The government has released the Medicare Parts A & B Premiums and Deductibles for 2025. There are 67,300,000 covered members representing 18.7% of the American population and 8.2% of the world’s population.
Most medical caregivers accept Medicare patients. In-take clerks at hospitals, outpatient facilities, and doctor offices, with their three-ring binder close at hand, know exactly what you owe at the point of service through instant access to your government records while you’re standing at the check-out counter waiting to pay your ‘fair share’ (A term stolen from recent campaign rhetoric).
“Sir, I see you have met your annual deductible. Your cost for today’s visit is 20% of what Medicare allows which comes out to $18. We charge non-Medicare patients a lot more because we can get away with it, but don’t worry, the government says we can’t get away with it with you by balance billing the difference! By the way, do you have a Medicare supplement? If so we will file on your behalf and you will owe nothing for todays visit! Beats a poke in the eye doesn’t it!”
“This is great! I own a company here in town. We are looking for a new health insurance plan. Our current plan sucks. How can I get in touch with a Medicare sales office for a group quote?”
“Sir, I can put you in touch with Risk Managers. They can build a duplicate plan at more than half the cost! The only drawback is you will have to educate your employees that not all medical providers will accept it.”
“That’s great. But I don’t understand why some providers won’t take that plan. If they take Medicare why wouldn’t they take the same plan on a commercial basis? It doesn’t make sense to me!
“Ahhhhh…… great question and I’m glad you asked. We lose money on Medicare patients, that’s why we take it. Since we can’t balance bill for the difference, we “balance bill” commercial carriers by charging more!”
“Ok, so I still don’t understand why we would have any issues with providers not accepting our insurance when we understand and agree providers can charge any amount they want. If our plan pays X and the provider wants Y the patient has the option of going somewhere else if they want free care where X is accepted, or they can pay the difference. It’s their choice!”
“Sir, I hate to be blunt but no one shops for health care services. It’s un-American. It’s time consuming. It’s a tedious, frustrating experience. It’s inconvenient!”
“Well, tough titty said the kitty! My employees don’t have to take the company’s insurance if they don’t like it. What the knuckleheads don’t understand is that they are the ones paying for all of this through lower wages. If I can save as much as you say I can with the Risk Managers plan, my employees will enjoy higher take-home pay!?
“Good luck Sir! We won’t take that insurance. We will consider your employees as cash pay!”
“What’s your cash pay rate?”
“It’s 100% of Medicare or less, depending on the service!”
“Great, my plan will pay cash on the day of service on behalf of my cash paying plan members!”
“No sir, If a patient has insurance that’s all we’ll accept. We won’t take cash!”
“Great, so there is no problem after all!”
The employer terminated his legacy health plan off cycle and built his own with the help of Risk Managers. He educated his employees to good effect followed by educating local health care givers with equally good effect.
And all lived happily ever after……………
This story is a true account of an employer in deep South Texas who more than a decade ago implemented a Medicare Based Health plan. For over a decade since his group rates have remained static without any reduction in benefits.
