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> If you're in regular medicare, don't you have a government agency filling the same role at the table with you and your doctor? There are no death panels. If

> If you're in regular medicare, don't you have a government agency filling the same role at the table with you and your doctor? There are no death panels. If Medicare covers the procedure (you can look the procedure up in the What's Covered app) and the doctor deems it medically necessary, Medicare pays and then your Medigap plan pays. So cosmetic surgery isn't covered but removing skin cancers is. In the Medicare Advantage case, you are an account and when your account gets expensive, Allison Janey's company gets very passive aggressive. Traditional Medicare sets a policy. Medicare Advantage sets a policy AND manages a cost (you're the cost). > Not all doctors take Medicare either The vast majority of doctors take Medicare and accept Medicare Assignment, the standard amount that Medicare pays for a procedure. Cedars Sinai takes Medicare. > I've also heard something that if a doctor accepts Medicare and Medicare won't pay for a procedure, you can't pay for it out of pocket; is that accurate, or something misleading I picked up? Yeah, that's nonsense. > And doesn't the patient have to pay some portion of some procedures etc? Medicare pays 80% (except for preventatives where it pays 100%). You get a Medigap plan for the 20%. Mine is UHC Plan G which costs $134/mo and includes some extra benefits. There is no logical way that Blue Cross or Kaiser can sit between you and Medicare (they get paid by Medicare to take your risk) make billions and still provide the standard of coverage that Traditional Medicare offers. That's a shell game.

mindslight 4y ago
> There are no death panels. The overall function of private "insurance" is appropriately labeled a "death panel". In general I find it very odd how so much scare propaganda against changing things is based on describing the actual current dynamic.
chimeracoder 4y ago
> Yeah, that's nonsense. Not exactly. Medicare limits the ability to which non-participating providers or providers who accept assignment can charge patients for additional services beyond what Medicare will cover. You actually can end up in a situation where you can't pay out of pocket for additional services because the only providers available (logistically or practically) cannot accept those payments.
- CalChris 4y ago
  > accepts Medicare and Medicare won't pay for a procedure Dermatologist accepts Medicare and Medicare Assignment but Medicare won't pay for cosmetic surgery. Sounds fair. > Medicare limits the ability to which non-participating providers or providers who accept assignment can charge patients for additional services beyond what Medicare will cover First, non-participating providers can charge whatever they want; they're non-participating and not bound by Medicare rules. After that you'd have to show me the rule that says a participating dermatologist can't charge what they want for cosmetic surgery. Medicare has rules for what they cover (What's Covered) and what they'll pay (Medicare Assignment). Medicare Advantage has some rules but it also manages your costs and their profit.
  - chimeracoder 4y ago
    > Dermatologist accepts Medicare and Medicare Assignment but Medicare won't pay for cosmetic surgery. Sounds fair. That's not what I'm talking about at all. I don't know where you got "cosmetic surgery" out of that. A common pattern is that Medicare will only cover a certain service X times per week/month/year. Because their limits are inherently coarse by design, they're not going to be appropriate for all patients. A patient for whom (X+2)/(unit time) or even 2X/(unit time) would be more appropriate can only obtain the additional services from another provider altogether. Which, in plenty of circumstances, may not actually be literally possible. > First, non-participating providers can charge whatever they want; they're non-participating and not bound by Medicare rules. Incorrect. Non-participating providers can only charge the limiting charge (usually 15% more than the Medicare reimbursement rate, though some states cap it at a lower value).
    - CalChris 4y ago
      So we're talking about two different things (and thus in a sense, both right). By non-participating you're referring to Extra Charges as opposed to what I'm thinking of, a doctor who is not accepting Medicare payment at all and is thus unencumbered by its rules. Yes, the first case is limited by Medicare Assignment. BTW, it's not exactly 15% either. It's a strange calculation. It's pretty rare. Plan G covers it. I think Mayo, Cleveland, ... may charge it. I don't know why a doctor wouldn't charge it but it's uncommon.

mindslight 4y ago

> There are no death panels. The overall function of private "insurance" is appropriately labeled a "death panel". In general I find it very odd how so much scare propaganda against changing things is based on describing the actual current dynamic.

chimeracoder 4y ago

> Yeah, that's nonsense. Not exactly. Medicare limits the ability to which non-participating providers or providers who accept assignment can charge patients for additional services beyond what Medicare will cover. You actually can end up in a situation where you can't pay out of pocket for additional services because the only providers available (logistically or practically) cannot accept those payments.

CalChris 4y ago
> accepts Medicare and Medicare won't pay for a procedure Dermatologist accepts Medicare and Medicare Assignment but Medicare won't pay for cosmetic surgery. Sounds fair. > Medicare limits the ability to which non-participating providers or providers who accept assignment can charge patients for additional services beyond what Medicare will cover First, non-participating providers can charge whatever they want; they're non-participating and not bound by Medicare rules. After that you'd have to show me the rule that says a participating dermatologist can't charge what they want for cosmetic surgery. Medicare has rules for what they cover (What's Covered) and what they'll pay (Medicare Assignment). Medicare Advantage has some rules but it also manages your costs and their profit.
- chimeracoder 4y ago
  > Dermatologist accepts Medicare and Medicare Assignment but Medicare won't pay for cosmetic surgery. Sounds fair. That's not what I'm talking about at all. I don't know where you got "cosmetic surgery" out of that. A common pattern is that Medicare will only cover a certain service X times per week/month/year. Because their limits are inherently coarse by design, they're not going to be appropriate for all patients. A patient for whom (X+2)/(unit time) or even 2X/(unit time) would be more appropriate can only obtain the additional services from another provider altogether. Which, in plenty of circumstances, may not actually be literally possible. > First, non-participating providers can charge whatever they want; they're non-participating and not bound by Medicare rules. Incorrect. Non-participating providers can only charge the limiting charge (usually 15% more than the Medicare reimbursement rate, though some states cap it at a lower value).
  - CalChris 4y ago
    So we're talking about two different things (and thus in a sense, both right). By non-participating you're referring to Extra Charges as opposed to what I'm thinking of, a doctor who is not accepting Medicare payment at all and is thus unencumbered by its rules. Yes, the first case is limited by Medicare Assignment. BTW, it's not exactly 15% either. It's a strange calculation. It's pretty rare. Plan G covers it. I think Mayo, Cleveland, ... may charge it. I don't know why a doctor wouldn't charge it but it's uncommon.