to look. I am very thankful for my medical degree, and that I have kept up with current advances.
You would probably need a Government entirely of physicians to develop the willpower to do something for health, which always starts with PREVENTATIVE MEDICINE, A hard sell, given that you must spend money and effort to block something which will probably, but may not always, occur.
There is low hanging fruit. Why are sugary drinks not heavily taxed, since they produce obesity which causes a lot of costly medical disorders, such as diabetes, inflammatory diseases, and cancer, but not everybody all the time?
Why is efficiency of telehealth not more widely embraced, but stymied by moneymaking lobbiests and lawyer powered difficulties, in addition to Patient’s and doctor’s old habits?
And then there are the jealously guarded American freedoms to do stupid things, such as avoid vaccines and masks, even in a prodigiously expensive and dangerous Covid epidemic.
Given human nature, a complete solution would seem to be impossible, and we should content ourselves with minor victories wherever they can be attained.
Embrace sleep, diet, and exercise, and KEEP HEALTHY.
–Dr. C
Empowering Patients Through Education And Telemedicine
Doctors Without Waiting Rooms 