Tag: Medicare

Medicare: Its Beginnings

On July 30, 1965, almost 50 years ago, Congress enacted Medicare to ensure that older adults had health insurance. Back then, almost half of Americans over 65 were uninsured, either no insurer was willing to cover them or the available insurance was unaffordable. Medicare offered them access to quality affordable health care. Medicare was designed to work—offering essentially automatic coverage for anyone who turned 65, deducting the premium from their Social Security check, and affording them access to doctors and hospitals anywhere in the United States. Medicare did not have a cap on out-of-pocket costs, nor did it cover long-term care or prescription drugs. But, health care costs were far lower then.

Thanks to Medicare, today just 2 percent of older adults lack health insurance coverage, while in 1962 48 percent of them lacked coverage. And, Americans’ life expectancy has increased significantly. Moreover, people with Medicare tend to rate it more highly than private insurance. According to the Commonwealth Fund, “people with Medicare indicate they are less likely to have problems getting needed care and to have burdensome medical bills and negative insurance experiences.”

Medicare today is in the forefront of insurers driving health care innovations throughout the health care system. Private insurers tend to keep their innovations confidential. Medicare therefore takes the lead in ensuring systemic improvements. According to the Commonwealth Fund, it is “developing models to promote high-quality, evidence-based care and reducing incentives to provide more services, regardless of their value to patients.” Could Medicare be stronger and better still? Of course. But, is it able to deliver better value than private insurance, in terms of cost and the ability to promote a better health care system? You bet. Check out this infographic on Medicare’s origins.

January 13, 2015
Medicare costs are dropping

This 2014 chart from The New York Times shows that, thanks to the Affordable Care Act, projected Medicare costs are dropping significantly. According to the NYT, “the reduced estimates mean that the federal government’s long-term budget deficit is considerably less severe than commonly thought just a few years ago.” In 2014 dollars, average costs per individual with Medicare is down to $11,300 from a Congressional Budget Office projection of $12,700.

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Medicare Trustees project Trust Fund to last until 2030

January 8, 2015
Two ways to make sure Medicare covers ambulance services

Medicare covers ambulance services when they are medically necessary. Here’s how to ensure Medicare will pay:

1. Be prepared. Identify an ambulance company to use. Confirm with your local ambulance service that it is Medicare-certified. If you are enrolled in a Medicare Advantage plan, find out which ambulance is in the health plan’s network.
2. Only use an ambulance if you have an immediate health risk or are bed-bound and require constant monitoring. And, make sure that the ambulance will take you to the hospital you want to use if there is more than one hospital in your area. Under the law, the ambulance generally must take you to the nearest hospital.

If you want Medicare to pay for ambulance services, do not use an ambulette. Medicare will not cover it. For more information, visit Medicare Interactive.

November 19, 2014
Medicaid, Medicare and long-term care
Long-term care can cost a lot. Medicare sometimes picks up a small piece of the cost. Medicaid can cover a lot of the cost. Paying out-of-pocket for long-term care tends to be extremely expensive. Here are some key facts on Medicaid, Medicare and long-term care:
- Fact: Medicaid covers about two-thirds of all long-term care spending, about $131 billion in 2011. 87% of Medicaid spending on older adults is for long-term care. One in three older adults with Medicaid receive long-term care through Medicaid.
- Fact: 43% of people with Medicaid needing long-term care are under the age of 65.
- Fact: Medicare does not cover long-term custodial care, nor does standard health insurance. Medicare contributed 21% to long-term care in 2011, because it covers skilled nursing care and skilled therapy services for a limited time post-hospitalization.
Here’s more from Just Care on aging in place and long-term care services and supports:
Click here to learn more about long-term services and supports from the Robert Wood Johnson Foundation and here to learn more about long-term care from JAMA.

Photo Credit: RWJF
October 15, 2014
Evidence suggests cutting Medicare will hurt kids
Benefits to kids tend to go hand in hand with benefits to older adults. And, evidence suggests that cutting Medicare will hurt kids. If you analyze the data, countries that spend a greater share of their income benefiting older adults, also spend a greater share of their income benefiting kids, report Shawn Fremstad and Dean Baker, Center for Economic Policy and Research. The evidence further suggests that cutting Medicare will not mean more money for kids. Congress has never made financial trade-offs between older adults and kids.
- Fact: Jonathan Bradshaw and Emese Mayhew report that “Nations make choices about the level of resources they commit to children and the elderly, and the countries that are most generous to children also tend to be most generous to the elderly.”
- Fact: The U.S., for the most part, spends less than other OECD countries on retirement benefits. Indeed, they are relatively moderate, says Fremstad, relying on data from Jonathan Bradshaw and Emese Mayhew.
- Fact: There is no evident tradeoff between government benefits to kids and benefits to older adults, according to sociologist David Brady. In Rich Democracies, Poor People: How Politics Explains Poverty, Brady looks at poverty data in 18 OECD countries to show that in countries with high poverty rates among elderly, there are high poverty rates among kids and vice versa.
- Fact: As the U.S. has created programs for older adults, such as Medicare, we have also created programs for the young, such as Head Start. And, funding has increased at the national, state and local levels for both older Americans and the young, according to Baker.
Fremstad and Baker believe that the economic security of kids in America, both today and in the future, depends in good part on their parents’ and grandparents’ economic security, because families take care of one another across the generations. If we give their parents and grandparents greater security, working-class kids will be better off as well.

To learn more about how countries that spend more on seniors also spend more on children from the Center for Economic and Policy Rights (CEPR), click here. CEPR also has this post, explaining that our parents are not stealing from our kids. And, yet another showing the fallacy of the argument that spending on older adults in any takes money from kids.
October 15, 2014
Two questions you should answer during the Medicare Open Enrollment Period
For anyone on Medicare and many caregivers, Medicare’s Open Enrollment Period is a time to reconsider coverage options. The open enrollment period runs between October 15th and December 7th this year. Here are two questions you should answer during the Medicare Open Enrollment Period:

1. Is your Medicare doctor and hospital coverage meeting your needs?
- If you’re in traditional Medicare and have supplemental coverage, you might be paying a little more than if you are in a private Medicare Advantage plan, but you have the widest choice of hospitals and doctors. And, you have good protection against health and financial risk.
- If you’re in a private Medicare plan, you might save some money upfront, but you have a limited group of doctors and hospitals you can use. If you end up needing a lot of health care, it’s hard to know whether the doctors or hospitals in the health plan’s network will meet your needs. If you use out-of-network doctors and hospitals, you will likely spend a lot out of pocket for that care, more than your costs in traditional Medicare with a Medicare supplemental plan. Also, if you will be traveling out of area and you need care, it’s not likely your care will be covered, except in emergencies or urgent care situations.
2. Is your Medicare (Part D) drug coverage meeting your needs? If you have Part D drug coverage, you should consider your options and not assume that the plan you have is still the one that you want or will cover the same drugs with the same cost sharing next year. The Part D plans often change the drugs they cover and the terms under which they cover drugs from one year to the next, as well as midyear sometimes. What makes sense this year may not make much sense at all next year. In 2015, the average monthly premium nationally is $32.

To compare Medicare plan benefits and cost, visit the Open Enrollment Center page on the Medicare website.
October 10, 2014
History of Medicare

https://youtube.com/watch?v=693XQSujAh8frameborder%3D0allowfullscreen

Medicare and other programs that benefit older adults and people with disabilities have gone through a lot over the years. The history of Medicare speaks volumes for Medicare’s value in keeping older adults and people with disabilities out of poverty and living longer. Watch the video from Kaiser Family Foundation to learn more.

October 10, 2014
Three things to know about cardiac care
More than 2 million people in America experience a heart attack or heart failure each year. Often they need cardiac care, specifically rehab services. Here’s what you should know:
1. Coverage: Medicare will cover most of the cost of your cardiac rehab care if you meet the qualifying criteria, which differs depending upon whether you receive the care as an outpatient or as an inpatient, after a hospitalization. The amount of care you receive will depend upon your condition.
2. Access: Your doctor is responsible for prescribing the services you need and should be able to help you decide where to receive them. If you qualify for cardiac care in a Medicare-certified facility, make sure that the facility has a good cardiac rehab program.
3. Cost: If you have traditional Medicare and supplemental insurance that fills gaps in coverage, your cardiac care costs should be covered once you’ve met the deductible. If you are in a Medicare HMO or other private plan, you are likely to have a copay. You should ask about it.
October 3, 2014
Older eligibility for Medicare is not wiser

Older eligibility for Medicare is not wiser. Raising the Medicare eligibility age from 65 to 67 actually ends up costing twice as much as it saves according to the Kaiser Family Foundation. And, it would hurt millions of older adults who would need to wait two more years to be eligible for Medicare as well as increase costs for people with Medicare.

How would it affect you financially? It depends on where you live, where you work and how much you earn. Kaiser estimates the net increase in out-of pocket expenses for people at $3.7 billion. An estimated third of older adults would save money; however the two-thirds of older adults would be faced with greater out-of-pocket expenses.

The average increase per person would be $2,200. People who qualify for Medicaid typically would pay less. People who need to enroll in a state health exchange may pay more or less based on income and eligibility for federal help paying premiums. People covered under their employers’ plan, both actively working and retired, would typically need to pay more.

Furthermore, if 65 and 66 year-olds are not paying into Medicare, Medicare loses their premium contributions. Since they are the youngest Medicare enrollees, they help subsidize the cost of older enrollees. Without their enrollment in Medicare, premiums will also rise for everyone enrolled in Medicare. To make matters worse, if these 65 and 66 year-olds enroll in the state exchanges, as the oldest enrollees, their premiums will be the highest.How much does raising the Medicare eligibility age really help the federal budget?

By eliminating coverage of 65 and 66 year olds, it would save $31.1 billion over ten years. But overall health care spending would rise because individuals, employers and states would be spending substantially more. The net federal savings would actually only be $5.7 billion, and it would cost individuals (and their employers, and states) $11.8 billion in 2014.

Read more about this issue from the Kaiser Family Foundation here.

September 11, 2014
Are you spending as much on health care as you are on food?

If you have Medicare, you might just be spending as much on health care as you are on food: health care is typically 13.9% of household spending.As you age, watch out. Your healthcare costs can eat up a huge portion of your total household spending.

Healthcare spending often represents a large share of overall household spending, particularly for older adults with Medicare, living on fixed incomes, who need significant amounts of care. For sure, you spend a larger portion of your income on health care as you age and as your income decreases. And, of course, the more health care you need, especially if you need long-term care, the more likely a greater portion of your income goes to health care.

Household spending on health care is significantly higher on average for people with Medicare. As of 2012, the typical Medicare household has a lower income, $33,993, and higher health care costs than younger household’s income, $53,000. In 2012 Medicare households spent 13.9% of their total household spending on healthcare costs, $4722, whereas non-Medicare households spent closer to 5%, $2722.

So, what do people spend their health care dollars on? Mostly they are paying a lot for health insurance, such as premiums and coinsurance payments. Premiums alone typically account for two-thirds of total spending for people with Medicare, a yearly average of $3088. Other out-of-pocket costs include an average of $873 for medical services, $613 for prescription drugs, and $149 for medical supplies. The share of healthcare costs mirrors the cost of food and transportation for Medicare households.

Click here to read more from Kaiser Family Foundation.

September 4, 2014