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I have family members on Medicaid and help them with their care. Medicaid covers 100% of everything, from doctors visits to specialists, ER care, surgery, dental, vision, medications, etc at no cost to the beneficiary. By law, Medicaid has to pay for everything, so patients don't get pushed around by providers or insurers about billing or additional costs. The headache surrounding billing and paying for care just doesn't exist. Policyholders can confidently see doctors and buy prescriptions they need without worrying about being sent mystery bills several months down the line, or being unable to fill medication, including brand name medication. On the private insurer side, if you're prescribed an on-patent medication that has no generics, every insurer I've had has fought me every step of the way for coverage, and some plans just don't cover brand name medication at all. Even when you work with your doctor and insurer to get coverage for specific medications, insurers will decide 4 months later that they don't want to cover it anymore and you have to jump through those hoops all over again. My "favorite" experience was having to cycle through several medications that I had been prescribed in the past that weren't effective in order to make my insurer happy so that they'd cover the medication that does work. Apparently the private insurer knows how to treat patients better than doctors do. Then I moved and had to switch insurers, and the insurer wanted me to go through the process of taking drugs that don't work all over again. I gave up and just pay for the actually-efficacious prescription out of pocket, and none of those costs go towards my deductible. I now pay $18 per pill for something that costs $34 total for a 30-day supply, which is about a dollar per pill, in other first world countries. If it was possible, I'd drop my own coverage instantly for Medicaid. Doing so would make my life immeasurably better. > Doesn't seem like the rest of the world's universal healthcare did any better than ours? On every metric, other countries' healthcare systems outperform the healthcare system in the US, resulting in higher quality care and patient outcomes, all for much less than the US spends[1]. [1] https://www.healthsystemtracker.org/chart-collection/quality... |
I also care for a family member on Medicaid and, while it’s very far from perfect, I agree that in many every-day scenarios it’s remarkably superior to my employer-provided coverage.
Most of the downsides I’ve experienced are issues with getting specialist appointments in a timely fashion and providers creating unexpected reimbursement loopholes - which are thankfully rare, but remarkably abusive when they have occurred.
Eg: Medicaid will get you booked with an allergy clinic four months out and during the appointment they tell you “Oh by the way, Medicaid only covers ~5 basic allergen tests; if you want the standard regional allergen test that’s $150 up front and if you want the full spectrum test that’ll be $300.”
Meanwhile, half a year prior, I went to the same clinic, got my appointment booked for 2-3 weeks out, and wasn’t even asked about the test type - they hit me with the full spectrum and I just had to toss a minor copay on the way out the door.
I guess the overall moral of the story is that our healthcare system is broken and jammed up with perverse incentives at every rung of the ladder.