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Tag: Coinsurance

  • What are your Medicare premiums in 2025?

    What are your Medicare premiums in 2025?

    Medicare only covers about half of a typical person’s health care costs. People with Medicare generally pay a monthly Medicare Part B premium, about 16 percent of their medical and inpatient costs out of pocket (or through supplemental coverage: Medigap, Medicaid or retiree insurance) as well as some or all of the cost of dental, vision, hearing and long-term care services. Medicare Part B premiums and other out-of-pocket costs are rising in 2025. Here’s what you need to know.

    Part B premiums in 2024:
    In 2025, people whose modified adjusted gross income from two years ago as reported on their federal tax return is $106,000 or less pay a monthly Part B premium of $185, an increase of $10.30.

    People with incomes above $106,000–about eight percent of the Medicare population–pay a Medicare Part B premium of:

    • $259 a month, if their income is above $106,000 and no more than $133,000.
    • $370 a month, if their income is above $133,000 and no more than $167,000.
    • $480.90 a month, if their income is above $167,000 and no more than $200,000.
    • $591.90 a month, if their income is above $200,000 and less than $500,000.
    • $628.90 a month, if their income is $500,000 or more.

    For couples with combined incomes of $400,000 or less two years ago, filing a joint tax return, the premium amount doubles. Couples filing jointly with annual incomes above $400,000 and less than $750,000 each pay a $591.90 monthly premium. And, couples with annual incomes of $750,000 and above each pay a $628.90 monthly premium. Visit this CMS web site for your Part B premium amount if you are filing separate returns.

    Medicare Part B annual deductible: $257, an increase of $17 from the annual deductible of $240 in 2024.

    For more than four decades, the Medicare Part B premium (medical insurance) was the same for everyone regardless of income, geography or health status, a quarter of the cost of Part B services. (Medicare Part A, hospital insurance, is premium-free if you have contributed into Social Security for at least 40 quarters.)  In 2007, wealthier people with Medicare began paying higher premiums.

    Here are 2025 Medicare Part A costs:

    • There is no Medicare Part A premium if you or your spouse are among the 99 percent of people with Medicare who have at least 40 quarters of Medicare-covered employment.
    • The Medicare Part A inpatient hospital deductible is $1,676, in 2025, and  coinsurance for hospitalizations after day 60 is $419 a day in a benefit period; coinsurance for lifetime reserve days is $838 a day.
    • The Medicare Part A daily coinsurance for skilled nursing facility stays after day 20 is $209.50.

    Extra Help paying your Medicare premiums and out-of-pocket costs: People with low incomes and assets have help paying these costs through Medicaid and the Medicare Savings Program. You should apply through your Medicaid office, if you think you might be eligible.

    Here’s more from Just Care:

  • What are your Medicare premiums in 2024?

    What are your Medicare premiums in 2024?

    Medicare only covers about half of a typical person’s health care costs. People with Medicare generally pay a monthly Medicare Part B premium, more than 20 percent of their medical and inpatient costs out of pocket (or through Medigap or Medicaid,) as well as most or all of the cost of dental, vision, hearing and long-term care services. Medicare Part B premiums and other out-of-pocket costs are rising in 2024. Here’s what you need to know.

    Part B premiums in 2024:
    In 2024, people whose modified adjusted gross income from two years ago as reported on their federal tax return is $103,000 or less pay a monthly Part B premium of $174.70, an increase of $9.80.

    People with incomes above $103,000–about eight percent of the Medicare population–pay a Medicare Part B premium of:

    • $244.60 a month, if their income is above $103,000 and no more than $129,000.
    • $349.40 a month, if their income is above $129,000 and no more than $161,000.
    • $454.20 a month, if their income is above $161,000 and no more than $193,000.
    • $559 a month, if their income is above $193,000 and less than $500,000.
    • $594 a month, if their income is $500,000 or more.

    For couples with combined incomes of $386,000 or less two years ago, filing a joint tax return, the premium amount doubles. Couples filing jointly with annual incomes above $386,000 and less than $750,000 each pay a $559 monthly premium. And, couples with annual incomes of $750,000 and above each pay a $594 monthly premium. Visit this CMS web site for your Part B premium amount if you are filing separate returns.

    Medicare Part B annual deductible: $240, an increase of $14 from the annual deductible of $226 in 2023.

    For more than four decades, the Medicare Part B premium (medical insurance) was the same for everyone regardless of income, geography or health status, a quarter of the cost of Part B services. (Medicare Part A, hospital insurance, is premium-free if you have contributed into Social Security for at least 40 quarters.)  In 2007, wealthier people with Medicare began paying higher premiums.

    Here are 2024 Medicare Part A costs:

    • There is no Medicare Part A premium if you or your spouse are among the 99 percent of people with Medicare who have at least 40 quarters of coverage.
    • The Medicare Part A premium, if you or a spouse has at least 30 quarters of coverage, is $278 a month, the same as in 2023; if you don’t have at least 30 quarters, the premium is $505 a month, a $1 decrease from 2023.
    • The Medicare Part A inpatient hospital deductible is $1,632, in 2024 an increase of $32 from 2023, and  coinsurance for hospitalizations after day 60 is $408 a day in a benefit period; coinsurance for lifetime reserve days is $816 a day.
    • The Medicare Part A daily coinsurance for skilled nursing facility stays after day 20 is $204, an increase of $4.00 from $200 in 2023.

    Extra Help paying your Medicare premiums and out-of-pocket costs: People with low incomes and assets have help paying these costs through Medicaid and the Medicare Savings Program. You should apply through your Medicaid office, if you think you might be eligible.

    Here’s more from Just Care:

  • What are your Medicare premium and other costs in 2023?

    What are your Medicare premium and other costs in 2023?

    In 2023, the standard monthly Medicare Part B premium, which covers medical and outpatient care, is $164.90, a monthly decrease of $5.20 from $170.10, for people with annual incomes of $97,000 or less in 2021. At the same time that your Medicare Part B premium is decreasing, your Social Security increase is increasing a 8.7 percent, providing an average additional $146 a month in benefits.

    Social Security benefits in 2023 will be up an average of $1,827 for a single retiree.

    In 2023, people whose modified adjusted gross income from two years ago as reported on their federal tax return–about seven percent of the Medicare population–pay a Medicare Part B premium of:

    • $230.80 a month, if their income is above $97,000 and no more than $123,000.
    • $329.70 a month, if their income is above $123,000 and no more than $153,000
    • $428.60 a month, if their income is above $153,000 and no more than $183,000
    • $527.50 a month, if their income is above $183,000 and less than $500,000
    • $560.50 a month, if their income is $500,000 or more

    For couples with combined incomes of $366,000 or less two years ago, filing a joint tax return, the premium amount doubles. Couples with annual incomes above $366,000 and less than $750,000 each pay a $527.50 monthly premium. And, couples with annual incomes of $750,000 and above each pay a $560.50 monthly premium. Visit this CMS web site for your Part B premium amount if you are filing separate returns.

    Medicare Part B annual deductible: $226, a decrease of $7 from the annual deductible of $233 in 2022.

    For more than four decades, the Medicare Part B premium (medical insurance) was the same for everyone regardless of income, geography or health status, a quarter of the cost of Part B services. (Medicare Part A, hospital insurance, is premium-free if you have contributed into Social Security for at least 40 quarters.)  In 2007, wealthier people with Medicare began paying higher premiums.

    Here are 2023: Medicare Part A costs:

    • There is no Medicare Part A premium if you or your spouse have at least 40 quarters of coverage.
    • The Medicare Part A premium, if you or a spouse has at least 30 quarters of coverage, is $278 a month; if you don’t have at least 30 quarters, the premium is $506 a month.
    • The Medicare Part A inpatient hospital deductible is $1,600, in 2023 an increase of $44 from 2022, and  coinsurance for hospitalizations after day 60 is $400 a day in a benefit period; coinsurance for lifetime reserve days is $800 a day.
    • The Medicare Part A daily coinsurance for skilled nursing facility stays after day 20 is $200, an increase of $5.50 from $194.50 in 2022.

    Extra Help paying your Medicare premiums and out-of-pocket costs: People with low incomes and assets have help paying these costs through the Medicare Savings Program. You should apply through your Medicaid office, if you think you might be eligible.

    People with incomes up to 135 percent of the federal poverty level, (the exact amount will be released in 2023) are eligible for help paying their premiums through Medicaid or a Medicare Savings Program.

    In 2023, for full low-income subsidy (LIS) benefits through the Qualified Medicare Beneficiary (QMB) program, your assets cannot be higher than $9,090 ($13,630 if married). For partial LIS benefits, your assets cannot be higher than $15,160 ($30,240 if married).

    That said, if you notify the Social Security Administration (SSA) that you plan to use some of your assets for burial expenses, for full LIS benefits, your assets can be as high as $10,590 ($16,630 if married). For partial LIS benefits, your assets can be as high as $16,660 ($33,240 if married).

    Here’s more from Just Care:

  • With Medicare private plans, your costs are unpredictable

    With Medicare private plans, your costs are unpredictable

    With Medicare private plans, be they Medicare Advantage plans or Medicare Part D prescription drug plans, your costs are unpredictable. The corporate health insurers offering these health plans are free to increase your costs at any time. It’s another reason that you cannot meaningfully compare your private Medicare health plan options during the Fall open enrollment period.

    Susan Jaffe reports for Kaiser Health News on a woman who picked a Humana drug plan through Medicare’s Plan Finder during the Fall open enrollment period specifically because of the copay for the drug she takes. By January, Humana had increased the copay nearly 400 percent!

    Not only can Medicare private plans increase drug copays at the beginning of the year, they can do so again and again and again throughout the course of the year. The copays they list for the start of the following year during the Fall open enrollment period theoretically could be part of a bait and switch.

    CMS must approve a Part D drug plan’s drug tiering. But, the Part D plans retain a lot of latitude about what to charge enrollees. Also, enrollees’ drug costs depend upon a range of factors, including the pharmacies they use.

    AARP analyzed drug prices in December 2021 and again in January 2022. It found that 75 of the 100 drugs that Medicare Part D spends the most on had had a price increase averaging 5.2 percent in that time. None had a price drop.

    Medicare does warn people that prices can change. But, it does not allow people to switch to a new Part D drug plan after January 1 if they have been misled into signing up for a drug plan that charges them more than represented on the Medicare Plan Finder. People must wait until the next Fall open enrollment period, when they can again be misled.

    Sometimes, drug manufacturers give discounts to insurers or their pharmacy benefit managers. But, it’s impossible to know how much of those discounts insurers pocket. There’s little information surrounding what they do with them. The discounts tend not to go toward lower drug prices. If anything, they go toward lower premiums.

    Not surprisingly, lots of people with Medicare can’t afford their drugs even with Part D coverage. The copays are too high. One recent analysis found that a copay increase of as little as $10.40 led many people to stop taking all their medicines and ultimately to thousands of needless deaths.

    Fixed and predictable prescription drug copays are increasingly not the norm. Instead, insurers are charging enrollees a percentage of a drug’s price. And, with prescription drug costs often sky high, the coinsurance can be a lot of money.

    Medicare offers some enrollees extra help paying for their drugs through the Extra Help program. But, only people who meet specific income and asset levels qualify.

    Here’s more from Just Care:

  • What if physicians can’t calculate patients’ out-of-pocket costs?

    What if physicians can’t calculate patients’ out-of-pocket costs?

    A new paper in JAMA Network Open finds that physicians are bad at figuring out patients’ out-of-pocket prescription drug costs, even when deductible, coinsurance, copay and out-of-pocket cap information is at their fingertips. Of course, the goal of giving physicians this information is to help ensure that cost is not a barrier to patients filling their prescriptions. So, what if physicians can’t calculate patients’ out-of-pocket costs?

    The authors tested a hypothetical scenario with a group of physicians. In the scenario, a patient was prescribed a drug that cost $1,000 a month. Physicians were then asked what the drug would cost the insured patient at different times of the year–before the deductible was met, once it was met and a copay (a fixed out-of-pocket amount) was required, once it was met and coinsurance (a percentage of the drug’s cost) was required, and once the patient had reached the out-of-pocket cap.

    The authors found that fewer than two-thirds of respondent physicians answered a single one of these questions correctly. Only slightly more than one in five of them (21 percent) answered all four questions about patient drug costs correctly. Bottom line: Calculating patient costs is not easy, even for people with graduate degrees!

    The authors conclude that out-of-pocket costs should be simpler to calculate. If physicians can’t calculate them, how can anyone expect patients to do so? The sad truth is that policymakers do not seem to care or to be willing to fix this problem. And, the only solution that will ensure everyone can fill their prescriptions is to have no copayment for life-saving drugs and no more than nominal copayments for all other drugs.

    Keep in mind that out-of-pocket costs are just one of many considerations when choosing a health plan. And, because there are so many tradeoffs involved and so many unknowns, it’s not possible to ensure people choose a health plan that meets their needs. At best, you can know whether your doctors are in-network at the time you enroll (doctors can leave at any time,) along with your out-of-pocket maximum. But, whether the health plan will delay or deny access to care your doctor recommends is critically important, yet unknowable.

    Here’s more from Just Care:

  • What are Medicare premium and other costs in 2022?

    What are Medicare premium and other costs in 2022?

    The Medicare Open Enrollment period ends on December 7, so you still have time to review your Medicare options for 2022. Particularly if you have Medicare Part D drug coverage or are enrolled in a Medicare Advantage private plan–a health plan offered by a corporate health insurance company–it could save you a lot of money. Your Medicare Part B premium is rising regardless of whether you are enrolled in traditional Medicare or a Medicare Advantage plan.

    In 2022, the standard monthly Medicare Part B premium, which covers medical and outpatient care, is $170.10, a monthly increase of $21.60 from $148.50, for people with annual incomes of $88,000 or less in 2021. Your Social Security increase should cover that cost and, for most people, provide an additional $70 a month in benefits.

    Social Security benefits in 2022 will be up an average of nearly six percent from this year, around $90 a month. Some of that increase will go towards the higher Medicare monthly premium.

    In 2022, people whose modified adjusted gross income from two years ago as reported on their federal tax return–about six percent of the Medicare population–pay a Medicare Part B premium of:
    • $238.10 a month, if their income is above $91,000 and no more than $114,000.
    • $340.20 a month, if their income is above $114,000 and no more than $142,000
    • $442.30 a month, if their income is above $142,000 and no more than $170,000
    • $544.30 a month, if their income is above $170,000 and less than $500,000
    • $578.30 a month, if their income is $500,000 or more

    For couples with combined incomes of $330,000 or less two years ago, filing a joint tax return, the premium amount doubles. Couples with annual incomes above $340,000 and less than $750,000 each pay a $544.30 monthly premium. And, couples with annual incomes of $750,000 and above each pay a $578.30 monthly premium. Visit this CMS web site for your Part B premium amount if you are filing separate returns.

    Medicare Part B annual deductible: $233, an increase of $30 from the annual deductible of $203 in 2021.

    People with incomes up to 135 percent of the federal poverty level, ($1,456 in monthly income for an individual and $1,960 for a couple in 2020; these amounts may increase in 2021) are eligible for help paying their premiums through Medicaid or a Medicare Savings Program.

    For more than four decades, the Medicare Part B premium (medical insurance) was the same for everyone regardless of income, geography or health status, a quarter of the cost of Part B services. (Medicare Part A, hospital insurance, is premium-free if you have contributed into Social Security for at least 40 quarters.)  In 2007, wealthier people with Medicare began paying higher premiums.

    Here are 2021 Medicare Part A costs:

    • There is no Medicare Part A premium if you or your spouse have at least 40 quarters of coverage.
    • The Medicare Part A premium, if you or a spouse has at least 30 quarters of coverage, is $259 a month; if you don’t have at least 30 quarters, the premium could be $471 a month.
    • The Medicare Part A inpatient hospital deductible is $1,556, in 2022 an increase of $72 from 2021, and  coinsurance for hospitalizations after day 60 is $389 a day in a benefit period; coinsurance for lifetime reserve days is $778 a day.
    • The Medicare Part A daily coinsurance for skilled nursing facility stays after day 20 is $194.50, an increase of $9.00 from $185.50 in 2020.

    Here’s more from Just Care:

  • Congresswoman Jayapal introduces Medicare for All bill

    Congresswoman Jayapal introduces Medicare for All bill

    Today, Congresswoman Jayapal and 105 co-sponsors introduced the Medicare for All Act in the U.S. House of Representatives. Unlike most other health reform bills in the House and the Senate, the Medicare for All Act offers comprehensive health care for everyone in the US, including long-term care, and takes hundreds of billions of dollars of waste out of the system.

    The Medicare for All Act would fix our broken health insurance system. We have 30 million uninsured and tens of millions more people who have inadequate coverage, which keeps them from getting needed care. We ration health care even for people with insurance, based on their ability to pay deductibles, coinsurance and out-of-network bills.

    Commercial health insurers add as much as $500 billion in administrative waste to the cost of health care. Moreover, they have no ability to rein in doctor, hospital and prescription drug costs to fair levels. Not surprisingly, we spend about twice as much per person on health care as other wealthy countries, which have far better health outcomes.

    Because health care costs are so high in the US, approximately one in three adults are not getting care their doctors recommend or are not going to the doctor or filling a prescription. 33 percent of U.S. adults go without recommended care, do not see a doctor when sick, or fail to fill a prescription. In wealthy European countries such as Germany and the Netherlands, only about one in 12-14 adults go without recommended care.

    The Medicare for All Act ensures that our health care system puts patients first, giving everyone equal access to good care. A large majority of the public support it, including 86 percent of Democrats and 52 percent of Republicans. And, support is growing as people learn more about how it works and why it works.

    Not only would people be able to use the doctors and hospitals they want, all necessary services would be covered in full, including long-term care, mental health, reproductive health, dental, vision, medical supplies, and prescription drugs.

    The Medicare for All Act would create 2.6 million new jobs. It would help small businesses, as they no longer would need to pay for commercial health insurance for their workers. No longer would insurers come between patients and their doctors to decide what care was needed.

    Moreover, the cost of covering everyone and eliminating premiums, deductibles and copayments would be entirely offset by the savings achieved from the elimination of waste and health insurance industry profits as well as lower provider rates and prescription drug prices. The law would be phased in over two years.

    If you support Medicare for all, please sign this petition.

    Here’s more from Just Care:

  • Eve’s story: Commercial health insurance, inhumane choices

    Eve’s story: Commercial health insurance, inhumane choices

    Millions of hard-working Americans with common health conditions struggle every day to stay healthy because they must rely on commercial insurance to cover their care. Deductibles and coinsurance are so high that people must prioritize their families’ health care needs. They are forced to make choices that are inhumane and unconscionable.

    Eve and her husband Errol Meikle are two middle-class Americans in just this predicament, forced to prioritize their families’ medical needs, hoping against hope for Medicare for All. Medicare for All is a health care system that builds on Medicare. It allows people to see most doctors and use most hospitals anywhere in the country. It improves on Medicare, eliminating premiums, deductibles and coinsurance and expanding benefits to include vision, hearing, dental and home and community-based care. Medicare for All recognizes health care as a right and guarantees everyone in America access to the care they need.

    Eve, a registered nurse, and Errol, a customer service rep, live in Florida with their three children, ages 18, 14, and 6. With good jobs and an annual income just over $80,000, they can no longer ensure their family gets health care. And, they have insurance!

    Eve and her daughter, Kylee, 14, have chronic health conditions requiring attention. Eve has ulcerative colitis. Kylee has scoliosis and gastritis.  But, the deductibles and coinsurance required to get all the care they both need have forced the family into medical debt.

    To live as much as possible within their budget, Eve and Errol must choose which health conditions get medical attention. Putting aside total out-of-pocket health care costs, upfront costs just to get into the doctor’s office, are often prohibitive. Because of Kylee’s scoliosis and gastritis, today, the Meikle’s owe thousands of dollars to doctors and hospitals.

    The big bills started coming in January 2016, soon after Eve got health insurance through her job, and the family started to take care of their health issues. They were not able to do so before then.

    When Eve took her daughter, Kylee, for her annual checkup, the doctor said she needed X-rays to determine whether she had scoliosis. The X-rays alone cost several hundred dollars. And, that was only the beginning. Kylee needed to see a specialist.

    Shopping for health care was not helpful. Eve contacted several specialists in her network to try to keep costs down. But, none could tell Eve what the visit would cost. There were different levels of service, ranging in cost from $450 to $850. And, this was just for a consult and review of X-rays. Kylee would need treatment as well.

    Eve knew she needed to get Kylee to the specialist. Scoliosis can become worse over time and cause problems. But, she didn’t end up doing so because in the six months she was expected to wait for the specialist appointment, Kylee developed a new serious condition.  In Eve’s words, Eve “had to let scoliosis go and pray it would not become worse every year.”

    In the summer of 2018, Kylee became so sick that she could not go to school. She had nausea every day and needed to stay in bed. So, Eve made the call that this illness trumped the scoliosis and ended up canceling the appointment with the bone specialist.  She needed to find out what was wrong with Kylee and get her treatment.

    She scheduled appointments for Kylee with two different specialists to figure out what was causing her severe symptoms. While waiting for the appointments, Kylee had to be admitted to the ER. Her symptoms became too severe–nausea, not eating, not sleeping. Eve hoped to get a diagnosis.

    The hospital sent Kylee home with a prescription but without a diagnosis. Eve was told that “hopefully” the specialist could figure out what was wrong with Kylee. By then, Eve had paid $275 upfront, her copay, to walk in to the ER. Then, after they left the ER, the physician and ER bills came in at nearly $2,000, which she was expected to pay by “cash, check or credit card.” Eve’s insurance has a $3,000 individual family member deductible and a family deductible of $10,000 before it begins covering 70 percent of the approved rate for covered services. Eve could not pay the ER bill and let the hospital staff know. She was told to call the hospital and set up a payment plan.

    Eve then took Kylee to the specialist to get a diagnosis and proper treatment. The upfront doctor’s cost for the visit was $200.  The two procedures Kylee needed, the colonoscopy and the EGD, cost $900 more upfront. And, Eve was charged $180 to learn the diagnosis.

    The total cost for Kylee’s procedures was more than $17,000. Eve owed over $5,000 for the coinsurance, 30 percent of the cost. That’s when Kylee was diagnosed with gastritis and given a prescription.

    Eve was told to schedule a follow-up visit for Kylee, so the doctor could check on how Kylee was doing. But Eve chose not to make that visit. It would have cost $163 upfront. Eve could not imagine what the doctor would say that was worth the cost. “All she’s going to say is how’s it going?” In Eve’s view, there was nothing more the doctor could do. There were no other medications to give. With so much medical debt already, Eve had no choice but to gamble with her daughter’s health. Kylee’s gastritis is still not 100 percent better, and she has yet to see a specialist about her scoliosis.

    Meanwhile, Eve has had to put her ulcerative colitis, which she has had for 22 years, on the back burner.  After taking Kylee from one specialist to another, she had maxed out her credit card. But, Eve’s ulcerative colitis has caused her tremendous and continual pain and misery. It makes getting through a 13-hour shift very difficult.

    Eve explained that one way to treat the ulcerative colitis is to keep your life stress-free. She knows that’s not realistic. She has to go to work, and she has little time to rest. She also needs medications. But, it would be too much to pay for the appointment to get the prescription she needs. Moreover, drugs are expensive. “It’s more on top of more on top of more.”

    Eve and her husband are both college educated, with good jobs, and consider themselves to be making good money. Understandably, Eve struggles to understand their financial and health care situation. They don’t live a fancy lifestyle. “No fancy car. No fancy home.” They pay their mortgage and bills. She says, “I’m frugal. I couldn’t be more frugal.” And, she asks “Why am I having to cancel doctors’ appointments for my family and decide which of my illnesses need the most attention and which will be on the back burner until we can afford to take care of them?”

    That’s Eve’s story. With expensive commercial health insurance from her hospital, Eve lives in pain everyday, and she and her daughter have not been able to get all the care they need.  Eve feels penalized for having health insurance. In her words, “It’s not health insurance when you have to pay so much upfront when you need to see the doctor. It’s a coupon. It’s not insuring me for anything.”

    Eve has often talked with her husband about dropping their insurance and paying out of pocket for their care. Without insurance, she says she could get discounted rates. She could pay $200 instead of $800 for a visit.  And, she would keep the $550 monthly insurance premium in her pocket.  She would have $6,600 a year to pay the discounted fees at the doctor’s office. She also knows that in the event of a catastrophic condition, she would be bankrupt without insurance. So, she keeps it.

    Eve’s choice to have health insurance and make tradeoffs with her own and her families’ health care, is not one that should exist in a humane health care system.

    Eve has always believed in universal health care.  She actively lobbies for Medicare for All, speaks about it and participates in conferences. As she puts it, she is “befuddled” by our current commercial health insurance system. “This isn’t working.” She, and the millions of people like her, must make choices that no one should have to make.

    If you support Medicare for all, please sign this petition to Congress.

    Here’s more from Just Care:

  • Hospital prices should be disclosed, but knowing them won’t help you shop for health care

    Hospital prices should be disclosed, but knowing them won’t help you shop for health care

    A new Trump administration policy requires all hospitals to disclose their prices for people without insurance as a means to help people shop for health care. This policy will never help people save money or get needed care. Nor will it ease their stress about hospital costs. Without Medicare for All–which does away with deductibles and coinsurance–health care costs will remain a burden, forcing people to make choices about their families’ care that no one should have to make.

    Today, people with and without insurance have little clue what their out-of-pocket costs will be in hospital–unless they have traditional Medicare. Hospitals can hide the amounts they charge different insurers for different procedures; insurers, in turn, neither disclose nor limit people’s out-of-pocket hospital costs. People with commercial insurance are regularly surprised by how high they are.

    Hospitals rates tend to put patients at serious financial and health risk. Even with insurance, between deductibles and coinsurance, hospital costs are often beyond their means. Until we eliminate deductibles and coinsurance, the US will continue to ration care based on people’s ability to pay.

    For these reasons, the Trump administration policy requiring hospitals to disclose their charges for the uninsured is of little, if any, benefit to people. It provides no information for people with insurance. And, even if there were full hospital price transparency–information on rates for the insured and uninsured–it is hard to imagine how it would ever help people.

    In short, you should not be expected to shop for health care. You generally have little control over the services you receive in hospital. Moreover, hospital fees for a procedure are an amalgam of different provider charges. The surgeon’s fee might be lower at one hospital than another and the anesthesiologist’s fee higher. But, you could not very well go to one hospital for anesthesia and another hospital for surgery.

    Most important, price should not be the driving factor in choosing where to get health care services. Quality matters. You would never buy a car or a home without factoring in quality. You certainly should not do so with health care services. Yet, we have virtually no good public information available on quality of these services.

    To be clear, hospital price transparency is good public policy even if it cannot help patients. It allows policy experts easily to compare costs for different services, among hospitals, in a particular area, and across the country, for different health plans, and for people without insurance.

    Full hospital price transparency would reveal which insurers are getting better rates for different services and reinforce the point that the health care marketplace sets arbitrary and unreasonable prices and fails to rein in costs. It would expose lack of competition. And, it would help show why we need Medicare for All, fair rates for everyone no matter where they live or which hospital they use.

    Here’s more from Just Care:

  • People with Medicare spend an average of $5,500 on health care annually

    People with Medicare spend an average of $5,500 on health care annually

    Medicare works to ensure people access to quality affordable health care, but average out-of-pocket health care costs are still considerable. A new report from the Kaiser Family Foundation finds that individuals typically spend more than $3,200 a year just on Medicare premiums, deductibles and coinsurance. When you add in costs for services Medicare does not pay for, people spend an average of $5,500 a year out of pocket on health care or, put differently, more than 40 percent of their Social Security benefits.

    Juliet Cubanski and Tricia Neuman analyzed data from 2013 to determine the amount people with Medicare spend on health care. All in, they found that spending on health care eats up about 41 percent of the average monthly Social Security check, $1,115. Average annual Social Security benefits were $13,375 in 2013 and average total income for a person with Medicare was $35,317.  Their report establishes that people with Medicare have far higher annual average out-of-pocket health care costs than the Center for Retirement Research found based on 2014 data, 41 percent of their Social Security benefits as compared to 33 percent.

    To be sure, the percentage of income spent on health care is far higher for people who rely exclusively or almost exclusively on Social Security for their retirement income. And, a notable portion of the 62 million people receiving Social Security benefits rely almost exclusively on Social Security for their income. More than one in five married couples and more than four in ten individuals rely on Social Security for more than 90 percent of their income, according to the Social Security Administration.

    When the Kaiser Family Foundation researchers dug deeper, they found that people over 85 and women typically spent an even higher share of their Social Security income on health care than men and people under 85. People 85 and older spent on average 74 percent of their Social Security benefits on health care costs Medicare does not cover. Women over 85 spent more than men, 83 percent of their Social Security benefits as compared to 58 percent. Because Medicare does not pay for custodial nursing home care or most other long-term care services and supports, the oldest cohort of people with Medicare have especially high out-of-pocket costs.

    Out-of-pocket costs for people in poor health and people with lower incomes were also higher than other people. People in fair or poor health spent an average of $6,128 on health care as compared to $5,246 for people in excellent, very good or good health. Put differently, people who could perform all the activities of daily living–bathing, feeding, toiletting, dressing and transferring–spent on average $4,673 out of pocket a year on health care, whereas people who needed help with activities of daily living spent on average $6,946.

    The researchers found that one in four people with traditional Medicare spent almost 30 percent of their total income on health care costs Medicare does not cover. And, one in ten people spent just under 60 percent of their total income.

    We need to increase Social Security benefits if we want to ensure retirees can make ends meet and keep older adults from falling into poverty. Their situation is projected to get even worse as health care costs continue to grow.

    If you want Congress to expand Social Security benefits, please sign this petition.

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