Observation about increasing costs of healthcare

[Horse with no Name]

From my first hand perspective.
Every day in my job working as a nurse in a medical office.....the mountains of paperwork piled on to us to fill out.
I spend half of my day filling out forms from FMLA to forms required by these new "absence management" companies to prior authorizations and peer-to-peer reviews from insurance companies who are fighting to deny you the physical therapy and medications and diagnostic tests that you need.
This is truly ridiculous and there will HAVE to be a point with the increasing number of forms that someone is going to have to pay for the administrative time of filling out all of these forms.
If I can offer one shred of advice...do NOT let someone talk you out of your traditional Medicare. I can assure you that the other plans do NOT offer the same benefits. Their formulary is very constricting and you or someone in your doctors office WILL have to fight for almost anything you do.
#frustration

[virgogal]

1. I've had traditional Medicare for years---and am very pleased.

[Horse with no Name]

2. It actually is very easy to get things paid for by it

the other plans? Not so much.

[Freddie]

3. My daughter is a home care nurse manager

This is exactly her advice--stay with traditional Medicare! Regular Medicare does not second-guess the nurses about how much care the patient needs. She says Medicare HMOs are horrible and are always trying to stop care no matter what is needed.

[Horse with no Name]

4. well it makes sense

the only way they can make money is not to spend it.
That is the conundrum of putting profit into healthcare.

[W_HAMILTON]

6. Can you (or the OP) explain this further?

My elderly mother will have open enrollment soon, and I have been looking for other options in the past for her to switch to, but I'm just not familiar with it all. Right now, she is on a "Medicare Advantage." Are you (and the OP) saying that it would probably benefit her more to switch to a full Medicare plan instead? If she does that, do you all recommend purchasing one of those Medigap policies?

[Freddie]

11. From my daughter and others in health care

I've heard that Medicare Advantage (HMO) plans are great for younger, healthier seniors but as people need more care they are a problem. My daughter has to fight with them to keep her patients on home care because they are not flexible with what is "normal" for each diagnosis (you got a knee replacement, you get x days of care). Traditional Medicare rarely if ever does this.
Also virtually every doctor or facility that has lots of senior patients takes regular Medicare but they don't all take the Advantage plans.
I have honestly had no personal experience here as both my parents (now deceased) had traditional Medicare with a great supplement plan they bought through the state teachers pension system. They never had to deal with HMOs back when they were working and I can't imagine them doing so as seniors with multiple doctors and issues.

[Horse with no Name]

15. Thank you. You explained this very well.

The problem with the Medicare Advantage plans are that eventually, age catches up with almost everyone and if you are stuck with one when it does....then you have some real problems and you might find that if you need a good specialist, that specialist may not be on your list of providers.
Our facility doesn't take ALL of the Medicare plans either. They are reviewed on an annual basis.

[forthemiddle]

16. All Medicare Advantage progams follow traditional Medicare rules

I don't know what your daughter is referring to, but for knee replacements (and all other procedures that allow aftercare rehab) there are set rules on how long the rehab can occur.

Medicare Advantage programs all must, by law, start with the Medicare baselines, and can add additional coverage from that point.

You are correct about all doctors not accepting all Advantage programs.

[Proud Veteran]

10. My UAW retiree sponsored Medicare Advantage PPO is Excellent

Feel most fortunate to have coverage for 0$ monthly contribution
with an annual $630 out-of-pocket max. My generic drug co-pay is being increased to $24(90 day supply) in 2017. Was in the MA HMO which was more costly and believe their is more latitude with the MA PPO. Being the good Dem that I am would like to see this evolve into single payer for all. I'm of the belief that healthcare is a right and not a privilege.

[Sherman A1]

5. It has become a real game

and it is so very sad.

[Trailrider1951]

7. Thank you so much for your information!

I turn 65 the end of November and you would not believe the tsunami of junk mail and phone calls, all wanting me to sign up for United Healthcare, Humana, Blue Cross, AARP and the like. There must be mucho dinero involved for these companies to spend this much on just one (1) person! I must get 20 calls a day, taken by the answering machine thank you very much. And every day I pull one to four solicitations from my mailbox, all wanting me to sign up for their "Medicare" program. No thank you. I trust dead-and-gone FDR MUCH more than United Healthcare!

[Warpy]

8. I was uninsured for 26 years before Medicare kicked in

and I got stubborn as hell about giving any of those bloodsuckers a dime of my money. I have slightly more than enough to live on and even with a hospitalization last year, I'm ahead of the game paying the over the top costs myself rather than paying premiums.

Also, you'll want to thank LBJ. FDR rammed Social Security through. LBJ twisted arms all over Congress and got us Medicare.

Republicans have yowled about both of them ever since.

[Horse with no Name]

14. What I find is that we can "eventually" get things covered

but it takes a lot of work and a lot of documentation and a heck of a lot of man hours to do it.
What this eventually leads to is major health systems deciding that they don't want to do that much work to get paid and they get dropped as an authorized payor.
When we see traditional Medicare....it is almost an audible sigh of relief because we know we can get a surgery approval fairly easily.
This doesn't mean that we can get unnecessary surgery approved but it does mean that if there is a need, we can provide it without a huge investment of time and effort.

[PoindexterOglethorpe]

9. I am in an Advantage Plan, and it's

beyond excellent, at least for my limited needs.

So please don't trash all Advantage Plans.

Although to address your main observation about filling out forms, I recall reading as far back as the 1970's that doctors wished that all the insurance plans would at least use the same forms. If we could require that, even if everything else is different, that would save a lot of money and time.

[awoke_in_2003]

12. From a patient point of view

Every time you go to a new doctor, you spend 15 minutes filling out the same paperwork you've filled out countless times before. Why can't we have centralized records? That would help put a crimp in opioid abuse. Why can't doctor A see what doctor B is doing?

[Horse with no Name]

13. I hear that as well

BUT....you would be very surprised at what the patient's don't want their doctors to know from practitioner to practitioner.
You would also be surprised that even though EMR's don't routinely travel from facility to facility, there is a feature that is incorporated into them from YOUR insurance company that gives us access to your prescription records. That way we can tell if you are filling your pain meds from doctor to doctor.
AND if we don't respond to that, your insurance company sends us a letter telling you that we need to watch you for potential drug abuse.
I personally find that a little draconian.