One out of every five elderly Americans encounters each day on the restricted profits with little flexibility for unforeseen medical expenses. Once medical care is needed, these six million near-poor elderly people depend on Medicare for help with the medical bills. Thesis: the universal coverage of Medicare guarantees older adults access to America’s health care system and suggests defense from financial trouble once illness strikes. However, gaps in a scope of Medicare and Medicaid’s benefits and financial obligations for coverage may result in burdensome financial burdens.
Health Care Insurance Programs
Given the altering demographics of US society and the connection between quality of life and first-class health care, health care differences are likely to become a pressing problem in communities across the nation. One-fourth of senior people have no supplemental Medicare or Medicaid insurance coverage for their needs, whilst 16% of people under age 65 have no insurance coverage. Additionally, preventive health screening rates are predominantly low for older adults.
Americans nowadays live longer than ever before. Senior people are sicker than younger and spend more on health care. Though older Americans reflect only thirteen percent of the entire populace, they spend nearly thirty percent of the money used for health care. In contradiction to popular conviction, Medicaid and Medicare cannot cover all medicinal expenses when a person is over age 65. In fact, both programs do not cover many chronic conditions, leaving elderly people to pay for treatment. Therefore, the altering demographics of Medicare fuel worries concerning financing the program’s costs.
Medicare is the nationwide health insurance program for the Social Security recipients who are older than 65 or disabled. It is controlled by federal Health Care Financing Administration. The private insurance organizations contract with the administration to make payments to the therapeutic providers. Medicare is not welfare program. That is, individual assets and income are not considered in deciding the person’s benefits or eligibility. Medicare coverage reminds the coverage, which private insurance organizations offer: Medicare pays only a part of the cost of the medical care and beneficiary assumes the cost of the deductibles and co-payments to the healthcare providers. Medicare still does not provide payment for routine eye and dental examination, physical examinations, long-term custodial care hearing aids, and immunizations (apart from annual flu and pneumonia shots).
This program has some coverage components. Part A covers the in-patient medical care, in-patient care in a skilled nursing facility, home health care services and hospice care. Part B covers the hospital care and services provided by physicians, long-lasting clinic equipment and outpatient care and domestic services. Part A is paid typically through the federal payroll taxes; many beneficiaries do not pay a premium for the coverage. Part B is paid through monthly premiums provided by beneficiaries who select this coverage and common revenues from federal administration. Beneficiaries may have to pay deductibles and co-payments under Part A and B. Part D is a voluntary outpatient prescription drug possibility provided under the individual plans, which contract with Medicare. Medicare reformers have hoped for prescription drug possibility for many years. Nevertheless, there are winners and losers with the organization of this benefit. Medicare beneficiaries will have coverage, which is restricted to the accepted drug list and will compensate high premiums and deductibles, which will carry on rising every year. The pharmaceutical firms, on the other hand, were capable to defeat efforts to reduce the cost of prescription drugs through administrative cost negotiations and the importation of drugs from other countries.
Medicare Supplemental Insurance — also recognized as Medigap — may assist beneficiaries in paying for medical care, which Medicare does not cover, counting co-payments and deductibles. Medigap insurance fills certain gaps in the Medicare coverage, paying for costs that Medicare does not finance. The more holes Medigap plan covers, the more costly the policy is to purchase. Eligibility for the Medigap policies may differ. Plans have to suggest assured enrollment for novel Medicare beneficiaries older than 65 years old: the plan cannot decline to enroll beneficiary, even if a person is sick or injured.
Medicaid is quite different. Based on need, it assists in paying clinic care for low-income elderly or disabled Americans. Eligibility for Medicaid is, in fact, based on the applicant’s assets and income. Medicaid is paid jointly by federal and state governments and, whilst every state must follow basic eligibility and benefit requirements, crucial details vary among the US states. Medicaid covers much more nursing home care than Medicare, and finances skilled and custodial care. It never limits the time beneficiary may remain in a nursing home. Both programs can be a resource of funding for long-lasting home care, but Medicare may cover home health care solitary if an individual is homebound and requires experienced therapy or nursing services.
Future of Medicare and Medicaid
The future of Medicare is uncertain. Consistent with the Social Security and Medicare Trustees, between 2005 and 2030, spending on Medicare is projected to augment by 331 percent, whilst the GDP grows by only 72 percent. Much of this increase in costs is due to the introduction of novel technologies that are expensive to evolve and also bring “added years of life,” resulting in higher lifetime spending.
Despite these anxieties, prospects for Medicare may not be quite as terrible as some researches suggest. Maintaining humans healthy before they reach age 65 could reduce expenses later in living, and postponing morbidity “till age 85 or 90, when humans would then acknowledge pneumonia or other less “costly illnesses” could also result in crucial savings. Additionally, researches have found wide-spread geographic variation in per capita Medicare spending with little dissimilarity in patient satisfaction or outcomes. According to Mark McClellan, the director of the Center for Medicare under George W. Bush, “Medicare spending may be 35% higher than it has to be” (Lubitz, 2005). Also, the basic resource of health care inflation is not the aging of the populace, but the high cost of health care in the country. Bringing costs under control would do much to alleviate Medicare’s financial troubles.
The downturn in the US economy in 2008 shows the significance of Medicaid as a safety-net for those who would be without coverage if this program did not exist. Though the Obama administration has responded to the recent economic crisis with the unprecedented federal stimulus package since the Great Depression of the 1930s, states will have to discover methods to preserve and extend their Medicaid programs to meet increasing demand for coverage. As mentioned previously, US Recovery and Reinvestment Act of 2009 will provide states with only about 40% of projected state deficits. Meanwhile, as the administration wrestle with health policy challenges, which are intensified by these problems, the role of both Medicaid and Medicare in wider plans for health care reform remains unclear.
Older adults experience the impacts of health care inequalities more noticeably than any other group. They are especially at risk as they are more likely than younger people to have chronic diseases, make frequent visits to medical facilities, and live in poverty. Improving access to health care services for older adults has been crucial public policy objective for years. Many policy initiatives call for eradicating inequalities in health care to foster better quality of living for older people. The coverage of Medicare and Medicaid assures older adults entry to America’s health care system and suggests defense from financial catastrophe when disease or illness strikes. However, gaps in a scope of Medicare and Medicaid’s benefits and financial obligations for coverage may result in burdensome financial situation. Medicare does not provide payment for long-term custodial care hearing aids, dental and eye examinations, regular physical examinations, and immunizations (except annual flu and pneumonia shots); and Medigap makes the additional costs really excessive. One-fourth of older grown-ups have no supplemental Medicare or Medicaid insurance coverage for their health care needs, whilst 16% of people under age 65 have no health insurance coverage. Also, preventive health screening rates are mostly low for older adults.
The older adults are most likely to experience dissimilar barriers to obtaining quality health care services even via the most popular programs, such as Medicare and Medicaid. That is why community administrations, social service agencies and other entities will need to get ready for the augmenting older adult populace to guarantee older adults’ health needs are addressed and quality medical services are readily accessible for people that need health care services the most.