By Linda Bennett
For more than half a century Medicare has helped people visit a doctor and get hospital care. Labor unions are proud to have helped establish and preserve Medicare because health care is a right not a privilege.
Five key points about Medicare
1 Medicare is a success story in several ways.
a It has lifted people out of poverty. Before Medicare was enacted 1/3 of seniors lived in poverty. Medicare helped reduce that percentage to 14%.
b Because of Medicare , as then President Johnson stated, no one will be denied the miracles of modern medicine. As a result to Medicare and the access to modern medicine it provides, people are living longer.
c Medicare is an intergenerational benefit. Because younger people know that their older family members have access to health care, these younger people can plan for college to make other financial investments.
2 The ABCD’s of Medicare
a Part A provides hospital coverage. It is finances for most people by contributions they make while working.
b Part B provides for access to office visits to doctors and a few other outpatient services. It is financed 25% by premiums paid by the beneficiary and 75% from federal general revenues.
c Part C is called Medicare Advantage. In the past it was called Medicare + Choice. It is a private insurance plan that SUPPLANTS not supplements traditional fee for service Medicare.
d Part B is the Prescription Drug benefit.
3 Prescription Drug Prices are a problem for Medicare and Medicare beneficiaries. In the past 5 years prices on the 20 most commonly prescribed brand name drugs for Medicare beneficiaries rose by nearly ten times.
4 The Tax cuts for CEOs created a deficit that will be used by some in Congress to call for cuts to Medicare Medicaid and other federal health care programs. The budgets of Speaker Paul Ryan call for $2.1 Trillion in cuts to these core programs over ten years. While the budget is the latest version glosses over how this will be done, earlier budgets with similar calls for cuts used “premium supports” or vouchers to end Medicare as we know it and block grant Medicaid.
5 Medicare is strengthened by the ACA.
a The ACA protects people with pre-existing conditions from discrimination. This is particularly import for older Americans because as we age we are more likely to have a pre-existing conditions. For people who are 55 to 64 and waiting to enroll in Medicare, the ACA was a game changer for them, providing them with access to coverage. Before the ACA, many of these individuals would have not been able to get care until they enrolled in Medicare. When they did enroll in Medicare they were more costly because they needed more care.
b Some 3.4 million Americans age 55-64 rely on the ACA for coverage. 2.8 million older Americans without employer sponsored coverage depend on the ACA and get financial help to purchase coverage.
c The ACA improved Medicare by ensuring that the part D coverage gap, known as the donut hole, would be closed. Since its enactment, the ACA has saved seniors $268 billion by addressing this coverage gap.
d The ACA improved Medicare by adding more than an ounce of prevention. The ACA removed the obstacles of co-pays and deductibles that made it harder for many seniors to access preventive services.
e The ACA gave Medicare beneficiaries more protections from insurance corporation abuses. Now under Part C Medicare Advantage plans, insurers must spend at least 85 cents on claims for every $1.00 of premiums paid.
f The ACA helped older people with job-related insurance have access to care when they need it most. Before the ACA employer coverage could have annual or lifetime limits on medical claims insurance would cover. After those limits were hit, the enrollee would be on the hook for 100% of the price of the medical bill. The ACA put an end to this practice.
Medicaid is important to Medicare
• One in five Medicare beneficiaries is also on Medicaid because of their income. For these Americans Medicaid pays their Medicare Part B premiums and co-payments, ensuring they can access the care they need.
• Medicaid NOT Medicare covers long-term services, like nursing home care or in home care with activities of daily living.
Fight to Improve Medicare
1 We are working to defend and protect Medicare but also improve this successful and important program.
2 The recently passed bipartisan legislation to address the opioid crisis includes a number of new benefits for Medicare beneficiaries. This is important because in 13 states the highest rate of opioid related in-patient stays are among the 65 and over population.
a The legislation will make sure beneficiaries are screened for risk of opioid addiction at the welcome to Medicare and annual wellness visits.
b Medicare benefits are expanded to cover opioid treatment providers and Medicaid Assisted Treatment. Currently these providers are not eligible to be Medicare providers meaning beneficiaries must pay for 100% of treatment out of pocket.