Help! I’ve Fallen and No Insurance Company Will Take My Voucher!

I am not opposed to lowering Medicare costs.  After all, it is money I have put in and would like it to be around when I need it.  Medicare has been a life saver for many people.  It is a plan that has provided health care treatment without the threat of being dropped.  It doesn’t have any pre existing conditions.  Everyone is welcome.  Every year there is an open enrollment period for supplemental and prescription plans, and anyone can change plans without penalty.

Contrary to popular opinion, it is not free.  Medicare A is free but that only pays for hospitalization.  Medicare B, which pays 80% of doctors bills, has a monthly premium taken from your social security check. There are deductibles, coinsurance and co-pays. Penalties are added if not enrolled at 65 of 1% per month not  enrolled. Supplemental plans or medigap or advantage plans, at a monthly premium cost, will cover what is leftover.  And finally Medicare Part D, the prescription plan, has a monthly premium, copays, coinsurance and a maximum or donut hole.  It is not inexpensive to be fully covered under medicare.

Medicare is not ideal but it has helped many who would have been without any health insurance.

The pressure is now on to change Medicare with the release of the Republican budget.  The proposal is to replace the “entitlement” (my money in the coffers) to a government voucher program. The concept of vouchers is enticing, the love child of the conservative fiscal agenda.  The idea is let people make their own decisions on health insurance.  It has merit in a perfect world.  Ideally, people will make the right decisions about their insurance.  But my experience is people do not understand insurance plans and what is offered.

When I get a new client, I always ask for a copy of their insurance plan.  I read it through including the fine print.  It tells me what the person is eligible for.  It is not uncommon for a client to say to me, “I thought that was covered in my plan”.  For instance, many plans offer hospital coverage with deductible and coinsurance.  It also will state, coverage includes only ONE doctor visit from any specialty a day.  This means if the hospitalist sees you and then the cardiologist or neurologist, only one of the visits is paid for.  Once the insurance denies payment for other visits, the hospital then bills at their highest rate, not the insurance negotiated rate.

A voucher system can only work for the elderly and disabled if the insurance companies do not have control of what is offered and how it is decided.  For instance, will their  be no pre existing conditions for all enrollees?  If pre existing conditions are allowed, many chronically ill seniors will be without insurance.

Will there be a no out of pocket limit?  I can not imagine putting a burden on retirees to worry about cost.  A recent study from Mayo CLinic, showed many seniors don’t take their medications as prescribed to save.  people already make decisions between food and medication.  This cannot be imposed on our senior citizens.

Perhaps most important is medications.  Will seniors once again be forced to purchase all their medications?  Will their be a prescription component?

To leave these decisions to the insurance companies, is to deny too many people health care.  Currently, the back up plan for  people denied care for pre existing conditions is the  high risk pools.  With strict guidelines for insurance companies, the high risk pools will become the receptacle for denied vouchers.  If charter schools are the touchstone for the voucher system, then it is clear people will be denied care as students are denied entry.

How will the public be educated as to the new system?  They think the new healthcare reform act is difficult?  This will be need a tremendous amount of money to get off the ground and educate people.  It is not going to be as simple as saying, here is your voucher, choose a plan.  If that is the attitude and there is no standards for insurance plans, the scam insurance companies offering little and taking seniors money will benefit.

I await a clear definition.