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Here's a statement of the obvious: The opinions expressed here are those of the participants, not those of the Mutual Fund Observer. We cannot vouch for the accuracy or appropriateness of any of it, though we do encourage civility and good humor.

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  • edited October 14
    Crash said:

    ...Medicare will eat it anyhow.

    There's a lot of that notion going around. Let's walk through that.

    I did this relatively quickly - please check my math. Also see Disclaimer below.

    Looking ahead...
    If your gross SS is $15,000 annually, a 2022 5.9% COLA increases your gross by $885. If SS is $20,000, an increase of $1,180.

    No definitive word yet on the Medicare Part B increase for 2022.

    Looking back...
    In 2020, Part B increased 6.72% to $144.60 monthly from $135.50. Annually that was a $109 increase.

    In 2021, Part B increased 2.70% to $148.50 monthly from $144.60. Annually that was a $47 increase.

    So...
    IF the past two years are any indication, it is very unlikely, barring an extraneously high Pt B increase for 2022, that anyone grossing $15K-$20K annually will not be in a better net position is 2022.

    NOTE: Part D premiums are NOT considered here but would also affect net, if applicable, as would other variables, increase in Pt B penalty, etc.

    Disclaimer: Data provided by long-since retired auditor type whose calculation accuracy rate may or may not resemble his stellar rate from back in the day. Just sayin'.
  • This article has little to do or say about medicare. It certainly doesn't say medicare is going to eat the SS increase you are getting. This is more about the affect all inflation has on low income people, specifically low income retired people and suggests how to best handle your savings to cope with the problem.
  • edited October 14
    MikeM said:

    This article has little to do or say about medicare. It certainly doesn't say medicare is going to eat the SS increase you are getting. This is more about the affect all inflation has on low income people, specifically low income retired people and suggests how to best handle your savings to cope with the problem.

    I didn't post the article, but Agreed.

    What is says about Medicare is:

    ...What's more, rising Medicare premiums -- which are deducted from one's Social Security check -- will reduce the amount left over to pay for other essentials, according to the Center for Retirement Research at Boston College.

    Johnson notes the Centers for Medicare and Medicaid Services have estimated that prescription drug plan premiums will increase by nearly 5% in 2022. And the Part D out-of-pocket threshold before reaching the catastrophic phase of coverage will grow by 7.6%...
  • The State of MI retired teachers healthcare premiums have actually declined over the last couple of years, but the deductibles and out-of-pocket costs have risen, very substantially. Items like urgent care or ER visits are very costly now, and the drug prices we pay at the pharmacy have risen plenty. It’s much harder to get approval for prescriptions as the insurers constantly force the doctors to rejustify use of a drug the patient has been taking for years. My doctor says his staff spends hours a week talking to retired docs hired by the insurance companies to just say “no” whenever a prescription renewal is presented.

    Our Part D provider sends us countless ads urging us to use mail order for refills. One had best read the fine print because there is a $40 minimum charge, even if the Rx is for a month’s supply of Lisinipril, a drug we pay $1.75 for when we buy it at the local pharmacy. If the doctor orders a 90-day supply of the same drug, the pharmacy is required by the insurer to charge us $16. We go in every month because we have always been thrifty.
  • edited October 14
    Pus-wad usurers, extortionists. You're smart to just make the trip to the drug store.
  • "In 2021, Part B increased 2.70% to $148.50 monthly from $144.60. Annually that was a $47 increase."

    That is correct, but remember that the 2021 was supposed to be four times this amount or $15.60 ($3.90 x 4). It was limited to 25% by the law that was passed to help with Covid (can't remember the law's official name).

    It is my understanding that this will be deducted this year in addition to the new calculated amount for 2022, so whatever this year's amount calculates out to, this $11.70 ($3.90 x 3) will be added as well. Of course, this assumes that your particular SS benefit increase exceeds this Medicare increase, otherwise you are held harmless.

    Just my two cents worth
  • edited October 16

    "In 2021, Part B increased 2.70% to $148.50 monthly from $144.60. Annually that was a $47 increase."

    That is correct, but remember that the 2021 was supposed to be four times this amount or $15.60 ($3.90 x 4). It was limited to 25% by the law that was passed to help with Covid (can't remember the law's official name).
    ----------------------
    stillers: As my wife likes to say, "Good remembering!" Here's an article about that from 09/21/20:
    https://www.cnbc.com/2020/09/29/congress-may-limit-medicare-part-b-premium-increase-for-2021-.html
    ------------------------
    It is my understanding that this will be deducted this year in addition to the new calculated amount for 2022, so whatever this year's amount calculates out to, this $11.70 ($3.90 x 3) will be added as well. Of course, this assumes that your particular SS benefit increase exceeds this Medicare increase, otherwise you are held harmless.
    ----------------------------
    stillers: Not sure how that's your "understanding " of that. I've never seen that written but I could have missed it. Do you have a reference/link? Having worked in other areas of the Program for a coupla decades, it would knock me off my chair to learn that was correct, or even contemplated as something that could pass, or pass-through, as it were. But I digress.

    All that aside, and cutting to the chase, here's medicareresources.org's take on it as of 10/05/21:
    https://www.medicareresources.org/faqs/how-much-does-medicare-part-b-cost/

    Excerpts:
    Medicare Part B costs: key takeaways
    Standard Part B premiums are $148.50/month in 2021; projected to be $158.50/month in 2022...

    ...As described below, the Social Security cost-of-living adjustment can sometimes limit the increase in Part B premiums, but that’s not expected to be the case for 2022, as the COLA is expected to be historically large.

    The Part B premium increase from 2020 to 2021 was smaller than initially projected, thanks to a short-term government spending bill that was enacted in the fall of 2020, and that included a provision to cap the increase in the Part B premium for 2021.


    That ($158.50-148.50 or) $10 increase is in line with some other estimates I've seen and does not quite compute with what you posted.

    And in relation to the subject of my post, a response to another poster's comment, "Medicare will eat it anyhow," even if correct, the absolute Medicare Pt B increase in 2022 will be small relative to the SS COLA increase for the vast majority of recipients.
    -----------------------------
    Just my two cents worth
    -------------------
    stillers: As we used to say in the bizness, "Noted."
    -------------------

  • I'm still tracking this thread. It leaves me just a little bit encouraged.
  • Update: New monthly premium for Part B will be $170.10 per month, which is an increase of $21.60 per month. Also, Part B deductible will increase from $203 annually in 2021 to $233 annually in 2022. Everywhere I had read indicated around a $10 a month increase, so more than expected. If your SS increase is less than the Medicare increase, you will be held harmless.
  • edited November 13
    BenWP said:

    … for a month’s supply of Lisinipril, a drug we pay $1.75 for when we buy it at the local pharmacy. If the doctor orders a 90-day supply of the same drug, the pharmacy is required by the insurer to charge us $16. We go in every month because we have always been thrifty.

    @BenWP - Thanks for the tip. (I’m the idiot who has been paying $16.00 )

    Likely, like me, there’s a Meijers store near you. So, using Good RX, this med can be had for $10.94 for 90 days - and you would only have to make one trip instead of 3. (Click the “90 day supply” tab to view price.)

    One wonders however at this Voodoo Insurance whereby the medicines cost less if you pay out of pocket instead of using your insurance. What’s wrong with this picture?


    PT Barnum?
  • @hank who said "One wonders however at this Voodoo Insurance whereby the medicines cost less if you pay out of pocket instead of using your insurance. What’s wrong with this picture?"

    From p[ersonal experience I can tell you that doctor visits cost a lot more if you pay for them out of pocket rather than playing the insurance scam game.
  • @hank: there is still insurance coverage, as I understand it. We have, as you may, OptumRx, the plan offered for retired school personnel in MI. Just Thursday, despite telling the doctor how we wanted the script written, Meijer had the 90-day supply ready for $17.90. I asked them to redo it and yesterday I got the 30-day Rx for $1.67. Since we shop there regularly, going once a month is not burdensome. The pharmacy claims it must charge what the insurer requires. OptumRx has deals with certain pharmacies, so not all retail outlets in MI have the same price. Kroger does not, for example. Weird.
  • msf
    edited November 13
    It depends on the physician or other medical provider.

    I used an ACA plan that didn't include one of my doctors and he charged me a reasonably modest cash rate. Same for some physical therapy sessions that I paid for out of pocket while I sicced the state regulators on my insurer for improperly denying preapproval.

    OTOH, a different doctor that had been covered by my insurance refused to give me a discount for cash when my insurance no longer covered him. My SO's insurer did cover the doctor and it paid literally just half as much. I switched doctors and haven't gone back.
  • msf
    edited November 13

    Update: New monthly premium for Part B will be $170.10 per month, which is an increase of $21.60 per month. Also, Part B deductible will increase from $203 annually in 2021 to $233 annually in 2022. Everywhere I had read indicated around a $10 a month increase, so more than expected. If your SS increase is less than the Medicare increase, you will be held harmless.

    Perhaps 20/20 hindsight, but this should not have come as a major surprise. (I've played the game of hoping for, or "anticipating" a smaller increase, so I'm not an innocent bystander here.)

    The increase last year was less than it should have been, because of a law that cut the increase by 3/4 only for 2021. The actual 2021 premium should have been closer to $160. Insurance premiums are set based on anticipated costs, not last year's costs. Since medical costs barely budged in 2021, one might anticipate a smart rise in costs during 2022. Thus Medicare (and other health insurance) premiums should have been expected to rise a fair amount above $160.

    Viewed that way, the $170 premium is disappointing but not surprising.

    For the "hold harmless" rule to apply, one must not be subject to IRMAA. (More than 90% of Medicare participants are not subject to IRMAA.)
  • edited November 14
    From my experiences with the office staff in doctor's offices I wouldn't be at all surprised if the doctor actually had no knowledge of the various machinations regarding his compensation. Sometimes the communication between doctors and their office staffs is remarkably poor. Sometimes the answer that you get from one office staff person is directly at odds with another staff member. Sometimes it's pathetically obvious that an office staff person is completely ignorant of commonly encountered insurance procedures.

    Why an ignorant or untrained office staff member is allowed to interface with the public is really beyond me, but it happens more frequently than you might think.
  • edited November 13
    @BenWP - Yes, sounds like you & I have same plan. I’ve found in the past that some seldom prescribed meds that cost $50 - $100 with that insurance plan can be had for approximately $10 - $15 if I use Good RX instead (at Meijers). So, I’m not totally blind-sided by your post. But - Geez - liscinopril’s an old and very commonly prescribed med for controlling blood pressure. I’m surprised that price gouging is occurring on this very common med. Cudos to you for noting the discrepancies in pricing.
  • Out of curiosity, I fed lisinopril into GoodRx, and the cheapest price it gave me for a 90 day supply was at a supermarket without a coupon. If you use a GoodRx coupon at the same place it would cost over 10% more.
  • edited November 14
    IRMAA?
    Irish Reconnaissance Masterly Art Assignment?
    Iridescent Reality Mimicry American Association?
    It's Really My Aroma Ability?
    Of course, I clicked on the link and saw it. Stoopid Gummint Alphabet Soup.

  • ...And what is intended by the remark, above: "to be held harmless?"
  • That’s very helpful, @hank. The drugs that cost in the range you noted are probably Tier 3, and we do have a couple of them. I’ll check out GoodRx.
  • @Old_Joe

    I retired in 2019 after 40 years in primary care medical practice, both self employed and as an employee.

    When I was self employed, my livelihood and the salaries of all of our employees depended on the knowledge and expertise of the billing staff, who worked long hours to get us every dollar they could out of the insurance companies. Despite many hours talking to them, I still do not understand medical billing. We paid these folks good salaries to sit on the phone for hours and wrangle with other staff at Blue Cross for example, over $15 or $20. But we figured if they spent 30 minutes collecting $50 we were ahead of the game.

    A lot of physicians don't bother, or hire a billing service, who just tries once. In primary care, however, the margins are so thin ( our overhead never dropped below 55%) every dollar counted.

    I think we would have been better off charging $50 a visit, cash. We would have needed far fewer staff, but it was unclear ( and I could never get an answer) if we didn't take insurance, if our patients would have had any of their tests or prescriptions covered. That is where the real costs in health care are, not doctor's salaries, especially primary care.

    Once I joined a hospital owned practice, it was their problem, but I can tell you collections and efficiency fell off the cliff.

    It is in the financial interest of the insurance companies to make this as complicated as possible, as they live off of the 25% America spends on administrative expenses. Highest in the world!
  • @sma3- Good morning. Yes sir, you've certainly been there and done that.
  • @sma3
    Yes, thank you for sharing your perspective. The "other" major benefit of MFO, the not investing side of life.
  • msf
    edited November 14
    Thanks for the insight from the provider's perspective. As a patient (or in business terms, as a customer), I've wound up delving into not just CPT codes but their modifiers. In one doctor's office after I started questioning some things, they sent their claims coder out to talk with me and we had a friendly ten minute discussion. Among other things, we talked about how absurd the whole system is.

    I've gone to providers and pointed out that the insurer didn't process the claim correctly and that the provider (not me) should be getting more money. More often than not the response was that it wasn't worth their time and effort to refile and that there's a certain amount of slack built into the system.

    It goes the other way as well. I was infuriated when, a year after an insurer had properly denied a doctor's claim for a procedure already included in a global surgical package, the insurer spontaneously paid the claim.

    Regarding tests prescribed by out-of-network physicians being covered: my experience is that they are. As I noted above, under ACA I went to a doctor who wasn't covered. The blood work that he prescribed was always covered, so long as it was sent to an in-network lab. (Let's not get into how the drawing of blood is paid for; it depends on who draws the blood!)
  • I'm learning. And some of what I suspected is being confirmed. Ya know what we DON'T need? Coders. Because if we are all covered, a la Canada and Europe, Single Payer would simply COVER it. But alas..... And if there is "slack" pre-built into the system, then the old saw about "close enough for government work" would be no surprise to anyone, either.
  • Many European countries do not use single payer systems.
    Everyone in France must buy health insurance, sold by a number of nonprofit funds [i.e. multiple payers]. ...

    Switzerland has a universal health care system, requiring all to buy insurance. The plans resemble those in the United States under the Affordable Care Act: offered by private insurance companies, community rated and guaranteed-issue, with prices varying by things like breadth of network, size of deductible and ease of seeing a specialist.
    https://www.nytimes.com/interactive/2017/09/18/upshot/best-health-care-system-country-bracket.html

    See also: International Health Systems for Single Payer Advocates
    https://www.pnhp.org/single_payer_resources/international_health_systems_for_single_payer_advocates.php

    Even with a single payer system (e.g. original Medicare), providers would still need to code claims to receive payment for services rendered:
    What are ICD Diagnosis Codes Used For?
    Help Medicare claims paying offices process Medicare claims
    https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Mandatory-Insurer-Reporting-For-Non-Group-Health-Plans/NGHP-Training-Material/Downloads/ICD-Diagnosis-Code-Requirements-Part-I.pdf (see slide 5)

    Codings are used not just for billing purposes but to keep accurate records and communicate clearly. From the UK's National Health Service, describing a coder's job:
    You begin by recording the stay of an elderly woman who had a hip operation two days ago. From her medical notes, you find out the ward she stayed on before surgery, how long her operation took, her recovery time and any other treatment she received. Then you use the special alphanumeric code you've been trained in and record everything on the computer system.

    These records can be understood throughout the NHS and used to plan for future patient care.
    https://www.stepintothenhs.nhs.uk/careers/clinical-coder
  • okey dokey. As long as we are not justifying the ridiculously complicated nonsense.
  • Things definitely get much simpler with a single payer. I'd stop seeing all these signs on the walls and doors of my PCP's office saying that procedure X needs approval if patient is covered by insurer A, but go ahead if covered by insurer B. And there would be somewhat less gaming of the system - coding procedures to maximize payments.
  • And there would be somewhat less gaming of the system - coding procedures to maximize payments.
    Reading THAT just makes my blood boil.
  • In a sense, the whole claims system is a game. The insurers do everything they can to come up with excuses to deny or delay paying the fair amount on claims.

    My doctor's office had a claim denied because they had not stated explicitly that the coding was in ICD-10 (the current coding system) rather than ICD-9, which had been obsolete for years. They had to refile with no changes, just a declaration that it was coded correctly.

    Medicare Advantage insurers game the government by trying to make their customers appear as sick as possible. The way the system works, "To provide an incentive for insurers to cover sicker patients, the plans are paid commensurately more for their care."

    So the insurers push customers to accept a one time in-home visit from an insurer's clinician to find any condition that would get the insurer more money. Of course that's not what the insurers tell their customers the visit is for. And it raises all our costs.

    "If you are healthy and the visit results in an increased risk score, you won’t have to pay more for your care. But the higher Medicare reimbursement your insurer receives may contribute to the nation’s rising health care costs."

    https://www.health.harvard.edu/blog/medicare-advantage-when-insurance-companies-make-house-calls-201512168844

    In this game, I find I'm more on the side of the providers. Especially PCPs, where as @sma3 noted, margins are razor thin. Which is not to say that I haven't seen gross abuses of the system by providers. But I haven't seen nearly the level of nickel and diming that the insurers do that drives up administrative costs. Just MHO.
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