Medicare buy-in, public option… who’s on first?

It all sounds so simple, but it’s anything but.

And, no, the problem is not your insurance company and never has been. Large employers don’t even use insurance. Employers who offer several options know what happens when employees select options that serve their best interest and why shouldn’t they? Medicare can’t work without supplemental coverage, Medicare has no out of pocket limits. At present Medicare has the ability to fix reimbursement levels only because costs can be shifted to the private sector.

Medicare for all in some fashion maybe our long-term goal but as an option we’re in for a bumpy ride.

The Biden platform says this:

Giving Americans a new choice, a public health insurance option like Medicare. If your insurance company isn’t doing right by you, you should have another, better choice. Whether you’re covered through your employer, buying your insurance on your own, or going without coverage altogether, Biden will give you the choice to purchase a public health insurance option like Medicare. As in Medicare, the Biden public option will reduce costs for patients by negotiating lower prices from hospitals and other health care providers. It also will better coordinate (😷)among all of a patient’s doctors to improve the efficacy and quality of their care, and cover primary care without any co-payments. And it will bring relief to small businesses struggling to afford coverage for their employees.

(😷)This refers to voluntary Accountable Care Organizations, but that coordination is very limited because Medicare also say this about such organizations “If your doctor participates in these programs, you can still see any doctor or health care provider who accepts Medicare. Nobody—not your doctor, not anyone—can tell you who you have to see. Your Medicare benefits will also stay the same.”

But Biden has another option.

“Under this concept, Americans would have access, if they choose, to Medicare when they turn 60, instead of when they turn 65. Medicare benefits would be provided to them as they are to current Medicare recipients. This would make Medicare available to a set of Americans who work hard and retire before they turn 65, or who would prefer to leave their employer plans, the public option, or other plans they access through the Affordable Care Act before they retire.”

Such a system may transfer a good deal of spending from private employment-based insurance plans to Medicare. But exactly how much health care spending shifts critically depends on who ends up switching.

A Medicare buy-in policy has two likely outcomes.

Only workers who spend a lot on health care would switch. Should that happen, the impact on employer spending on health care could be large.

Or, only workers who spend very little on health care switch; high spenders may remain in the employer-plan in order to benefit from defined out-of-pocket spending maximums. Low spenders probably would not be concerned about Medicare’s lack of an out-of-pocket maximum.

Either way, employer-based coverage will be in turmoil. Employers may react in different ways, perhaps terminate coverage, maybe switch to reimbursing for a Medigap policy.

If the low spenders leave an employer, the remaining workers will pay more.


    1. No. As beneficiaries, we only pay 25% of the cost of Part B. Same with Part D. Part A premium shown is the full cost as if the individual never paid FICA-Med.

      In other words, under current Medicare provisions, current workers are shouldering most of the cost to provide old folks coverage. I can’t see asking taxpayers to shoulder 75% of the cost to cover another 10+MM Americans ages 60 – 64. So, my guess is that we just won’t tell them – we’ll just add to deficit spending, increasing the debt, to buy more votes.

      Bush II did the same thing when he signed off on Medicare Part D.

      Liked by 1 person

  1. So, assuming those at age 60 are blended in with everyone else at age 65 or older, we are talking about the following premiums: Medicare Part A: $458/month, $5,496/year; Part B: ~594/month, $7,128/year, and Part D: ~$122/month, $1,464/year, for a total of $1,174/month, $14,086 per year – and that is for a plan with hospital and other deductibles > $1,500. If you buy a Medicare Supplement policy, maybe $200 a month, another $2,400 a year, for a total of $1,375/month, $16,486/year – per person!

    Who is going to pay those rates?

    Liked by 1 person

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