Talk:Medicare (United States)/Archive 2

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


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


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

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

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

Possible changes for factual accuracy
(in order of presentation not importance)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Possible changes for factual accuracy
)== Possible changes for factual accuracy ==

(in order of presentation not importance)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Unfunded Obligations?
The unfunded obligations section says the new reform will reduce the unfunded obligation to 3 trillion. I looked at source for this and it's the: "2011 ANNUAL REPORT OF THE BOARDS OF TRUSTEES OF THE FEDERAL HOSPITAL INSURANCE AND FEDERAL SUPPLEMENTARY MEDICAL INSURANCE TRUST FUNDS"

I'm not too sure (which is why I'm not editing it) but there's a footnote in the report (footnote 41) that indicates it's numbers are assuming the SGR is implemented. Because of Congress' track record on the SGR, I think this should be called out in the wiki article. Assuming the footnote applies to the reduction that is. 130.164.67.183 (talk) 16:53, 25 May 2012 (UTC)

Misleading sentence
"Medicare serves a large population of old, sick, and low-income people, many of whom would be unable to afford health care otherwise."

It also serves high-income people. This sentence is expressing the intention of Medicare as if the result were as intended. --Coching (talk) 22:21, 29 June 2012 (UTC)

Premium support rewrite
The subsection on Premium support in this article doesn't provide a clear description for the basic concept and is missing information to balance criticisms. I've worked on some changes to the section, adding in a clearer description of the main idea behind premium support proposals that have been made and responses to criticisms. This rewrite also removes the following two portions of the existing section, which were unsourced or not supported by the source included:


 * Even if required to offer coverage to everyone, they might market their plans to healthy people, impose high co-pays on people who need care for a serious condition, exclude from their networks the doctors and hospitals that people in poor health might want to see, or otherwise make themselves less attractive to the most vulnerable. Risk adjustment, a technique that the government can use to reallocate payments to health plans based on the health status of their enrollees, can help mitigate this problem. But research suggests that Medicare Advantage plans, which receive risk-adjusted payment, have been quite successful at identifying the people with the greatest health care need within  each risk category and pushing them out in order to minimize their costs.


 * It is also unclear whether the plan would guarantee people with Medicare the same benefits they have today or whether health plans could offer limited coverage at low cost, which would reduce costs for enrollees who were healthy, but shift more costs to people in poor health. The plan has yet to be scored for savings.

For the first portion, the source provided does not support the statements made about the potential impact of premium support on beneficiaries or those about risk adjustment. The source used focuses on Medicare Advantage but provides no comparison with premium support, so its use here to draw a conclusion about premium support seems like editorialization to me. The second one I removed due to lack of support for the statements.

The section is fairly long so I've put my rewrite into a "collapse box":

Premium support:

Since the mid-1990s, there have been a number of proposals to change Medicare from a publicly run social insurance program with a defined benefit, for which there is no limit to the government’s expenses, into a program that offers “premium support” for enrollees. The basic concept behind the proposals is that the government would contribute a set share of payment, ie. a defined contribution, for premium Medicare enrollees' basic health services. Insurers would compete to provide Medicare benefits and this competition would set the level of fixed contribution. Additionally, enrollees would be able to purchase greater coverage by paying more in addition to the fixed government contribution. Conversely, enrollees could choose lower cost coverage and keep the difference between their coverage costs and the fixed government contribution. The goal of premium Medicare plans is for greater cost-effectiveness; if such a proposal worked as planned, the financial incentive would be greatest for Medicare plans that offer the best care at the lowest cost.

There have been a number of criticisms of the premium support model. Some have raised concern about risk selection, where insurers find ways to avoid covering people expected to have high health care costs. Premium support proposals, such as the 2011 plan proposed by Paul Ryan, have aimed to avoid risk selection by including protection language mandating that plans participating in such coverage must provide insurance to all beneficiaries and are not able to avoid covering higher risk beneficiaries. Some critics are concerned that the Medicare population, which has particularly high rates of cognitive impairment and dementia, would have a hard time choosing between competing health plans. Robert Moffit, a senior fellow of The Heritage Foundation responded to this concern, stating that while there may be research indicating that individuals have difficulty making the correct choice of health care plan, there's no evidence to show that government officials can make better choices. Henry Aaron, one of the original proponents of premium supports has recently argued that the idea should not be implemented, given that Medicare Advantage plans have not successfully contained costs more effectively than traditional Medicare and because the political climate is hostile to the kinds of regulations that would be needed to make the idea workable.

Two distinct premium support systems have recently been proposed to Congress in order to control the cost of Medicare. The House Republicans’ 2012 budget would have abolished traditional Medicare and required the eligible population to purchase private insurance with a newly created premium support program. This plan would have cut the cost of Medicare by capping the value of the voucher and tying its growth to inflation, which is expected to be lower than rising health costs, saving roughly 155 billion over ten years. Paul Ryan, the plan’s author claimed that competition would drive down costs, but the CBO found that the plan would dramatically raise the cost of health care, with all of the additional costs falling on enrollees. The CBO found that under the plan, typical 65-year olds would go from paying 35 percent of their health care costs to paying 68 percent by 2030.

In December 2011, Ryan and Sen. Ron Wyden jointly proposed a new premium support system. Unlike Ryan’s original plan, this new system would maintain traditional Medicare as an option, and the premium support would not be tied to inflation. The spending targets in the Ryan-Wyden plan are the same as the targets included in the Affordable Care Act; it is unclear whether the plan would reduce Medicare expenditure relative to current law.

I've used a source published by my employer, The Heritage Foundation, and written by a colleague, so I'd appreciate if other editors could read this rewrite to make sure the changes are neutral. Can someone review this and add it to the article in place of the current section if it looks ok? Thanks! Thurmant (talk) 19:59, 26 September 2012 (UTC)


 * Be careful about using the non-neutral Heritage foundation as a source for any topic that has to do with the government. Somedifferentstuff (talk) 09:00, 5 October 2012 (UTC)


 * Thanks for your comment, Somedifferentstuff, I am careful about adding Heritage sources and ask for review of drafted material when I use one. Although the source may be non-neutral I try to only use it to support additions that are balanced overall. Did you read through my draft here? I'd be interested in any feedback you might have. Thurmant (talk) 18:39, 19 October 2012 (UTC)


 * As there haven't been any other replies, although I've asked at a few other places for editors to take a look at this, I've been bold and added the new version into the article. I do feel that my edits have improved the explanation of premium support so that the section is easier to understand and more balanced. Having said that, if anyone has questions or wants to discuss it further, I'd be open to that and ask editors to reply here or leave a message on my Talk page. Thanks! Thurmant (talk) 18:53, 31 October 2012 (UTC)

Part A premiums?
"If you are eligible for premium-free Part A, and you don't buy it when you're first eligible, your monthly premium may go up 10%."

Does not make sense. How can a premium-free part go up in cost by 10%? Dlong2 (talk) 14:19, 21 November 2012 (UTC)

Formatting problem
There is a problem with the section titled "Program history." After the first paragraph, each succeeding one shows as a single line running off the right side of the screen. I am not knowledgeable enough to fix this. I am using Firefox, ver 16.0.2. Alweiss (talk) 17:26, 28 November 2012 (UTC)

Out of date chart in Costs and funding challenges section
The chart highlighting Medicare and Medicaid Spending as % of GDP in the Costs and funding challenges section does not reflect current CBO analysis of the situation and the numbers displayed have since been revised. See the 2012 Long-Term Budget Outlook (Box 1-1 on pages 14 and following) for a discussion of this issue and the evolution of CBO's analysis.

Unfortunately, I haven't been able to find an updated chart, but the chart as is is inaccurate and not current. I recommend deleting it until a more recent chart can be identified.--Ericjwilson (talk) 22:29, 23 April 2013 (UTC)

Updated with a new chart I created. --Ericjwilson (talk) 14:25, 29 April 2013 (UTC)

Not reversed
"Without further continuing congressional intervention, the SGR is expected to decrease physician payments from 25% to 35% over the next several years" - Not from 35% to 25%? SHIMONSHA (talk) 16:20, 17 April 2013 (UTC)
 * This confused me too. Should "decreased" be changed to "increased?" Or should the numbers be switched? Adamh4 (talk) 17:24, 28 March 2014 (UTC)

Image Removed
An image comparing the growth of costs for Medicare vs Private Insurance has been removed by this user. The graph was completely inappropriate and misleading. The horizontal axis started at 1, which may be misleading as the title claimed to compare benefits starting in 1970 (after consideration, the creator must have intended for 1=1970). In addition the last installment on the graph was 41, which exceeds the time span noted in the title (1970-2009, which only spans 39 units if 1970 is taken as 1). In addition, the vertical axis was unlabeled and started likewise at 1, with no clear indication on what was being measured (scalar units of initial costs in the 70's?). The image would benefit from % units with 1970 as a base if this was intended. If anyone would like to add a new image that compares private and Medicare services, please do so. However, this graph was misleading, inaccurate, and poorly constructed. — Preceding unsigned comment added by 66.61.70.84 (talk) 23:45, 23 June 2014 (UTC)

Lede
"As a social insurance program, Medicare spreads the financial risk associated with illness across society to protect everyone..." How does Medicare spread the financial risk to my 3 year old neice, or is she not part of "society"? How about the large proportion of our population who pay zero taxes? Are they assuming part of the financial risk? The quoted claim is obviously FALSE. Conflation of tax-payers with "society", especially given our miserable voter turn-out rate, is falacious logic. To continue, how are those over 65 (and a few others) "everyone"? Again, this is false, and obviously so. My question is: how did this get into Wikipedia? Why hasn't the obvious flaws in this contrafactual nonsense been corrected? Where are the volunteer editors, the ones capable of thought?173.189.76.20 (talk) 13:22, 12 August 2014 (UTC)
 * Technically, for the 3 year old, the financial risk could be considered spread to her as part of her guardian(s) share, but there are many examples that hold much better. With WP:RS and WP:OR in mind, we could maybe modify the lede to say that is the intention, or promise, of Medicare, without saying that is what it actually does. —PC-XT+ 06:45, 23 August 2014 (UTC)

Estimated net Medicare benefits for different worker categories
This entire section seems to have been taken from one book:

Joseph Fried Democrats and Republicans – Rhetoric and Reality Algora Publishing http://www.worldcat.org/title/democrats-and-republicans-rhetoric-and-reality-comparing-the-voters-in-statistics-and-anecdotes/

According to WP:RS, under WP:SCHOLARSHIP, "Articles should rely on secondary sources whenever possible.... Material such as an article, book, monograph, or research paper that has been vetted by the scholarly community is regarded as reliable, where the material has been published in reputable peer-reviewed sources or by well-regarded academic presses."

First, is Algora Publishing a well-regarded academic press? I can't find anything to indicate that it is.

Second, and more important, I can't find any reviews of the book anywhere, even on its Amazon.com page.

Third, I can't find anything about Joseph Fried to indicate that he's a recognized expert himself.

Accordingly, unless someone can demonstrate that this is a WP:RS according to Wikipedia criteria, I'm going to delete the whole section.

I'd like to see a good section on the solvency of Medicare, giving the arguments for and against, in accordance with WP:NPOV and WP:RS. But this section has a way to go.

Any comments? --Nbauman (talk) 01:46, 23 October 2014 (UTC)

Domestic charges only
I didn't notice any statement here that says that US domestic charges only are considered for reimbursement (consistent with all social medical programs). That is, client must use a US hospital, US doctor, located in the US, as well as pharmacy in the US for Part D. Shouldn't that be mentioned somewhere? Student7 (talk) 00:56, 13 May 2015 (UTC)

2050?
The idea of estimating, or attempting to estimate, ANY sort of statistics with regards to this program 35 years into the future is patently ridiculous, bureaucratic, indeed political, doubletalk. Even BEFORE the advent of the Unaffordable Care Act, the state of insurance and healthcare in this country were already in flux, by most estimates in crisis. To adapt such blarney from the official govt webpage is no more supportable than quoting various blogs. If Medicare exists AT ALL in 35 years, it's form will likely be unrecognizable, so such a prognostication is about as accurate and useful as predicting who will prevail in the Super Bowl or the Kentucky Derby 10 years hence. Unless I see a convincing argument on this page within the next few weeks, I will be deleting some stuff. This page can be useful, esp to those (myself included) not familiar with the program. Let's strive for clarity, rather than perpetuating the administrative and political confusion. 2050! Rags (talk) 13:13, 28 May 2015 (UTC)

Incorrect percentage
Under the program history section it says that 65% of people over 65 had insurance but I believe it should say that 65% of people over 65 had NO insurance prior to medicare. — Preceding unsigned comment added by 64.194.66.23 (talk) 23:19, 19 July 2015 (UTC)

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How do you pay for Medicare when you are not SSN? But have your Medicare card? — Preceding unsigned comment added by Doughyboy53 (talk • contribs) 23:38, 7 November 2015 (UTC)

How to pay for medicare — Preceding unsigned comment added by Doughyboy53 (talk • contribs) 23:41, 7 November 2015 (UTC)

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