We All Should Care About Medicare
In the past, I’ve talked a lot about the nuances of policies that affect Medicare, which is only natural since Medicare is a part of the lives of over 60 million older Americans. One of the challenges I face is trying to extract the rhetoric that seems to permeate any proposed changes to Medicare and then explain the impact these changes could have on our healthcare. It’s also difficult to separate fact from fiction in these days of social media influencers and conspiracy theories. We’ve all been notified, on smartphones, our PCs, by email, etc., of some huge problem with Medicare or parts of our healthcare. These dire predictions ultimately turn out to just be a way to get us to access the supplied link and page through endless pages of ad-infused worthless dialogue - the very definition of “clickbait.” I thought, at the start of the new year and a new administration, it would be a good idea to talk about some of the basic facts about Medicare and dispel some of the “clickbait” myths that seem to linger around this critical program.
Medicare is free – Medicare Part A (the hospital coverage) doesn’t require an insurance premium but will require some out-of-pocket costs. Part B (coverage for doctors and some infused and special drugs) does require a premium (you may not notice it because it is deducted from your social security payment) and often requires some out-of-pocket costs. It’s also worth noting that your premium will increase depending on your income. Part D (prescription drug coverage) does require a premium and may also include out-of-pocket costs. Part C (Medicare Advantage) often does not require a premium but could have some out-of-pocket costs for services. Basic Medicare doesn’t cover long-term care, most dental care, vision care, or hearing aids. A majority of seniors opt to pay for some kind of supplemental insurance or Medicare Advantage to cover many of the out-of-pocket costs of basic Medicare.
Medicare Advantage Plans are inferior – Medicare Advantage (MA), Part C, is a program that allows private insurance companies to assume the responsibility of providing healthcare to eligible Medicare patients. They must, at a minimum, provide all of the services that Medicare provides. Lately, there has been a great deal of negative discussion concerning the insurance companies that offer Medicare Advantage to seniors. While MA plans are not for everybody, they offer some benefits that can be very valuable. Many MA plans to go beyond the Minimum Medicare benefits by providing some level of dental, vision, hearing, and prescription drug coverage. Some offer free memberships to exercise facilities and wellness programs. MA plans often have their own network of providers so anyone considering joining a MA plan needs to ascertain if their preferred doctors and hospitals are in the plan’s network.
You can enroll in Medicare anytime – Actually, there are specific enrollment periods. Most people become eligible at age 65 and have a 7-month Initial Enrollment Period to sign up. Missing this period can result in penalties. After your initial enrollment, there is an open enrollment period every year from October 15th to December 15th, where you can change your insurance for Medicare Supplemental, MA, or Part D. You can also be eligible for Medicare if you are under 65 if you qualify for certain disabilities and some serious diseases.
Medicare and Medicaid are the same. Like Medicare, Medicaid provides coverage but is a Federal and state program for low-income individuals.
Medicare is in financial trouble - Medicare is facing some financial challenges, but it's not running out of money yet. According to the latest Trustees Report, the Hospital Insurance Trust Fund, which covers Medicare Part A, is projected to be able to pay 100% of scheduled benefits until 2036. After that, it will still have enough income to cover about 89% of the scheduled benefits. The Supplemental Medical Insurance Trust Fund, which covers Medicare Parts B and D, is projected to remain adequately financed into the indefinite future because its funding sources - beneficiary premiums and federal contributions - are automatically adjusted each year to cover costs. This doesn’t mean that our lawmakers don’t have the power to impact the financial condition of Medicare, they can make it better or worse.
The more we understand the facts about Medicare, the more we are able to determine what changes will help or hurt us. There are many sources and opinions available that might have some degree of fact, but at best, they don’t tell the whole story, and at worst, they use these partial facts to lead us to bad solutions. As new members of Congress are elected it is important that they quickly come up to speed on Medicare and find trusted sources for the facts on these complicated programs. In my years advocating for seniors, I’ve found myself numerous times explaining the difference between Medicare and Medicaid to brand-new legislative assistants. I found it extremely valuable to establish myself as a trusted source of information for these lawmakers, showing them that I would be willing to put aside my biases and share the pluses and minuses of legislative action.
It is our lawmakers that have the ability in this new session of Congress to make changes to Medicare. With Republicans holding the majority in both the Senate and the House and a Republican President, there is the possibility that there will be substantial changes in Medicare. It is up to us to first understand how these changes will affect us and then contact our lawmakers and tell them how we feel about these changes. I will do my best to keep you up to date on any proposed changes to your healthcare and I hope that you will do what you can to make your feelings known to those in Washington that represent you. Buckle up, this year is going to be quite a ride.
Best, Thair