Boy, eventhough we don't live in the states, i found this very interesting! but, i will say and i hate to admit this, but we Canadians do have it lucky, especially if you are a senior! when i picked up one of Al's prescriptions on monday, i was listening to the lady explaining to a man, about how the medical plans work for seniors, it seems that there is a co-pay to the government of 100.00 per quarter after that MOSTLY all prescriptions are free or a 2.00 charge depending on the pharmacy. our health care - staying in the hospital is free this would be a ward type of room - 4 to a room, however at this new fancy hospital we have there are only a few of these rooms, and then you would be put in a semi-private room at no extra charge - or if you requested this and wanted to pay out of pocket i think it is 54.00 per day. Al has been lucky he usually ends up in a private room (we have semi-private coverage, free through his being employed at the College), and a private room is 118.00 per day. Eye exams are free for seniors, diabetics and people with illnesses that it might cause blindness or you pay if you do not have private insurance i think it is 42.00 per exams. if you are not a senior and make over 30 thousand a year you pay for health care and it is a percent, i remember on the income tax forms it would be about 200.00 per year for a family. we are very lucky here and the government does look after seniors and those on assistance (or welfare, as it was called before), i'm actually looking forward to paying the 100.00 and then nothing! - Al's meds would be paid for after just 1 of his prescriptions! PB - i don't think you're old at all--you don't write like an older person! debbie

>>Aren't medical expenses in the US heavily concentrated on measures to stave off inevitable death? >> I've read several articles (must have been either AARP, NYTimes or WSJournal) that say that 80% of Medicare's budget is spent on 20% of insureds - the very frail and dying. But we should remember, this is true the world over. It's merely a question of who pays for it and for how long. Nobody anywhere wants to be the one who says to the family, "the plug has to be pulled because we're not going to pay for it any longer." Now, the ridiculous claim of "Medicare Death Panels" has been thoroughly debunked already, so no need to go over that ground again. Factually, ALL insurance companies globally have a Chief Medical Examiner whose job it is to approve or disallow payment for expensive treatments. That's what they do - balancing medical guidelines, doctor preferences, patient coverage, and company profit (no, company profit is not always paramount; but is an important factor in overall portfolio risk management). In the absence of clear, specific legal forms by the patient as to how end-of-life treatment is handled, the medical profession by its nature will do everything to save you from dying. Palliative care and pain management is only beginning to make an impact on their thinking, but again - without clear legal guidelines as to what the patient wants, ESPECIALLY if those instructions are contrary to what the family expresses - the doctors will do everything possible. And these days, "everything possible" is usually expensive with little regards to the quality of life. That's why it's absolutely critical to talk about what you want with not only your spouse, but your doctor and your family. Then put it in writing! BTW, I should amend my posting about the 'wellness' exam of the Healthcare Reform Bill. The NYTimes did an absolutely wonderful, comprehensive piece on this subject - what is covered, what is not, and why some consumers are surprised when they receive a bill they didn't expect. We have to remember, a physical exam for a 16-yr-old is going to be different than that of a 50-yr-old, which is again different than the exam for a 70-yr-old with severe medical issues. As it stands now, with the government gradually clarifying what is paid for and what is not, the two key things to note are: most of these don't begin until next year, and in areas where it's still 'gray' without legal definition, the insurers are allowed to make their own decisions about what is covered and what is not. (Access to the NYTimes is limited to 20 free articles/mo.) Preventing Sickness, With Plenty of Red Tape NY TImes September 19, 2011 (Excerpt) "Prevention has never been the cornerstone of American medicine. In this country, we tend to go to the doctor only when something is wrong, a habit long bemoaned by researchers and medical groups. The federal government aims to change that, and soon. Starting this year, insurers will be required under the Affordable Care Act to completely cover such services as annual physicals, childhood vaccinations and dozens of screening tests for everything from high blood pressure to abdominal aortic aneurysms. Just last month, the Department of Health and Human Services released additional guidelines specifying fully covered preventive services for women. Mammograms, cervical cancer screening and other services already had been mandated; the new recommendations expand that list to include screenings for human papillomavirus (which causes cervical cancer) and domestic abuse, and reimbursement and counseling for contraceptives. These services are to be fully covered by most insurance plans beginning in August 2012. Despite these new regulations, there's still a lot of ambiguity - and not just among consumers - about what qualifies as preventive care and what insurers are obligated to pay for. "I've seen so much confusion among patients and doctors alike trying to figure out what's paid for and what isn't," said Dr. John Santa, director of the Consumer Reports Health Ratings Center and a primary care doctor. " Here is a link that might be useful: Full Article: Preventing Sickness

I have only encountered one MD who opted out of Medicare. This was the orthopod who did my left hip replacement before I was 65. I was foolish to go back to him for the right hip after he opted out. There are tons of other highly qualified orthopods. I paid $7K with zero reimbursement. Dumb Sue. Some MD's with 'niches' can get away with opting out. Ten years ago I found that some GP's were going the 'retainer' route. They charged a patient a set annual fee ($8-10K) and spent no time 'messing' with Medicare or any other insurance plan. I don't know if that worked. I haven't heard anything about it recently.

patti43, after much research we decided on UHC Plan J as our supplement plan and the AARP Rx plan also through UHC. And you're right...if you don't sign up for a Rx plan now then if you sigh up later the premiums will be higher. At this point in time I'm not on any medications, but that will likely change in the future. So, caught between a rock and a hard spot, I signed up for a Rx plan. mcmann, all insurance reimbursements to Doctors are based on the allowable amounts designated by Medicare. Other insurance companies only pay a % of what Medicare would pay and the balance is simply a non-collectible write-off. This is a shame because the elderly segment of our population is left out in the cold trying to find doctors that will accept them as new patients because their doctor has stopped accepting Medicare or has retired. And I can't really blame them for not wanting to work long hours only to find that they've collected less than their expenses.