Democrats Introduce Medicare Expansion at Age 55

Discussion in 'Senior Insurance Forum' started by Northeast Agent, Aug 8, 2017.

  1. jdeasy
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    jdeasy Well-Known Member

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    Of course doctors can decide to not take new patients. But no where does it say they are permitted to limit that to not taking new Medicare patients.

    And doctors don't have to take medicare patients. But again, they can't pick and chose.

    What's next from the experts down at the hair salon, doctors can refuse medicare patients that have diabetes?

    Where does this new adverse selection stop?

    If there's a doctor out there that accepts medicare and is taking new patients but then decides that he will only accept new patients if they are not on medicare is flat out wrong and would be told so if a complaint was filed.
     
  2. sman
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    sman Well-Known Member

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    Knock yourself out. File all the complaints you want. That doesn't change the fact that doctors CAN and are PERMITTED to not take on NEW Medicare patients while continuing to see CURRENT patients who happen to be on Medicare. All the arguing you want to do about it will not change it.

    But don't believe me or the other folks who have stated it happens and is allowed. Because obviously you know more than all of us.
     
  3. sshafran
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    sshafran Well-Known Member

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    Where, specifically, is the "proof" that the doctor signs this binding contract with CMS that
    . if they accept payment from Medicare, then
    . they will also "keep the doors open" to anyone on Medicare
    . if they have the doors open to people not on Medicare.
     
  4. GreenSky
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    GreenSky Well-Known Member

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    A doctor can choose which patients to see and which ones not to see. Until the guberment takes over healthcare (and they will), a doctor is still a private business and can opt to see someone or not.

    And who would the complaint be filed with? CMS doesn't dictate that a doctor must see everyone that want to see him/her.

    While we are on the road to socialism, it's not quite here yet.

    Rick
     
  5. jdeasy
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    jdeasy Well-Known Member

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    OK, you guys win. Adverse selection is fine and dandy. No violation at all.

    You just can't provide any documentation that adverse selection is legal.

    Other than that clients said so, that is.

    If it ever happens to one of my clients I will file a complaint. Probably won't mention that I read on the internet that somebody said they had heard of it and it was OK.
     
  6. sshafran
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    sshafran Well-Known Member

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    I can hear the phone call now.

    "I'd like to report a violation of code... hold on a second. Ah, well, not sure. But this doctor operated as an individual in a free country - so he must have violated something."

    In the meantime, perhaps one of your prospects will report you for refusing to sell them a MAPD plan. After all, you sell Med Supps. Stinkin' adverse selection.
     
  7. roadrunner
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    roadrunner Well-Known Member

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    I have a few family members whom are Doctors (primary)

    I also have a family member whom is a state inspector for the state of Indiana, investigates Medicare fraud for the state. Prior to that they were a State Trooper for 40 years. Pretty straight and narrow fella.

    I posted the following question to them.(Primary location is in Indiana)
    1. Must they take ANY and ALL new patients that have ORIGINAL MEDICARE???

    NO. If a new patient calls that is on ORIGINAL MEDICARE, they do not have to take that person as a new patient. The choice is not based on race,health,sex, etc.
    It is based on the TYPE of insurance the person has. A practice has the choice to choose and limit the types of insurance they accept.
    If they only took Medicare they would not be able to keep their doors open, due to the time frame of actually getting paid, and the reimbursement level.

    My family member stated that they may start the year adding patients but when that threshold is met, they back off for a few months perhaps not taking on any new patients. Patients move,pass away, change doctors on their own, and then they take new Medicare as "slots" open. They try to accommodate and make recommendations to other docs in the area.


    The state, nor CMS can dictate that you must see EVERY MEDICARE PATIENT THAT SHOWS UP ON YOUR DOORSTEP.
    Can you imagine?? Pull into the parking lot and 1000 patients on Medicare are waiting?
    The state can't dictate if you take insurance/cash.
    If you are accepting new patients/not accepting new patients

    YES. If a current patient rolls into Original Medicare the doctor MUST continue care for the current Patient.

    2. If a doctor refuses to take a new Original Medicare patient, and a call is placed to the DOI, or CMS what type of action would be taken against the physician?
    None

    ** disclaimer** You will NOT FIND this in the Medicare and You Book.

    ----------

    Forgot to add:

    If the physician location is a Clinic,etc. that accepts state or federal funds
    they would have additional guidelines due to the funding factor.
     
  8. sman
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    sman Well-Known Member

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    You say we're right and then talk as if we're just making sh1t up. You are a prideful man who just can't accept you're wrong about something.

    Explain how not accepting NEW Medicare patients is adverse selection. If it's because seniors are typically less healthy than non-seniors, then explain why the same doctors see their existing patients who age in to Medicare.

    Obviously you don't understand the regulatory burden doctors face in order to get paid by Medicare. Nor the reduced reimbursement rates compared to private insurance. Taking a quick look at a recent EOB I received for a doctor visit, he charged $199, but the contractual price he has with my insurance carrier is $121.71. That same visit for a person with Medicare would have been around $70 (the Medicare assignment rate).

    So for the same service and less regulatory requirement, the doctor makes $50+ more on the person who isn't on Medicare. Now multiply that by 30-40 patients per day. That's $7,500 - $10,000 per week or $390,000 - $520,000 per year. And don't discount the regulatory requirements. Doctors have to spend more time filling out required forms in order to get paid by Medicare. And no, these aren't forms the staff completes. These are forms the doctor must complete about each visit for each Medicare patient.

    Just because no one is providing you with the CMS magic bullet you want doesn't make it not true. If it were against the law for doctors to do this that would mean hundreds of thousands of doctors across the country are breaking the law.

    Let us know how that complaint works out if and when you file it.
     
  9. roygbiv
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    roygbiv Member

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    MA plans already accept under 65 medicare beneficiaries; there is no age limit so long as they have Part A and Part B. Medicare Supplements on the other are different. At this time the States regulate which Medicare Supplement plans should be made available to under 65; in many cases Plan A is the only plan available. That said, these plans are already there. Not much change is needed should this proposal come to law.
     
  10. somarco
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    somarco Well-Known Member

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    A few years ago Georgia told Medigap carriers they had to offer coverage under 65 and offer the same plans available to 65+.

    Carriers responded.

    Now all of them offer U65 Medigap with the "normal" IEP rules (no underwriting). Premiums make Obamacare rates look like bargains.
     

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