Dan Weissmann

Masking the American well being care system means we inform some scary tales. This episode of “An Arm and a Leg” feels like an actual horror film. 

It makes use of one among Hollywood’s favourite tropes: machines taking on. And the machines belong to the personal medical health insurance firm UnitedHealth Group. 

Host Dan Weissmann talks to Stat Information reporter Bob Herman about his investigation into Medicare Benefit plans that use an algorithm to make choices about affected person care. The algorithm is owned by a subsidiary of UnitedHealth Group.

Herman tells Weissmann that a few of UnitedHealth’s personal staff say the algorithm creates a “ethical disaster” during which care is unfairly denied.

Scary stuff! Such reporting even has caught the attention of highly effective individuals in authorities, placing Medicare Benefit plans underneath scrutiny.

Dan Weissmann

@danweissmann

Host and producer of “An Arm and a Leg.” Beforehand, Dan was a employees reporter for Market and Chicago’s WBEZ. His work additionally seems on All Issues Thought of, Market, the BBC, 99 % Invisible, and Reveal, from the Heart for Investigative Reporting.

Credit

Emily Pisacreta
Producer

Adam Raymonda
Audio Wizard

Ellen Weiss
Editor

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Transcript: Son of Medicare: Assault of the Machines

Word: “An Arm and a Leg” makes use of speech-recognition software program to generate transcripts, which can include errors. Please use the transcript as a device however examine the corresponding audio earlier than quoting the podcast.

Dan: Hey there–

So that is sort of a horror story. Nevertheless it’s not fairly the sort of story it’d sound like at first.

As a result of at first, it’d sound like a horror story about machines taking on, making all the selections– and making horrible, horrifying decisions. Very age-of-Synthetic Intelligence.

However that is actually a narrative about choices made by individuals. For cash.

It’s additionally sort of a twofer sequel– like these films that pit two characters from earlier tales towards one another. Like Godzilla vs King Kong, or Alien vs Predator.

Though on this case, I’ve gotta admit, the 2 monsters should not essentially preventing one another.

Let’s get reacquainted with them. 

On one facet, getting back from our final episode, we’ve received Medicare Benefit: That is the model of Medicare that’s run by personal insurance coverage firms. 

It’s received a brilliant and interesting facet, in comparison with the standard Medicare program run by the federal authorities, as a result of: It may well value so much much less, month to month — saving individuals cash on premiums. And it usually comes with further advantages, like dental protection, which conventional Medicare doesn’t provide. [I know.]

However Medicare Benefit can have a darkish facet, which is mainly: Nicely, you find yourself coping with personal insurance coverage firms for the remainder of your life. You want one thing — a take a look at, a process, no matter — they may determine to not cowl it.

Which might be scary. 

Our different returning monster — am I actually calling them a monster? — effectively, final time we talked about them, in 2023, we had an knowledgeable calling them a behemoth. That’s United HealthGroup. You would possibly keep in mind, they’re not solely one of many greatest insurance coverage firms 

— and possibly not-coincidentally the very greatest supplier of Medicare Benefit plans —

they’ve additionally received a complete different enterprise– underneath the umbrella identify Optum. And Optum has spent the final bunch of years shopping for up a gazillion different well being care firms of each form. 

That features medical practices — they make use of extra docs than anybody else, by an enormous margin. It consists of surgical procedure facilities, and home-health firms, and each sort of intermediary firm you may think about that works behind the scenes — and have their fingers in an enormous proportion of physician payments and pharmacy visits. 

Just a few years in the past, United purchased an organization known as NaviHealth, which supplies providers to insurance coverage firms that run Medicare Benefit plans. 

NaviHealth’s job is to determine how lengthy somebody wants to remain in a nursing house, like in the event you’re discharged from a hospital after surgical procedure, however you’re not able to go house but.

And the horror story– the tales, as dug up by reporters — begins after United purchased NaviHealth.

And in line with their experiences, it includes individuals getting kicked out of these nursing properties who aren’t able to go house. 

Individuals getting despatched house who can’t stroll up the steps of their home. Who can’t stroll in any respect. Who’re on feeding tubes. Individuals who NaviHealth’s personal staff are saying, “Wait. This individual isn’t able to go house.”

However their new bosses have informed them: You’re probably not making these choices anymore. 

That is the place machines do enter the image.

NaviHealth’s distinctive providing has all the time been its proprietary algorithm– an algorithm that makes predictions about how lengthy any given affected person would possibly want to remain. 

Earlier than United purchased the corporate, that algorithm was used as a information, a first-guess. People weighed in with their very own judgment about what sufferers wanted.

After United purchased the corporate, individuals inside have informed reporters, that modified: The brand new homeowners mainly informed their staff, If the algorithm says somebody can go house after x days, that’s after we’re chopping them off.

 Like just about any horror film, this story’s received individuals working round making an attempt to inform everybody: HEY, WATCH OUT! THERE’S SOMETHING BIG AND DANGEROUS HAPPENING HERE.

And on this case, they’ve truly gotten the eye of some individuals who might need the ability to do one thing about it. Now, what these individuals will do? We don’t know but. 

And, by the best way: Sure, I stated on the finish of our final episode that we’d be speaking about Medicaid this time round. That’s coming! However for now, strap in for this one. 

That is An Arm and a Leg, a present about why well being care prices so freaking a lot, and what we will possibly do about it. I’m Dan Weissmann. I’m a reporter, and I like a problem. So our job on this present is to take some of the enraging, terrifying, miserable components of American life, and produce you one thing entertaining, empowering, and helpful.

So. I stated that, like each horror film, this one has people who find themselves seeing what’s occurring and try to warn everyone?

Like these films, we’re gonna comply with a kind of individuals, watch them uncover the issue, see how deep it goes, and begin ringing alarm bells. Let’s meet our man.

Bob Herman: My identify is Bob Herman. I’m a reporter at STAT Information

Dan: Stat is a tremendous medical information publication. Bob covers the enterprise of drugs there. Bob began engaged on this story in November 2022, after speaking to a supply who runs nursing properties. Bob’s supply was complaining about Medicare Benefit. 

Bob Herman: There have been a whole lot of fee denials. They only weren’t in a position to receives a commission. And simply offhandedly, the supply talked about like, um, you understand, they usually’re attributing all the pieces to this algorithm. This algorithm stated, , solely 17 days for our sufferers after which time’s up and I went working to Casey Ross 

Dan: Casey is a reporter at Stat who focuses on tech and AI in healthcare. Bob stated, hey, what do you consider this? Wanna crew up?

Bob Herman: And he was hooked.

Dan: They began speaking to individuals who labored at nursing properties, speaking to consultants, and speaking to households. And it was clear: They had been onto one thing. 

Bob Herman: It took so many households unexpectedly to be like, what do you imply we’re going house? The, you understand, my husband, my spouse, my grandma, my grandpa, they will’t go to the toilet on their very own. Like, what do you? It was simply, it was so complicated to individuals. It appeared like such a, a chilly calculation,​

Dan: One individual they ended up speaking with was Gloria Bent. Her husband Gary was despatched to a nursing house for rehab after mind surgical procedure for most cancers. He was weak. He couldn’t stroll. And he had one thing known as “left neglect”: His mind didn’t register that there was a left facet of his physique. Right here’s Gloria testifying earlier than a Senate committee about how — when Gary arrived on the nursing house — the very first thing he received was a discharge date. That’s…

Gloria Bent: Earlier than the employees of the power may even consider my husband or develop a plan of care, I used to be contacted by somebody who recognized themselves as my Navi Well being Care Coordinator

Dan: Gloria says when she informed the nursing house employees she’d heard from NaviHealth, they groaned. And informed her what to anticipate. 

Gloria Bent: I used to be informed that I had simply entered a battlefield, that I may count on a collection of notices of denial of Medicare fee accompanied by a discharge date that will be two days after I received that discover.

Dan: Yeah, they stated she’d get two days discover. Gloria says the nursing house employees informed her she’d have 24 hours to attraction every of these, however even when she gained, the denials would hold coming. In truth, they stated,

Gloria Bent: If we gained a few appeals, then we may count on that the frequency with which these denials had been going to return would improve.

Dan: All of which occurred. NaviHealth began issuing denials July 15, 2022, after Gary had been on the house for a month.

Gloria appealed. She informed senators what the physician who evaluated the attraction discovered: Gary couldn’t  stroll. He couldn’t even transfer — like from mattress to a chair — with out assist from two individuals.. That reviewer took Gloria’s facet.

Her husband’s subsequent denial got here per week after the primary. Gloria gained that attraction too. She says the reviewer famous that Gary wanted most help with actions of every day residing. 

The third denial got here 4 days later, and this time Gloria misplaced. 

Gary got here house in an ambulance: As Gloria testified, he couldn’t get into or out of a automotive with out help from somebody with particular coaching. 

And when he received into the ambulance, he had a fever. The subsequent morning, he wound up in one other ambulance — headed to a hospital with meningitis. He misplaced a whole lot of the functioning he’d picked up on the nursing house. 

He died at house a number of months later. When Gloria testified within the Senate, all of it was nonetheless contemporary. She informed them that as terrible as Gary’s sickness and decline had been, the fights with insurance coverage had been an added trauma.

Gloria Bent: This shouldn’t be occurring to households and sufferers. It’s merciless. Our household continues to battle with the query that I hear you asking at this time. Why are people who find themselves sufferers solely on paper or by way of the lens of an algorithm

making choices that deny the providers judged crucial by well being care suppliers who know their sufferers.

Dan: Bob Herman calls Gloria’s story heartbreaking, like so many others he’s seen. 

And his consideration goes to 1 a part of Gloria’s story past denial-by-algorithm. 

As a result of: It’s not only one denial. It’s that collection of denials. You possibly can attraction, however as Gloria testified, the denials velocity up. And it’s important to win each single time. The corporate solely has to win as soon as. 

I imply, until you’re able to get a lawyer and take your probabilities in courtroom– which, along with being a significant endeavor, additionally means racking up nursing house payments and authorized payments chances are you’ll by no means get reimbursed for, whereas the courtroom course of performs out. 

Bob Herman: This attraction system is designed in such a manner that individuals will quit. When you’ve got a job, you understand, even in the event you don’t, and also you’re, and also you’re additionally making an attempt to maintain a member of the family, um, it’s a rigorous monotonous course of that can chew individuals up and spit them out after which the individuals are inevitably going to surrender. And I believe in some methods insurers know that.

Dan: Going out on a limb to say: I believe so too. So Bob and Casey’s first story on NaviHealth got here out in March of 2023. They had been the characters within the film who go, “HEY, I THINK THERE’S SOMETHING REALLY BAD HAPPENING HERE.”

And other people began paying consideration. Just like the U.S. Senate. which held that listening to the place Gloria Bent informed her story. 

And just like the federal company that runs Medicare — the Facilities for Medicare and Medicaid Companies, CMS. 

CMS finalized a rule that informed insurers: You possibly can’t deny care to individuals simply from utilizing an algorithm. 

And one thing else occurred too: Bob and Casey began immediately getting so much MORE data. 

Bob Herman: We acquired so many responses from individuals and it simply opened the floodgates for former staff, simply sufferers and relations, simply everybody throughout the board.

Dan: And never simply former staff. Present staff. And what they discovered was: There was completely a technique at work in how this algorithm was getting used. It was technique some individuals on the within didn’t be ok with. 

And this technique received developed after United HealthGroup — and its subsidiary, Optum– purchased NaviHealth in 2020. And right here’s what NaviHealth staff began telling Casey and Bob about that technique.

Bob Herman: For a few of us, it’s creating this ethical disaster. Like we all know that we’re having to take heed to an algorithm to primarily kick somebody out of a nursing house, despite the fact that we all know that they will barely stroll 20 ft.

Dan: What Bob and Casey discovered from insiders– and the way it connects to United’s function as a well being care behemoth– that’s subsequent.

This episode of An Arm and a Leg is produced in partnership with KFF Well being Information. That’s a nonprofit newsroom overlaying healthcare in America. Their reporters do superb work, and I’m honored to work with them. We’ll have a little bit extra about KFF Well being Information on the finish of this episode.

So, NaviHealth — the corporate with the algorithm — received began in 2015.. And the concept behind it was to make use of knowledge to get individuals house quicker from nursing properties in the event that they didn’t truly must be there. 

As a result of there was a whole lot of proof that some individuals had been being saved longer than they wanted. 

Bob Herman: There’s some validity to the concept there’s, there’s wasteful care in Medicare, like, you understand, there’s been instances prior to now proving that individuals keep in a nursing house for manner longer than is important. And clearly there’s monetary incentives for nursing properties to maintain individuals so long as attainable. 

Dan: Conventional Medicare does have limits on nursing house care — however in the event you want “post-acute care” — assist getting again in your ft after leaving a hospital conventional Medicare pays in full for 20 days– just about no questions requested. One of many promoting factors of Medicare Benefit — like promoting factors to coverage nerds and politicians — was that it may minimize waste, by asking these sorts of questions. NaviHealth and its algorithm had been designed to assist Medicare Benefit plans ask these questions in a wise manner. 

Bob Herman: There have been… a whole lot of believers inside NaviHealth that had been like, okay, I believe we’re doing the correct factor. We’re making an attempt to verify individuals get house sooner as a result of who doesn’t wish to be at house.  

Dan: And as these staff informed Bob and Casey: Earlier than United and Optum got here in, the algorithm had been there as a information — a sort of first guess — however not the ultimate phrase. 

NaviHealth has employees individuals who work together immediately with sufferers. And again within the day, the pre-United day, Bob and Casey discovered that these employees may make their very own judgments. 

Which made sense, as a result of the algorithm doesn’t know all the pieces about any particular person case. It’s simply making predictions primarily based on the info it has.

Bob Herman: And there was simply, simply this noticeable change after United and OptiMentor that it felt extra inflexible. There’s no extra variation. 

Dan: If the algorithm says you go, you’re just about going.

Bob Herman: United has stated, no, that’s not the case, however clearly these paperwork and different communications that we’ve gotten sort of say in any other case.

Dan: As a result of these staff weren’t simply speaking. They had been sharing. Inner memos. Emails. Coaching supplies. All making clear: The corporate needed individuals shipped out on the algorithm’s timetable. 

Bob Herman: Paperwork got here in displaying that like this was a fairly specific technique. , UnitedHealth was telling its staff. Hear, we have now this algorithm. We predict it’s actually good. So when it tells you what number of, what number of days somebody must be in a nursing house, persist with it.

Dan: Keep on with it or possibly be fired. Bob and Casey received paperwork — worker efficiency targets– saying: How shut you persist with the algorithm’s suggestions? That’s a part of how we’re evaluating your job efficiency. 

Bob Herman: It’s okay. Algorithm stated 17 days, you higher probably not go outdoors of that as a result of your job is on the road. 

Dan: Right here’s how carefully individuals had been anticipated to stay to it. In 2022, worker efficiency targets shared with STAT confirmed that employees had been anticipated to maintain precise time in nursing properties to inside three % of what the algorithm stated it must be. Throughout the board.

So, say you had 10 sufferers, and the algorithm stated they every ought to get 10 days. That’s 100 days. Your job was to make it possible for the entire precise days for these sufferers didn’t go previous 103 days.

Then, in 2023, the expectations received extra stringent: Keep inside one % of the algorithm’s predictions. 10 sufferers, the algorithm says 100 days complete? Don’t let it get previous 100 and one. 

Bob Herman: Like that’s, nearly nothing. Like what, what, your fingers are tied. For those who’re that worker, what are you going to do? Are you going to get fired? Are you going to do what you’re informed?

Dan: And one one who ended up speaking, to did get fired. 

Bob Herman: Right. Sure. Uh, Amber Lynch did get fired And what she stated was what we had additionally heard simply extra broadly was it, it created this inner battle, like, Oh my God, what I’m doing doesn’t really feel proper. 

Dan: Amber Lynch was a case supervisor. She informed Bob and Casey about onepatient who couldn’t climb the steps in his house after knee surgical procedure. However the algorithm stated he was prepared. Amber’s supervisor stated, “Have you ever requested the nursing house employees in the event that they’ve tried to show him butt bumping?” Amber grit her tooth and made the suggestion to the rehab director.

Amber Lynch: And he or she checked out me like I had two heads. She’s like, he’s 78 years previous. He’s not going to try this. He’s not secure to climb the steps but. He’s not doing it. We’re not going to have it butt bump the steps.

Dan: Amber informed Bob and Casey that when she received fired, it was partly for failing to hit the one % goal and partly for being late with paperwork– which she informed Bob and Casey she fell behind as a result of her caseload was so heavy.

She wasn’t the one one with that criticism. 

Bob and Casey’s story reveals one other NaviHealth case supervisor– not named within the story as a result of they’re nonetheless on the job — of their house workplace, struggling to maintain up. 

That week, they had been presupposed to work with 27 sufferers and their households. Collect paperwork, maintain conferences. One other week, shortly earlier than, they’d had 40 sufferers. 

“Do you assume I used to be in a position to course of all the pieces appropriately and name everybody appropriately the best way I used to be presupposed to?” the case supervisor requested. “No. It’s unimaginable. Nobody might be that quick and that efficient and seize all the data that’s wanted.”

Bob and Casey watched this case supervisor fill out a digital type, feeding the algorithm the knowledge it requested for on a person in his 80s with coronary heart failure, kidney illness, diabetes and bother swallowing, who was recovering from a damaged shoulder. 

A couple of minutes later, the pc spat out a quantity: 17 days. 

The case supervisor didn’t have a whole lot of time or leeway to argue, however they had been skeptical that the algorithm may get that quantity precisely proper primarily based on solely the info it had. 

And what knowledge is the algorithm working with? What’s it evaluating the info on any given affected person TO? Bob Herman says that’s a giant query.

Bob Herman: It’s one thing that for positive, like Casey and I, it’s been bothering us. Like, what, how is that this complete system? Like, what’s it primarily based on? And we had been by no means actually given straight solutions on that. NaviHealth and Optum and United have stated it’s primarily based on hundreds of thousands of affected person data over time. The sources of that, it’s, it’s a little bit unclear, the place all that’s coming from. 

Dan: Bob and Casey talked with an knowledgeable named Ziad Obermeyer, a professor on the College of California Berkeley College of Public Well being, who is just not anti-algorithm. He truly builds algorithmic instruments for resolution making in public well being. 

AND he’s completed analysis displaying that some widely-used algorithms simply scale up and automate issues like racial bias.

He informed Bob and Casey: Utilizing an algorithm primarily based on how lengthy different, earlier sufferers have stayed in a nursing house — that’s not an incredible thought.

As a result of individuals get compelled out of nursing properties, in his phrases, “as a result of they will’t pay or as a result of their insurance coverage sucks.” He stated, “So the algorightm is mainly studying all of the inequalities of our present system.”

And leaving apart that sort of bias, it appears unlikely to Bob that any algorithm may predict precisely what each single affected person will want each single time. 

Regardless of how a lot knowledge it’s received, it’s predicting from averages.

Bob Herman: It jogs my memory of, like, a basketball recreation the place let’s say somebody averages 27 factors per recreation. They don’t have 27 factors each single, the sport they go on the market. It simply varies occasionally.

Dan: However the NaviHealth algorithm doesn’t should be proper each time for United to earn cash utilizing it. 

Utilizing it to make choices can permit United to spice up earnings coming and going.

Bob Herman: United well being and the opposite insurance coverage firms that use Navi well being. Are utilizing this know-how to roughly kick individuals out of nursing properties earlier than they’re prepared. And that’s the claims denial facet the place it’s like, okay, let’s save as a lot cash as we will as an alternative of getting to pay it to a nursing house.

Dan: And that’s only one facet of it. The insurance coverage facet. Claims denial. However United isn’t simply within the insurance coverage enterprise. 

United’s Optum facet is in each different a part of well being care. 

Together with — within the years since United took over NaviHealth — house well being providers. The sort of providers you’re more likely to want whenever you depart a nursing house.

In 2022, Optum purchased one prime house well being firm in what one commerce publication known as a “monster, jaw-dropping mega-deal” — greater than 5 billion {dollars}. In 2023, Optum made a deal to purchase a second mega-provider. 

Bob and Casey’s story says NaviHealth’s shortening nursing house stays is integral to United’s technique for these acquisitions. It does appear to open up new alternatives.

Bob Herman: You’re out of the nursing house as a result of our algorithm stated so. Now we’re going to ship you to a house well being company or we’re going to ship some house well being aides into your house. And by the best way, we personal them. 

Dan: Oh, proper, as a result of: For those who’re in a Medicare Benefit plan, your insurer can inform you which suppliers are coated. 

Bob Herman: So the true query turns into, how a lot is United doubtlessly paying itself?

Dan: That’s: How a lot would possibly United find yourself taking cash out of 1 pocket — the medical health insurance facet — and paying itself into one other pocket, Optum’s home-health providers?

We don’t know the reply to how a lot United is paying itself on this manner, or hoping to. And United has stated its insurance coverage arm doesn’t favor its in-house companies.

Nevertheless it looks like an inexpensive query to ask. Really, it’s a query the feds appear to be asking.

Optum hasn’t wrapped up its buy of that second home-health firm but, and in February 2024, the Wall Avenue Journal and different shops reported that the U.S. Division of Justice had opened an anti-trust investigation. 

And also you don’t should be in a Medicare Benefit plan run by United to get kicked out of a nursing house on an algorithm’s say-so. 

Bob Herman says NaviHealth sells its algorithm-driven providers to different huge insurance coverage firms 

He says, put collectively, the businesses that use NaviHealth cowl as many as  15 million individuals — about half of everyone in Medicare Benefit.

Bob Herman: Odds are, in the event you’re in a Medicare Benefit plan, there’s a, there’s a very good shot that your protection insurance policies, in the event you get actually sick and want nursing house care, for instance, or any sort of publish acute care, an algorithm might be at play in some unspecified time in the future.

Dan: That is the darkish facet of Medicare Benefit. 

Bob Herman: Everybody loves their Medicare Benefit plan once they first enroll, proper? As a result of it’s providing all these bells and whistles. It’s, right here’s a health club membership. It’s received dental and imaginative and prescient, which common Medicare doesn’t have. And it’s additionally simply, it’s, it’s cheaper. Like, if it’s simply from a monetary standpoint, if, in the event you’re a low revenue senior, How do you flip it down? There’s, there’s so many plans that provide like free, there’s no month-to-month premiums along with all of the bells and whistles. However No person understands the commerce offs , Once you’re signing up for Medicare and Medicare Benefit, you’re on the more healthy facet of, of being a senior, proper?

Dan: And none of us can rely on staying wholesome without end. Once you join Medicare  you’re signing up your future self — whether or not that’s ten or twenty or extra years out. That future you, would possibly actually need good medical care. 

And at that time, as we defined in our final episode, if Medicare Benefit isn’t working for you, chances are you’ll not have the ability to get out of it.

Bob Herman: You possibly can doubtlessly not absolutely get the care that you simply want. We shouldn’t assume that, that this couldn’t occur to us as a result of it could actually. 

Dan: So, yeah. Form of a horror story. However: In contrast to some horror films, when Bob and Casey began publishing their tales, they began getting individuals’s consideration.

We talked about the brand new guidelines from the feds and the senate hearings after Bob and Casey’s first story in March 2023

Later within the yr, when Bob and Casey revealed their story with paperwork and tales from inside NaviHealth, a class-action lawsuit received filed.

Since then, CMS has stated it is going to step up audits underneath its new guidelines. 

Bob Herman: There was a memo that CMS despatched out to Medicare benefit plans that stated, Hey, pay attention, we’re telling you once more, don’t deny care solely on any AI or algorithms. Like simply don’t do it. 

Dan: And in February 2024, the Senate held one other listening to. 

Right here’s Senator Elizabeth Warren at that listening to, saying these CMS guidelines aren’t sufficient. We’d like stronger guardrails.

Elizabeth Warren: Till CMS can confirm that AI algorithms reliably adhere to Medicare protection requirements by regulation, then my view on that is CMS ought to prohibit insurance coverage firms from utilizing them of their MA plans for protection choices. They’ve received to show they work earlier than they put them in place.

Dan: So individuals — individuals with at the very least some energy– are paying some consideration. 

Bob Herman: I don’t assume that is essentially going to flee. Political scrutiny for some time. 

Dan: So, mainly, the story isn’t over. 

This isn’t a kind of horror films the place the monster’s been safely defeated on the finish, and everyone simply begins cleansing up the mess. And it’s not one the place the monster is simply on the free, unleashing the apocalypse. 

As a result of it’s not a film. There’s no ending. There’s simply all of us making an attempt to determine what’s occurring, and what we will possibly do about it.

One very last thing: I received a whole lot of emails after our final episode, the place we laid out a whole lot of details about Medicare Benefit and conventional Medicare. Most of it was alongside the traces of, Thanks! That was actually useful! Which made me really feel actually good.

And we received a pair notes about issues we may have completed higher. Particularly this: We stated Conventional Medicare leaves you on the hook for 20 % of all the pieces, with out an out of pocket restrict. 

Which is true — however just for Medicare Half B: Physician visits, outpatient surgical procedures and checks. Which may add up, for positive.

Medicare Half A — in the event you’re truly hospitalized — covers most providers at 100%, after you meet the deductible. In 2024 that’s one thousand, 600 thirty-two {dollars}. 

Because of Clarke Lancina for pointing that out. 

There have been a bunch of different, superb notes in my inbox not too long ago, and I wish to say: Please hold them coming. 

For those who go to arm and a leg present dot com, slash, contact, no matter you kind there goes straight to my inbox. You possibly can connect stuff too: paperwork… voice memos. 

Please let me hear from you. That’s arm and a leg present dot com, slash contact.

I’ll catch you in a number of weeks. 

Until then, maintain your self.

This episode of an arm and a leg was produced by me, Dan Weissmann, with assist from Emily Pisacreta, and edited by Ellen Weiss. 

Adam Raymonda is our audio wizard. Our music is by Dave Weiner and blue dot periods. Additional music on this episode from Epidemic Sound.

Gabrielle Healy is our managing editor for viewers. She edits the primary assist package publication. 

Bea Bosco is our consulting director of operations. Sarah Ballama is our operations supervisor. 

And Arm and a Leg is produced in partnership with KFF Well being Information. That’s a nationwide newsroom producing in depth journalism about healthcare in America and a core program at KFF, an unbiased supply of well being coverage analysis, polling and journalism. 

Zach Dyer is senior audio producer at KFF Well being Information. He’s editorial liaison to this present. 

And due to the Institute for Nonprofit Information for serving as our fiscal sponsor, permitting us to simply accept tax exempt donations. You possibly can study extra about INN at INN. org. 

Lastly, due to everyone who helps this present financially– you may take part any time at arm and a leg present dot com, slash, help — and thanks for listening.

“An Arm and a Leg” is a co-production of KFF Well being Information and Public Highway Productions.

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