but they now are in the business of selling ins, more now than ever. and let me tell you getting bills for fil (now in nursing home and on Medicaid can be mind boggling...one week fil had a $7 grand bill for nursing home and 3-4 day stay in hospital that was over $42,000....(they couldn't get rid of something that was leaving him in isolation)

I carry AARP's United Healthcare and am quite contented with the job that it does. It pays half of the 20% that Medicare does not pay and between the two medical coverages...companies, hospitals, medicos are not entitled to any further payments from me, personally. Perhaps this means less to people who can afford to pay additional medical expenses...but I cannot.

An example: Before I had an allergic reaction to Eylea [eye inject-able for macular degeneration], Medicare was being billed $2,300 per shot. Medicare approved and paid $1,961 for each shot. Aetna/United Healthcare picked up and paid half of the remaining balance due that Medicare did not cover. I had nine shots. Without Aetna/United Healthcare's coverage, I, personally, would have been billed $2,790. Aetna, UH negotiated to pay half of that amount and that settled the entire billed amount. The medico can go back to my healthcare carriers and push for more payment...but they don't come after me for a penny. Plus...I never pay a co-pay for anything. Aetna/UH pays them for me.

I currently pay $2664/year for my supplemental coverage. Just the $2790 noted above exceeds that amount and that's just one such billing.

The 20% that you're citing may not be nearly as minimal as you make it sound. Best to re-examine that 20% for individual cases...not as just a numerical figure that sounds minimal when it may not be. My deceased husband died after 20 months of pancreatic cancer and infection related sepsis. His medical expenses for just one year of treatment exceeded a half a million dollars. I never paid a penny over what Medicare and our supplemental approved. Had I not had good medical reimbursement coverage...I wouldn't be sitting here at my desk typing away on my computer keyboard.

20% of half a million dollars is a lot of money to anyone. I'm very grateful for my medicare insurance coverage.

I agree in part, I dislike them. But AARP isn't a front organization for anything but they do sell membership lists and license the use of the organization's name for pseudo-endorsement in return for $$$. That's what you're referring to with UHC.

As is the case with too many organizations that (at least) began with intentions of looking after the greater good, AARP seems to have evolved into an organization that is usually looking out for itself primarily.

Consumers Union is another. I find its magazine moderately useful (when taken with a bit of skepticism and recognition that it has its own agenda to pursue) but I'm annoyed that some of my money indirectly funds its political activism in directions I disagree with.

That's just how the world is.

I didn't subscribe to my UH coverage via an advertisement or mailing. I went through AARP directly and I did so because they had negotiated a coverage contract with UH that exceeded what I would have gotten had I gone to UH directly...and for a better price.

I get as annoyed as the next guy over the stuff being pushed at seniors...and occasionally drag out my soap box to voice my disgust...but I can't...and won't...do it in this case. AARP did me no harm and in fact, saved me some hard earned coins. They've done it where my auto insurance is concerned, as well. I'm an avid comparison shopper...for everything...and believe me...if AARP had scalped me...I wouldn't be using them.

As for Consumer's Union...don't get me started. LOL I used to respect them. No more!

I'm not slamming the insurance. I'm angry about an ad that leads a senior who is on or new to Meidcare to believe he will pay 20% of some inflated provider bill when he will NOT. (He'll pay 20% of the Medicare adjusted bill.)

United isn't the only company to do this, but they have the AARP connection. Presumably AARP could make them stop the scare tactics.

I forgot that, anne, there are AARP discounts that are indeed worthwhile. I'm glad you could take advantage of that for insurance. My wife joined with travel-related discounts in mind, for hotels and car rentals (we don't belong to AAA).

Thank you for a further explanation, Sue. With that...I agree wholeheartedly...with you. Because I've always been satisfied with my personal coverage I admit that I tend to turn a deaf ear/eye to insurance advertisements. Perhaps it's time I paid better attention. Nothing "irks" me more than seeing a senior being taken advantage of by glib verbiage. I spend a lot of personal time trying to educate my small circle of seniors in these matters. Sometimes I'm successful. Sometimes not. Lately I have a huge annoyance with all the "personalities" sponsoring reverse mortgages. I think those ads should be outlawed. But that's another subject altogether. :-)

I'm not usually a joiner, Snidely [as in signing on with AARP]...but when it became necessary that I had to provide my own coverages...I researched the major senior advocate [AARP] to see what they could do to help me. They haven't failed me yet and on that basis alone, I'll defend them. I wish I could take advantage of some of the more pleasurable discounts they offer...but, alas, if they just continue to save me medical expenses...I'll remain happy. Plus....miracle of miracles in this day and age...a live personal answers their phone and is always gracious whenever I've needed that extra little piece of information. :-)

Oh, please. If you want to target misleading TV commercials, you could easily find a lot worse than AARP. I'm not even much of a television watcher, and I see infuriating, objectionable ads all the time. I've posted here before about how "truth in advertising" seems to have disappeared.

I'm happy with my AARP United Health Care insurance. I had their prescription drug plan as well until this year when I switched to the Walmart/Humana plan. At $17 a month, it was $30/mo. cheaper than the AARP, and since I don't take any prescription drugs on a regular basis I figured it would be worth a shot. After picking up a prescription for doxycycline last week, I'm not so sure. I had to pay $62 for 15 days worth. I'll probably need two refills, and this could eat up my monthly savings in a hurry.

I try to at least flip through AARP's two publications each month because I've found a lot of useful information in them. Insurance or no insurance, AARP remains the most powerful lobby in Washington for seniors.

Alisande,

Just a heads up. There is a loophole in the law that allows companies to sell antibiotics without a prescription for use on fish. The loophole has been widely exploited and many antibiotics including doxycycline are available cheap on Ebay.

The capsules appear identical to ones sold by a pharmacy.

People should use their own judgment and discretion, I just thought I would mention it.

Yikes!!

This is a serious health matter. Rolling the dice like you suggest Lucille doesn't seem like a great idea. Anyone considering this should contact me, I'd send you a check. (Offer limited to those who have expressed agreement with one of my posts in the past)

The article is interesting, Snidely. It certainly paves the way for some very interesting discussion.

"AARP's arguments on the Medicare bill ought
to be considered on their merits. But powerful groups like AARP don't
win arguments simply through pure logical force – they also leverage the
authority of their name."

And to that almost closing statement I ask...Why shouldn't they use their name?! They've built a strong, viable company...the "American way" from what I can see...so why shouldn't they use whatever legal leverage they have earned to represent their products as well as their membership.

If government succeeds with disallowing first dollar coverage...they're going to do monetary harm to not only those seniors who need it the most...but to themselves. They'll force a needy population back to knocking on government's doors for replacement of what government is thinking taking away. If common sense is applied to this type of thinking...it's a completely illogical circle of political proffering offering little, if any, monetary solution to either party involved. For shame!

Medicare is an extremely flawed system at best. It's very poorly monitored [which I can attest to on a personal basis having tried several times to get them to refuse reimbursement for chemotherapy charges that were bogus] and they're seemingly incapable of policing themselves. It pays out billions of dollars every year in illegal claims. If it would clean up its own house and pay closer attention to its reimbursement procedures, there'd be no need for disallowing first dollar plans.

I could ramble on but my diet controlled 120/80 BP would probably take an upward turn for the worse and I'd have to look to medicare for medication reimbursement to bring it back down to earth. Tsk! Tsk! :-) Besides...I'm quite sure you see the direction I'm taking.

Thanks for the additional info.

I help a 91 year old woman with some errands. She never got (or was even eligible for) supplemental insurance. She had a sinus procedure in the doctor's office (the only ENT group in the area) and was billed the excess of more than $1000 over what Medicare paid. She has very limited SS income, section 8 housing assistance, and would never be able to pay that, except at maybe $25 a month. It went to collections. We did explain to the doctor and then to the collection agency that they cannot attach her SS income, so no further action. But she's now reported as a deadbeat.

Yeah, that would scare some people. I'd rather have the supplemental insurance.

In California it's called Medical. In the rest of the country...to my knowledge...it's called Medicaid. Sushipup...she may be eligible for Medicaid as well as Medicare. If she is...and she applies...Medicaid [or Medical] will cover most [or in some cases...all] of her medical insurance premiums...thereby making her financially able to get a supplemental policy. I don't know what State you live in so my advice should be judged applicable by what your State allows.

As for paying as little as $25/mo...in my State...a medico must accept any payment offered as long as it's paid on a regular basis and in good faith...without listing the payee as delinquent or indigent.

I have an acquaintance who was so financially strapped that she could not pay the entire cost of the birth of her second child. Her husband had unexpectedly lost his job during their pregnancy through no fault of his own. All their insurance was discontinued. She discussed her situation with the hospital and they agreed to accept her terms. She paid $5/wk until the bill was settled in full. It took a while...as you might imagine...but all involved parties were satisfied and their pride left in tact. IMO...the good will earned far outweighed the monetary reimbursement...and obviously, those medicos involved agreed with me.

Your friends doctor's humanity certainly needs some serious attention. How very sad to put her through such stress and embarrassment.

I will be 66 in August. When I turned 65, I was enrolled in Medicare Part A. I was able to defer Medicare Part B because although I had recently retired, my husband was still working and I was covered under his (CalPERS ) PERSCare Blue Cross PPO (basic) health care plan. Now that he has retired (two months ago), I had to sign up for Medicare Part B, and my Blue Cross PPO basic plan was converted to the Blue Cross PPO Medicare Supplement plan.

It's my understanding that most (if not all) basic health insurance plans cover 80% -- and that 80% means 80% of the amount allowed by the insurance carrier. The insured then is responsible for the remaining 20% of the allowed amount. So why would any person, just because they are now a senior, think that they would be responsible for 20% of whatever outrageous amount is billed?

In my case, my Blue Cross PPO Medicare Supplement plan picks up (i.e., pays for) that 20%. It also pays 100% of the Medicare Part A deductibles and 100% of the Medicare Part B deductibles. It also includes prescription drug coverage with no coverage gap.

And we're lucky in that the amount that the state contributes to retirees health care coverage pays for the monthly premium for hubby's basic plan, my supplement plan, and the monthly Medicare Part B premium and monthly IRMAA premium.

Sushipup1 -- as far as I know, everyone is eligible for a supplemental plan, but if they don't sign up when they first become eligible for Medicare (or, as in my case, after an allowed deferral ), they might have to qualify for the coverage -- just as a person can be denied life insurance for existing conditions. But, also as far as I understand, during the open enrollment period this year your friend could sign up for a supplemental plan.

Now, as for what the ENT charged....

A provider is a Medicare participating provider if they agree to charge only the Medicare-approved fee for all services (they write off the amount Medicare doesn't cover). The patient pays the 20% of that approved fee that Medicare doesn't pay.

A nonparticipating provider is one who sees Medicare patients and sends a bill to Medicare, but does not accept the Medicare-approved fee as the full fee for the service provided. The provider can charge the patient up to Medicare's limiting charge.

Medicare lowers its approved fee by 5% for nonparticipating providers. In other words, the approved fee for a nonparticipating provider will be 95% of the approved fee for a participating provider. Then, the nonparticipating provider can charge the patient 115% of the lowered (95%) fee. If you do the math, it works out to the nonparticipating provider's fee being 109.25% -- that is, the maximum you can be charged by a nonparticipating provider is 9.25% more than Medicare's approved fee.

There is a third type of provider -- one who doesn't get involved with Medicare at all. They don't submit a bill to Medicare and won't accept any fee limitations by Medicare. They reject Medicare. They will see patients who are on Medicare, but only after the patient signs a contract stating that they understand these terms and agree to pay the provider's full fee themselves. However, that provider must inform you if the service to be provided would be covered by Medicare if rendered by a provider who sees Medicare patients.

So, either the ENT is a participating provider who violated Medicare's rules and charged more than the limiting fee (in which case he should be reported to Medicare), or else your friend signed a contract to be seen by a provider who rejects Medicare and she agreed to pay his entire fee. But, yeah, if she can't afford it, she can't afford it. Because her only income is SS which cannot be garnished, she is what is referred to as "judgment proof."

She did not sign up for supplement plan when they first became available. She could never pass any qualifications for it now (diabetic, blind). Her income is two hundred dollars more than could qualify for MediCal. And it's the only ENT provider in a city of 125,000 people.

When I said I was happy with my AARP United Health Care supplemental policy (Medicare Part C), I should have added that when I turned 65 I started out with Blue Cross/Blue Shield's policy.

Correct me if I'm wrong, but it is my understanding that the Medicare supplements are standardized: Medicare Part C is Medicare Part C, with identical coverage no matter who supplies it or how much it costs. In my case, the BC/BS policy cost way more than the AARP recommended policy, even though the coverage was the same. When I realized this, I switched.

You are correct. Plans are standardized (more proper to say Medicare or Medigap Supplement C, because Medicare Part C is actually something else.) This insurance is sold by a number of providers and prices vary. Another thing to know: you cannot change to a higher benefit plan without qualifying. Only when you first are eligible for the insurance do you have no medical qualifying stipulations. So if you want to move up to a Plan F, for example, you have to pass all medical scrutiny. It is not the same as Medicare Part D plans. You can change Medigap plans once a year, same as Part D (altho at different times of the year.) If you did not buy Medigap when you first signed up for Medicare Part B, then you will have to pass physical tests, and pre-existing conditions, etc.

Thanks for clarifying, Sushipup.

Lucille, that is so interesting! Given the way I've been feeling, I don't think I'll take a chance on fish doxy from eBay this time, but I'll look further into this. I read once that veterinary pharmaceuticals are subject to more stringent testing than products intended for humans. I don't know if that's true, though.

What does the enormous price difference say about the manufacturer's marketing practices?

alisande, doxycycline is a generic drug, not a brand product. No manufacturer has control of the market, there are many producers of it worldwide, so no company's marketing practices are involved. The problem with stratospheric US drug prices (for branded products, at least) could be easily fixed with a couple of federal law changes to give us rules and practices that more closely parallel how it is in other countries. Unfortunately, it's a political hot potato that politicians are unwilling to address.

Buying this or any drug from ebay, or any other non-mainstream seller, is likely to get you something made in India, or Uganda, or (fill in the blank) that was produced with no regulatory inspection or oversight. And is it the drug you think it is? Often not.

Veterinary drugs? Many (not all) are lower dosage forms of human drugs, whose use relies on trials and testing before approval for human use. They're sometimes from the same sources.

Thanks, Snidely. I wasn't thinking--I'm so used to calling it doxy that I forgot it was the generic name. I've had to take it several times over the past 5 or 6 years. It used to be a cheapie, but no more!

My BC/BS Medigap policy costs $888/year. It's the high-deductible version of Plan F. I assume a risk of $2800 out of pocket, after which the policy pays everything Medicare does not pay. Last year my OOP was under $300, so my care/coverage cost $1188 plus Part B ($1260). I was 'money ahead'.

This spring I was hospitalized for four days for pneumonia, admitted through the ER.

The insurance ads would have me believe I would pay 20% of a provider's charges. My hospital charged $18,000 for ER and four days of room and board, pharmacy, EKG, etc. Do I owe 20% of $18K? I do not. I owe $1260 on this portion of my charges -- after Medicare adjustments and Medicare payments.

There are also, of course, doctors' charges -- before the hospitalization, during it, and following it. From January 1 until June 1 my OOP -- including the hospital's fees -- total $1800. Last year I was 'out' $1188, and $1700 ahead of having bought a non-deductible Plan F. This year I'm 'out' $2688, but still ahead, and still protected. The most I can pay is $3688. I would have already been out $2800 just in premiums for the non-deductible plan.

I digress. My main point is that nobody should believe they will pay 20% of what a Medicare licensed provider charges on that first inflated bill. The ads are specific to Medicare coverage. They do not say that your 20% may well be less than the policy costs. (My $300 OOP for all of 2014 versus a Medigap premium of $2800 for a non-deductible Plan F.)

"veterinary pharmaceutical"

Are there differences in capsule appearance between medication meant for human consumption and this produced for animal consumption? I don't know. I put the info out there because it is an interesting loophole. I would doubt that fish need dosage controlled capsules, and if I had to guess, I would think these are not produced for fish..