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  • 3 Steps to Get Rid of Heartburn and GERD Forever October 31, 2014
    Heartburn and GERD are caused by too little stomach acid and bacterial overgrowth in the stomach and intestines. There are three steps to treat heartburn and GERD without drugs and keep them from returning. Reduce factors that promote bacterial overgrowth …
  • OMTEC 2014 – Keynote Interview with Industry Leaders (Installment 5 of 5) October 31, 2014
    Original, essential content from OMTEC. Industry leaders Michael Butler, Dirk Kuyper and Mike Matson discuss the intricacies of supplier relationships within the orthopaedic industry.
  • OMTEC 2014 – Keynote Interview with Industry Leaders (Installment 4 of 5) October 31, 2014
    Original, essential content from OMTEC. Industry leaders Michael Butler, Dirk Kuyper and Mike Matson discuss the intricacies of supplier relationships within the orthopaedic industry.
  • OMTEC 2014 – Keynote Interview with Industry Leaders (Installment 3 of 5) October 31, 2014
    Original, essential content from OMTEC. Industry leaders Michael Butler, Dirk Kuyper and Mike Matson discuss the intricacies of supplier relationships within the orthopaedic industry.
  • The Wasting of Taxpayer Money October 29, 2014
    by G. Keith Smith, MD If you are looking for proof of the fact that the wonderful folks in D.C. are more interested in lining the pockets of their pals than demonstrating good stewardship of the loot from the robbery …
  • Giving Birth in America is Most Expensive in the World October 27, 2014
    While a woman is preparing for giving birth, one worry she doesn’t want to have is about the cost of delivery. Insured women are finding that some policies do not cover maternity care, services that most often do not have …
  • Physicians are Not Medicine’s Top Earners October 24, 2014
    Physicians are the most highly trained members of the medical industry’s force, yet have median compensation.  The largest salaries go to the Medicrats who oversee the business of medicine. Insurance CEOs average $584,000 compared to surgeons ($306,000) or a general …
  • Health Benefits of Honey October 22, 2014
    Honey has been used as a natural sweetener long before sugar. Bees collect pollen from  plant to plant, which is passed along from bee to bee until it eventually is deposited into the honeycomb. They beat their wings to evaporate …
  • Rotten Food and the VA Hospital October 20, 2014
    by G. Keith Smith, MD Imagine for a moment that you own and operate a restaurant knowing that if you provide spoiled food and rotten service, you will subsequently make more money.  You openly employ strong-arm and intimidation tactics to …
  • Hospitals want patients to pay in advance October 17, 2014
    Hospitals are asking for payments from patients before they leave the facility so they don’t end up with unpaid bills. Knowing the costs before the procedure is important because insurance deductibles are increasing and so are procedure costs. Obamacare policies …
  • Massachusetts is First State To Require Health Care Price Tags October 15, 2014
    Massachusetts has started a new era of shopping for medical care. You can go to your health insurer’s website and find the price of everything you may require listed, from an office visit to a scan or procedure. For the …
  • Physicians Remove Government from Medical Equation October 13, 2014
    by Gerard Gianoli, MD Doctors in Nevada and across the country are protesting against the government’s intrusion into health care, but we aren’t voicing our concerns using bullhorns and pickets. Instead, many of the state’s 5,400 physicians are protesting silently …
  • Revolutionary Idea Could Change Medicine October 10, 2014
    For those of us who get woozy when having blood drawn for routine testing, a simple pin prick may be the blood test of the future. Elizabeth Holmes, the CEO and founder of Theranos, says that her company can run …
  • Why Accountable Care Organizations Are Failing October 8, 2014
    by Richard Amerling, MD Accountable Care Organizations (ACOs), a key piece of the Affordable Care Act (“ObamaCare”) “reform” plan, are failing because they must fail. ACOs are based on faulty assumptions, poor economics, and junk science. They would not exist …
  • Common Sense Travel Restrictions to Stop Ebola: Dr. Jane Orient October 7, 2014
    Dr. Orient appears on Cavuto – October 6, 2014
  • What Employers Can Do To Reduce The Cost Of Obamacare October 6, 2014
    The Obamacare mandate will be enforced on large employers in 2015 and small employers in 2016. Large companies who self-insure can have a plan that does not cover hospitalization, mental health care, or emergency room visits.  Small companies have to …
  • Ralph Weber Talks About Fixed Pricing – Video October 3, 2014
    You can ask the price of a procedure at a hospital, but may ask several different people before finally getting an answer. Listing set prices for procedures has lead to medical tourism. People will travel to get the price they …
  • Here’s The Thing #5 Fixed Pricing HD October 3, 2014
  • 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. …

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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This entry was posted in Common Sense Health Care Solutions, Cost of Health Care, Economics, Employer Health Plan, Free market medicine, Health Care News, Health Care Reform, Health Care Repeal, Health Care Taxes, Health Insurance, Health Law and Legislation, Insurance, Medical Tourism, Obamacare, Politics and tagged , , , , , , , , , , , , , , , , , . Bookmark the permalink.
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