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From: Dinosaur_Sr on 10 Apr 2010 12:52 On Apr 10, 7:12 am, "Kommienezuspadt" <NoS...(a)NoThanks.net> wrote: > "BAR" <sc...(a)you.com> wrote in message > > news:MPG.26299218c29dda33989dc6(a)news.giganews.com... > > > > > In article <2VMvn.98948$sx5.6...(a)newsfe16.iad>, NoS...(a)NoThanks.net > > says... > > >> > so -- you are saying you support loopholes like this? > > >> > interesting --- that's far too loose with money for my taste. > > >> Very stupid policy, IMHO. > > >> The whole free drug for seniors policy is/was a bad policy. This is > >> typical of these sorts of things though, IMHO. Some "deal" has to be > >> made to satisfy some contingency. How about "you use a product, like > >> say drugs, you pay for it"? Why is that so bad? And who is going to > >> pay for it if the user doesn't...and where are those people going to > >> get the money? > > >> === > >> except -- it is not free... facts -- darned liberal facts. > > > What portion of the cost is born by the direct beneficiary? > > That depends on factors --- you should look it up -- but Medicare Part D has > a deductible -- > > read this for a start -- or in your case -- have someone read it for you. > > then run along > > Beneficiary cost sharing (deductibles, coinsurance, etc.) > The MMA establishes a standard drug benefit that Part D plans may offer.[6] > The standard benefit is defined in terms of the benefit structure and not in > terms of the drugs that must be covered. In 2008, this standard benefit > requires payment of a $275 deductible. The beneficiary then pays 25% of the > cost of a covered Part D prescription drug up to an initial coverage limit > of $2,510. The defined standard benefit is not the most common benefit > offered by Part D plans. Only 10 percent of plans for 2008 offer the defined > standard benefit. Most eliminate the deductible and use tiered drug > co-payments rather than coinsurance.[7] > > Once the initial coverage limit is reached, the beneficiary is subject to > another deductible, known officially as the Coverage Gap but referred to > more commonly as the "Donut Hole," in which they must pay the full cost of > medicine. When total out-of-pocket expenses on formulary drugs for the year, > including the deductible and initial coinsurance, reach $4050 (now $4350 in > 2009[8]), the beneficiary then reaches catastrophic coverage, in which he or > she pays $2.25 for a generic or preferred drug and $5.65 for other drugs, or > 5% coinsurance, whichever is greater. The $4050 amount is calculated on a > yearly basis, and a beneficiary who amasses $4050 in out-of-pocket costs by > December 31 of one year will start his or her deductible anew on January 1. > Most low-income subsidy patients are exempt from all or part of the donut > hole and the deductible. > > The only out-of-pocket costs that count toward getting out of the coverage > gap or into catastrophic coverage are True Out-Of-Pocket (TrOOP) > expenditures. TrOOP expenditures accrue only when drugs on the enrolled-in > plan's formulary are purchased in accordance with the restrictions on those > drugs. Any other purchases do not count toward either the coverage gap or > catastrophic coverage. Monthly premium payments do not count towards TrOOP. ....and isn't it *TERRIBLE* that these poor people have to pay for some of the drugs they consume...so how do you pay for even this when everyone is consuming drugs?
From: dene on 10 Apr 2010 15:49 "Dinosaur_Sr" <frostback(a)dukesofbiohazard.com> wrote in message news:73b1da5a-b64d-46e1-9e92-8506b0b2ba4a(a)u31g2000yqb.googlegroups.com... On Apr 9, 1:55 pm, "dene" <d...(a)remove.ipns.com> wrote: > "Dinosaur_Sr" <frostb...(a)dukesofbiohazard.com> wrote in message > > news:8f9e8c65-f27d-40ce-974a-aca10aca853d(a)y14g2000yqm.googlegroups.com... > > > ------------------------------------------------------------------- > > > People have that choice now and often take it....but it's not the best > > choice for everyone. For example...young married couple in their 20's, > > having children. Are you expecting them to pony up the first 10k for the > > pre-natal and delivery? > > > -Greg > > People do not have that choice. They get the health insurance provided > by their employer, and that insurance is far too often designed to > suit the needs of the older (and more powerful within the company) > employees. People need to be able to choose their own insurance as > much as possible, and certainty don't need the govt. or their > employers making those choices. > > --------------------------------------------------------------------- > > Employers pay most, if not all, the insurance for the employee, so they > ain't complaining. Their dependents have the choice of buying in or > acquiring their own plans, which they often do. There are no victims in > your scenario. They have choices. > > -Greg The money allocated to salaries and benefits is a budgeted item. You want to be as competitive as possible. If the money were not spent on health insurance, it would go to salary. My advocacy is for the employee to get the benefit of what they earn and make their own decisions with respect to things like health care, as opposed to have the salary paid to the employee reduced and some health insurance program imposed on the employee by the employer...or the govt..the govt would be worse though, IMHO as it is in fact less responsive to the employee and far more expensive. ------------------------------------------------------------------ IOW, people buy health insurance like they buy car insurance. Fine with me. You still have to force people to buy it otherwise only the sick will buy it in their time of need. In the scenario you wish for, how do you force them to buy? The present system does a fair job of enrolling all, by forcing the employees to particpate. Again, how is this accomplished on an individual basis? -Greg
From: dene on 10 Apr 2010 15:51 "BAR" <screw(a)you.com> wrote in message news:MPG.262a3caef73997d7989dc9(a)news.giganews.com... > In article <l2Zvn.98993$sx5.13818(a)newsfe16.iad>, NoSpam(a)NoThanks.net > says... > > > What portion of the cost is born by the direct beneficiary? > > > > That depends on factors --- you should look it up -- but Medicare Part D has > > a deductible -- > > > > > > read this for a start -- or in your case -- have someone read it for you. > > > > then run along > > > > Beneficiary cost sharing (deductibles, coinsurance, etc.) > > The MMA establishes a standard drug benefit that Part D plans may offer.[6] > > The standard benefit is defined in terms of the benefit structure and not in > > terms of the drugs that must be covered. In 2008, this standard benefit > > requires payment of a $275 deductible. The beneficiary then pays 25% of the > > cost of a covered Part D prescription drug up to an initial coverage limit > > of $2,510. The defined standard benefit is not the most common benefit > > offered by Part D plans. Only 10 percent of plans for 2008 offer the defined > > standard benefit. Most eliminate the deductible and use tiered drug > > co-payments rather than coinsurance.[7] > > > > Once the initial coverage limit is reached, the beneficiary is subject to > > another deductible, known officially as the Coverage Gap but referred to > > more commonly as the "Donut Hole," in which they must pay the full cost of > > medicine. When total out-of-pocket expenses on formulary drugs for the year, > > including the deductible and initial coinsurance, reach $4050 (now $4350 in > > 2009[8]), the beneficiary then reaches catastrophic coverage, in which he or > > she pays $2.25 for a generic or preferred drug and $5.65 for other drugs, or > > 5% coinsurance, whichever is greater. The $4050 amount is calculated on a > > yearly basis, and a beneficiary who amasses $4050 in out-of-pocket costs by > > December 31 of one year will start his or her deductible anew on January 1. > > Most low-income subsidy patients are exempt from all or part of the donut > > hole and the deductible. > > > > The only out-of-pocket costs that count toward getting out of the coverage > > gap or into catastrophic coverage are True Out-Of-Pocket (TrOOP) > > expenditures. TrOOP expenditures accrue only when drugs on the enrolled-in > > plan's formulary are purchased in accordance with the restrictions on those > > drugs. Any other purchases do not count toward either the coverage gap or > > catastrophic coverage. Monthly premium payments do not count towards TrOOP. > > > > You miss the whole point. If you use it you should pay for it. > > > The whole Medicare part D plan was the stupidest thing ever implemented. In other words, grandma needs to pony up $300 for her meds or suffers or dies. That was the previous system. You want to return to that? -Greg
From: dene on 10 Apr 2010 15:53 "Dinosaur_Sr" <frostback(a)dukesofbiohazard.com> wrote in message news:2db963a2-1832-4516-89da-57f94a233a34(a)u31g2000yqb.googlegroups.com... On Apr 10, 7:12 am, "Kommienezuspadt" <NoS...(a)NoThanks.net> wrote: > "BAR" <sc...(a)you.com> wrote in message > > news:MPG.26299218c29dda33989dc6(a)news.giganews.com... > > > > > In article <2VMvn.98948$sx5.6...(a)newsfe16.iad>, NoS...(a)NoThanks.net > > says... > > >> > so -- you are saying you support loopholes like this? > > >> > interesting --- that's far too loose with money for my taste. > > >> Very stupid policy, IMHO. > > >> The whole free drug for seniors policy is/was a bad policy. This is > >> typical of these sorts of things though, IMHO. Some "deal" has to be > >> made to satisfy some contingency. How about "you use a product, like > >> say drugs, you pay for it"? Why is that so bad? And who is going to > >> pay for it if the user doesn't...and where are those people going to > >> get the money? > > >> === > >> except -- it is not free... facts -- darned liberal facts. > > > What portion of the cost is born by the direct beneficiary? > > That depends on factors --- you should look it up -- but Medicare Part D has > a deductible -- > > read this for a start -- or in your case -- have someone read it for you. > > then run along > > Beneficiary cost sharing (deductibles, coinsurance, etc.) > The MMA establishes a standard drug benefit that Part D plans may offer.[6] > The standard benefit is defined in terms of the benefit structure and not in > terms of the drugs that must be covered. In 2008, this standard benefit > requires payment of a $275 deductible. The beneficiary then pays 25% of the > cost of a covered Part D prescription drug up to an initial coverage limit > of $2,510. The defined standard benefit is not the most common benefit > offered by Part D plans. Only 10 percent of plans for 2008 offer the defined > standard benefit. Most eliminate the deductible and use tiered drug > co-payments rather than coinsurance.[7] > > Once the initial coverage limit is reached, the beneficiary is subject to > another deductible, known officially as the Coverage Gap but referred to > more commonly as the "Donut Hole," in which they must pay the full cost of > medicine. When total out-of-pocket expenses on formulary drugs for the year, > including the deductible and initial coinsurance, reach $4050 (now $4350 in > 2009[8]), the beneficiary then reaches catastrophic coverage, in which he or > she pays $2.25 for a generic or preferred drug and $5.65 for other drugs, or > 5% coinsurance, whichever is greater. The $4050 amount is calculated on a > yearly basis, and a beneficiary who amasses $4050 in out-of-pocket costs by > December 31 of one year will start his or her deductible anew on January 1. > Most low-income subsidy patients are exempt from all or part of the donut > hole and the deductible. > > The only out-of-pocket costs that count toward getting out of the coverage > gap or into catastrophic coverage are True Out-Of-Pocket (TrOOP) > expenditures. TrOOP expenditures accrue only when drugs on the enrolled-in > plan's formulary are purchased in accordance with the restrictions on those > drugs. Any other purchases do not count toward either the coverage gap or > catastrophic coverage. Monthly premium payments do not count towards TrOOP. ....and isn't it *TERRIBLE* that these poor people have to pay for some of the drugs they consume...so how do you pay for even this when everyone is consuming drugs? --------------------------------------------------------------------- There isn't a part D plan out there that doesn't have co-pays and/or deductibles. The participants are paying a portion of their meds plus the premium. What's so wrong with that? -Greg
From: dene on 10 Apr 2010 15:57
"Dinosaur_Sr" <frostback(a)dukesofbiohazard.com> wrote in message news:9138607c-c11e-464a-a732-a609a18938dd(a)y17g2000yqd.googlegroups.com... Or how about you get what you can earn...and the govt helps out people in legitimate need...but no universality to any entitlement. ----------------------------------------------------------- That's the system in place now, Rob. Part D is not an entitlement. It's VOLUNTARY. For example, BK chose to not enroll and that's his right. He will be penalized if he enrolls later. By having more enrolled, costs are reduced, because the insurance companies have more leverage with the Rx companies. The program is working. -Greg |