Wills, Trusts & Estates Prof Blog

Editor: Gerry W. Beyer
Texas Tech Univ. School of Law

Tuesday, January 31, 2012

Problems with Medicare

UnknownSmartMoney reveals some of the problems with the Medicare system in America:

  1. Medicare spends millions on unproven procedures: Medicare will spend a lot of money each year on treatments that are not even necessary according to many medical experts. Treatment that may be necessary to one person is not going to be necessary for others and critics say that many of these procedures Medicare is paying for could be eliminated. Examples of such services include digital mammograms and liquid-based cytology.
  2. Medicare is more broke than Social Security. The amount an individual puts into social security and the amount that social security pays out for an individual are more closely balanced than the amount of Medicare paid in and then put out per individual. An average couple will have paid $119,000 in Medicare payroll taxes throughout their careers and then they will receive medical services worth $357, 000.  An average couple will have put $598,000 into social security and will receive about $556,000 in benefits.
  3. Medicare  “pays for dead people”: In 2010, Medicare and Medicaid Services contributed more than $3.6 million for “Medicare Part D (the prescription drug benefit) to deceased beneficiaries.” Some of this can be attributed to fraud, mistake, and clerical error on part of Medicare.
  4. Do not expect a five-star plan: It is hard to find a Medicare system ranked at five stars so do not be alarmed if you cannot find one in your area. The five star ranking is reserved for the highest quality care that is given to beneficiaries.
  5. Many doctors do not want to take Medicare: Many doctors limit how many Medicare patients they will treat. They feel Medicare payment rates are too low and are at risk of getting lower.
  6. Medicare gets ripped off a lot: Last year Medicare and Medicaid saw improper payments for Medicare for $47.9 billion. Fraud and clerical error are the main sources of these improper payments.
  7. Medicare does not cover a lot of the care that seniors need most: Medicare does not cover nursing home care and getting reimbursement for home care is very difficult.
  8. Settlements from something gone wrong go to Medicare: Since Medicare paid some of your doctor bills, it has a claim against any damages for expenses.
  9. Complaints are not always heard: A report from the Office of the Inspector General reveals that the Center of Medicare and Medicaid Services is supposed to notify the Joint Commission of complaints they receive concerning hospitals, but often times they don’t notify the Commission.
  10. If Medicare denies a claim, don’t pay out of pocket: It might be better to appeal. Out of the few people who do appeal, more than half either receive more care of get a higher payment. If you appeal, you have a good chance of getting your claim approved. 

Catey Hill, 10 Things Medicare Won’t Tell You, SmartMoney EG, Dec. 21, 2011.

Special thanks to Jim Hillhouse (Professional Legal Marketing  (PLM, Inc.)) for bringing this article to my attention. 


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