Kaiser Advantage or ???

[Bill N]

The part I really like is that the hospitals bill in the thousands, and Kaiser only pays them in the 100's. If they bill $10,000 for a procedure or on call doctor, Kaiser will only pay what medicare allows - then the hospital just writes off the rest. The notifications to me mentioning the difference ends with a statement like, "You are not responsible for payment of this difference."

Reminds me of an interesting story in the local rag a few weeks ago.  People were asking how the two very large hospitals in our area could possibly be 'non-profit' when they charged those humongous amounts.  The answer is simple:  They charge the large amounts, Medicare or private insurance pays much lower amounts and the remainder is 'written off' but it is shown as a loss and therefore just about every transaction is a loss and the institution is a 'non-profit'.  Of course there are hundreds of other legal requirements but that is the heart of how non-profit is determined.

As of me, after reading all the posts on this thread I thank my lucky stars I have Medicare and Tricare For Life (TFL). a Medicare supplement,  from my military retirement.  Most of my drugs are either free, or $13 for 90 day supplies.  I doubt that my wife or I have paid more than $100 for medical services (not including Medicare premiums) over the past  5 years.  We have both had cataract surgeries and the wife has had four surgeries for various things over the years with no charges.  My son recently had a policy requiring an $8000 deductible before it paid anything and he had a huge hernia that we thought could be life threatening.  We gave him the deductible and he got the hernia (turned out to be 5 hernias) repaired.  If you don't your health you have nothing.

 

[Tom]

[quote author=Bill N]They charge the large amounts, Medicare or private insurance pays much lower amounts and the remainder is 'written off' but it is shown as a loss and therefore just about every transaction is a loss and the institution is a 'non-profit'.[/quote]

I wonder if the providers who are not claiming non-profit status are able to deduct the writeoff  ???

I'd been paying cash for my chiropractor visits and, when I turned 65, I asked if he accepted/billed Medicare, which he did. A few months later I was in his office with my (first) Medicare statement asking if I owed him money. The statement showed a list of charges, most of which were denied. He explained that, for the same procedure, Medicare will sometimes pay for one 'code', and sometimes for another. So, he figured that he has to bill for multiple codes (8 or so), knowing that Medicare will pay one of them, although he doesn't know in advance which one they'll pay for.

Bottom line, I didn't owe him any money and, for every visit I make, he gets paid almost what I used to pay him when I paid cash.

 

[Bob Buchanan]

As for Obamacare.. It is still a Baby and it is too soon to be posting an opinion on it that is anything other than political.. As I said the article was about the Kiaser paln the member choose. Which was clearly not the best plan for him. 

Again though, I hope the author didn't blame Kaiser for the fellow signing up for the wrong policy. A lot of dissatisfaction toward OBC is just the opposite - in that folks with watered down plans "are" happy with them - but are forced to buy what OBC feels is better for them. And I can understand that from my own case.

Before quitting my job with the government and starting my own business ("years" ago), I called Aetna (my plan with the government) to see what my alternatives were. They told me that because I had selected them, when I left the government I could keep the same coverage at the same price. Unfortunately, I didn't get that in writing. Within 6 months my premiums quadrupled - and priced me completely out of that market.

I then found a policy with State Farm for the small business that was expensive, but cheaper than Aetna. Within a year, that doubled in pricing. After another year I could only afford a high deductible hospital stay necessary only policy. I had to pay for everything else. So I can understand why some folks don't especially want what OBC mandates they should have.

 

[Just Lou]

This subject can sometimes elicit more accidental misinformation (or confusion) than discussions on RMP-3, battery charging or Walmart parking.

First, let me say that while I'm no fan of "Obamacare", but having also retired from IBM, that Obamacare had nothing to do with recent changes to IBM retirees insurance options.  The rising cost of healthcare, and healthcare insurance, dictated those changes.

BTW - Those changes have greatly improved my healthcare coverage.  As a retiree on medicare, the best plan previously offered to me, here in NC, was a Medicare Advantage plan with Drug coverage, through BCBS.  My co-pays, ER/Hosp charges and OOP costs were increasing yearly since retirement.  Under the new plan, IBM did step out of the picture as far as selecting coverage plans on my behalf, but they do make a yearly contribution of $3k+ that I can use to cover medical insurance and/or medical expenses as I see fit. 

Bottom line, I was able to replace the Advantage plan with a Medigap Plan (Medicare Supplement Plan F), Part D (drug coverage via Humana) and a vision Plan, at NO cost to me.

My recent pace maker implementation had a combined Hospital and Doctor(s) bill of over $49k.  I paid $0.

My even more recent hospital stay of five days, to locate and repair a rather large bleeding stomach ulcer, should result in the same $0 outlay.

I suspect expect that in future years I will have to add my own dollars to the kitty or opt for less complete coverage.

Now, to my reason for replying here. (I hope these few words take some of the mystery out of plan selection) 

• The only real requirement of a Medicare Advantage Plan is that they provide the equivalent of your Medicare Part A and Part B coverage.  Most plans offer drug coverage and additional benefits to garner your business.  As previously mentioned, these plans have varying costs, OOP limits, and restrictions on specific doctor, hospital and geographical usage.
• It's actually easier to compare Medicare Supplement plans than it is the Advantage plans, because they are standardized.  That's not to say all supplemental plans are alike, or cost the same, BUT it is a Medicare dictated requirement, that company As plan (A,B,C,,,N) coverage is exactly the same as company Bs plan (A,B,C,,,N), making comparisons easier.
• Costs, of course, can vary all over the map. 

 

[Bamaman]

Gary B:  You've picked a pretty complicated subject.  This is one where you'll get answers all over the gambit.

My family had Kaiser HMO for years in Atlanta.  Their service was good for sniffles and minor issues.  It's almost like they were after good customer ratings--telling you what you wanted to hear.  But when you get down to the serious ailments, we were simply in trouble--and didn't realize how bad we were being served.

My wife had problems for years and years, and let me just say she remained chronically anemic.  She suffered through most of those Kaiser years.  It wasn't until we transferred to another state and went on BCBS PPO program that her "problem" was handled in one quick day surgery visit.

In retrospect, Kaiser's specialty doctors in our part of Atlanta were not really top notch.  We question how they were being evaluated by Kaiser.  By $ outlay per patient? 

My wife is a Medical Technologist experienced in running large hospital laboratories.  She is medically proficient in dealing with doctors and medical plans.  And she says that staying with Kaiser HMO for all those years was the worst decision we've ever made.  Their indecision in treatment plans cost her to lose her lifestyle, and it wasn't until she took charge of her healthcare through another type of program did she make headway in solving problems Kaiser chose to ignore.

While I'm not eligible for Medicare, I'll be on a PPO type Medicare Advantage program arranged through my employer next year.  My wife has been with United Healthcare Medicare Advantage plan for a # of years, and it's served her well.  I do know that she often talks about what Kaiser didn't do for her, and that using their doctors in large city Kaiser facilities is not the way to go.

 

[Bob Buchanan]

This subject can sometimes elicit more accidental misinformation (or confusion) than discussions on RMP-3, battery charging or Walmart parking.

First, let me say that while I'm no fan of "Obamacare", but having also retired from IBM, that Obamacare had nothing to do with recent changes to IBM retirees insurance options.  The rising cost of healthcare, and healthcare insurance, dictated those changes.

But as I wrote, Lou -- IBM and other larger company's found the excuse to do what they did and get out from under the financial burden of healthcare to retirees, because of OBC. They could then dump everyone into the exchanges. Some faired well and some didn't as a result.

Any other "accidental misinformation" you care to point out? 

 

[garyb1st]

Bamaman, it's unfortunate your experience with Kaiser was not good.  Our experience has been just the opposite.  My wife has had three surgeries at Kaiser.  The most recent was shoulder surgery.  That was followed by surgery to remove the metal plate and screws.  I am relatively healthy and have never been hospitalized.  Consequently my experience with Kaiser is limited to mundane physicals, blood work and the various exams seniors are subjected to. 

My reason for posting had nothing to do with Kaiser's quality of care.  Like Lou, my old company changed the way they administer the Retiree Health Coverage.  Previously my annual expense was limited to co-pays for dr. visits and some exams.  It had no deductibles.  I doubt our annual out of pocket exceeded $500.  And that primarily because of my wife's surgeries.  Under the new program, I will have more financial risk and wanted to find out what other coverages were available.  My Retiree Coverage will reimburse me up to a fixed amount each year.  Any amount not used carries over to the next year.  If I can maintain my health for a few years I will likely have enough in the "bank" to offset most co-pays and deductibles. 

Gary

 

[garyb1st]

But as I wrote, Lou -- IBM and other larger company's found the excuse to do what they did and get out from under the financial burden of healthcare to retirees, because of OBC. They could then dump everyone into the exchanges. Some faired well and some didn't as a result.

I don't think OBC is the reason Northrop Grumman changed the way they approach their Retiree Health Care program.  Northrop discontinued offering Retiree Health Care to new hires long before OBC was on the scene.  It was around the same time they discontinued offering pension plans with defined benefits.  That was around 2002 as I recall.  They moved to the new cash balance plans which was one of the reasons I took early retirement.  The other thing they did a few years ago was to fix the annual credit each retiree received for health insurance.  As health care costs continue to increase and eventually exceeds the annual credit, the retiree becomes responsible for all excess premium.  So OBC may be taking the hit for all the bad news, but IMHO, it's just good old Corporate America's desire to hang onto all the green. 

 

[Bob.n.Carolyn]

When we decided to change to an Advantage plan, we considered Kaiser.  This was mostly because (a) Friends and family around So Cal love it, and (b) Consumer Report magazine, in it's insurance company/plan comparison survey from about 6 months ago, rated Kaiser #1 in most areas where it's offered.  I would encourage you to read this article:

http://www.consumerreports.org/health/insurance/NCQA-rankings.htm?state=CA&planCategory=medicareHMO

 

[Just Lou]

But as I wrote, Lou -- IBM and other larger company's found the excuse to do what they did and get out from under the financial burden of healthcare to retirees, because of OBC. They could then dump everyone into the exchanges. Some faired well and some didn't as a result.

Any other "accidental misinformation" you care to point out? 

In the interest of preventing further "misinformation", IBM did NOT "get out from under the financial burden of health care to retirees".  IBM has given me a report every year, for the past 22 years of my retirement, stating exactly how much they have contributed to my healthcare.  It has always been a fixed amount per retiree.  They have maintained, actually increased, that amount under the current plan of establishing the aforementioned $3k+ yearly health fund on my behalf.

Any other "accidental misinformation" you care to dispute?  ???

 

[Bob Buchanan]

In the interest of preventing further "misinformation", IBM did NOT "get out from under the financial burden of health care to retirees".  IBM has given me a report every year, for the past 22 years of my retirement, stating exactly how much they have contributed to my healthcare.  It has always been a fixed amount per retiree.  They have maintained, actually increased, that amount under the current plan of establishing the aforementioned $3k+ yearly health fund on my behalf.

Any other "accidental misinformation" you care to dispute?  ???

That's great, Lou - but has nothing to do with your comment that I responded to -- that IBM's decision had nothing to do with OBC.

I also respond when you state up front that in your supreme wisdom you are going to correct the misinformation you find in this or any thread vs. just simply stating that you disagree with another point of view and stating your own POV.

 

[Just Lou]

That's great, Lou - but has nothing to do with your comment that I responded to -- that IBM's decision had nothing to do with OBC.

I also respond when you state up front that in your supreme wisdom you are going to correct the misinformation you find in this or any thread vs. just simply stating that you disagree with another point of view and stating your own POV.

Bob, my initial intent was only an attempt to remove the confusion (and some misinformation) that often permeates these topics on Medicare Advantage and Medicare Supplemental plans, (i.e. that one companies Medicare Supplement is/was better than another, ...they are the same, by law), however, you gave me an opening by providing some "misinformation" of your own.

IBM did NOT dump anyone into the exchanges to purchase "Obamacare".  For your further information, I do NOT possess any "Supreme Wisdom", but I do have a certain level of first hand knowledge and experience on the subject being discussed.  IBM has, like many other companies, made yearly changes to the retiree healthcare offerings in a continuing effort to provide cost effective and flexible options, but not as a direct result of 'Obamacare".

IBM did (this last year) establish the aforementioned assistance account for retirees on Medicare, and contracted with One Exchange? to administer the account and to assist with purchasing supplemental coverage if desired by the retiree.  Nothing to do with "Obamacare".

It may come as a surprise to you, but us folks on Medicare can't even go onto the AHC site and buy "Obamacare".  We get informed that we don't need anymore insurance, because we already have coverage under Medicare.

Now, if you still feel that my replies "had nothing to do with your response", I'm not sure how I could make it any more clear.  I can't foresee the future, but I can say that IBM's recent changes in healthcare assistance to retirees on Medicare had ABSOLUTELY nothing to do with "Obamacare".  The two are mutually exclusive.

PS - I do appreciate your feeling of obligation to respond to my posting style as well as the content.  Keep up the good work.

 

[Dragginourbedaround]

This is in regard to Kaiser in the DC metro area. My mother retired from the government about a hundred years ago. When my dad passed away she moved down from Boston and moved in with me she switched to Kaiser and loved them. Me not so much. I like the fact the you have great access to your primary care physician and your records are online. But when she was 78 she broke her hip and Kaiser told her repeatedly it was a sore muscle from bowling. Eight weeks later they diagnosed a stress fracture of the hip. I tried to get her to leave Kaiser, but she really liked her primary care Dr. When she had cardiac problems her PC would not send her to a specialist. Last year at 89 she fell and broke her back. Again they misdiagnosed it. Twelve weeks and many copay's for tests later they admitted they missed it. You pay for their errors (although I don't think that is just Kaiser's problem). She is now in the process of switching plans.

 

[garyb1st]

But when she was 78 she broke her hip and Kaiser told her repeatedly it was a sore muscle from bowling. Eight weeks later they diagnosed a stress fracture of the hip. I tried to get her to leave Kaiser, but she really liked her primary care Dr. When she had cardiac problems her PC would not send her to a specialist. Last year at 89 she fell and broke her back. Again they misdiagnosed it. Twelve weeks and many copay's for tests later they admitted they missed it. You pay for their errors (although I don't think that is just Kaiser's problem). She is now in the process of switching plans.

Kaiser allows you to choose your doctor.  Not sure that's as easy as it sounds because quite honestly, unless you have a referral, it's just a guessing game.  But then, isn't that true with all plans.  When my daughter had breast cancer last year, she wasn't happy with the surgeon.  She asked Kaiser for another doctor and found one that she felt very comfortable with.  At Kaiser, you really do have a lot of options.  But they're your options.  After she completed chemo, they wanted her to do radiation therapy.  She thought about it, consulted several docs and finally decided to forgo that treatment.  That's always a difficult choice.  But today, 18 months later, she is cancer free. 

No one is going to email you and suggest you might try a different primary care doc.  But then that's true where ever you go.  It may not be the same in smaller communities, but here is L.A., there are more Kaiser hospitals than I can think of.  So far as I know, I have the option of going to the facility of my choice.  My daughter in in the Northern California and while not as large many options, it certainly is more than one.  Unfortunately, some folks get comfortable with the status quo and are quite forgiving when they should go else where.  It took your mother a long time.  But that was your mothers choice. 

Personally, I think we are all responsible for our own health.  I never take a pill without first researching that pill.  Actually, I rarely take a pill even when prescribed.  For me, too many variables.  I'll take my chances and just see if things get better on their own.  Fortunately they have.  I also don't believe in vaccinations.  Every year Kaiser sends me at least a dozen reminders to get a flu shot.  I haven't had a shot in more than 50 years.  Fifteen years ago, a doctor prescribed a med for cholesterol.  He thought my numbers were too high.  I never took it.  My current doctor says my cholesterol is excellent.  Same numbers.  Two points of view.  The difference is my good cholesterol is more than twice as high as the average.  That brings up the whole number.  So go figure.  Personally I believe that for every benefit a pill or shot may have there are countless risks that are not completely understood.  When I here of someone who takes multiple pills daily, I just shake my head.  The pharmacist would need a main frame computer to determine all the drug interactions.  No thank you.  Not for me. 

Sorry for the rant.  I now return you to your regular programming....thread.
           

 

[Tom]

I have no personal experience with Kaiser, but have had co-workers who did and always seemed to complain. Some of the Kaiser stories we read are scary. OTOH we have friends who swear by Kaiser.

Just an alternate data point - while we looked after an elderly person for the last 7 years, she had 3 surgeries, several long stays in a rehab facility, and numerous doctor visits, in addition to taking a large number of pills daily. She paid $0 out of pocket for copays or deductibles. Her medical coverage was Medicare, supplemental, and prescription, and her monthly premiums were no more than Kaiser. She was able to (and did) change providers whenever she wanted, with no penalties or hassle.

I just don't see the "Kaiser advantage" that's promoted so ardently.

 

[Just Lou]

[quote author=Tom]

Just an alternate data point - while we looked after an elderly neighbor for the last 7 years, she had 3 surgeries, several long stays in a rehab facility, and numerous doctor visits, in addition to taking a large number of pills daily. She paid $0 out of pocket for copays or deductibles. Her medical coverage was Medicare, supplemental, and prescription, and her monthly premiums were no more than Kaiser. She was able to (and did) change providers whenever she wanted, with no penalties or hassle.

I just don't see the "Kaiser advantage" that's promoted so ardently.
[/quote]Tom, that's another benefit of a Supplement over the average Advantage plan, There are no 'doctor or hospital network restrictions' to be concerned with.  You can use any doctor who accepts Medicare, and you will both generally benefit..

 

[HappyWanderer]

Tom, that's another benefit of a Supplement over the average Advantage plan, There are no 'doctor or hospital network restrictions' to be concerned with.  You can use any doctor who accepts Medicare, and you will both generally benefit..

With the ongoing reductions in Medicare reimbursements, there are fewer doctors accepting new Medicare patients. Another piece of the puzzle to consider.

 

[Tom]

[quote author=Just Lou]Tom, that's another benefit of a Supplement over the average Advantage plan ...[/quote]

That's why I have Medicare + supplemental.

 

[Just Lou]

With the ongoing reductions in Medicare reimbursements, there are fewer doctors accepting new Medicare patients. Another piece of the puzzle to consider.

Actually, there has never been a reduction in Medicare reimbursements.  Every year since the law was passed, dictating a reduction in Payments, Congress has voted to implement a temporary "Doc Fix" preventing it from taking effect.  That will cease to be an option soon.

I agree with you, however, that fewer doctors are accepting Medicare (and fewer still, accepting Medicaid) and that's only going to get worse under full OBC implementation.