There is definitely conflicting info In This thread. Some of it implying if youre piss poor and can't afford health care you will get taken care of regardless and Medicare just takes care of it.
However, you hear all too often of hard working Americans both working class and middle class bankrupting themselves, using their savings or remortgaging their homes. All because their insurance doesn't cover the expensive cancer treatments or the upfront costs are insane like 50 to 100k.
It's not conflicting: Both are true.
First a nitpick: Medicare is only for seniors and disabled. Medicaid is for lower income individuals...
if they qualify. It's a small distinction but an important one because Medicare is fully federally run whereas Medicaid is state run with federal assistance.
I digress. Neither Medicare nor Medicaid will pay 100% of medical bills. Medicare has an 80%/20% benefit split, meaning they'll pay up to 80% of
what they consider the claim to be worth and the patient has to pay the other 20%. Medicare also has premiums that have to be paid - for 2025 the Part B (general care) premium is $185 a month. Medicare recipients can cover that other 20% by buying Medicare Supplemental Insurance through a third party, but that usually costs hundreds of dollars per month in added premiums. Medicaid, conversely, usually doesn't have premiums but they
do have copays and deductibles, depending on state system and managed care plans they contract with.
So, if someone is on Medicare and they don't have a supplemental insurance plan, they have to pay 20% of every Medicare claim. If they have something catastrophic that requires a lengthy hospital stay with multiple procedures, that 20% bill can easily be enough to bankrupt them
despite having Medicare.
I can give a practical example from my late mother's 2007 heart attack that had a botched stent. She ended up in the hospital for three weeks and needed three more surgeries including an internal defibrillator. Her combined total bill was over $600K. Medicare determined they'd pay $274K, which was all the hospital and various doctors and practices would get. Of
that determined amount, Medicare only
actually paid out 80%, and my mom got bills to the tune of $55K. Thankfully my dad had invested in a Medicare supplemental insurance plan so my mom ultimately paid nothing but if she had to pay the bill out of pocket, it would have been a massive financially hit. She could have paid it, but it would have taken nearly half of her
lifetime retirement savings.
As an aside, if people think getting claims through private insurance is bad, just wait until you have to deal with Medicare. I've managed my wife's Medicare benefits for the last four years and they're much quicker to deny claims and medications than any private insurers we
ever had in the past. We're going on month 7 and appeal number 2 trying to get her hemolytic anemia treatment approved (rituximab IV infusions). Meanwhile, that IV doesn't even require a prior authoriziation on my private insurer's prescription formulary. It's why I laugh anytime I hear someone champion Medicare for All. If they had to deal with Medicare on a regular basis, they wouldn't want government anywhere near their care. Either you deal with corporate bean counters or government bureaucrats determining whether or not you get care. I'll take bean counters over bureaucrats.