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Wed Jan 9, 2013, 08:04 PM

Questions for those on Medicare (or who have experience with it)

I know Medicare Part B has a 20% coinsurance for most services. The information about it on the Medicare and AARP sites is a little vague, so I am hoping people who have experience using Medicare can fill in a few blanks for me.

1) It says that the 20% includes doctor's fees for services performed in the hospital. So does that mean you pay 20% of the whole cost of a surgery or other procedure, or just the portion of the procedure that comprises the fees for the doctor's time (as opposed to the supplies, facility fee, other personnel, etc.)?

2) Do doctors ever voluntarily disclose the expected cost of a procedure or treatment in advance so you can figure out how much you will have to pay for it?

3) If you request that information beforehand, how difficult is it to get it so you have some idea how much your bill will be?

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Arrow 73 replies Author Time Post
Reply Questions for those on Medicare (or who have experience with it) (Original post)
democrattotheend Jan 2013 OP
southernyankeebelle Jan 2013 #1
underpants Jan 2013 #2
spartan61 Jan 2013 #3
ReformedGOPer Jan 2013 #31
Glitterati Jan 2013 #4
democrattotheend Jan 2013 #5
Glitterati Jan 2013 #11
democrattotheend Jan 2013 #16
Glitterati Jan 2013 #18
Glitterati Jan 2013 #33
stopwastingmymoney Jan 2013 #53
Glitterati Jan 2013 #58
stopwastingmymoney Jan 2013 #64
yellowdogintexas Jan 2013 #51
Democrat 4 Ever Jan 2013 #34
Glitterati Jan 2013 #36
Yo_Mama Jan 2013 #67
Glitterati Jan 2013 #69
Yo_Mama Jan 2013 #70
Yo_Mama Jan 2013 #66
Old Codger Jan 2013 #6
REP Jan 2013 #7
silverweb Jan 2013 #60
REP Jan 2013 #61
silverweb Jan 2013 #62
MindandSoul Jan 2013 #8
democrattotheend Jan 2013 #15
virgogal Jan 2013 #45
democrattotheend Jan 2013 #46
virgogal Jan 2013 #47
ancianita Jan 2013 #68
dhol82 Jan 2013 #9
virgogal Jan 2013 #10
Glitterati Jan 2013 #12
KoKo Jan 2013 #30
virgogal Jan 2013 #44
Glitterati Jan 2013 #50
virgogal Jan 2013 #65
TheKentuckian Jan 2013 #13
Glitterati Jan 2013 #14
KoKo Jan 2013 #17
Glitterati Jan 2013 #20
KoKo Jan 2013 #26
Glitterati Jan 2013 #27
democrattotheend Jan 2013 #23
democrattotheend Jan 2013 #19
Glitterati Jan 2013 #21
democrattotheend Jan 2013 #24
Glitterati Jan 2013 #25
democrattotheend Jan 2013 #28
Glitterati Jan 2013 #29
democrattotheend Jan 2013 #32
Glitterati Jan 2013 #35
democrattotheend Jan 2013 #38
Glitterati Jan 2013 #39
democrattotheend Jan 2013 #41
Glitterati Jan 2013 #42
democrattotheend Jan 2013 #43
Glitterati Jan 2013 #48
Glitterati Jan 2013 #49
Downwinder Jan 2013 #56
Blue_In_AK Jan 2013 #40
Downwinder Jan 2013 #22
Blue_In_AK Jan 2013 #37
bkkyosemite Jan 2013 #52
mrmpa Jan 2013 #57
DesertFlower Jan 2013 #54
bkkyosemite Jan 2013 #71
DesertFlower Jan 2013 #73
YOHABLO Jan 2013 #55
bkkyosemite Jan 2013 #72
Thirties Child Jan 2013 #59
2pooped2pop Jan 2013 #63

Response to democrattotheend (Original post)

Wed Jan 9, 2013, 08:11 PM

1. Well I will be using my Medicare for the first time tommorrow. I got a book. But I have to

 

tell you there is to much information I get confused. I have even got online with mymedicare.com.
Again to much. If you are talking about the hospital stay you might want to call the hospital. They probably have someone there that can talk to you about medicare. I got my card in the mail and I was automatically put on A & B. You can also call and make a phone appointment at home and they will call you back and a time and day of your choice. They will sit down and talk with you also. I called my primary doctor office and spoke with the lady that usually makes my specialist appointment. She gave me alot of information. You can try that.

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Response to democrattotheend (Original post)

Wed Jan 9, 2013, 08:13 PM

2. Some, sort of, answers

I deal with drugs that are billed under Med B (typical inhaled/infused - anything with devices, called DME, or supplies or nursing) and you basically have a 20% copay or "Coinsurance".

Typically, from what I have read, doctors are amazingly unaware of the costs. Most of this is due to need for treatment and not for protection from lawsuits as many would tell you. They are also encouraged by administrators because the hospitals make good money off of these.

I would say the best idea is to explain to your doctor that you have cost concerns. You may be surprised how unaware they are of cost. If you can go to the administrative offices and ask questions - or you can stay on the phone with your insurance company if you want.

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Response to democrattotheend (Original post)

Wed Jan 9, 2013, 08:17 PM

3. Medicare Part B

does pay 80% and you are responsible for the remaining 20%. That is why it is important to have supplementary insurance which pays for what Medicare doesn't pay. I pay $104.50 per month this year for my Medicare and $160 per month for my supplementary ins. This also covers 80% of my Rx, my dental, my vision and hearing, with a $250 deductible. This is through the CT State Teachers Retirement. My husband has the same policies and it 's a good thing because he has been fighting cancer since 2011. If we didn't have this we most likely would have to file bankruptcy because we would have gone through all of our savings. I only have positive things to say about Medicare. I find it efficient and well run.

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Response to spartan61 (Reply #3)

Wed Jan 9, 2013, 10:14 PM

31. my husband is also on medicare.

and we have had a similar experience. His supplementary is 125.00 per month, and they pay anything that isn't covered under part A or part B. It's very well run and we have no ccomplaints.

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Response to democrattotheend (Original post)

Wed Jan 9, 2013, 08:20 PM

4. Whew boy, are you in for a shock!

First, call the doctor's office and get the EXACT name of the procedures he is expected to perform.

Then, call the Medicare office and explain you need to find out what your cost is going to be for these procedures.

They are going to tell you there is a "usual and customary" fee for specific procedures. They are WELL below what your doctor and hospital are going to charge.

Forget the 20%. You are liable for any cost OVER the usual and customary fee, unless your doctor is going to accept that amount.

And, it's going to be a LOT of money.

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Response to Glitterati (Reply #4)

Wed Jan 9, 2013, 08:25 PM

5. That is good advice, thanks

I was actually asking as part of my research for a paper...I am about 40 years too young for Medicare. But my dad will be eligible in a few years so I will definitely pass this advice along.

How do you know if your doctor accepts the regular Medicare fee or a higher fee? Do they tell you that in advance? And isn't there a cap on the amount a doctor who charges more than the usual and customary rate can charge Medicare patients?

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Response to democrattotheend (Reply #5)

Wed Jan 9, 2013, 09:25 PM

11. Our first hand experience

My husband was disabled. Because disability recipients don't qualify for Medicare for 2 years from their disability date by Social Security, he went untreated with heart disease after open heart surgery - a quad bypass.

When he finally got Medicare, he went to his cardiologist. The cardio wanted to runs some tests - EKG, scans, etc. The total bill was going to be around $6,000.00 for these tests.

After he called Medicare, we found out we would owe more than 4,000.00 of it. The doctor basically told him "too bad" we couldn't afford it.

He didn't have the tests and he was dead within a month.

Yeah, he had Medicare a whopping 6 weeks before he died.

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Response to Glitterati (Reply #11)

Wed Jan 9, 2013, 09:47 PM

16. Wow, I am so sorry

You hear stories like that about private insurance all the time but it's rare to hear stories like that about Medicare.

I am surprised the cardiologist wanted upfront payment...I thought docs usually do the tests and then bill later, without telling you how much it's going to cost.

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Response to democrattotheend (Reply #16)

Wed Jan 9, 2013, 09:51 PM

18. Oh, they do.

This doctor had no intention of spelling out the costs until I made my husband start asking questions of him and Medicare.

We spent the last 8 years of his life fighting with medical bills.

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Response to democrattotheend (Reply #16)

Wed Jan 9, 2013, 10:20 PM

33. BTW, here's annother FYI for you

Folks on Social Security Disability not only don't qualify for medicare for 2 years, there is no supplemental plan which will cover anyone under the Medicare age.

Bottom line - if you are disabled, you can't buy a supplemental plan AT ANY PRICE. No one will write the policy.

on edit:
This is the end result of Republicans who have been screaming "freeloaders!" for years.


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Response to Glitterati (Reply #33)

Thu Jan 10, 2013, 12:57 AM

53. Not necessarily


My husband is blind, disabled and on Medicare. He has a supplemental policy with Kaiser.

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Response to stopwastingmymoney (Reply #53)

Thu Jan 10, 2013, 02:26 AM

58. At what age, though?

n/t

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Response to Glitterati (Reply #58)

Thu Jan 10, 2013, 10:07 AM

64. 51 now


He's had it for a couple of years now

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Response to democrattotheend (Reply #5)

Thu Jan 10, 2013, 12:16 AM

51. doctors accepting Medicare fees

what you want to ask the office mgr at the surgeon's office is whether the doctor 'accepts assignment' on Medicare

a simple example of what this means:

$100 service $60 'usual and customary rate" (used to be called the area prevailing rate)

dr doesn't accept assignment : Medicare pays the doctor 80% of $60 and you may be billed for the remaining amount
There may be a cap built in there. I used to process these claims and that was how it worked then. Some things have changed.

Dr does accept assignment: Medicare pays the doctor 80% of $60 and you are responsible for 20% of $60.

Moral of the story : choose physicians who accept Medicare assignment.
If you have surgery there will be an anesthesiologist and a million labs. You have no choice in whether these providers accept assignment but usually the interpretation of your labs will be assigned

the facility bills under part A. the docs bill under Part B

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Response to Glitterati (Reply #4)

Wed Jan 9, 2013, 10:23 PM

34. Well, actually you just need to make sure the doctor accepts Medicare. If he/she does then you are

responsible only for 20% of the usual and customary care fee. If the doctor accepts Medicare it means the government will mail him his check directly to him - docs like this a lot - guaranteed payment made very fast. By agreeing to accept the U&C fee the doctor gives up the right to bill you the difference. Period. They have to adjustment off the difference. Example: I did medical billing for a psych group. The doctors billed $150.00/for a 50 minute session. Medicare recognized the usual and customary as $60/hr. They would pay the doc $48.00, you would pay $12.00 and the doctor adjusts off $90.00. The docs have a valid complaint that the U&C is too low to really sustain a practice - especially if you are only seeing one patient an hour, but they do like the ease and the fast payment. Just make sure your doctor accepts Medicare. The great mystery in all of this is how Medicare (and most health insurance companies) arrive at the U&C fee for each procedure. They can never explain or justify the expense - it's just whatever they decide.

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Response to Democrat 4 Ever (Reply #34)

Wed Jan 9, 2013, 10:27 PM

36. Not this Doctor

Not in Georgia.

He specifically told my husband he was responsible for the costs Medicare did not pay.

He took Medicare. HE just didn't accept the U&C.

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Response to Glitterati (Reply #36)

Sat Jan 12, 2013, 10:20 PM

67. There's a difference between accepting Medicare and accepting assignment.

If you accept assignment, the fee is whatever CMS says it is. CMS pays the doctor 80% of it directly. The fees allowed are generally low.

If a doctor accepts Medicare but not assignment, then the doctor can charge extra and Medicare pays the patient - the doctor collects from the patient.

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Response to Yo_Mama (Reply #67)

Sun Jan 13, 2013, 08:20 AM

69. I see...however,

this was the only cardiologist within 35 miles who took Medicare at all.

We just had no choices.

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Response to Glitterati (Reply #69)

Sun Jan 13, 2013, 02:00 PM

70. Yeah, I get it.

I'm sorry!

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Response to Glitterati (Reply #4)

Sat Jan 12, 2013, 10:09 PM

66. You have to get a doctor/hospital that accepts assignment

If they do, then medicare pays them the 80% separately, but the fees are capped at what Medicare allows. If they don't accept assignment, then Medicare pays you and you remit whatever you get to the doctor, but he/she can charge anything he/she wants.

Since older folks don't have much money, most places do accept assignment - but it also leads to them limiting the amount of Medicare patients they take. For some types of practice, such as cardiology, they are pretty much locked in to Medicare.

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Response to democrattotheend (Original post)

Wed Jan 9, 2013, 08:26 PM

6. My experience

So far and I have had it for quite a while now, the Dr. and the hospital will be more than glad to give you the numbers on what your portion will be before hand and quite often will give you a discount if you can pay up front...at least this has been what I have experienced... You can also check with Medicare to get what the are paying for any specific procedure....

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Response to democrattotheend (Original post)

Wed Jan 9, 2013, 08:29 PM

7. I have Kaiser

It's a flat fee for everything

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Response to REP (Reply #7)

Thu Jan 10, 2013, 02:33 AM

60. I'm thinking about Kaiser.

My Medicare will kick in later this year and I've been wanting to research Kaiser as my supplemental, hoping to get everything covered that way.

You're happy? No nasty surprises?

I simply don't have the stamina anymore to wade through reams of rules, conditions, and exceptions, only to be hit with a surprise bill after all is said and done.

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Response to silverweb (Reply #60)

Thu Jan 10, 2013, 04:27 AM

61. I've been very happy with it

I don't pay for labs or tests, not even MRIs or CTs or any of the other horrible things I've been put through.

$20 copay for office visits and outpatient surgery. My Rx co-pay is $30 or $10 for 100 day fill (less if I use mail order).

If my kidney disease gets worse, dialysis and transplant are covered.

I have excellent doctors, including a raft of specialists for my list of weird shit.

I do have a retiree plan; I retired on disability and I know how very, very lucky I am to have had a Union job!!

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Response to REP (Reply #61)

Thu Jan 10, 2013, 04:57 AM

62. Thank you!

That's a huge help.

I had Kaiser through my job some years ago and loved it, was very upset when the company was sold and insurance changed. It'll be nice to be able to get it again.

They have seminars for people going on Medicare, so I'll have to schedule attendance at one in the next few months.

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Response to democrattotheend (Original post)

Wed Jan 9, 2013, 08:39 PM

8. Your co-payment for each medicare service covered is 20%

My husband has been on medicare for about 8 years, and he has had several major surgeries since then. Medicare pays 80% and you are responsible for the other 20%.

However, we chose to take a Medicare supplemental insurance (many types exist, but we took the "cadillac plan" which covers the COMPLETE 20% that Medicare doesn't cover). These can be (depending on the coverage you choose, quite expensive, but well worth it as the needs increase with age.

Let me give you an example and compare this to an "investment."

My husband pays about $55.00 per month for Medicare for a total over the last 8 years of (about) $5,200.
He is also covered by a supplemental insurance that costs us ABOUT $180.00 per month for a total of $16,000 (approximate).

Over the last 8 years, the cost of his health care (including the 4 surgeries) came to close to $200,000 IF HE HAD NO COVERAGE AT ALL. Because he was covered, and medicare has "special rates" for each services, the cost went down to about $100,000 (I.e., this is a rounded figure to make the calculation easier).

Medicare paid 80% of that which came to $80,000
The private supplemental insurance covered 20% of that which came to $20,000

Now. . .which "investment" do you think would be the smartest?

Investing $5,200 and saving $80,000?
or
Investing $16,000 and saving $20,000?

Now, please note that both are "good investment," but . . .when you look at it that way, you can see WHY Medicare is in trouble (pays too much for too low a fee, for people who, because of aging, will ONLY have greater needs in the future), but we keep on complaining about medicare not "being efficient!"

While we praise private health care industry for being "more efficient" than the government. . .but the only reason they are more efficient is because they charge A LOT MORE for A LOT LESS coverage!

I have always wonder why Medicare doesn't offer an option to reimburse 100% of the cost of care for people over 65 at a cost of (let's say), $100.00 extra dollars per month (for a total of $155.00 per month, you would have 100% of your health care need paid for by Medicare)

This could TRIPLE the entry in Medicare funding, AND would take away the co-payment paid by the elderly for a much smaller pay out.

In the case of my husband, for example, it would look like this:

Over the last 8 years, instead of paying $5,200 to Medicare AND $16,000 to a private insurance (for a total of $21,200)
We would have paid, $13, 200 to Medicare alone.

AND, obviously, Medicare would have paid received $13,200 INSTEAD of $5,200
and would have disbursed $100,000 instead of $80,000

Both party (My husband AND Medicare) would have greatly benefited from that arrangement. . .the only party left out of this "win/win" situation would have been. . . Private health care insurance covering the Medicare supplement!

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Response to MindandSoul (Reply #8)

Wed Jan 9, 2013, 09:41 PM

15. Interesting. I am actually proposing the opposite in my paper

I started out writing about why they should not raise the Medicare age, but decided to expand the paper to propose alternative cost-savings. I am proposing that Medigap be reformed to have some cost exposure rather than covering everything, in order to bring down the premiums and enable more people to be able to afford it, as well as saving Medicare money by forcing patients to ask questions about cost and consider cost in deciding whether to do an expensive procedure, particularly one with little chance of success.

The way I structured my proposal, it is targeted primarily at ensuring that cost is not completely absent from the equation when patients and their families make decisions about life support or aggressive treatments with low probabilities of prolonging life. Medicare spends 27% of its budget on care in the last year of life, and studies showed that 1/3 of Medicare beneficiaries who died in 2008 had surgery in their last year of life, 1/5 in their last month. The way Medicare is currently structured, there is no incentive for doctors or patients who have supplemental insurance to consider cost in making these decisions, and family members who have no cost considerations often want the doctor to do everything they can despite the low odds of success, which is both enormously expensive for Medicare and often causes the patient more suffering than if she had been moved to hospice or pallative care or allowed to go home and die on her own terms.

I know this is going to be controversial on both the left and the right, but Medicare spends a huge chunk of its budget on a relatively small number of beneficiaries. I think it's only fair that people who want to use public funds to keep someone on life support or perform expensive "hail Mary" surgeries ought to pay at least a small fraction of the cost.

On a broader level, I think ensuring that patients have some relationship to the cost of their care is important to prevent waste and overbilling. Without cost-sharing and with loose enforcement from Medicare there is little accountability for doctors who upcode or perform expensive and unnecessary tests, which often result in treatment procedures that were arguably unnecessary and cause the patient more discomfort and complications. For example, most men who have prostate cancer will die of something else before they become symptomatic. Having the surgery often causes impotence or incontinence or both. I wish I had known that before my dad had his prostate surgery...I would have at least encouraged him to seek a second opinion. But in his case, it was arguably the right thing to do because they caught it when he was 58. PSA tests are almost completely useless for men over 75 and the medical community does not recommend them, but they continue to be conducted (in part because of lobbying from oncologists and the diaper industry) and often lead to unnecessary surgeries that cause impotence or incontinence.

I know a lot of seniors are struggling and I don't want anyone to go bankrupt paying for healthcare, but I think completely disconnecting people from the cost of their care and not allowing the government to set any limits (heaven forbid, death panels!) creates so much waste and drives up costs and makes the system unsustainable in the long run.

Since I know the American people would never accept having Medicare set limits on how much it will spend per patient or refuse treatments that have a low probability of keeping someone alive, I am proposing restructuring Medigap and Medicare Advantage to require some cost-sharing so that people cannot insist on aggressive hail Mary treatment for terminally ill patients or unlimited life support without baring any of the cost.

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Response to democrattotheend (Reply #15)

Wed Jan 9, 2013, 11:06 PM

45. Can you document your statement that diaper companies are

lobbying for PSA tests for men over 75?

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Response to virgogal (Reply #45)

Wed Jan 9, 2013, 11:17 PM

46. Sure, here's my source

It doesn't specifically say diaper companies lobbied for screenings for over 75, but it says the Preventative Service Task Force recommended stopping them for all ages because the harm outweighs the benefit, especially for men over 75. But Medicare spent $146 million on PSA's for men over 75. 15% of terminally ill men received prostate cancer screenings between 2003 and 2008.

It also says the diaper companies "got involved" because prostate surgery sometimes leads to incontinence, which is good for their business.

http://www.publicintegrity.org/2011/10/07/6898/forty-percent-medicare-spending-common-cancer-screenings-unnecessary-probe-suggests

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Response to democrattotheend (Reply #46)

Wed Jan 9, 2013, 11:23 PM

47. Thank you very much---I'll read it tomorrow--getting late here in the East.

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Response to MindandSoul (Reply #8)

Sat Jan 12, 2013, 10:21 PM

68. MandS, this is pure Single Payer system that I was protesting for back in 2009.

The whole country would benefit from this system. Anyway, back to the topic at hand...

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Response to democrattotheend (Original post)

Wed Jan 9, 2013, 09:10 PM

9. wow


i have been on medicare for about a year and a half. got the aarp cadillac plan. costs me $240/month. the prescription addition costs me another $35/month.

not sure how you other guys get it for less.

as an fyi, here in the new york metropolitan area, most md's accept medicare. have to say that i am embarrassed by how little the reimbursement is. wish i could top it up but it's not allowed.

as a side note, i am a, pretty much retired, health professional. have a problem understanding how the medicare reimbursement covers many of the costs. would not be surprised if, in the future, some docs opt out of the system.

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Response to dhol82 (Reply #9)

Wed Jan 9, 2013, 09:19 PM

10. I had an endocrinologist refuse to treat me as a Medicare patient and

this was about 10 years ago.

That was the only time,but I'm afraid it's going to get worse.

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Response to virgogal (Reply #10)

Wed Jan 9, 2013, 09:32 PM

12. Most doctors in Georgia refuse Medicare and Medicaid patients

The teaching hospitals (Emory, etc.) and doctors are just about the only ones who take it.


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Response to Glitterati (Reply #12)


Response to Glitterati (Reply #12)

Wed Jan 9, 2013, 11:00 PM

44. My refusal was at a teaching hospital in MA. All of my friends are

on Medicare and I've never heard of another denial.

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Response to virgogal (Reply #44)

Wed Jan 9, 2013, 11:59 PM

50. I'm guessing

You live in a state where Democrats have some control. I don't. I'm in Georgia and everyone - doctors, hospital, etc. - are free to do as they please. In the field of medicine, that means they can pick and choose their patients.

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Response to Glitterati (Reply #50)

Sat Jan 12, 2013, 09:47 PM

65. Terrific guess---I'm in MA.

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Response to democrattotheend (Original post)

Wed Jan 9, 2013, 09:37 PM

13. Get a supplement. Yes, the 20% is hanging out there.

Medicare for all is selling ourselves short, we need Tricare for all and to expand the dental coverage even at that.

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Response to TheKentuckian (Reply #13)

Wed Jan 9, 2013, 09:41 PM

14. IF you can afford it.

Lots of folks on Social Security can't. Are you reading these replies in this thread alone? Folks are paying more than DOUBLE Medicare premiums for the remaining 20% of their bills.

Do you get that? You're paying DOUBLE Medicare premiums for someone to cover 20% of your medical bills!!!

Talk about screwed.

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Response to Glitterati (Reply #14)


Response to KoKo (Reply #17)

Wed Jan 9, 2013, 09:56 PM

20. Already there.

My husband's case was the classic example of Alan Grayson's "Die Quickly."

He had Medicare for 6 weeks before he had to refuse the tests which might have warned us of the coming heart attack that killed him.

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Response to Glitterati (Reply #20)


Response to KoKo (Reply #26)

Wed Jan 9, 2013, 10:04 PM

27. Medicare didn't deny the tests.

We couldn't afford them. Please read upthread. I explained the situation there.

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Response to KoKo (Reply #17)

Wed Jan 9, 2013, 10:00 PM

23. It's been a good deal for my grandpa

At least, it has been the last few years, while he has been in and out of the hospital and had frequent doctor visits, therapy and prescriptions for mental health.

But he did pay premiums for years when he was healthy, so I guess he's just getting his money's worth now.

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Response to Glitterati (Reply #14)

Wed Jan 9, 2013, 09:55 PM

19. That's because the Medicare premiums are heavily subsidized

From the money you paid in or the money that comes out of current workers' paychecks, depending on how you look at it.

They estimated when they considered Medicare buy-in for people ages 55-64 that the unsubsidized premium would be about $600/mo per person. It would probably be higher, even much higher, for older age groups.

Medigap premiums are not subsidized and thus cost more. If Medicare premiums were based on the actual risk of providing you coverage they would be a lot more than $104/mo.

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Response to democrattotheend (Reply #19)

Wed Jan 9, 2013, 10:00 PM

21. Regardless

You're talking about the average Social Security recipient who gets $1200.00/month. And, you're saying they should pay Medicare $104.00 and then a supplemental another $215.00 out of that $1200. leaving them $900.00 or less to LIVE on?

Not. going. to. happen.

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Response to Glitterati (Reply #21)

Wed Jan 9, 2013, 10:01 PM

24. Not necessarily

I just meant that you can't say Medicare is so much more efficient because it charges less for 80% than Medigap charges for 20%, without acknowledging that Medicare is heavily subsidized.

In my paper, I am proposing restructuring Medigap to discourage the purchase of policies that cover ALL costs not covered by Medicare, in order to avoid situations where people can choose unlimited life support for a relative or costly hail mary surgeries for people with terminal conditions without any consideration of the cost.

Having Medigap policies that cover most but not all out of pocket costs would also make the policies more affordable by lowering the risk and thus the premiums.

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Response to democrattotheend (Reply #24)

Wed Jan 9, 2013, 10:02 PM

25. Those are the facts

Necessarily.

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Response to Glitterati (Reply #25)

Wed Jan 9, 2013, 10:05 PM

28. I meant not necessarily as in those with limited incomes should not necessarily buy them

Not that I dispute the facts of how much they cost or that they might be unaffordable to some people. Sorry if that wasn't clear.

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Response to democrattotheend (Reply #28)

Wed Jan 9, 2013, 10:08 PM

29. I think what you are missing is this

$1200.00/month is the AVERAGE Social Security payment per month.

You're not talking about SOME, you're talking about MOST.

That's the point you're missing........these folks have skin in the game - their LIFE.

Even WITH Medicare, they can't afford medical care, much less a supplemental insurance policy to cover 20% of the bills they can't afford to begin with.

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Response to Glitterati (Reply #29)

Wed Jan 9, 2013, 10:18 PM

32. I understand that

I'm not proposing that we charge Medicare beneficiaries more...I am proposing that we restructure supplemental insurance for those who can afford it to pay most but not all of the costs, so that those people would not be completely detached from the cost of their care when making decisions, especially toward the end of life when aggressive treatment has a low probability of success but is often demanded by family members who want the doctors to do anything that might have any chance of prolonging their life a little bit, no matter what the cost to Medicare.

This in turn would help protect Medicare and maybe even bring down costs a little by reducing overall costs. It would also make supplemental insurance more affordable by reducing how much it has to pay out.

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Response to democrattotheend (Reply #32)

Wed Jan 9, 2013, 10:24 PM

35. Trust me, no ONE is detached from the cost of their care

I just spent 3 days in the hospital uninsured. My 4.5 hours in the ER bill was $15,000.00.

No one is detached from those kinds of costs.

Stress is what caused my illness to become deadly. Do you think the stress of $50,000.00 in hospital bills is going to help me get well?

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Response to Glitterati (Reply #35)

Wed Jan 9, 2013, 10:34 PM

38. Those with Medicare and supplemental are detached

My grandfather spent 3 days in the hospital and a week and a half in a mental health ward and did not pay a cent for it, because Medicare and his Medigap policy paid everything.

I am proposing that people with those policies have some cost-sharing (in exchange for lower premiums). Not people like you who don't have supplemental insurance and already pay too much out of pocket.

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Response to democrattotheend (Reply #38)

Wed Jan 9, 2013, 10:43 PM

39. That's simply not fair

Because of ONE person, you are extrapolating that to everyone.

My husband is a classic example of having lots of skin in the game, caring about cost. As are most people.

Here's the thing you forget.

When you have a medical emergency, you can't "shop" for the cheapest doctor or hospital. You go to the nearest medical facility. Once there, you are ASSIGNED the doctor who treats you. You have no choice and you most certainly did not shop around for him/her.

Before his disability was approved, my husband was hospitalized under Medicaid. The doctors he was assigned, was angry with him for refusing to be transported to the hospital where he got sick. So, he told him he would just keep him in the hospital, regardless of need, until he transferred out.

It was only threats of turning him in for Medicaid fraud that changed his mind.

You're not concerning yourself with the true problem - the cost of medical care in this country. If the hospitals and doctors weren't so damned expensive, we wouldn't have any of these issues.

Why, in God's name, did it cost me $15,000.00 to sit in the ER, in a bed, waiting for the hospital to find a room for me to be admitted to? What part of those costs are prohibitive? It's not like I could just walk out of the ER and go "shopping" for a room with a bed in it. Do you realize the ER charges in 4 hour increments for the bed they put you in?

WHEN do the costs get addressed instead of beating up on sick people whose only alternative is to pray like hell they don't get sick!!!!!!! When?

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Response to Glitterati (Reply #39)

Wed Jan 9, 2013, 10:46 PM

41. I am trying to propose ways to lower costs for everyone

Which I don't think can happen if people don't hold their doctors accountable for charging so much.

And as long as you have supplemental insurance that pays every penny there is no incentive to.

Plus, it's unfair that those who can afford it buy supplemental policies that cover everything while those who can't afford those policies get stuck with much higher out of pocket costs, to the point of sometimes being fatal as in your husband's case.

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Response to democrattotheend (Reply #41)

Wed Jan 9, 2013, 10:51 PM

42. Your assumption is simply WRONG, though

You are blaming the wrong party. A patient ALREADY has every incentive not to incur costs - with no control. What the hell is it you think someone is supposed to do while a patient in the hospital to control costs - or put "skin in the game" as you call it.

There are simple options for the patient:
A. Refuse to pay the price the Doctor is asking and put your life at risk
B. Die

Do you really think someone who is ill can "shop around" for the best price? Or refuse a test the doctor orders? Not take the meds because the hospital charges more than the Walmart pharmacy? Rip out the IV because the meds cost too much?

Just HOW is a patient supposed to control costs when they lack control of ANYthing?

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Response to Glitterati (Reply #42)

Wed Jan 9, 2013, 10:59 PM

43. Here's an example of what I am talking about

This article talks about how a woman not only incurred $1.2 million in medical bills during her last 6 months of life but probably suffered more than she would have if she had just been allowed to die peacefully. The article notes that cost never figured in at all when making decisions about her care because she had Medicare and supplemental, so there were no out of pocket costs for anything.

http://www.stltoday.com/news/local/woman-s--month-decline-highlights-end-of-life-care/article_d9310228-bd52-11e1-b34e-001a4bcf6878.html

I just don't think it's fair that someone can incur such high costs on Medicare's dime without her family ever having to think about costs, when poorer seniors like yourself who cannot afford supplemental coverage are forced to forego necessary care because of cost.

If Medigap covered 15% of the cost instead of 20% and patients had a 5% coinsurance rate, more people would be able to afford supplemental coverage, and people would have a greater incentive to consider whether expensive, low-probability of success surgery done just in case it might prolong a terminally ill patient's life by 2 months is worth it.

If Medicare could save money on expensive and often not cost-effective end of life procedures that often make things worse, it could afford to charge lower premiums and copays for those who cannot afford supplemental.

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Response to democrattotheend (Reply #43)

Wed Jan 9, 2013, 11:26 PM

48. You're STILL blaming the wrong party

It's not the patient nor the family who made those decisions - it's the doctor AND the hospital.

Let's just talk about my specific situation.

I have Graves Disease (hyperthyroidism). 22 years ago, I had an original diagnosis, got care, and was released from medical care. This instance was "supposedly" from a pregnancy and would not recur. At least that is what I was told by my Doctor.

22 years later, the day after Thanksgiving, my family insisted I go to the ER because I was so sick. My legs and feet were so swollen, you couldn't distinguish my shin from my foot, nor my lower leg from my thigh. Additionally, I couldn't walk up the 14 stairs to my kitchen, I could only CRAWL up them. Also, between Halloween and Thanksgiving, I had lost 60 pounds. Frankly, I looked (and still do) like a walking skeleton.

I finally relented and went to the ER. I was diagnosed with a deadly thyroid storm, congestive heart failure and fluid on my lungs.

I was admitted to the hospital, put on IVs, meds and complete bed rest.

When the endocrinologist came in and started talking surgery, I called my sister (a 2nd year medical student) to come home. She had worked at a clinic in downtown Atlanta while she was at Georgia Tech and I knew the doctors there were high quality, caring and cognizant of cost controls - they treat the underserved, the poor.

At any rate, we got the doctors at the hospital to release me, got an appointment at Good Sam and I went home after 3 days. Sick as a dog, with lots of prescriptions I can't afford, but on my way to better, cheaper care. In fact, the day after I got home, I passed out on a concrete floor and broke my nose because the meds dropped my blood pressure too fast. I refused to go back to the hospital. My single goal was to get to the cheaper doctors.

I did get to Good Sam, loved the doctor who stopped the surgery talk, explaining that in Europe patients stayed on the meds I was on for years without needing surgery!

So yesterday, I saw the endocrinologist at Good Sam. She is talking about, eventually, killing my thyroid completely with a radioactive iodine treatment I have to drink. Of course, this treatment presents risks to my daughter at home, because I will be radioactive for WEEKS. She will have to stay with family for a couple of weeks. But, it requires no hospitalization, no surgery. No more expensive medical bills. And, the medication they will replace my thyroid function with will cost 10 CENTS a day, instead of the one I am on now that costs $5.90 per day.

I'm getting the best possible care at a cost that is reasonable - not "usual and customary." My visit with the endocrinologist cost $25.00 yesterday. I got the bill from the hospital for THEIR endocrinologist who came to my room one time - $970.00 - whose only solution was surgery to remove my thyroid and eventually put me on the same $0.10/medication as above.

But, the ONLY reason that doctor released me from the hospital is because HE worked at Good Sam once and knows the doctors and standard of care there. He actually told me "you're a walking malpractice lawsuit if I let you out of here." Frankly, that's why I refused to go back to the hospital when I passed out - so I didn't scare this man half to death and he locked me in that hospital until I was transported by ambulance to Good Sam.

What you also have to understand is the good luck of having a med student in the family who knew where to go, and how to get me there.

Most patients are not so lucky.

Also, uninsured or insured, the outcome would have been exactly the same. Insurance would NOT have stopped me from looking for the best possible care I could obtain at the best possible cost.


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Response to democrattotheend (Reply #43)

Wed Jan 9, 2013, 11:55 PM

49. Here's what is needed

STRONG patient advocates, whose sole job is to ensure the patient (or an unconscious patient's responsible party) is informed of ALL the choices of care and ensures patient care is valuable and proper.

Throughout this process, there is no one who has the sole responsibility to ensure a patient is informed, appraised of ALL the possibilities, and whose wishes are being respected.

Preferably, a medical student, nurse practitioner, etc. who understands the field of care and has the power to enforce provisions legally.

The hospital endocrinologist had one purpose - to do surgery; dismissing the radioactive iodine as "that is dangerous, too." She simply refused to discuss the possibility. When I told her I couldn't afford surgery because I was uninsured, she left my room and I never saw her again.

It is THIS kind of care that must be avoided - taking the most expensive, most dangerous course of action because the parties involved make more money.

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Response to democrattotheend (Reply #24)

Thu Jan 10, 2013, 01:16 AM

56. Don't like that.

There is no way I could afford the copay. OTOH by spacing it out on a monthly basis for Medigap I can do it. Additionally there is talk about means testing. Means testing would limit the assets an individual could maintain, making the copays that much more un-affordable.

If you want to cut the end of life costs, authorize euthanasia at the individual's request either with a living will or in person.

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Response to Glitterati (Reply #14)

Wed Jan 9, 2013, 10:45 PM

40. My husband's pension withholds $300 from his monthly check

for our supplemental insurance but there is a $5,000 per year deductible. After that, they pay 100% of everything, which i guess would be great if we ever get really sick. They were deducting $800 a month before we both went on Medicare, but the deductible was much smaller.

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Response to democrattotheend (Original post)

Wed Jan 9, 2013, 10:00 PM

22. I have Medicare A and B plus a supplemental policy and Part D

I qualify for the Part D extra help.

If the Dr. accepts Medicare assignment he is limited to what Medicare will pay plus 20% copay.

My supplemental has covered deductible and all copays. It also extends hospital coverage. The supplementals and Part D are approved by CMS and are crafted to their standards.

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Response to democrattotheend (Original post)

Wed Jan 9, 2013, 10:34 PM

37. When I had cataract/cornea surgery last year,

the doctor's office did calculate my portion, although I think I did end up paying a little more because the first eye had to be redone because the cornea transplant slipped off center. Still, it wasn't too much. The surgery center ended up being two or three times more, plus I had an anesthesiologist fee, of which my portion was pretty small.

Our supplemental insurance has a $5,000 patient out-of-pocket deductible before it kicks in. I think our total portion on the two eyes was about $2,500. Medicare paid a LOT.

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Response to democrattotheend (Original post)

Thu Jan 10, 2013, 12:29 AM

52. I don't know if this has been said here

as I have to run but I have been on Medicare for years. I have had a Advantage plans where you pay co-pays to the doctors and I have had a supplemental where you pay a larger premium but you pay no co-pays and your 20% is paid for along with the 80% from Medicare.

I use AARP supplemental F plan that covers most things both in the hosptial and in the doctors office, labs xrays etc.

Of both options to take care of the 20% I prefer the supplemental type. AARP gives you a discount on your premium for the first 10 years and it gradually goes up about $10 to $12 a year. I pay currently for myself $112. per month AARP supplemental and of couse out of my Social Security Medicare takes their premium also of $104. If you need prescriptions there are those plans too. I do not need the prescriptions because I am covered through my husband's pension although we pay for that in a premium also. Insurance is a pain but you need it. It's about $250 a month altogether for me. Hope this helps I know it can be confusing in the beginning.

I think the advantage plans are a waste. The premiums jump too much and they continue to find more for you to pay on co-pays.

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Response to bkkyosemite (Reply #52)

Thu Jan 10, 2013, 01:32 AM

57. My 82 year old mother has a medicare advantage plan......

She pays $0 per month for this. She has co pays, but not more than $30 per appointment. If she is hospitalized, she pays a flat $250, no matter the length of the stay. I bought a subscription to our local ambulance service, $40 for the year. If either of us go to the hospital by ambulance, we pay nothing.

The hospital we use, gives you a 15% discount, if you pay the bill within 10 days. Mom had surgery (outpatient) and received the bill for $250, but paid it in 10 day and deducted $37.50 from the bill.

For prescriptions, even though Mom has a federal government pension, she is eligible for a state run program for prescriptions. However, I sat down and looked at all her prescriptions. Using the state program she was budgeting $100 a month for her meds, the state only allows you to get 30 days worth of meds, cost is $8 for generics and $15 for non generic. I found 2 pharmacies where she could get most of her prescriptions at either $4 a month of $10 for 3 months, and she would not have to use her insurance. She now budgets $100 every 3 month, she saves $800 per year.

As for me, I'm 9 years away from being eligible for medicare. I am currently uninsured. I'm able to get two of my prescriptions at $0 cost & one @ $4. The others were anywhere from $39 to $600. I went to Costco & have one prescription that at the pharmacy I was using was $68 a month, I get it Cost for $14.

It's an insane system.

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Response to democrattotheend (Original post)

Thu Jan 10, 2013, 12:58 AM

54. i just got medicare 6/12 when my husband

passed away. i looked into the supplemental plans and some of them ran almost $300 a month and didn't cover some of the drugs i take. because of hubby's years with IBM i qualified for a supplemental medical/drug plan through united health care. i get the same drug coverage we had before but i have a $4,000 deductible per year, but it's also a $4,000 max out of pocket. it costs $28 a month. i don't go to that many docs so i did the math. at $300 a month ($3600 a year) plus having to pay for some of my own drugs i decided to go with the high deductible. figured i could spend almost $4,000 a year just in supplemental policies that might not be used. so my medicare this year is $104 plus $28 for my supplemental.

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Response to DesertFlower (Reply #54)

Sat Jan 19, 2013, 09:20 PM

71. The supplemental is really not a supplemental

I too have my husband's IBM pension supplemental in order to get the prescriptions thru IBM. That is why I get the supplemental through AARP for doctors and hosptial as the one you speak of would not cover all the appointments I have to go to. Small world

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Response to bkkyosemite (Reply #71)

Wed Jan 23, 2013, 08:46 PM

73. yes. it is.

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Response to democrattotheend (Original post)

Thu Jan 10, 2013, 01:06 AM

55. Oh My, They sure do make it all so easy. It's all bull if you ask me. Single Payer Now !!

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Response to YOHABLO (Reply #55)

Sat Jan 19, 2013, 09:21 PM

72. HR 676 Single Payer Now Agreed!

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Response to democrattotheend (Original post)

Thu Jan 10, 2013, 02:31 AM

59. Medicare is a blessing for us

Personal experience. We have supplemental insurance that is great for prescriptions, although we can get more and more of them for $4 from Kroger or WalMart. Medicare seems to always bring doctor's and hospital's prices way down. Last February my husbaand was in the hospital six days after a messy full knee replacement - the whole thing included a nuclear heart stress test, several visits by lurking cardiologists and tremendous delayed bleeding, which in the past has come close to killing him. The hospital bill was over $33,000 but after Medicare negotiated lower costs, and after our supplemental did whatever it does, we paid something like $1100. Later in 2012 he had two more minor surgeries on his knee, with platelet transfusions each time, as well as two procedures on a detached retina, and the cost has been negligble for all four. I mean neglible as in none for some of them.

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Response to democrattotheend (Original post)

Thu Jan 10, 2013, 08:54 AM

63. info on supplemental insurance

the supplemental stuff is very confusing. Forget medigap if that is still around but know this if you are deciding on a supplement plan.

All plan A's are the same
All plan B's are the same
All plan F's are the same

In other words, a plan a is a plan a. By any company. It is required to be the same. So if you decide you like plan A, you then just have to look at who offers it, at what price, and how easy they might be to work with to make your decision.

If you decide you like plan F. Just look at all who offer it and decide from there.

It makes it a lot easier when you realize that each plan is the same by whatever carrier.

I think I chose a plan F for my mom. Cost 132 a month from mutual of Omaha. Paid almost everything but 56.00 per doctor visit. When she died, while on life support, I got zero in bills. When she went to er a few years earlier, there were little or no bills. She did not have many meds so we had no problems.

as to your questions on doctor services, yes I think those are are billed as separate cost but end up being about 20% out of pocket across the board.

blue cross/sheild used to have a search engine that would tell you the cost of different procedures at different facilities and also list the out of pocket cost. You might try to find that. If one place charges 800 bucks for something and another charges 500 for the same thing your out of pocket cost would differ by about 60 bucks.

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