JustCare

Tag: Deductible

  • Medical debt on the rise

    Medical debt on the rise

    New research from the Peterson Center on Health Care and the Kaiser Family Foundation finds that Americans are now holding at least $195 billion in medical debt. Nine in ten of them have health insurance. Emergency care, COVID-19 care and mental health care are the three biggest causes.

    Three million Americans owe more than $10,000 in medical debt, and 16 million Americans owe more than $1,000. Not surprisingly, the most vulnerable Americans face the greatest debt. Researchers say that “Medical debt can happen to almost anyone in the United States, but this debt is most pronounced among people who are already struggling with poor health, financial insecurity, or both,”

    In a separate survey of 1,250 people, researchers found that more than half (55 percent) say they have some medical debt. And, almost half of these people report not being able to purchase a home or put money aside for retirement as a result.

    Nearly seven in 10 people (69 percent) who purchase their own health insurance have medical debt and just over six in ten (61 percent) who have employer coverage have medical debt. Just under six in ten (59 percent) without health insurance report having medical debt.

    People with health insurance appear to have the same rate of medical debt as people without health insurance. But having health insurance limits the amount of debt people have. Health insurance deductibles have sky-rocketed over the last several years, presenting a barrier to care for many Americans. They are also a driver of medical debt.

    Employer plan deductibles average $1,669 in 2022 for people who work for large employers. People working in companies with fewer than 200 workers face even higher average deductibles, $2,379. And, individuals with state health insurance exchange plans and no subsidies faced average deductibles of $4,364 in 2020.

    Total average out-of-pocket costs for health care are now $12,530. That includes premiums, deductibles and copays. And, it represents about 20 percent of the typical person’s annual income, $67,521 in 2020.

    People not yet eligible for Medicare, with incomes between 100 and 400 percent of the federal poverty level, are entitled to subsidies on health insurance through the state health insurance exchanges, which can bring down their health care costs significantly. People with Medicare with low incomes are also eligible for government assistance paying premiums, deductibles and coinsurance, through Medicaid and Medicare Savings Programs.

    To minimize your costs, plan ahead. If you have Medicare, to save money, make sure you have the number of the local ambulance that takes Medicare on your phone and your refrigerator. If you’re in a Medicare Advantage plan, have the number of an in-network ambulance.

    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:

  • Death and debt by deductibles

    Death and debt by deductibles

    Note: This post was originally published on The Potter Report.

    Congrats, America! Earlier this month you passed an annual milestone: Two days after Tax Day, you made it to… Deductible Relief Day!

    What’s that? It’s the day where the average person with employer-based health insurance has spent enough on health expenses to finally meet their deductible.

    Health insurance deductibles have been rising so rapidly (year after year after year) that the Kaiser Family Foundation decided to track the trend to show how severely Americans are getting ripped off (and sick). And it’s bad.

    As you might guess, the Deductible Relief Day is being pushed further each year. In 2005, you had to wait until February 28. By 2009, you wouldn’t be popping champagne until March 18. In 2019, you waited two months more than that.

    As the Kaiser Family Foundation noted, in 2009, the average deductible was $533 for a single person. In 2018, it was $1350. How? The insurance industry strategy of moving all of us into high-deductible plans (one of the many gross abuses I saw first-hand at Cigna) has paid off well for my former employers.

    In 2018, about 85% of covered workers were enrolled in a high-deductible plan, up from just 50% ten years earlier. Another way of looking at this: Average enrollee spending on deductibles more than tripled between 2007 and 2017.

    And Kaiser didn’t look at people who buy their coverage on their own through the ACA exchanges. They’re in even *worse* shape. The Commonwealth Fund found that 40% of people in ACA plans are underinsured because of high out-of-pocket charges – and many likely never meet their deductibles.

    As a result, millions of Americans are not going to the doctor or picking up prescriptions. Insurers LOVE that. It’s far fewer claims to pay! It’s why, when many other businesses went belly up during COVID-19, insurers made record profits: medical treatment was less accessible!

    President Biden, are you paying attention to this? You must.

    Millions of people WITH insurance who voted for you, including folks on Obamacare, CAN’T USE IT because of deductibles! Insurers can charge families up to $7,200 before they’ll pay a dime. It keeps going up. Every. Single. Year.

    No wonder more and more Americans with insurance are turning to GoFundMe or bankruptcy court. It’s not just the premiums you gotta worry about, Joe. Deductibles are eating us alive. You and Congress need to pay attention before NO Americans can meet their deductibles.

    Here’s more from Just Care:

  • Medicare Part D drug coverage in 2021

    Medicare Part D drug coverage in 2021

    Whether you are enrolled in traditional Medicare or a Medicare Advantage plan, you can get prescription drug coverage that will cover your costs at the pharmacy through a Medicare Part D drug plan. Medicare Part D doesn’t cover your full costs, but it provides important partial coverage. About 75 percent of people with Medicare–46 million–are enrolled in Part D.

    Commercial insurance companies contract with the federal government to provide Part D drug coverage to people with Medicare. In Medicare Advantage plans, the Medicare private option through which private health insurers contract with the federal government to deliver Medicare benefits, Part D coverage is usually administered by the insurer offering the Medicare Advantage plan.

    Here’s how Medicare Part D coverage works in 2021 and what to consider before choosing a Part D drug plan, along with how to enroll in Part D and Part D premiums. In choosing among Medicare Advantage plans, in addition to considering your deductibles and copays for medical and hospital services, you should factor in your prescription drug costs. Your costs could differ considerably in different Medicare Advantage plans.

    • Part D drug plans usually have a deductible, which can require you to pay up to several hundred dollars out of pocket before your coverage kicks in. In 2021, the defined standard benefit deductible is $445. Enhanced drug plans generally have low or no deductibles and cover a wider array of drugs, but they charge higher monthly premiums.
    • After you pay your deductible, your drug plan covers 75 percent of your drug costs. During this “initial coverage period,” you pay 25 percent coinsurance until your total drug costs reach $4,130.
    • If your drug costs are higher than $4,130, you will spend 25 percent of the drug plan’s cost for covered brand-name drugs and 37 percent of the drug plan’s cost for covered generic drugs until your total out-of-pocket costs reach $6,550 ($10,048 in total drug spending.)
    • If your income is low, you may be eligible for the “Extra Help” program, which helps cover your coinsurance costs.
    • No matter which Part D plan you choose, after you have paid $6,550 of your own money for covered drugs, Medicare will pick up 95% of the cost of your drugs. You will pay the greater of 5 percent of the cost or $3.70 for generic drugs and $9.20 for brand-name drugs.

    Keep your costs down: Unfortunately, if you take a lot of high-cost drugs, unless your income is low and you qualify for Extra Help or another low-income program, there is no limit on your out-of-pocket drug costs. No matter what your drugs cost, you can save a lot of money if you do your homework when picking a Part D plan. Each drug plan has different premiums, deductibles and copays and covers different drugs under different conditions.

    • Does the Part D plan cover the drugs you take? You want to make sure the drugs you take are on the Part D drug plan’s formulary and about any restrictions on coverage. If you choose a plan that does not cover some of your drugs, you should ask your doctor if you could take the drug on the formulary instead. Or, you should figure out which plan covers the most of your drug costs.
    • Where can you get your drugs? Find out whether you can continue to use the pharmacy you currently use to get your drugs as well as whether you can get drugs by mail order and when you travel.
    • What will your costs be? Ask what your out-of-pocket costs will be for the monthly premium, the deductible, copays for your drugs at in-network pharmacies and the copays at out-of-network pharmacies. If your income is below 150 percent of the federal poverty level ($19,140 for individuals/$25,860 for married couples in 2020) and you have modest assets (less than $14,610 for individuals/$29,160 for couples in 2020), you qualify for help paying your Part D costs under the Extra Help (Low-Income Subsidy (LIS) program.)
    • Is the drug plan in your service area? If you are enrolled in traditional Medicare, you must choose a drug plan in your service area, so you should understand what that area is.

    You should also check to see whether you are eligible for a state pharmaceutical plan.

    Enrollment: If you have traditional Medicare, you can call Medicare at 1-800-633-4227 to sign up for Part D at the same time you sign up for traditional Medicare, so that you have full coverage. Most Medicare Advantage plans fold Medicare Part D coverage into their benefit package. Again, if your income is low, you may be eligible for help paying the cost of this coverage. And, if you’d like, you can ask to have your Part D premium deducted from your Social Security check.

    Click here for Medicare’s plan finder tool that can help you choose a drug plan. It will tell you which drugs a particular plan covers at any given time.

    Keep in mind that each Fall you will need to study your options if you want to keep your costs down, since most drug plans, as well as Medicare Advantage plans that offer drug coverage, change their premium, deductibles, copays and the drugs they cover from one year to the next. The average drug plan monthly premium is around $33, but the premium can be a lot higher. Premiums, copays and coinsurance vary tremendously depending upon the plan you choose.

    If you use insulin, look into plans that offer low-cost insulin under a new Trump administration initiative.

    Medicare charges you a higher premium if your income is above $88,000. That additional premium for your Part D drug coverage will be as low as $12.30 if your income in 2019 was above $88,000 and no more than $111,000, and as high as $77.10 a month if your annual income in 2019 was above $500,000.

    NB: Because out-of-pocket costs for drugs can be very high, Kaiser Health News reports that millions of people who use a lot of costly drugs buy them from abroad at far lower cost.

    Here’s more from Just Care:

  • What are the major differences between Medicare for all and a public option?

    What are the major differences between Medicare for all and a public option?

    The latest Kaiser Family Foundation health tracking poll reveals substantial public confusion about various health reform proposals. Americans do not understand major differences between Medicare for all and a public option. Here’s a cheat sheet.

    Would both Medicare for All and a public option cover all Americans? Would they both require people to pay monthly premiums? No. Medicare for All is designed to guarantee all Americans health care coverage automatically. It would be paid for much like Social Security, public schools, and police departments. Medicare for All does not require people to pay monthly premiums.

    Rather, with Medicare for All, premium contributions that once went to private health insurers would go to the government in the form of taxes, based largely on income. Everyone would be covered by single-payer, public health insurance. Instead of paying private premiums, you would pay an income-based tax, effectively a public premium. Yet, 44 percent of people surveyed did not understand that they would not need to pay monthly health insurance premiums with Medicare for All.

    In stark contrast, a public option, which could be designed in a variety of ways, would likely work more like private health insurance today, requiring you to pay a monthly premium. Still, 50 percent of people surveyed did not understand that they would have to pay a monthly premium for their coverage. Moreover, 53 percent of people surveyed thought the public option would cover everyone, which is not at all clear.

    A public option would not likely guarantee coverage to all Americans, unless the federal government increased taxes enormously to pay for it. And, no one is proposing a sizable tax increase to cover the cost of the public option; rather, proponents, like Pete Buttigieg, are saying that a public option would not raise taxes significantly. Consequently, people could opt not to pay their premiums. And, it’s more than likely many people would not be able to afford their premiums, since the public option would not rein in health care costs substantially.

    Would both Medicare for All and a public option require people to pay deductibles and copays? No. Medicare for All eliminates deductibles and copays. But, more than six in ten Americans don’t understand that people would not pay deductibles or copays with Medicare for All. And, more than three in ten Americans do not understand that people would continue to pay deductibles and copays with a public option, as the do today.

    How about unrestricted access to doctors and hospitals?  With Medicare for All, you can use whichever doctors and hospitals you would like. But, a public option builds on our current system and likely would allow provider networks, restricting access to doctors and hospitals.

    What about costs? Only Medicare for All reins in health care costs substantially. It is estimated to save middle-income households 9.6 percent of their annual income. Medicare for All creates significant savings because it eliminates private health insurers and, with that, about $600 billion a year in administrative costs. It also cuts prescription drug costs in half. A public option could not save much money. It would cut prescription drug costs, but it keeps all the administrative waste in our health care system.

    And, what happens to private health insurance? With Medicare for All, your primary insurance is public insurance; you could not keep your private health insurance. Still, almost half of Americans do not understand that Medicare for All would not allow them to keep their current health insurance; that’s key to bringing down costs. About 40 percent believe that a public option would not allow them to keep their current health insurance either, though it would.

    Here’s more from Just Care:

  • Programs that lower your costs if you have Medicare

    Programs that lower your costs if you have Medicare

    Medicare only covers about half of a typical person’s health care costs. So, even with Medicare, many people struggle to afford premiums, deductibles and other out-of-pockets health care costs. Some people qualify for Medicare, which fills most of the gaps in Medicare. But, if you do not qualify for Medicaid, there are other programs that lower your health care costs.

    1. Medicare Savings Programs. Depending on your income, Medicare Savings Programs, administered by Medicaid, help pay for Medicare premiums and coinsurance, even if you don’t qualify for Medicaid. There are three programs, Qualified Medicare Beneficiary (QMB), Specified-Low Income Medicare Beneficiary (SLMB) and Qualified Individual (QI). Income and asset limits, and how they are counted, are listed below for 2018, but vary somewhat by state. You should apply through your local Medicaid office.
      • Qualified Medicare Beneficiary (QMB)—100 percent of federal poverty level (FPL) + $20
        • Income limit monthly depends upon where you live but is around
          • $1,061 for individuals
          • $1,430 for couples
        • Asset limit
          • Individuals: $7,730
          • Couples: $11,600
      • Specified Low-income Medicare Beneficiary (SLMB)—120 percent of FPL + $20
        • Income limit monthly depends upon where you live but is around
          • $1,260 for individuals
          • $1,711 for couples
        • Asset limit
          • Individuals: $7,730
          • Couples: $11,600
      • Qualifying Individual (QI)—135 percent of FPL +$20
        • Income limit monthly depends upon where you live but is around
          • $1,428 for individuals
          • $1,923 for couples
        • Asset limit
          • Individuals: $7,730
          • Couples: $11,600

      No matter what state you live in, the first $20 of your income and the first $65 of your monthly wages are not counted as income. In addition, half of your monthly wages, after the first $65 is not counted, nor are food stamps. Some of your assets are also not counted, including your primary home, if you own it, your car, your wedding and engagement rings, a burial plot and $1,500 in burial funds, your life insurance with a cash value less than $1,500, and your furniture, household and personal items. Your bank accounts, stocks and bonds are counted.

      Tip: If your income is low but too high to qualify you for Medicaid, it is worth looking into whether you qualify for any of these programs. According to MACPAC, an independent agency that advises Congress on Medicaid policy, less than a half the people over 65 who qualify for the Qualified Medicare Beneficiary program (48%) are enrolled. And, an even smaller share of people over 65 who qualify for the Specified Low-Income Medicare Beneficiary program (28%) are enrolled. About one in seven people over 65 (15%) who qualify for the QI program are enrolled.

    2. Extra Help with Medicare Part D prescription drug coverage: You may qualify for Extra Help, a program administered by Medicaid, which pays for some or all of the cost of your drug coverage. The amount of help with cost-sharing depends on the level of your income and assets. In 2018, you may qualify if you have up to $18,735 in yearly income ($25,365 for a married couple) and up to $14,390 in assets  ($28,720 for a married couple). With Extra Help your drug costs are no more than $3.40 for each generic/$8.50 for each brand-name covered drug. And, depending upon your income, you may pay only part of your Medicare drug plan premiums and deductibles. You get Extra Help automatically if you have Medicaid or a Medicare Savings Program or receive Supplemental Security Income benefits. You can apply for Extra Help online here. (Some states have State Pharmaceutical Assistance Programs that provide even more assistance.)
    3. Federally Qualified Health Centers (FQHCs) and other programs run by the Human Resources and Services Administration: FQHCs are located across the country and provide a wide range of services to underserved populations and areas on a sliding-feed scale. They might waive the Medicare deductible and coinsurance, depending upon your income.
    4. Hill-Burton programs offer free or reduced care at Hill-Burton facilities in 38 states. Hill-Burton does not cover services fully covered by Medicare or Medicaid. Eligibility depends on your family size and income.
    5. Veterans’ Administration: If you are a vet, the Veterans’ Administration (VA) offers low-cost services and prescription drugs directly. And, you can have VA coverage as well as Medicare.

    Keep in mind that you may be eligible for Medicaid based on your income after paying for some health care costs. To contact your state Medicaid office, click here.

    Here’s more from Just Care:

  • Health care costs continue to rise faster than inflation

    Health care costs continue to rise faster than inflation

    Americans want Congress to address out-of-control health care costs; these costs have been Americans’ top policy concern for several years. Until Congress acts, costs likely will continue to rise. Axios reports that in 2018, Americans spent $3.65 trillion on health care, 17.7 percent of the economy. 

    Health care spending grew by 4.6% between 2017 and 2018. It grew even more than in the previous year, when it grew by 4.2%. Both years, higher prices, not an increase in utilization, fueled the increase. According to federal actuaries, corporate health insurers and corporate Medicare plans did not rein in health care prices. 

    Corporate health insurers have an incentive to allow provider rates to increase. The more they pay providers, the more they can charge in premiums. The more they charge in premiums, the more they can profit.

    Higher health care costs in 2018 as well as in 2017 led to a one million person increase in the number of uninsured in each of those years. At the end of 2018, there were 30.7 million uninsured. Health insurance premiums are up, as are deductibles. In 2018, deductibles were $500 higher than a decade earlier, $1,400 as opposed to $900.

    The number of people with corporate health insurance–largely employer-based coverage–dropped a bit in 2018. But, the per capita cost of private health insurance rose by 6.7 percent to $6,199 a person. Hospitals, doctors and pharmaceutical companies were able to secure significantly higher rates from insurers, leading to higher insurance premiums.

    In 2018, total health care costs average around $11,000 per person. About one third of that cost was for hospital care. About one fifth of the cost was for medical care. And, about nine percent was for retail pharmacy costs.

    Medicare and Medicaid, public programs, experienced much slower growth than corporate health insurance, 2 percent and 3.7 percent as compared to 6.7 percent. Corporate Medicare and Medicaid insurers were responsible for increases in these programs’ spending.

    The National Business Group on Health expects that premiums will increase 5 percent for workers and their families in 2o2o. The average cost of workplace coverage will be $15,375, up from $14,642. Employers typically pay about 70 percent of premium costs for individuals and families.

    Workers will be responsible for an average of $4,500 in premiums in 2020. In 2018, the average household spent more than $5,000 on health care, double what they spent on health care 34 years earlier, in 1984.

    Here’s more from Just Care:

  • What are Medicare premium and other costs in 2020?

    What are Medicare premium and other costs in 2020?

    The 2020 standard monthly Medicare Part B premium, which covers medical and outpatient care, rises to $144.60. It represents a monthly increase of $9.10, from $135.50 this year, for people with incomes of $87,000 or less.
    Social Security benefits are increasing in 2020, up 1.6 percent from this year, an average of $24 a month. Some of that increase will go towards the higher Medicare monthly premium. But, most people will have about $15.00 more a month after paying the higher standard Medicare Part B premium.
    In 2020, 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:
    • $202.40 a month, if their income is above $87,000 and no more than $109,000.
    • $289.20 a month, if their income is above $109,000 and no more than $136,000
    • $376.00 a month, if their income is above $136,000 and no more than $163,000
    • $462.70 a month, if their income is above $163,000 and no more than $500,000
    • $491.60 a month, if their income is above $500,000

    For couples with combined incomes under $326,000 filing a joint tax return, the premium amount is double the individual income. Couples with incomes between $326,000 and $750,000 each pay a $491.60 monthly premium. And, couples with incomes over $750,000 each pay a $491.60 monthly premium. Visit this CMS web site if you are filing separate returns

    Part B annual deductible: $198, an increase of $13 from the annual deductible of $185 in 2019.

    People with incomes up to 135 percent of the federal poverty level, ($1,426 in monthly income for an individual and $1,923 for a couple in 2019; these amounts may increase in 2020) 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 2020 Part A costs:

    • There is no Part A premium if you or your spouse have at least 40 quarters of coverage.
    • The Part A premium if you or a spouse has at least 30 quarters of coverage is $252 a month; if you don’t have at least 30 quarters, the premium could be $458 a month.
    • The Part A inpatient hospital deductible is $1,408, an increase of $44 from $1,364 in 2019, and daily coinsurance for hospitalizations after day 60 is $352 a day in a benefit period; coinsurance for lifetime reserve days is $704 a day.
    • The Part A daily coinsurance for skilled nursing facility stays after day 20 is $176, an increase of $5.50 from $170.50 in 2019.

    Here’s more from Just Care:

  • Ten ways Medicare Advantage plans differ from traditional Medicare

    Ten ways Medicare Advantage plans differ from traditional Medicare

    There is a lot of confusion surrounding Medicare Advantage plans–commercial health insurance for people with Medicare–and the ways Medicare Advantage plans differ from traditional Medicare. You may hear about their low upfront costs relative to traditional Medicare and their “extra” benefits. But, they do not provide you with the same access to care you get with traditional Medicare, and your out-of-pocket costs can be many thousands of dollars.

    Medicare Advantage plans are supposed to deliver all the benefits of Medicare, but a slew of federal government audits reveal that they too often do not meet the needs of people with costly conditions. These audits show that many of them engage in inappropriate delays and denials of care and coverage, threaten the health and safety of their members, have highly inaccurate provider directories and overbill the federal government billions of dollars a year. They have all of the core failings of commercial insurance–for individuals, for taxpayers and for the public good.

    1. Restricted choice: Medicare Advantage plans limit the doctors and hospitals enrollees can use and have little incentive to include providers who deliver value in their networks. They do not compete with one another to deliver high value care and meet the needs of Americans who need costly care. If they attract people with costly conditions, they profit less. For this reason, sicker people are more likely to disenroll from them.
    2. Meaningless choice: Medicare Advantage plans do not disclose what they charge people out of pocket when they need costly care and which doctors and hospitals they will be able to use. They have never disclosed even average out-of-pocket costs to their members for costly care.
    3. Inequitable: Medicare Advantage plans shift costs to people most needing care; high deductibles, copays and an out-of-pocket cap that can be as high as $6,700 each year, for in-network care alone, undermine access and ration people’s care based on their ability to pay.
    4. Unreliable coverage: Medicare Advantage plans cannot offer reliable coverage or continuity of care as they are constantly changing the products and services they offer, the providers in their network, as well as their enrollees’ cost-sharing obligations. And, at times, they are pulling out of the market altogether. Moreover, according to the US HHS Office of the Inspector General, they engage in widespread inappropriate delays and denials of care and coverage.
    5. Unsustainable: Medicare Advantage plans cannot rein in costs or slow down the rate of growth in health care spending. They simply shift increasing costs onto their members.
    6. Inefficient: Medicare Advantage plans drive up costs through the time, money and personnel they require for billing and other insurance-related administrative activities.
    7. Profit-driven: With a few notable exceptions such as Kaiser, Intermountain and Geisinger, Medicare Advantage plans are obligated to put their shareholders first, with incentives to maximize profits and delay and deny medically necessary care.
    8. No innovation for the public good: Medicare Advantage plans have no incentive to innovate for the public good or disclose information about medical protocols, devices and other treatments that would benefit the public at large. What they learn about what’s working and not working in our health care system, they tend to keep to themselves.
    9. Unaccountable: Medicare Advantage plans treat much of their operations as proprietary, preventing needed oversight and public understanding of areas where they are failing consumers. According to the Medicare Payment Advisory Commission, MedPAC, they have failed to disclose complete and accurate data regarding the health care services their members receive, though required by law for effective oversight.
    10. Unethical: Medicare Advantage plans engage in fraudulent and illegal behavior. The federal government cannot always oversee them effectively and hold them accountable for inappropriate behavior, let alone illegal activities.

    With Medicare for All, there would be no need for Medicare Advantage plans. Everyone would have an improved and expanded Medicare, with freedom to use the doctors and hospitals of their choice anywhere in the nation without worry about the cost.

    If you support Medicare for All, please let your members of Congress know. Sign this petition.

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