Talk:Medicare (United States)

Dennisbyron (talk) 17:54, 26 February 2012 (UTC)== Possible changes for factual accuracy ==

(in order of presentation not importance)

1. You say "Congress later established Part C (Medicare Advantage)..."

Possibly confusing; it was not originally called Medicare Advantage. It was called Medicare Choice.

2. The article unnecessarily introduces the private/public dichotomy. This distinction is misleading and is pretty irrelevant to understanding Medicare.

All parts of Medicare are both private and public. They (A, B, C and D) are all public in that -- as the article says early in the Introduction -- the U.S. government is the single payer and it highly regulates benefits and prices and other aspects. On the other hand, they (A, B, C and D) all are administered by private insurance companies.

The best analogy is that all parts of Medicare work pretty much the way all self-insured employer-sponsored-insurance (ESI) works in the United States: the company pays but hires an insurance company to adminster its policies and resulting claims, etc. It also works like many of these self insured ESI programs in the sense that the company (or in this case the U.S. government) offers a kind of flagship policy (typically a very all encompassing Major Medical plan with low co-pays, etc.) and a bunch of typically less expensive alternatives (often localized), which are often HMOs or PPOs and/or often have a Health Savings Account tied to them. In Medicare's case, Parts A and B are like the Major Medical (conceptually but the Medicare insurance itself is terrible and needs to be supplemented before the analogy works) and Parts C and D are like the less expensive choices.

The more expensive/less expensive analogy holds up if you understand that over 70% of people that do not choose Part C, choose to supplement A & B with some type of private insurance and almost all the rest on Traditional Medicare get extensive government assistance such as Medicaid.

Footnote 3 shows an out of date Kaiser pie chart that explains this.

3. You say "A majority of Medicare enrollees have traditional Medicare (76 percent)...

But -- as described above -- almost all of these supplement "traditional Medicare" in some way. This is a key point in understanding how Medicare works.

4. You say "...and the rest have a Medicare Advantage plan (24 percent)."

These percentages are changing all the time. For 2012, I believe the numbers are 73/27 but the CBO estimates Medicare Advantage enrollment will drop to under 15% by 2019. You probably should just say about 80/20 to be safe

5. You say "Medicare covers about half (48 percent) of health care costs for enrollees. Medicare enrollees must cover the rest of the cost. These out-of-pocket costs vary depending on the amount of health care a Medicare enrollee needs. They might include uncovered services—such as long-term, dental, hearing, and vision care—and supplemental insurance."

This paragraph is a really apples and oranges job because as you accurately explain elsewhere Medicare has nothing to do with insuring long term care and even to the extent Part C plans provide some dental, vision and hearing coverage, it is minimal. You could change the word enrollees to "seniors" but you're still way down in weeds that no one is going to understand

Febraury 26, 2012 — Preceding unsigned comment added by Dennisbyron (talk • contribs) 17:53, 26 February 2012 (UTC)

Political arguments about the National Debt and Medicare

Maybe I have missed something fundamental in my thinking... but maybe I am not the only one .. so here goes with my question. Has nobody in the U.S. ever questioned the crazy logic of complaining about the various Trust Funds and then fretting about the deficits?

When I hear people in the U.S. complain about the government and health care, the argument seems to run like this....

"We can't have more government programs... the government is already up to its neck in debt...we would be laying down a problem for our children, our grandchildren and their grandchildren".... I am sure you have heard these arguments...

...and it seems logical to Americans until you realize this...

..... that about a third of all that government debt is due to the peculiar way Congress enacted Medicare and Social Security legislation. This requires the creation of IOUs in the form of bonds issued to the Medicare (and Social Security) trust funds when it takes those dollars from peoples' wages and salaries. I say "peculiar" because no equivalent of Medicare in other country I know of acts like this. In those other countries, the current generation of tax payers pays out the health care needs of the current generation of health care beneficiaries, just as the insurance industry takes money from the current generation of well policyholders in their pools to pay for the needs of the sick policyholders in those pools with only a small surplus held back in reserve. And in those other countries national retirement schemes, the current working generation pays out the retirement benefits of the retired. No trust fund needed and no artificial borrowing either.

So the way I look at it is this. Far from being a "bad thing", a huge chunk of the government debt in issue are bonds being held by the Medicare fund (and the Social Security Fund) and so are kind of a "good thing" ... they represent the stored up dollars that were taken out of circulation in the past when people were taxed and converted to debt (i.e. bonds held by the trust funds)to be redeemed later on to pay for benefits in ill health (or retirement).

If the US government were to act the same as other governments around the world do by taxing the current healthy people to paying the health care needs of the current sick ones (and similarly for retirment) it could simply wind up the Medicare and Social Security trust funds and nobody would notice it. One third of the US deficit could be wiped out with the stroke of a pen and a whole layer of bureaucracy would disappear along with it. Is there reason to believe that there could not be a social contract between the older and younger generations or between the sick as happens elsewhere? People in Europe are not threatened by the absence of a "social security trust fund" or a "health care trust fund". One third of America's debt is an accounting trick... Someone surely must have made a case for this in the past or pointed out the hipocrasy of complaining about the rising debt without realizing that it represents something rather positive in the case of health care and retirement benefits. Or have I missed something? --Hauskalainen (talk) 16:55, 15 November 2010 (UTC)

I had a feeling that I may have dealt with a related issue some time ago.. and now I just found it... but I got some very confusing answers then..... See this from the archive of this page.... http://en.wikipedia.org/wiki/Talk:Medicare_(United_States)/Archive_1#Funding_-_lack_of_clarity Here we have one person claiming that its just a Ponzi Scheme and another claim that is a pay-as-you-go scheme (which I presume means what I said is how other countries schemes work, and indeed how the private health industry works). Does the creation of a Medicare fund mean that when people retired in the 1960s soon afer Medicare was enacted that they were not eligible to get Medicare because they had never paid into Medicare? If they were paying out to all seniors then Medicare would seem to be a pay-as-you-go scheme with a fund on the side. To me it still seems very confusing and unnecessarily so.If it is a pay-as-you-go scheme it would be simpler and more honest to close the Medicare Trust Fund and cancel the debt. --Hauskalainen (talk) 17:09, 15 November 2010 (UTC)

The idea behind the Trust Fund (which exists only on paper as you have pointed out) was to allow for different cohorts of Medicare recipients, for example, the Baby Boomers will be going through this shortly. There are a huge number of people in that generation and they will live longer than the "Greatest" generation which is quickly dying off. Right now we are seeing the least demand on Medicare than we will see until 2035 or so. It will escalate. Congress intended to show Baby Boomers that the "money would be there for them", but then borrowed it back and spent it! So the money is not there for them and the burden on the working people per capita will be large, particularly since medical costs are soaring. {"Ponzi" scheme, as you have stated) The Universal Healthcare Bill of 2010 (or whatever it is called) "solves" this problem by chopping 27% from all doctors reimbursements, as though that would help! Doctors aren't getting that much now and are dropping (not taking new) Medicare patients as a result.

The problem is a long way from "solved." Congress hasn't yet begun to address the problem.

If other editors are not seeing a discussion relating to the improvement of this article, feel free to delete all of this! Student7 (talk) 23:54, 17 November 2010 (UTC)

You said something which illustrates precisely the point I make. You said "Congress intended to show Baby Boomers that the "money would be there for them", but then borrowed it back and spent it!" You say that they "borrowed the money and then spent it".

Where do you expect the money to be? In a Citibank account somewhere?

What happened was that the baby boomers contributions went out of circulation (dollar bills and bank deposits are "on demand" debt obligation of the US government) and they was replaced by a "longer term" debt obligation (a government bond) which has been held by the trust fund and has been accruing income. The Social Security and Medicare taxes were not income to the US government that could be spent. In fact the opposite is true. The interest on the debt which has had to be paid has come from the budget. The debt that was created was NOT created by government spending (at least not the debt represented by the Medicare and Social Security Trust Funds). But the way you speak about it is as though the government HAS be "spent the money". There is no basis in fact for that claim. You have to bear in mind that I am only talking about the one third of US government debt represented by money in the Medicare and Social Security Trust Funds. If the US government wound up the Trust Funds, the trust funds would hand over their bonds to the government and the government would destroy the debt. It could still carry on taxing working people and funded Medicare and Social Security from those funds, so there would be not much change except a reduction in government bureaucracy and a reduction in government debt. Medicare itself would still go on functioning just as now and in the same way as similar schemes do in other countries. Funded by revenues and without a mythical "Pot of Money" behind it. So that debt could disappear from the books overnight by a single legislative Act and the markets and the Tea Party people could be joyous about the reduction in the government debt. Complaining about a mountain of debt and the government having spent the Medicare pot is doublespeak. The debt (some of it anyway) IS the money for future Medicare expenditures. --Hauskalainen (talk) 22:24, 18 November 2010 (UTC)

And this all relates to the improvement of this article how? We're not here to change city hall. We just report what city hall does. We don't have to love it or even like it. We merely report it. Student7 (talk) 03:46, 20 November 2010 (UTC)

Well it was because I asked "Someone surely must have made a case for this in the past or pointed out the hipocrasy of complaining about the rising debt without realizing that it represents something rather positive in the case of health care and retirement benefits. Or have I missed something?".. to me it sems obvious that the "debt" representing peoples premiums for Medicare coverage in retirement or retirement pensions) is completely different to debt created when the government spends money on current expenditure. No other country does this, and it seems from what I hear that people do not seem to have grasped this.... they talk about the government being in debt AND Medicare going broke.... but if the U.S. only accounted for this in the same way as other governments do one third of the debt would not be there and they could not claim that Medicare was going broke. To me it seems important that the article ought to point this out... but I cannot add it unlesss someonr other me has said.. The fact tat I have not heard it said made me wonder if I had made an error of thinking also... but I don't think I have. So I asked both questions. They are related to a possble addition to the article.— Preceding unsigned comment added by Hauskalainen (talk • contribs) 19:05, 20 November 2010

Can add with WP:RELY references. Because these are controversial remarks, the references would need to be close to scholastic/academic. They can't be OpEd pieces of someone with a political axe to grind. Whether I, or another editor, agreed with it or not would be irrelevant. Student7 (talk) 18:45, 21 November 2010 (UTC)

The arguments that Medicare is going broke come up so often that they probably have WP:WEIGHT. The best commentary I've seen is by [Paul Krugman]. --Nbauman (talk) 23:05, 5 May 2011 (UTC)

Removal of information illustrating financial problem

To illustrate the problem confronting the system, the Associated Press published this example, picked up by many media nationwide.

"As an example of the problem, the average wage couple jointly earned $89,000 annually in 2010. Upon attaining eligibility for Medicare and retirement in 2011, they would have paid in $114,000 in Medicare payroll taxes total. But their expected average medical services, including prescriptions are expected to cost $355,000, about three times what they paid in. When the last of the Baby Boomers retire in about 2030, 80 million people will be expecting coverage; the ratio of tax payers supporting the system is expected to drop from today's 3.5 for each person, to 2.3.(ref)"With Medicare, people take out more than they put in". Florida Today. Melbourne, Florida. 2 January 2011. pp. 1A.(end ref)"

An editor "WP:JUSTDONTLIKEIT and removed it. I think his last rm said, in effect. That is tough, you pay in whatever. Sometimes you don't get it all out. That is the way insurance works.

Actually, that isn't the problem at all. The problem, since it affects everyone, is that there might not be sufficient money for the baby boomers. 80 million of them or so. The government can then, either borrow the money from somebody (China?). Somebody with deep pockets. Or cut back on services. Neither the quote nor the article mentioned any of these "conclusions", but an insightful reader might infer that. Both Democrats and Republicans understand the problem, just not the solution. It is merely an neutral, un-WP:BIASed representation of the problem. It is from a reliable source. Why can't it be recorded here? Student7 (talk) 14:49, 5 February 2011 (UTC)

This is not a case of "I don't like it" but one of "not writing from a neutral perspective". You choose to see a problem. In my country, health care is financed year by year with no carry over of surplusses as happens when the medicare trust fund was created. The trust fund is there surely to even out the flows. One expects the fund to deplete as the baby boomers come in. The issue of getting back more than what you paid in is what investors do all the time. Compound interest and/ or dividends on reinvested dividends do the job silently too yo know. There is no magic and no problem. The problem is your perspective. You have to write from a neutral perspective. You are NOT writing from a neutral perspective. You are saying "this is a problem".. but that is your opinion (or perhaps the opinion of the AP or its journalist). Its not for you to assert that there is a problem. WP does not express its own opinion as you made it do. The NHS in UK and Medicare in Canada and Australia do not have the equivalent of the Medicare trust fund... they are funded annually and nobody is the least bit scared when the budget balance trends to zero at year end or that there is an "unfunded liability". With Medicare in so much surplus (that is the trust fund). Those who in America say "the trust funds are bankrupt because they have an unfunded liability" would be laughed at in the UK, Canada or Australia because there, nobody is the least bit concerned that they have a zero balance at year end and a huge future unfunded bill for health care costs. Its only your perspective as a writer that says their has to be. And that is not a normal view from my perspective.Hauskalainen (talk) 00:35, 8 February 2011 (UTC)

The US has a "trust fund" as a mere illusion only. There is no "trust fund" per se. There has never been in Medicare. All money paid in in taxes during a year are (mostly) paid out to claimants. There is no "investment" of funds anyplace. It goes into the general fund which is oversubscribed. Except for a few years, the US Federal Budget has never balanced in the lifetime of most readers. The extra money needed has always been borrowed from somebody. In the past ten years or so, Americans have insufficient money to lend the government and the government has been forced to sell bonds to the Chinese, the only government with sufficient cash to buy them. Yes, there is a theoretical "trust fund" someplace which has always "lent" its money elsewhere. It's "assets" are fictional, in government bonds. This is pretty much like having a piggy bank that is empty except for an IOU from yourself! It is meaningless.

The problem is, this situation is getting worse, both for Medicare (and other social programs which aren't the problem here). Therefore, the US will have to do "something." And BTW, China has told us as much since they may not have funds or be willing to lend them at some future time. Neither the Democrats nor Republicans dispute this. The only problem they have is what that "something" should be.

The problem is not an illusion. It is a serious current problem on which many people are attempting to find a solution. Refusing to allow it to be presented, is not helpful. The source is unbiased; or, at worst, left-wing biased, usually sugar-coating the truth. It is not presenting a conservative pov, because they never do. Student7 (talk) 18:18, 10 February 2011 (UTC)

A couple of key points: the funds from Medicare trust were not just deposited into the general fund; what happened is that they were actually loaned from the trust fund to the general fund at a pre-determined interest rate. While it is true that there is no trust fund lock box as had been proposed in the past, the monies collected under FICA do actually belong to the trust fund, not the general fund, and must be repaid if congress doesn't legally restructure Medicare's funding mechanisms. -- 208.81.184.4 (talk) 23:30, 21 February 2011 (UTC)

Whatever the mechanism, my issue with the text is that it is NOT WRITTEN FROM A NEUTRAL PERSPECTIVE. It is written from the perspective that there IS A PROBLEM and that is NOT HOW WIKIPEDIA ARTICLES MUST BE WRITTEN. WP does not have an opinion about anything. We present the mainstream opinions of experts in their field with their supporting arguments. The argument that more is being taken out than ever got paid looks to me like a piece of OR that the AP published. People who are retiring soon. had they invested their money instead in mututal funds over the years, would also be able to take out more than they pay in. This is not how actuaries look at funds like this. The actuaries, as well as stating when the funds will run out on current trends will have pointed out the two main alternatives to prevent this. (1) to increase Medicare contributions and (2) to decrease Medicare costs. As health care in the US is currently twice as expensive as health care in other industrialized countries and delivers worse outcomes, I think most experts reckon the second option is eminently realizable. If the costs are reined in, there is no Medicare "problem". Opinions about Medicare's sustainability should come first and foremost from the trustee. The text as it currently stands is NOT WRITTEN FROM A NEUTRAL POINT OF VIEW, and for that reason I am deleting it (again).Hauskalainen (talk) 07:36, 22 February 2011 (UTC)

I don't understand why you believe that "it is a problem" is POV. The Medicare Board of Trustees report warns that Medicare will be bankrupt within the next few years. Your claim that "if costs are reined in there is no problem" is itself POV as there is no plan to rein in costs. According to the verifiable information from the most reliable source (the Medicare board of trustees), under current law Medicare is going to go bankrupt. End of story. Wikiant (talk) 00:01, 23 February 2011 (UTC)

The American way of doing things creates this "problem" but it is an illusion. For instance in Britain, as in most other countries, when old age pensions were introduced, the idea was that everybody would pay money in taxes during their working lives that would pay for pensions in old age. In practice, this is a pact between the generations and not a savings scheme. The current generation of working people pays the pensions of the presently retired. In other countries the national pensions and health care schemes do not create "savings plan" to create a fund from which future pensions (or medical expenses= are paid, which is how the Americans view their Social Security and Medicare systems. This makes the whole thing much more complex than it needs to be because then there has to be actuaries. The same problems have to be managed... for instance better health care and life styles mean that people are living longer in most countries and the solution may have to be that people work longer or pay more in during their working lives. When retirement pensions were introduced most people of retirement age were really at the end of their lives. Nowadays they have twenty of more years ahead of them. But only America can say their system "is going bankrupt because of their POV that the systems of national pensions and health care are akin to savings systems and insurance systems. It is a POV way of looking at the issue. No British politician would ever claim that the old age pension system or the NHS is "bankrupt" because there is no fund from which to pay future claims. The very idea is ridiculous. But it is true that there is no fund. In other words, as I have said above, the American government could tomorrow decide to terminate the Medicare and Social Security Trust Funds. The only net effect would be that government debt would be reduced in an instant by quite a sizeable sum. Going forward, all Medicare and Social Security payments could be met from taxes just as most other governments do. Then it is a political issue to determine what the Medicare and Social Security benefits ought to be and what the Medicare and Social Security taxes should be and who should pay them. Saying that Medicare and social security are "going bankrupt" is what certain politicians in America say all the time. But the truth is that there IS a fund behind these schemes and it has created a whole lot of government debt. But you can get rid of the debt and the funds in an instant if you had the political will. Then nobody could claim that Medicare or Social Security are "going down the pan" or words to that effect which make it seem that government is incompetent. This is just an illusion created because the designers of the system built the illusion into the system. You still have to manage the same basic problems .... at what medical benefits are payable, at what age a people entitled to get them, what is the copay in retirement, what are the taxes paid before becoming eligible. You just get rid of the misleading claim that the system is faulty if the fund depletes to zero. Other countries have a zero fund and they are perfectly healthy. Hauskalainen (talk) 13:41, 24 February 2011 (UTC)

I understand the details as to how the system works. This isn't a play on words. The term, "bankrupt" is used in its correct sense -- Medicare's liabilities will exceed its assets. There are only two ways that this bankruptcy can be avoided: (1) the US government increases wage taxes coming into Medicare, or (2) the US government reduces benefits flowing out of Medicare. There is no plan to do either of these things. Therefore, given the current facts, the statement that Medicare will go bankrupt is correct. To argue that bankruptcy can be avoided through unspecified and future political solutions is to introduce POV. Wikiant (talk) 00:43, 25 February 2011 (UTC)

I agree with Wikiant. Hauskalainen suggests that if the programs were cancelled, government debt would drop. I presume he meant the government's current annual deficit. The long-term debt for previous years Medicare liabilities, borrowed from various people and institutions, including China, would remain the same.

At least one country, Chile, does indeed have a trust fund for social security, as do various individual states in the U.S. for government pension funds. The books are kept separate. There is actual money in them, not IOUs. Student7 (talk) 23:22, 26 February 2011 (UTC)

My understanding of law is that bankruptcy is something that happens when an organization cannot meet its liabilities as and when they fall due. Medicare is not bankrupt. It is not illiquid. And it is actually in asset rich relative to its current liabilities. The issue is, as Wikiant says, what the position will be in 2025 or whenever it is when, under current rates of funding, the fund has been exhausted. Of course if there are no changes, then at that point Medicare will be bankrupt. But that is a huge IF. And there are big assumptions in there. That costs will not be able to be contained (though everyone knows that the American health care system wastes money presently on expensive tests, repetitive tests, rewarding doctors for doing interventions instead of keeping patients healthy and out of hospital in the first place. ) And there is an implicit. As I keep saying, other systems fund health care quite successfully out of taxes and even though they get an annual spend allocation, they may have a huge future liability and have no reserves beyond their annual budget they can never be termed "bankrupt". That is because the triangle (funding, service, quality) can always be managed to meet the budget. There is no reason to think that these three aspects cannot be applied to Medicare and to this extend it is highly POV to say that Medicare will be bankrupt in 2025 or whenever. Furthermore, it places a requirement on Medicare that is not placed on medical insurers. Because of law in many states, even before the PPACA, insurers cannot cancel policies. So in theory they too have long term liabilities. But insurers accounting policies only require that they cover their ongoing liabilities. So in that sense they too have future liabilities completely uncovered by their assets and rely on churn and flexibilty to modify premiums to stay solvent year on year. Nobody says that the health insurance industry is going bankrupt but they have if anything a bigger problem than Medicare has. Hauskalainen (talk) 18:28, 27 February 2011 (UTC)

I remember something similar on the Social Security System. Okay, the system takes in $100 billion in 2015 (say), and pays out $110 billion. On one hand, it is not totally bereft of money. It may be able to con billing agencies by "slow-paying," for example, for this relatively small amounts. Medicaid, in various states, has done that to nursing homes for years. On the other, since this is a spiraling situation, it is not "good", either. The money either has to come from the General Fund, or benefits have to be reduced.

It can be "prettied up" with a different name, but it is as close to bankruptcy, a term everyone understands, as I would like the government to get. I suppose it can be called something else, but it would not be understandable. An entity that didn't own the government and control the laws, would file for Chapter 11 and have their bills restructured and perhaps force bondholders to accept less. Can't do that to China, and would prefer not to do that to its own citizens either, for fear that they would never buy another bond again!

So, is the question "nomenclature?" There is a problem. It is "not good" fiscally. Are you saying we must rename it? Or you don't agree that there is a problem at all? Student7 (talk) 21:37, 28 February 2011 (UTC)

No new nomenclature is necessary. "Slow-paying" creditors is what happens in bankruptcy. In every sense of the word, what is projected for Medicare is pure and simply bankruptcy. Wikiant (talk) 23:34, 28 February 2011 (UTC)

Is Part A mandatory?

Is participation in Medicare Part A mandatory for persons age 65 and older? The article says that Part B is optional, but it does not tell whether Part A is optional or mandatory. If a person age 65 or older did not want to participate in Medicare, would he or she be able not to? Does receiving Social Security Retirement Income make Part A mandatory even if it is otherwise optional? I am NOT asking for anyone's opinion as to whether not participating in Medicare would advisable, only if it is possible legally. The article should include that information, but I cannot find it anywhere.--Jim10701 (talk) 22:55, 8 March 2011 (UTC)

This says a person is enrolled automatically. Doesn't say anything about rejecting it. http://www.socialsecurity.gov/pubs/10043.html#part5. I agree that the article should say something about automatic enrollment. If an editor can find where someone can reject this, I don't think that information should go here. It sounds WP:SOAPBOX. Why would someone forgo a freebie? To make a point? Exactly! Student7 (talk) 00:28, 11 March 2011 (UTC)

It should be noted that people are considered "entitled" to Part A, whereas they are "enrolled" into the voluntary Part B. There are no provisions to exclude yourself from this entitlement (and I doubt the administrators' information systems are setup to remove a person once they are included in the database.) However, people enrolled in Part A of Medicare don't have to participate - they simply just pay for the hospital services out of their pocket if they wish. Remember that most people over the age of 65 (or with ESRD or on Disability) will find it hard to purchase private insurance elsewhere.Mr0bunghole (talk) 03:31, 6 May 2011 (UTC)

Medicare Supplements pick up the "gaps", not Medicare Advantage

The first paragraph states that Medicare Advantage plans would normally pick up the "20%" of services not covered by original Medicare (someone enrolled in Parts A and B). This is incorrent. It is private insurance called Medicare Supplements, or Medigap, is used to pay these expenses. Medicare Advantage are the plans that are used to administer benefits under Part C of Medicare.

Additionally, the third section about taxes used to fund Medicare seems woefully out of place between the Administration and Benefits section. Medicare is health insurance, as such, benefits should likely be listed first, then followed by administration, then the other topics, including financing and taxes. Mr0bunghole (talk) 02:54, 6 May 2011 (UTC)

On Budget?

Is Medicare funding on-budget, that is, part of the annual Federal budget, or is it off-budget, that is, with its own separate funding source? Is the Medicare Trust Fund meant to cover all Medicare funding deficiencies or some portion determined by some obscure formula? Virgil H. Soule (talk) 23:19, 11 May 2011 (UTC)

Both the Medicare and Social Security budgets were consolidated with the rest of the Federal budget in the 1980s. Wikiant (talk) 03:24, 12 May 2011 (UTC)

will part 1 cover 24 hr out paticent stay?? — Preceding unsigned comment added by 71.50.67.250 (talk) 22:01, 29 August 2011 (UTC)

Possible changes for factual accuracy

)== Possible changes for factual accuracy ==

(in order of presentation not importance)

1. You say "Congress later established Part C (Medicare Advantage)..."

Possibly confusing; it was not originally called Medicare Advantage. It was called Medicare Choice.

2. The article unnecessarily introduces the private/public dichotomy. This distinction is misleading and is not relevant to understanding Medicare.

All parts of Medicare are both private and public. They (A, B, C and D) are all public in that -- as the article says early in the Introduction -- the U.S. government is the single payer and it highly regulates benefits and prices and other aspects. On the other hand, they (A, B, C and D) all are administered by private insurance companies as the article mentions later.

The best analogy is that all parts of Medicare work pretty much the way all self-insured employer-sponsored-insurance (ESI) works in the United States: the company pays but hires an insurance company to adminster its policies and resulting claims, etc. It also works like many of these self insured ESI programs in the sense that the company (or in this case the U.S. government) offers a kind of flagship policy (typically a very all encompassing Major Medical plan with low co-pays, etc.) and a bunch of typically less expensive alternatives (often localized), which are often HMOs or PPOs and/or often have a Health Savings Account tied to them. In Medicare's case, Parts A and B are like the Major Medical (conceptually but the Medicare insurance itself is terrible and needs to be supplemented before the analogy works) and Parts C and D are like the less expensive choices.

The more expensive/less expensive analogy holds up if you understand that over 70% of people that do not choose Part C, choose to supplement A & B with some type of private insurance and almost all the rest on Traditional Medicare get extensive government assistance such as Medicaid. Footnote 3 shows an out of date Kaiser pie chart that explains this.

3. You say "A majority of Medicare enrollees have traditional Medicare (76 percent)...

But -- as described above -- almost all of these supplement "traditional Medicare" in some way. This is a key point in understanding how Medicare works.

4. You say "...and the rest have a Medicare Advantage plan (24 percent)."

These percentages are changing all the time. For 2012, I believe the numbers are 73/27 but the CBO estimates Medicare Advantage enrollment will drop to under 15% by 2019. You probably should just say about 80/20 to be safe

5. You say "Medicare covers about half (48 percent) of health care costs for enrollees. Medicare enrollees must cover the rest of the cost. These out-of-pocket costs vary depending on the amount of health care a Medicare enrollee needs. They might include uncovered services—such as long-term, dental, hearing, and vision care—and supplemental insurance."

This paragraph is a really apples and oranges job because as you accurately explain elsewhere Medicare has nothing to do with insuring long term care and even to the extent Part C plans provide some dental, vision and hearing coverage, it is minimal. You could change the word enrollees to "seniors" but you're still way down in weeds that no one is going to understand — Preceding unsigned comment added by Dennisbyron (talk • contribs) 18:02, 26 February 2012 (UTC)

Graph Confusing / Selective

I was looking at the graph in section Comparison with private insurance and it seems to be confusing. What the labels on each side represent is not immediately clear (I understand the horizontal row, but not the vertical). In addition, I'm guessing this is the source material (table 16), and the graph appears to represent 'Common Benefits', not 'All Benefits', and the relationship between private health insurance and Medicare varies for each (private costs less per person for all benefits, but costs more for the common benefits).

I'm not sure yet if this matters, but the unclear graph needs more specification (IMO). LaserWraith (talk) 00:36, 16 May 2012 (UTC)