>>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

Here's an good website. I heard a great presentation bu a rep from this office, and I learned a lot. Every case they bust started with a citizen report. Here is a link that might be useful: Medicare fraud

It is confusing, Mare...and that's what got me into trouble in the first place. Let me see if I can explain my particular issue to further clarify why I'm being charged a penalty. When my husband died a few years ago, all my benefits died with him due to an agreement he had made with the PBA long before he even knew me. His decision, unfortunately, was irreversible. Throughout our married life...all contact involving his benefits package had to be made by him even though I was covered under all his plans, therefor I was often left in the dark about what the plan included and who the carriers were. I was already enrolled in Medicare when he passed and knew that I would have to replace the supplemental policy he'd had for me with BC/BS. I did so immediately. What I didn't know was that I had to replace the Medicare D policy. I had never needed it and had no idea what it was let alone the fact that it existed as part of his benefits package. To make matters worse, the PBA didn't notify me that I had to replace this coverage with a policy of my own choosing. I went for almost 4 years without realizing that I was in default with Medicare. Fortunately, it was brought to my attention and I applied for a policy but in so doing, I learned that I was going to be penalized for the time that had lapsed between the loss of my husband's coverage for me and my "awakening". The penalty is based on a formula...1% of the policy monthly premium...times the number of months that one goes without coverage. It was a substantial amount to me and I had limited recourse. I contacted Medicare and filed a challenge. They agreed that I had a basis for my challenge. They reduced the penalty by 12 months...but said ignorance of the law was no excuse and I was left responsible for the remaining month's penalty. The penalty is NEVER removed. From now until the day I die...I will have that penalty added to whatever Medicare Part D plan I carry. My only hope to be relieved of this burden is that two US high courts agree with me...that the penalty, along with the Federal edict to force people to carry health insurance above and beyond Medicare...is illegal. If the Supreme Court agrees with the two lower courts, the entire forced insurance system will be reversed and my penalty will be dropped. Needless to say, I'm anxiously awaiting their decision. I hope this gives you a little more info. If you are already enrolled in Medicare, the booklet that they send out every year will give you more information. Or, you can call their office. I've found them to be very helpful...even thought I don't always agree with them. As long as you get Medicare Part D coverage as soon as you're eligible, you shouldn't have to worry about a penalty...unless somewhere along the line you decide to drop the coverage...and then pick it up again at some later date. You'd be penalized for the lapsed coverage time. HTH Anne

"When you turn 65 and are employed, the usual route to health care is that you go on Medicare as yournprimary coverage with the company paying your premium, and the company’s insirance becomes tour secondary coverage for the twenty percent Medicare does not cover." I retired in my mid-50s and my coverage has been continuous through my former firm as a retirement benefit. Some aspects of it changed when I turned 65 and the coverage was integrated with Medicare but the only perceivable differences for me was the instruction to see providers that accept Medicare and to get health insurance when travelling outside the US. I pay the Medicare premium, as a deduction from my Social Security payments. I don't need to reiterate what I was told by my insurance company and by Stanford. If you have a disagreement with them, give them a call. You can repeat your thoughts over and over but it changes nothing - what you're describing may be common for some, and may be accurate as to what you have, but it's not what I have or have experienced.