BTW, before the ACA put the axe on preexisting conditions, being female was a preexisting condition.
yes, that’s what insurance companies would say. How would you like to have preexisting conditions added to Medicare?
Of course you won’t answer that because you’ve got yours and you’re not worried about saving dollars on someone else’s healthcare woes. If you really want to save taxpayer dollars, then put the limits on Medicare recipients over 72.
Faulty reasoning. Given a choice, far too many folk would choose to avoid paying their way…and not just with healthcare. Differences apart, the similarity among other developed nations is that contributions to the healthcare system aren’t left to the individual to choose if they pay. Some flexibility in how much personal coverage they opt for to varying degrees, maybe…but not if they make a contribution.
There’s a reason for that. When too many members of of a community are sick and unable to receive medical attention, the whole community suffers. So, although a cursory Google on the topic of “how does France/Germany or Switzerland etc fund medical care?” will pitch up mention of “insurance”, you’ll also see mandatory in the general description.
P.S…just imagine if the flexibility to deny coverage allowed insurance companies to refuse, say, Medicare Advantage plans to any Medicare beneficiaries who had any track record of the preventable diseases mentioned as contributing to the high cost of healthcare…and subject all supplemental plans to similar medical underwriting. Or, say, discrimination were allowed in judging whether medications were subsidized depending on previous lifestyle choices…say insulin or statins secondary to metabolic syndrome in the overweight and sedentary. You can bet the (unimaginative) young, healthy and the Good Custodians of their body would be very fond of voting for these restrictions, given a choice
First it has to be affordable to the individual. For the 60% of American workers making less than $40k per year it is not affordable on their own. Some of those folks have insurance through work but many do not.
The system is working excellently for the profiteers and miserably for America.
Caps have been around forever. For years the fine print of health insurance policies indicated your lifetime benefit was $1MM later raised to $1.5MM. That is high enough that I suspect less than 1% of the population reached the limit. Those that did should qualify for catastrophic illness coverage, which most people think govt should provide.
Encouraging people to carry health insurance when well is good policy. A cap on initial benefits is one way to do that. People who have been previously insured, most employees, should have no concern. The cap could he high enough to cover most ordinary situations. But discourage those who wait until they are sick to buy insurance.
Very little about Social Security or Medicare is automatic. You have to sign up for both programs. Those who resist get encouragement from employers or social workers. Eventually they get the message. But no doubt some do slip through the system without signing up.
In fact Medicare has that. You need a certificate of insurability to get coverage under some circumstances. And that can limit your coverage.
Medicare has never known a day without the preexisting clause.
The only reason the clause was a jonny come lately to private insurance policies is because for decades making money means not paying claims.
Why argue over an industry that is fraudulent or buys politicians so is not technically fraudulent. But only in spirit fraudulent.
You’re referring to Medicare part C, or Medicare Advantage which is basically private insurance taking your Medicare money and then charging you more.
Original Medicare — which includes [Part A (hospital insurance)]and [Part B (medical insurance)]— covers preexisting conditions; always has.
Not true if you’re referring to Original Medicare. EOI may be required for some Medicare Part C (private) providers but Medicare has no exception. If you are 65 or more , Medicare has to cover your health care as a provider; no exceptions.
I’m told this comes up if you change Medicare programs outside the normal enrollment periods.
What I know is I received a certificate when I changed Medicare programs. If no certificate, you may not be fully covered for a while.
I’m not 100% if it’s the same with all companies, but our supplemental is with United Healthcare and medical underwriting was required for all applicants over 70 bit not necessarily before. I think that must’ve been regardless of stated existing conditions.
The questions that are asked on the application don’t necessarily cover everything that could go wrong with a person…mainly to assess risk from cardio-metabolic disease, as far as I could tell. We didn’t transition to Medicare as our primary carrier until husband was 72 and me 66. By that time, I’d had a few episodes of Afib and husband his Half-a-Million-Dollar-Man open heart surgery. Although I answered all the specific questions asked to determine premiums quite honestly, our initial quotes were for the lowest, “healthy” category. Final quote had dh’s higher…but for the “wrong” reason (I mentioned his inaccurately documented medical history a while back in the context of Chronic Care Management) It seems that what in Real Life is a condition that could be potentially really expensive to treat…or kill him with short order…if anything goes awry didn’t raise any Red Flags, whereas the few medications he was taking and an inaccurate diagnosis of high BP triggered whatever algorithm says “not quite rude good health”.
Of course, as things have turned out, if I would’ve had my diagnosis of ASCVD and its severity investigated then (just over 2 years ago when I was 68 instead of not much more than 2 months) AND dh’s crazy aortopathy had been given its full life altering/threatening weight, I fancy we both would’ve been declined for supplemental coverage. However, not for Medicare A&B, as you correctly pointed out.
Lets simplify this for me so I am not reading into things.
You are saying the advantage plans do not have preexisting clauses? Or it goes state by state? I am learning something here.
Here’s a link to the story as recounted on the Health Related Finances that was actually before the CCM question cropped up there and here…
This whole performance…and the time spent on the phone with folks who ought to be designing cathedrals etc for a living…made me wonder if “Medicare For All” really means what people think it does. I have no idea how people manage if they don’t understand the system, 'cos it had me stumped.
Q. Do you have medicare part c? If you do, then it is not Original Medicare and there may be many, many restrictions that are not present in Original Medicare. For example, with Medicare you don’t need a primary care physician, nor do you need a referral to see a specialist. If your UHC policy is actually your Medigap supplemental, for co-pays ect… then, You can’t be denied coverage if you apply during your Medigap open enrollment period and you Medigap supplemental can not drop you in the future or rule your coverage out due to any newly acquired or preexisting medical condition. Further Medigap plans K and L limit your annual out-of-pocket costs in 2022 to $6,620 and $3,310, respectively.
I should add, Medigap can no longer be sold with a Drug coverage unless you have an older policy that predates 2006. You may choose Medicare Part D and that price is set no matter how many drugs you take, I believe.
I believe that TucsonBones clarified the point that trad Medicare (A and B) have no requirements as regards existing diseases among potential beneficiaries. The insurance company supplemental might.
Advantage plans are “pretend Medicare” in my book…I never even bothered to check them out as I was more concerned with actual access to medical care than the perceived cost savings that were advertised (I mean…why would they lie?!
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Looks to me as if TucsonBones is stating quite clearly
TB is getting into the supplementals. I am directly interested in the advantage plans pre existing coverage.
It’s insurance so a multitude of different plans/premiums/levels of protection/companies…
However, seeing as it’s impossible to know what you’re likely to get struck down with (starting tomorrow) there’s no real way of truly assessing personal risk/cost exposure, is there? I mean, if you were gifted with that level of foresight, you wouldn’t need insurance as you’d be accurately predicting the Powerball, LOTTO numbers and the winner of the Kentucky Derby!!
Kicker with us is, primarily because dh’s surgery was so scary, we felt a bit too exposed with anything other than a Plan G and rolled with that. As it’s worked out, his pharmaceutical needs work out so that it’s almost a waste of money but for the feeling of more security (right or wrong) whereas I’m REALLY making sparks fly off mine. 
But in the context of topping up traditional Medicare part A and B …insulation from the cost of co payments etc on covered services. It’s not mandatory.
Medicare Advantage plans advertise themselves as covering everything that traditional Medicare does with no discrimination…so that implies coverage of even pre existing conditions that would be covered by traditional Medicare. I haven’t checked the truth of that claim as everything else about the bamboozle was enough to put me off.
You’re the one who stated that Medicare has never known a day without a pre existing clause (or words to that effect) somewhere upstream so I assumed that you were aware of that fact WRT Medicare Advantage with some degree of certainty?
P.S…I fancy that, should some sort of medical underwriting be a prerequisite with a MA plan, it’d be to assess any premiums. A sort of bait-and-switcheroo after someone’s fallen for the initial promised no premiums/low cost bamboozle
I do not…hence the supplemental with UHC. I have no desire to aid and abet the insurance industry to dip its bread in the taxpayer funded gravy boat more than absolutely necessary…or put myself in an even more vulnerable position WRT my medical care.
This is true, even today.
I have a Medicare Part C/Advantage plan. I have had it (with the same insurance company) for a number of years now.
I wanted to get a lab test that was used by doctors for my niece about ten years ago. Then, it was experimental, expensive, and not covered by Medicare or most insurance. Currently, the test has gone mainstream and is approved, and covered, by Medicare. Full retail price for the test is $349 or $350, so not a huge expense by today’s standards. My cost would have been $49 if not covered by Medicare (per the testing company), so I wasn’t worried about the cost.
My Part C plan said it covered all lab tests approved/covered by Medicare. However, the lab test was NOT “in network”. We went back-and-forth for a month or more until the insurance company caved and said they would cover the test, because their policy did NOT specify whether the lab test needed to be “in network” (just “covered by Medicare”. So, it pays to read AND understand the terms of your “new and improved” policies every year…
Fun part? For 2023, their NEW policy (essentially the same as the 2022 policy) DID specify a 40% co-pay for out-of-network lab tests AND no co-pay for in-network lab tests covered by Medicare.
Blood sample drawn last week and submitted. Just got notice the lab had received the sample and will have results later this week. Now to see if they find anything “interesting”…