Basic medicare pays 80% if you want coverage for the other 20% you can purchase supplemental insurance. Or you can get a medicare advantage plan that covers everything for little or no additional cost, its heavily subsidized by medicare -- these plans do have deductibles, but they are no higher, often lower, than the deductibles with ordinary medicare supplemental policies. https://www.kff.org/medicare/fact-sheet/medicare-advantage/ Medicare Payments to Medicare Advantage Plans Medicare pays Medicare Advantage plans a capitated (per enrollee) amount to provide all Part A and B benefits. In addition, Medicare makes a separate payment to plans for providing prescription drug benefits under Medicare Part D, just as it does for stand-alone prescription drug plans (PDPs). Payments to plans are adjusted for enrollees’ health status and other factors. Over the years, the payment methodology has been modified to achieve different policy goals, for example, to attract plans in rural areas, achieve Medicare savings, or deliver extra benefits to plan enrollees. The Balanced Budget Act (BBA) of 1997 established a payment floor, applicable almost exclusively to rural counties. The Benefits Improvement and Protection Act (BIPA) of 2000 created payment floors for urban areas and increased the floor for rural areas. The Medicare Prescription Drug Improvement and Modernization Act (MMA) of 2003 increased payments across all areas, and the Affordable Care Act (ACA) of 2010 reduced payments to plans. Today, Medicare pays plans based on a bidding process. Plans submit “bids” based on estimated costs per enrollee for services covered under Medicare Parts A and B; all bids that meet the necessary requirements are accepted. The bids are compared to benchmark amounts that are set by a formula established in statute and vary by county (or region in the case of regional PPOs). The benchmarks range from 95% of traditional Medicare costs in the top quartile of counties with relatively high per capita Medicare costs, to 115% of traditional Medicare costs in the bottom quartile of counties with relatively low Medicare costs. If a plan’s bid is higher than the benchmark, enrollees pay the difference between the benchmark and the bid in the form of a monthly premium, in addition to the Medicare Part B premium. If the bid is lower than the benchmark, the plan and Medicare split the difference between the bid and the benchmark; the plan’s share is known as a “rebate,” which is designed to be used to provide supplemental benefits to enrollees. Payments to plans are then adjusted based on enrollees’ risk profiles. The ACA also established a new system of bonuses to compensate plans with high quality ratings. Since 2012, Medicare Advantage plans with 4 or more stars and new plans without ratings have been receiving bonus payments based on quality ratings. In 2019, 72 percent of Medicare Advantage enrollees are in plans with 4 or more stars. The ACA also reduced rebates for all plans, but allowed plans with higher quality ratings to keep a larger share of the rebate than plans with lower quality ratings. In 2019, Medicare payments to Medicare Advantage plans (including bonus payments) are roughly equal to the per capita costs in traditional Medicare, 100 percent, on average, according to the Medicare Payment Advisory Commission. The Secretary of Health and Human Services applies a downward adjustment to payments each year (5.9% in 2019) to help account for differences in the intensity of coding for health conditions by Medicare Advantage plans relative to traditional Medicare. Evidence indicates that beneficiaries who choose to enroll in Medicare Advantage plans have lower spending and use fewer services – before they enroll in Medicare Advantage plans – than similar beneficiaries who remain in traditional Medicare. This suggests that basing payments to plans on spending of those in traditional Medicare may systematically overestimate the expected costs of Medicare Advantage enrollees. Medicare Advantage Premiums The average premium for enrollees of Medicare Advantage plans are $29 per month in 2019, slightly lower than premiums in the past five years. Average premiums are lower for HMOs than for regional and local PPOs and significantly vary across counties. However, we do not know to what extent enrollees’ out-of-pocket expenses have changed since 2010 because we do not know to what extent cost-sharing for individual services has changed (Figure 6). Figure 6: Premiums paid by Medicare Advantage enrollees have slowly declined since 2015 Supplemental Benefits Medicare Advantage plans are paid to provide all Medicare benefits. In addition, since 2011, all plans have been required to limit beneficiaries’ out-of-pocket spending for services covered under Medicare Parts A and B to no more than $6,700 (in-network) or $10,000 (in-network and out-of-network combined). Limits have been required for regional PPOs since they were first authorized in 2006. Medicare Advantage enrollees’ average out-of-pocket limit for in-network services is $5,059 (HMOs and PPOs) and $8,818 for out-of-network services (PPOs). (Figure 7). Figure 7: Medicare Advantage enrollees’ out-of-pocket costs for in-network services are capped at $5,059 on average, in 2019 In addition, plans that receive rebates are required to use a portion of these payments to provide additional benefits, reduce premiums, or lower cost sharing for covered benefits. In 2019, most Medicare Advantage enrollees have access to benefits not covered by traditional Medicare, and almost eight in ten have access to a dental, fitness, or vision benefit (Figure 8). Figure 8: Most Medicare Advantage enrollees have access to some benefits not covered by traditional Medicare in 2019 Prescription Drug Benefits Medicare Advantage plans are generally required to offer at least one plan that covers the Part D drug benefit. In 2019, 90% of Medicare Advantage plans offer prescription drug coverage, while most Medicare Advantage enrollees (88%) select this benefit. In 2019, the average Part D deductible was $121 for Medicare Advantage plans that offer prescription drug coverage. The standard Medicare Part D benefit in 2020 will have a $435 deductible (up from $415 in 2019) and 25% coinsurance up to an initial coverage limit of $4,020 (up from $3,820 in 2019) in total drug costs, followed by a coverage gap (enrollees pay 25% of the total costs of brand-name drugs and 37% of the total costs of generics) until their total out-of-pocket Part D spending reaches $6,350 (up from $5,100 in 2019) when the catastrophic limit kicks in and beneficiaries pay 5% of the cost of drugs. The threshold at which an enrollee reaches the catastrophic threshold increased so significantly from 2019 to 2020 due to the expiration of the ACA provision that slowed the growth rate of this threshold between 2014 and 2019. Medicare Advantage Provider Networks Medicare Advantage plans are required to include a specified number of physicians for each of 26 medical specialties, plus chiropractic care, along with hospitals, and other providers within a particular driving time and distance of enrollees in order to ensure that Medicare Advantage enrollees have access to the physicians that they may need. Medicare Advantage plan networks have been found to include 51% of all hospitals in their county and 46% of the physicians in their county, on average. In 2015, more than one-third of Medicare Advantage enrollees (35%) were in plans with narrow physician networks. Future Issues Historically, Congress has enacted a number of changes that affect the role of private plans under Medicare, including adding new types of plans to the program, increasing or decreasing Medicare payments to plans, and expanding the types of extra benefits and services that plans can offer, beyond those included in traditional Medicare. In 2019, Medicare Advantage markets will have more companies offering plans and more plans available to beneficiaries compared to 2018. With new flexibility in plan offerings, utilization management techniques (such as Part B drug step therapy), and benefits, companies offering Medicare Advantage plans may respond to payment changes in several different ways, depending on the circumstances of the company, the location of their plans, their historical commitment to the Medicare market, and their quality ratings and bonus payments. Decisions made by these firms could have important implications for beneficiaries with respect to their choice of plans, out-of-pocket costs, and access to providers. Achieving a reasonable balance among multiple goals for the Medicare program—including keeping Medicare fiscally strong, setting adequate payments to private plans, and meeting beneficiaries’ health care needs—will continue to be a critical issue for policymakers in the future. Medicare Payments to Medicare Advantage Plans Medicare pays Medicare Advantage plans a capitated (per enrollee) amount to provide all Part A and B benefits. In addition, Medicare makes a separate payment to plans for providing prescription drug benefits under Medicare Part D, just as it does for stand-alone prescription drug plans (PDPs). Payments to plans are adjusted for enrollees’ health status and other factors. Over the years, the payment methodology has been modified to achieve different policy goals, for example, to attract plans in rural areas, achieve Medicare savings, or deliver extra benefits to plan enrollees. The Balanced Budget Act (BBA) of 1997 established a payment floor, applicable almost exclusively to rural counties. The Benefits Improvement and Protection Act (BIPA) of 2000 created payment floors for urban areas and increased the floor for rural areas. The Medicare Prescription Drug Improvement and Modernization Act (MMA) of 2003 increased payments across all areas, and the Affordable Care Act (ACA) of 2010 reduced payments to plans. Today, Medicare pays plans based on a bidding process. Plans submit “bids” based on estimated costs per enrollee for services covered under Medicare Parts A and B; all bids that meet the necessary requirements are accepted. The bids are compared to benchmark amounts that are set by a formula established in statute and vary by county (or region in the case of regional PPOs). The benchmarks range from 95% of traditional Medicare costs in the top quartile of counties with relatively high per capita Medicare costs, to 115% of traditional Medicare costs in the bottom quartile of counties with relatively low Medicare costs. If a plan’s bid is higher than the benchmark, enrollees pay the difference between the benchmark and the bid in the form of a monthly premium, in addition to the Medicare Part B premium. If the bid is lower than the benchmark, the plan and Medicare split the difference between the bid and the benchmark; the plan’s share is known as a “rebate,” which is designed to be used to provide supplemental benefits to enrollees. Payments to plans are then adjusted based on enrollees’ risk profiles. The ACA also established a new system of bonuses to compensate plans with high quality ratings. Since 2012, Medicare Advantage plans with 4 or more stars and new plans without ratings have been receiving bonus payments based on quality ratings. In 2019, 72 percent of Medicare Advantage enrollees are in plans with 4 or more stars. The ACA also reduced rebates for all plans, but allowed plans with higher quality ratings to keep a larger share of the rebate than plans with lower quality ratings. In 2019, Medicare payments to Medicare Advantage plans (including bonus payments) are roughly equal to the per capita costs in traditional Medicare, 100 percent, on average, according to the Medicare Payment Advisory Commission. The Secretary of Health and Human Services applies a downward adjustment to payments each year (5.9% in 2019) to help account for differences in the intensity of coding for health conditions by Medicare Advantage plans relative to traditional Medicare. Evidence indicates that beneficiaries who choose to enroll in Medicare Advantage plans have lower spending and use fewer services – before they enroll in Medicare Advantage plans – than similar beneficiaries who remain in traditional Medicare. This suggests that basing payments to plans on spending of those in traditional Medicare may systematically overestimate the expected costs of Medicare Advantage enrollees. Medicare Advantage Premiums The average premium for enrollees of Medicare Advantage plans are $29 per month in 2019, slightly lower than premiums in the past five years. Average premiums are lower for HMOs than for regional and local PPOs and significantly vary across counties. However, we do not know to what extent enrollees’ out-of-pocket expenses have changed since 2010 because we do not know to what extent cost-sharing for individual services has changed (Figure 6). Figure 6: Premiums paid by Medicare Advantage enrollees have slowly declined since 2015 Supplemental Benefits Medicare Advantage plans are paid to provide all Medicare benefits. In addition, since 2011, all plans have been required to limit beneficiaries’ out-of-pocket spending for services covered under Medicare Parts A and B to no more than $6,700 (in-network) or $10,000 (in-network and out-of-network combined). Limits have been required for regional PPOs since they were first authorized in 2006. Medicare Advantage enrollees’ average out-of-pocket limit for in-network services is $5,059 (HMOs and PPOs) and $8,818 for out-of-network services (PPOs). (Figure 7). Figure 7: Medicare Advantage enrollees’ out-of-pocket costs for in-network services are capped at $5,059 on average, in 2019 In addition, plans that receive rebates are required to use a portion of these payments to provide additional benefits, reduce premiums, or lower cost sharing for covered benefits. In 2019, most Medicare Advantage enrollees have access to benefits not covered by traditional Medicare, and almost eight in ten have access to a dental, fitness, or vision benefit (Figure 8). Figure 8: Most Medicare Advantage enrollees have access to some benefits not covered by traditional Medicare in 2019 Prescription Drug Benefits Medicare Advantage plans are generally required to offer at least one plan that covers the Part D drug benefit. In 2019, 90% of Medicare Advantage plans offer prescription drug coverage, while most Medicare Advantage enrollees (88%) select this benefit. In 2019, the average Part D deductible was $121 for Medicare Advantage plans that offer prescription drug coverage. The standard Medicare Part D benefit in 2020 will have a $435 deductible (up from $415 in 2019) and 25% coinsurance up to an initial coverage limit of $4,020 (up from $3,820 in 2019) in total drug costs, followed by a coverage gap (enrollees pay 25% of the total costs of brand-name drugs and 37% of the total costs of generics) until their total out-of-pocket Part D spending reaches $6,350 (up from $5,100 in 2019) when the catastrophic limit kicks in and beneficiaries pay 5% of the cost of drugs. The threshold at which an enrollee reaches the catastrophic threshold increased so significantly from 2019 to 2020 due to the expiration of the ACA provision that slowed the growth rate of this threshold between 2014 and 2019. Medicare Advantage Provider Networks Medicare Advantage plans are required to include a specified number of physicians for each of 26 medical specialties, plus chiropractic care, along with hospitals, and other providers within a particular driving time and distance of enrollees in order to ensure that Medicare Advantage enrollees have access to the physicians that they may need. Medicare Advantage plan networks have been found to include 51% of all hospitals in their county and 46% of the physicians in their county, on average. In 2015, more than one-third of Medicare Advantage enrollees (35%) were in plans with narrow physician networks. Future Issues Historically, Congress has enacted a number of changes that affect the role of private plans under Medicare, including adding new types of plans to the program, increasing or decreasing Medicare payments to plans, and expanding the types of extra benefits and services that plans can offer, beyond those included in traditional Medicare. In 2019, Medicare Advantage markets will have more companies offering plans and more plans available to beneficiaries compared to 2018. With new flexibility in plan offerings, utilization management techniques (such as Part B drug step therapy), and benefits, companies offering Medicare Advantage plans may respond to payment changes in several different ways, depending on the circumstances of the company, the location of their plans, their historical commitment to the Medicare market, and their quality ratings and bonus payments. Decisions made by these firms could have important implications for beneficiaries with respect to their choice of plans, out-of-pocket costs, and access to providers. Achieving a reasonable balance among multiple goals for the Medicare program—including keeping Medicare fiscally strong, setting adequate payments to private plans, and meeting beneficiaries’ health care needs—will continue to be a critical issue for policymakers in the future.
https://www.wheel.com/blog/alternative-career-ideas-for-burned-out-physicians/ Just say no to being a dope.
Unless the U.S. is a totally incompetent nation. we know that the public option, i.e., Medicare, can work and potentially cut our cost in half, plus delivery better health outcomes. It all ready does so in all industrialized countries of the world except in the U.S. That's our proof that it is possible. Now all we have to do is get busy and do it. Medicare for all does not mean necessarily that insurance companies would be cut out all together. Cutting them out completely would achieve the maxium in cost savings. Regardless You have to phase something like this in and make provisions to prevent catastrophic upheaval in the insurance industry. But it can be done.
Here is a suggestion for you. Go to the 81 percent that do take medicare payment. Now, 81 percent of family doctors will take on seniors on Medicare, a survey by the American Academy of Family Physicians found. That figure was 83 percent in 2010. Some 2.9 percent of family doctors have dropped out of Medicare altogether. In 2010, 2.8 percent reported taking this dramatic step. More doctors are practicing on a “concierge” or cash basis. Four percent of family practitioners now work on that model. That’s higher than the 3 percent in 2010.
You conveniently ignore the reality that the entire remainder of the industrialized world has largely solved these problems, certainly to a much greater extent than the U.S. has.