I was not talking about abandoning activism against the health insurance industry.
You can stand up against Advantage plans and all the other corporately designed arrangements for managing Medicare and still want to get the best coverage for yourself at the present time.
The “juggernaut” I referred to in yesterday’s post is the health care apparatus the city has been trying to push us into for the past couple of years. They developed the Empire and Aetna PPOs behind closed doors, rolling out the first one poorly, and not convincingly fixing all the bumps in this new one. (Are you sure all your doctors will even take this new plan, or will you be denied some procedures you used to get in Senior Care without a problem?) Neither plan has been capable of earning our complete trust.
That’s because these things are negotiated plans, and the city has only negotiated the terms of the Aetna one to last for two years. What will happen to individual parts of the coverage after that is anyone’s guess.
Protest as much as you want at the rallies, like the one of a few days ago at the introduction of legislation to stop the Aetna plan from going through. Join other campaigns for single payer, like the very active Physicians for a National Health Program and National Nurses United, or all the other groups supporting the Medicare for All bills in the House (HR1976) and Senate (S1655). Donate to Public Citizen, or to legislators like Sanders and Jayapal. Read and support the work of people like Wendell Potter, who rails against the Medicare Advantage industry, Pharmacy Benefits Managers, and the any other corporate invention that sucks millions out of public funds.
But while you’re taking to the streets and sending money to causes, you still have to figure out which coverage arrangement best suits you right now. I don’t see any way around this. There’s only a couple of options, and you need to sort through them.
If you let yourself be placed into the new Aetna PPO (presuming it gets through the lawsuit), you’ll still be in Medicare, but in addition:
• You’ll get pretty decent in- and out-patient coverage for “normal” senior health conditions.
• You’ll get reimbursed for your Part B premium and IRMAA surcharge. (Last year Part B was $2041 a year per person, and additional IRMAA amounts were calculated in tiers of income.)
If you opt out of the new plan, you’ll still have Medicare, but:
• You’ll have to get supplementary coverage through one of 10 different kinds of Medigaps on the open market. These pick up some or most of the remaining Part A and B costs, but don’t include drugs or extras (like an annual physical, meals after surgery, etc.). Under no circumstances should you choose an Advantage plan. That would make no sense whatsoever, as the MAPs offered by employers and unions usually have better coverage.
• You will not get reimbursed for Part B or IRMAA.
If you keep the HIP VIP HMO, things will stay as they are, including the reimbursements for Part B and IRMAA.
Any way you go – taking one of the two Advantage plans (Aetna PPO or HIP VIP HMO) or opting out altogether – you still get:
• Drug coverage if you purchase the drug rider (from January 1st, $103.50 a month with the Aetna plan, roughly $180 with the HIP)
• Dental, vision and hearing aid help through the Welfare Fund. No premiums, just union membership.
• SHIP reimbursements for quite a few health-related services, with a $100K lifetime cap. It costs $120 a year.
That’s it, folks. The good thing is that you can change your mind every fall. The bad thing is, there’ll still only be these same choices.
Unless the lawsuit succeeds, of course. We’ll have to then see what they come up with next.
"If you let yourself be placed into the new Aetna PPO (presuming it gets through the lawsuit), you’ll still be in Medicare" - this is the semantics we talk about -- People want to be in traditional medicare vs this version. In essence you are repeating what Mulgrew keeps claiming - aw shucks it's still medicare and I wish we could just call it that instead of that badly misnamed Medicare Adv -- Mulgrew would call it wonderful medicare. I think you need to qualify the differences in how med and Medadv are administered. Who ya gonna call when there's a problem? Right now we call Medicare. After Sept 1 we cal Aetna and their most probable non-unionized, lower paid and insentivized staff to help profit motive. By the way, the GHI emblem plans we've I had I am told is for a non-profit agency.
ReplyDeleteI also think to talk about how the money moves and the amounts Aetna gets from medicare to cover costs and profit. And that the admins of Medicare have nothing to gain personally compared to Aetna -- say the person you deal with has employee stock options. So to blandly say Medicare Advantage is just medicare without qualifying comments is misleading.
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