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  • Economists Say Third-Party Payment Key to Increases in Medical Cost October 1, 2014
    The rapid increase in medical costs starting in the 1970s is commonly ascribed be market imperfections. However, federal and state governments have long suppressed the functioning of the market system in the medical industry, write Maureen Buff and Timothy Terrell, …
  • Health Insurance Exchanges Waste Taxpayer Money September 29, 2014
    Obamacare may surpass Cash for Clunkers to become the prime example of federal taxpayer resource mismanagement. For every dollar in premiums for exchange coverage, taxpayers paid 94 cents in subsidies to either enroll people or encourage them to do so. …
  • Mesothelioma: An avoidable cancer? September 26, 2014
    by Sue Redmond Did you know? Mesothelioma is an aggressive cancer that attacks the lining of the body cavity called the mesothelium (80% of which occur within the lining of the lungs). The only known cause to mesothelioma is exposure …
  • Government Healthcare is Breech of Contract September 24, 2014
    by G. Keith Smith, MD One of the smartest people I have ever met is a property and contracts lawyer, someone from whom I have gleaned countless and valuable insights over the years.  He has advised me, among other things, …
  • Dr. Alieta Eck Campaign Update September 24, 2014
    Dr. Eck http://EckForCongress.com speaks to colleagues at AAPS 71st annual meeting on September 5, 2014.
  • Is There A Provider In The House? September 22, 2014
    by Marilyn Singleton, MD, JD Physicians have a proud heritage. We can boast Dr. Benjamin Rush, a founding father, signer of the Declaration of Independence, Surgeon General of the Continental Army, and opponent of slavery. And Dr. James Derham, born …
  • From EBM to Guidelines September 20, 2014
    Richard Amerling, MD presents at the 71st Annual Meeting of the Association of American Physicians and Surgeons, September 5, 2014.
  • Flaw In Federal Software Lets Employers Offer Plans Without Hospital Benefits September 19, 2014
    A flaw in the federal calculator for certifying that insurance meets the health law’s toughest standard is leading dozens of large employers to offer plans that lack basic benefits such as hospitalization coverage, according to brokers and consultants. The calculator …
  • Ralph Weber Talks About Cost Shifting – Video September 17, 2014
    How do hospitals come up with their prices? Medicare patients cause them to lose money. They have to make up the difference by charging the self-insured more. Non-profit hospitals keep beds vacant or build other facilities so as not to …
  • Here’s The Thing #4 Cost Shifting HD September 17, 2014
  • The Commoditization of Medicine September 17, 2014
    Parvez Dara, MD, FACP, MBA, author of http://jedismedicine.blogspot.com/, speaks at the AAPS 71st Annual Meeting in Charleston, SC.
  • The Progressive Train Wreck: From Medicare to HillaryCare to ObamaCare September 15, 2014
    Jane M Orient, MD presents at the AAPS 71st annual meeting, September 5, 2014, Charleston, SC.
  • Varying Prices for Lab Tests are Absurd September 15, 2014
    by Adrienne Snavely The health needs of a community vary by market. If you cannot find what you need or afford it, you should have the opportunity and information to go elsewhere without being penalized. A patient in Chicago went …
  • The Future Of Medicare September 14, 2014
    Lawrence R. Huntoon, MD, PhD presents at the 71st Annual Meeting of the Association of American Physicians and Surgeons, September 6, 2014, Charleston, South Carolina.
  • Unethical ABMS behaviors and the MOC Scam: How It Will Be Used to Control Medical Practice September 13, 2014
    Paul Kempen, MD, PhD presenting at 71st annual meeting of AAPS, September 6, 2014, Charleston, SC.
  • How is that low fat diet working out for you? September 12, 2014
    by Sue Redmond First, let’s ask where did the idea for the low diet come from? In the late 50’s and early 60’s the AMA worked on a theory and published a report that a low fat diet could help …
  • EHR: Remote Control – Craig M. Wax, D.O. September 12, 2014
    Dr. Wax of http://ip4pi.wordpress.com examines how government-controlled electronic health records undermine quality medical care and patient privacy. Presentation at 71st Annual AAPS Meeting Sept. 4-6, 2014.
  • Evidence-Based Medicine as Junk Science — Twila Brase RN September 11, 2014
    Twila Brase, President of http://CCHFreedom.org outlines how so-called evidence-based medicine (EBM) encourages one-size-fits-all healthcare, is a tool for increased control by insurance companies and the government, and is detrimental to individualized patient care.
  • What ObamaCare Means for Patients September 11, 2014
    Kris Held, MD addresses the 71st Annual Meeting of the Association of American Physicians and Surgeons, September 4, 2014 in Charleston, SC.
  • Private Health Care is Individualized Care, Not Public Health — Richard Amerling, MD September 10, 2014
    AAPS President-Elect Richard Amerling, MD opens the 71st Annual Meeting, Sept. 4, 2014, Charleston, SC.

Medicare Alternatives

by Tess St. Clair

People ask me all of the time about alternatives to Medicare. With the $700 billion dollars in Medicare cuts looming on the horizon as a result of PPACA, seniors are legitimately concerned.   Do yourself a favor, BEFORE you become Medicare eligible and fall victim to the system, and read the Medicare doctrine!

Once you are eligible for Medicare, your premium for Part A (Hospital coverage) is taken right out of your Social Security Benefit. Part B (Doctors’ Office Coverage), however, is voluntary. On the surface, one would think that Plan B covers less risk, but in a case of Chemotherapy, the risk covered by Plan B is substantial.

There are GAP policies available to cover excess charges to a set limit, which can help as well.  However, more and more, these policies are getting so expensive, makes you wonder why you should feel compelled to buy one, if Medicare is so great.  I mean, in a traditional PPO with 80/20 co-insurance, do we buy GAP policies to pay for the additional 20%?

Insurance brokers are required to take the course on Medicare, and believe me, I’m glad I did.  What I learned is that Medicare does not resemble the same Medicare from 1980’s.  It looks more like Canada Health, under which it is illegal for patients to pay a doctor!  Doctors’ hands are tied under Medicare, and they are not allowed to discuss medical options that are not covered by Medicare.  So, if you find a lump in your breast, get ready for a mastectomy because lumpectomy may not be covered!  Furthermore, with reimbursement levels so low, many doctors have stopped taking new Medicare patients and are slowly getting out of their contracts.  I can’t say I blame them.  It’s not just about how little they’re being paid, it’s that they can’t do their jobs and focus on true healing.  It is about being a government servant, not even a public servant, but a government servant!  They cannot be real doctors; they can only do what the government tells them they can, and face the consequences if they dare do otherwise!

By FAR, the best alternative to Medicare is to have private coverage, but not all private plans are “first payers” before Medicare. Generally your employer health plan must have 20 or more employees on it, and your employer must have chosen to have the plan as first payer before Medicare.

If you belong to a professional association that offers members the luxury of an Association Health Plan (AHP), they can design the plan so that it is the first payer, and Medicare is second.  I say “luxury” because AHPs allow bundling of many small employers with large employers of the same profession, and so you all get the benefit of large group rates and a great deal of financial freedom because these plans are not administered by third-party payers like Blue Cross, Aetna, and UHC.  Rather, the claims are managed by Third Party Administrators (TPAs). These plans almost always have substantially lower administrative costs.  By substantially, I mean 7% compared to 20% for small group plans.  Additionally, they are not governed by the State Department of Insurance; they are governed by ERISA, a Federal law, because these plans may cross state lines.  WOW!  Talk about buying insurance across state lines!

If you belong to a professional trade association, and they don’t offer you the luxury of a multi-employer, refund-of-premium plan as one of the member benefits, it could be because of the state that the association is located in or because the association is not a Federal 501 non-profit organization (state not for profit doesn’t count) that has been in existence for more than 3 years.  Other than that, there’s hardly any reason for your association not to have an AHP, or at least to look into it.

These plans are true insurance, not these pre-paid health plans that most people are familiar with.  The formula looks like this:

Pure cost of insurance + administration + commission = premium

At the end of the year, whatever is left in the Pure Cost of Insurance fund is reimbursed or rolled into the next year to pay premiums.

Tess St. Clair is the VP of Benefits Administration at Route Three Life Health Disability, Inc.



At MediBid, we restore market forces to medical care. Doctors get to set their own rates based on their training, experience, and outcomes, and patients get to shop for medical care across state lines and international borders. Many times with MediBid, you will find procedures that are more effective than procedures allowed, or covered by health plans. Transparency and competition are the only way to achieve reasonable costs. Many of our employer clients offering group health insurance through MediBid save $5,000 per employee per year. Those are substantial savings. Patients are saving an average of 48% vs. insurance discounted rates, or 80% vs. retail. Contact us for more information.
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