ELDERLY MEDICARE
With the enactment of Medicare in 1965, basic health insurance protection for hospital care and physician services was extended to nearly all elderly Americans. The universal nature of Medicare coverage means that virtually no elderly person is without insurance. Medicare facilitates access to physician services and guarantees admission to a hospital when needed. It means that coverage for the elderly does not vary by State of residence and does not limit the elderly`s choice of providers in the mainstream of American medical care.
Over its 30 years of operation, Medicare has provided elderly Americans, and especially poor elderly Americans, with the opportunity to benefit from the many advances of American medical technology, most notably treatment for heart disease and cataract surgery, and to gain improved access to the health care system. Low income elderly people have been particularly reliant of Medicare coverage because they are in poorer health than high income elderly, and therefore, are more likely to use health services.
Although Medicare provides basic health insurance to promote access to care, it is not an all inclusive comprehensive and free medical plan for the elderly poor and near poor. Financial concerns can still impede access to needed medical care, especially for those who have the most health needs. Medicare beneficiaries in poorer health are more likely to report barriers to care than beneficiaries with better health. Some of the financial burdens for care stem from the design and scope of the Medicare benefit package.
Modelled after private insurance coverage for the non-elderly population, Medicare has substantial cost sharing requirements and financial obligations for beneficiaries. The hospital insurance component provides fairly extensive coverage of short term hospital care and some coverage of post acute skilled nursing facility and home health services. The supplementary medical insurance component of Medicare covers physician care and related ambulatory services and home health visits. Medicare requires beneficiaries to pay a premium for coverage, deductible for hospital care, and a deductible 20 percent coinsurance for most physician and ambulatory care services.
For many elderly people, Medicare thus provides essential, but incomplete, protection against medical expenses. In addition to the required premiums and cost sharing, Medicare`s benefit package does not cover the full range of health services needed by many elderly people.
Particularly absent from the Medicare benefit package is coverage of outpatient prescription drugs, vision care, and dental services. In addition, Medicare does not cover chronic LTC needs, most notably nursing home care for the disabled elderly. Out of pocket spending on acute care medical services and insurance premiums for both Medicare and private supplemental policies are significant expenses in the budgets of elderly Americans. The average dollar amount of out of pocket spending increases with income.
Health expenditures for acute care services and premiums by the elderly represent one third of the family income of poor elderly people compared with 16 percent for those elderly who are better off. To provide assistance with cost sharing and additional protection, most elderly people have private insurance and /or Medical Aid Coverage to supplement their Medicare Coverage.
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