Facts About Medicare

Facts About Medicare

The Medicare program turned 50 in 2015.  As part of the recognition of Medicare’s first 50 years, the Center for Medicare Advocacy published its “Medicare Matters: 50 Insights for Medicare’s 50th Anniversary” in 2015. This lengthy article, found online at  https://www.medicareadvocacy.org/50-insights-for-medicares-50th-anniversary/, contains interesting facts about this important medical insurance program.  A few of those are:

Insight 2. Medicare Reduced Poverty

Medicare has not only provided access to care for people who could not get private insurance, it has also significantly reduced poverty.  As Nancy-Ann Min DeParle, former administrator of HCFA (Now CMS) stated in the preface to A Profile of Medicare in 1998:

Few programs in the history of the United States have brought as much benefit to society as Medicare. Since its enactment in 1965, Medicare has provided access to quality health care for those Americans least likely to be attractive to private insurers – those over age 65, disabled, or with end stage renal disease. Medicare has also prevented many Americans from slipping into poverty. The elderly’s poverty rate has declined dramatically since Medicare was enacted – from 29 percent in 1966 to 10.5 percent in 1995. Medicare also provides security across generations: it has given American families assurance that they will not have to bear the full burden of health care costs of their elderly or disabled parents or relatives at the expense of their young families.

As Medicare turns 50, the Center for Medicare Advocacy is taking some time to look back at our work over the last three decades.  While much has changed, many challenges to Medicare, unfortunately, stay the same.

Fifteen years ago the Center, the National Senior Citizens Law Center, and the Consumer Coalition for Quality Care wrote “The public should be informed of the dramatic changes envisioned [for Medicare]… we must remember that the Medicare program is sound, and that it has served our nation’s elderly and disabled well.”  This warning is even more critical today, as efforts to privatize Medicare continue, and expand.

We still must vigilantly protect a comprehensive, accessible, traditional Medicare program – the program that has improved the lives of our nation’s neediest populations and their families for 50 years.

Read more at: https://www.medicareadvocacy.org/medicare-info/medicare-and-health-care-reform/

Insight 3. Medicare Saves Lives

By Connie Cherba of Iowa

In early 2000, Edward, who was then 60 years old, applied for Social Security Disability. Despite having suffered from bipolar disorder for nearly 40 years, Edward had earned a PhD, but was not able to hold a job. While the Social Security Disability was economically important, becoming eligible for Medicare allowed him to access what would become life-saving, preventive medical benefits. Although Edward’s father died as a result of metastatic colon cancer, Edward had not been able to afford a colonoscopy.  He was not eligible for any state medical assistance. When Edward first became eligible for Medicare, he had his first colonoscopy which revealed a large polyp. According to Edward’s gastroenterologist, “that polyp would have been cancerous within a year.” Medicare kept Edward cancer free and likely saved his life. 

Read more about Medicare’s preventive benefits at: https://www.medicareadvocacy.org/medicare-info/medicare-part-b/#Medicare%20Preventive%20Benefits 

Insight 4. Medicare’s Future Was Strengthened by the Affordable Care Act (ACA)

By Max Richtman, President and CEO of the National Committee to Preserve Social Security and Medicare

“Medicare – one of our nation’s most popular and successful programs – celebrates its 50th anniversary this year, having been signed into law by President Lyndon Johnson on July 30, 1965. Before the enactment of Medicare, only 50 percent of seniors had health insurance and 35 percent lived in poverty. That was a time when even a minor illness or injury could bankrupt older Americans and their families.

Fast forward to 2015 when over 55.2 million Americans are expected to be receiving guaranteed health care benefits through the Medicare program regardless of their medical condition or income. This includes 46.1 million Americans age 65 and above and 9.1 million Americans receiving Social Security disability benefits. By the time the last of the baby boomers reaches age 65, it is expected that close to 80 million people will be covered through Medicare. Along with Social Security and Medicaid, Medicare’s guaranteed health insurance coverage without regard to health status is vital to our economic and health security in retirement or if we become disabled.

Medicare’s future has been strengthened by the Affordable Care Act (ACA), which improves care for Medicare beneficiaries by eliminating out-of-pocket costs for preventive screenings, annual wellness visits and personalized prevention plans; providing discounts on prescription drugs in the Part D coverage gap known as the “donut hole,” which will be phased out by 2020; and providing incentives to improve the quality of care that is provided. The ACA strengthens Medicare’s financing by reducing waste, fraud and abuse; slowing the rate of increase in payments to providers; and phasing out overpayments to private Medicare Advantage plans.

There’s a lot to celebrate about Medicare’s past, and thanks to the Affordable Care Act, a more hopeful outlook for the present and future.”

For more information see this article on the National Committee’s website.

Insight 10. Medicare Helps Older and Disabled People Stay Home

Medicare home health coverage can mean the difference between an individual staying home or becoming a nursing home resident.  While the Medicare skilled nursing facility benefit is very limited, for beneficiaries who meet the coverage criteria, the home care benefit can be an ongoing Godsend.

For people who can’t readily leave home without a major effort and/or assistance (defined as “homebound”), and who need nursing, physical, speech, or occupational therapy, Medicare home health coverage may be available. If so, Medicare covers these services as well as home health aides to assist with the activities of daily living – such as eating, dressing, bathing, and toileting.  Social worker services and medical supplies are also coverable.

It is a common misunderstanding that Medicare home care coverage is “an acute care benefit only.” CMS and Medicare policy-makers often repeat this refrain. But it’s not true. In fact, according to federal regulations and CMS policy, the home health benefit has no duration of time limitation.  Indeed, in 1980 Congress actually rescinded the 100-visit limitation and removed a prior hospital requirement. Further, there is no co-insurance – although proposals appear annually to impose one. 

Medicare helps people receive necessary care at home. To learn more about this important benefit, go to https://www.medicareadvocacy.org/medicare-info/home-health-care/.

11. Medicare Helps Low Income People

By Kevin Prindiville, Executive Director, Justice in Aging

Of the 54 million people with Medicare, a staggering 25% have annual incomes below $14,400.  For these people living in retirement, or coping with a disability in poverty, Medicare coverage offers a lifeline, a chance to get needed health care. That precious red white and blue Medicare card means that a doctor will see you, a physical therapist will help you recover from a stroke and much more.   But that lifeline disappears if you can’t afford to pay your $105 monthly Medicare Part B premium, or your $1260 hospital deductible, or if you have 10 prescriptions that need filling, each with a co-pay of $20 or $30.

Fortunately, the Medicare lifeline does work for many people in poverty, but only because safety net programs work together with Medicare to plug coverage gaps and make the Medicare benefit affordable.  The Medicaid program covers Medicare premiums, deductibles and co-payments.  Enrollees in full-scope Medicaid receive Medicaid long-term services along with coverage of their Medicare costs; those who qualify only for  Medicare Savings Programs – operated by state Medicaid agencies and generally offered to people with incomes slightly higher than full Medicaid cut-offs – get help with their Medicare costs but do not get other Medicaid services.  Today fully twenty percent of Medicare beneficiaries rely on Medicaid-funded programs for Medicare premium or cost-sharing assistance.  In addition, the Low Income Subsidy, known as “extra help,” provides relief to about 11 million beneficiaries who otherwise could not afford Medicare prescription drug program premiums, deductibles and co-pays.  That subsidy also protects low income beneficiaries from falling into the infamous donut hole.

Dual eligibles, people who qualify for both Medicare and Medicaid, need these safety net programs to remain strong and to grow.  When states seek instead to narrow Medicaid eligibility standards, they not only are cutting off people from needed Medicaid services, like long-term services and supports, but also are effectively making it impossible for dual eligibles to use their Medicare.  Medicare is a benefit that many earned working their whole lives at low-paying difficult jobs.  Like other workers, they saw their Medicare contributions deducted from each and every paycheck.  We at Justice in Aging are committed to working with the Center for Medicare Advocacy and other advocates to ensure that all Medicare beneficiaries, especially those who most need what Medicare can provide, can afford to use the benefits to which they are entitled.

Insight 16. Medicare Was a Precursor to Current Debates about the Role of Government 

By David Lipschutz, Center for Medicare Advocacy Senior Policy Attorney

In the run-up to the passage of a major expansion of health insurance coverage, a prominent and rising political figure urged people to oppose such expansion, and contact their members of Congress to express their opposition:

“Write those letters now; call your friends and tell them to write them. If you don’t, this program I promise you, will pass just as surely as the sun will come up tomorrow, and behind it will come other federal programs that will invade every area of freedom as we have known it in this country…And if you don’t do this and if I don’t do it, one of these days we are going to spend our sunset years telling our children and our children’s children, what it once was like in America when men were free.”

This was not a Tea Party activist denouncing the Affordable Care Act (ACA).  It was Ronald Reagan in a 1961 recording sponsored by the American Medical Association meant to defeat passage of the proposed Medicare program. 

While similar rhetoric abounds today regarding ACA, Medicare is now widely recognized as a grand success for older people, people with disabilities, and the American healthcare system. Very few would openly decry Medicare as a threat to democracy. Yet Medicare has been increasingly privatized, and it remains under threat from those who wish to further morph the program into a private system. Such threats range from policies that continue to favor Medicare Advantage plans over traditional Medicare, to annual budget proposals that would turn Medicare into a voucher (or premium support) program, to the recently passed “Doc Fix” law that weakens coverage of future Medigap plans and increases the cost of Medicare Part B, further encouraging people to enroll in private plans.  

People who care about the soul of Medicare need to pay attention to these gradual but determined steps towards privatization and away from the original cost-effective, universal program. If we don’t, we may have to tell our children what it was like when once Medicare was real.

Insight 36. Medicare Provides Silent Support for Generations

By an Anonymous Beneficiary from Iowa

In the last year I lost both of my parents.  They were 92 and 94 years old when they passed away.  They had been married for 69 years and died within less than 10 months of each other. In the last decade of their lives, due to their slowly declining health, my parents had to sell the home that my father built, their car, Dad’s beloved truck, and their boat. They first moved in to an assistive living facility where they received home health services. They continued to decline and eventually moved in to a skilled nursing facility. Over the last months of their lives, they both required multiple ambulance trips to the hospital, lengthy hospital stays, several courses of physical, occupational and speech therapy, lab work, pain medications, and eventually hospice care.

I was an advocate for my Mom and Dad as well as their power of attorney. I was involved with helping to coordinate my parents’ care and making sure they had the required medically necessary services in place. The last few years have been a rollercoaster of emotions as I watched my Mom and Dad decline and eventually pass away. Fortunately, not once did I have to worry about access to or coverage for the myriad health care services my parents needed.  Medicare was there through the ups and downs of their lives as a silent supporter allowing me to focus all of my time and energy on loving my parents and making sure they were well cared for in the last years, months, days and eventually seconds of their lives. 

As my parents went through their decline, I too became eligible for Medicare. I hope the Medicare program continues to be strong for me and a silent supporter for my children so they can focus on what truly matters most in life as my final days roll round and the end comes for me.

Insight 50.  Medicare is 50!

The 50th anniversary of Medicare has given us an opportunity to reflect on all it has accomplished to advance the health and well-being of families throughout the country. It also reminds us what could have been better – and what could still be improved.

We are thankful for the vision and fortitude of President Johnson and policy-makers in 1964 who insisted on a national program and refused its funding to segregated hospitals. We thank the 1972 Congress that added people with disabilities to those who receive Medicare coverage. We are grateful to those who expanded home health coverage in 1980 and added hospice coverage in 1982. We honor the years between 1965 and 1990 when Americans were willing to pay slightly more in payroll taxes to expand benefits. We recognize recent improvements to Medicare included in the Affordable Care Act – adding value to Part D drug coverage, new and no-cost preventive benefits to Part B, and years to the solvency of the Part A Trust Fund.

We remember the short-lived Medicare Catastrophic Coverage Act, which greatly added to coverage for nursing home care, added a respite benefit, and Part B drug coverage – and we regret its repeal. We are grateful for the 2006 addition of drug coverage, but regret it is only available through private plans. We appreciate all the support for Medicare and its anniversary, but regret the ever-increasing fragmenting and privatizing of the program. We are grateful for all Medicare has done to expand access to health care for older and disabled people, but fear it is becoming more oriented towards providers, insurance and pharmaceutical industries, and less focused on the needs and financial abilities of Medicare beneficiaries.

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