Wednesday, March 27, 2013

Medicare digs deeper

In a comment to my post explaining how co-insurance works, Mike offered up a very helpful correction:

"... this is EXACTLY the way coinsurance works for Medicare Part B.Anyone with Part B is on the hook for 20% of their Part B expenses no matter how large those expenses might be."

Quite so, and it gets worse:

"Medicare Has Stopped Paying Bills For Medical Diagnostic Tests ... The Medicare agency decided to change the way it reimburses these sorts of diagnostic tests. But it’s been slow to decide on its new approach. So in the absence of a policy, the Medicare program is simply not paying its bills."

Briefly, some of the major labs were "gaming the system" (this was apparently legal, but far from either optimal or ethical). Instead of actually addressing that problem, though, Ms Shecantbeserious has decided to just stop paying the bills. This has had a sort of 'domino effect' because MedSupp plans basically just follow Medicare's lead. So Medicare supplement policies, which augment Medicare itself, are beginning to do likewise
[ed: as Bob points out in the comments, Medigap plans ONLY pay if Medicare approves the claim].

One can see how this portends for the upcoming Exchange-based policies - when the government designs the plans (as they do with Medicare), the carriers will simply follow suit. So if The Fair Kathleen calls "foul" on some provider or another, those new ObamaTax policies will certainly do the same, leaving patients with even more out-of-pocket.

Oh frabjous day.
blog comments powered by Disqus