On 9/2/2017 2:02 PM, jbeattie wrote:

snip

Tom is over 70. He is on Medicare. Because he is paying a "premium" to participate in an HMO/PPO, he is undoubtedly on a Medicare Advantage Plan. Those plans are just different ways of allocating dollars from the Medicare Hospital Trust. Capitated payments are made to HMO/PPOs like Kaiser based on average costs for standard Medicare benefits paid to recipients in particular areas -- the capitation payment or "benchmark" is determined on a county-by-county basis, AFAIK. So, its kind of gambling. CMS pays an HMO/PPO $800-900 month and the HMO/PPO takes the upside and downside.

The actuaries at HMO/PPOs are well aware of the probabilities. There's
very little downside, especially to an HMO that owns its own hospitals
and whose doctors are salaried.

There was a fear that the Medicare Advantage Plans would all disappear a
few years ago, but they are still very profitable to the issuers.

I'm happy to contribute to Tom's, and other seniors' medical insurance
costs. But he should not pretend that those that are still working are
somehow not paying for his insurance, we definitely are.