Thank you Medicare. (Don't read if your health insurance is lacking)

[question everything]

Spouse had an open heart surgery, was in the hospital for 11 days, including 3 days at ICU.

Hospital charges are $88,000 and our copay is $1,000. Yes, we have it, set aside the stimulus payment.

Did not have any copay for the surgeon, nor the anesthesiologist, not for the three weeks rehab center.

The rest are $3.00 here, $4.00 there for X-rays.

One reason may be the unique arrangement where the local health insurance that provides Medicare Advantage also owns the large clinic and hospital and where all the healthcare providers are in the network.

Yes, of course we pay monthly insurance premiums and Medicare payment is deducted from the Social Security payment but they never reach these amounts..

[PoindexterOglethorpe]

1. I had a heart attack back in December.

Got a stent, was in the hospital three days. My total charges before adjustments and payment by my Advantage provider, came to $81,668.38. I paid $885.00. I did have about a $45 co-pay each time at cardiac rehab, but that wasn't too bad.

[doc03]

3. My insurance has a maximum out of pocket

copay of $1000.

[trof]

4. Which plan do you have?

A, B, C, etc.?
We have N.

[question everything]

5. Have no idea what these letters mean

Started with private plan Medicare Part B which covers doctors visits also Medicine - Part D, I suppose.

Then a couple of years ago they had to change to Medicare Advantage which means the private insurance is now Medicare. Used to be that when the Medicare would pay, say, for hospital stay, the rest would be covered by the private insurance and with our copay. Now Medicare is out of it.

For example, for years ago spouse had a knee replacement surgery. The hospital for three days charge was $42,000,, Medicare paid $13,000, private insurance $1,100 and our co pay was $200.

Even then I wondered, on these pages, whether the hospital really needs $42,000, how come it can survive with $15,000.

[trof]

6. OK, you have Medicare Advantage. That's a whole' nuther plan.

You say "they had to change...". Who is 'they' and why did 'they' have to change?
I'm unclear.

[question everything]

7. Three years ago Medicare decided that our region had too many "cost" plans

(and I am not even sure what this means.)

So many had o switch to Advantage and while doing that reshuffled providers and networks and whatnot.

My primary physician was no longer in the network so I had to switch carrier. In the long run I think that I am better off. Spouse stayed with the same carrier which, as I stated in the op, also owns a vast network of clinics and specialists and, perhaps the hospital.