Why doesn’t Medicare cover the services so many older people need? By Julie Rovner

Why doesn’t Medicare cover the services so many older people need?


23 Aug 2021
Monday afternoon

(SitNews) – Sorry, Joe Namath. Despite what you keep saying in those TV commercials, under Medicare, the elderly are not ?? Right to waive co-payments and to obtain dental care, dentures, eyeglasses, prescription drug coverage, home helpers, unlimited transportation, and home-delivered meals, all at no additional cost . But if Democratic congressional lawmakers have a say, seniors may soon qualify for some of these services.

Namath’s advertisement offers private Medicare Advantage plans, which frequently offer benefits that traditional Medicare does not ?? in exchange for being limited to certain doctors and hospitals. ??Traditional?? Medicare does not cover many benefits used heavily by its beneficiaries, including most vision, dental and hearing care, and drug coverage is only available by purchasing a separate insurance plan. ?? Health insurance part D.

But Democrats in the House and Senate plan to try to change that as early as this fall. On Monday, Senate Majority Leader Chuck Schumer released an outline of an upcoming budget bill that includes a directive to the Senate Finance Committee to extend Medicare to include dental, visual and hearing. The trap ?? all Democrats in the Senate and nearly all in the House will have to agree on the entire finance bill for it to become law.

Still, this raises a question about Medicare: Why has it taken so long to add such clearly needed benefits?

As with almost everything about the American health care system, the answer is complicated and a combination of politics and politics.

“Medicare is the kind of program where you would expect the benefits to be extended over and over again. It’s popular, and the perk extensions sound great, ?? said Jonathan Oberlander, professor of health policy at the University of North Carolina-Chapel Hill and author of the book “The Politics of Medicare”. “This is one of the big puzzles of health insurance policy: why have extensions of benefits been so rare? “

In fact, in the 56 years since Medicare became law, only a few benefits have been added to the package, which was created to mimic a 1965 Blue Cross / Blue Shield plan. During the 1980s and 1990s, some preventive care was added, such as pneumonia vaccines and mammograms. Republicans spearheaded the addition of prescription drug coverage in 2003, when they controlled both Congress and the White House. But they decided to separate this coverage from the traditional benefits of the program.

Other efforts to expand benefits have not worked so well. In 1988, a bipartisan effort in Congress produced the Medicare Catastrophic Coverage Act, which would have added drug coverage to traditional Medicare and also filled a hole: the fact that there is no limit on the amount that patients can be billed for their share of covered benefits. This law, however, was repealed just a year later after older people rebelled against being asked to pay most of the bill for the new benefits through a new income “surtax”. . Today, Medicare beneficiaries still face the risk of unlimited spending.

Medicare is funded by a combination of money paid directly to the government from paychecks and taxes paid by American workers and their employers. This brings us to another big reason why the Medicare benefit package has not been stepped up further? the cost of the current program.

?? When Medicare was created, its architects assumed the expansion, both in terms of population and in terms of benefits later, ?? Oberlander said. “They hadn’t foreseen the right turn in American politics, and they had not foreseen that Medicare would be seen as a tax problem and that policymakers would be more concerned with avoiding the next shortfall. than to extend benefits. ??

In fact, in the 1980s and 1990s, spending on health insurance was more often restricted than increased. A series of budget reconciliation bills has reduced Medicare by millions of dollars ?? usually at the expense of paying doctors, hospitals and other health care providers.

Medicare has remained popular over the years, but it has become less generous than most private insurance policies. However, many Medicare patients have been able to find additional coverage to cover what Medicare does not, through private “Medigap”. policies, employer-provided retirement plans or Medicaid for low-income people. In recent years, Medicare managed care plans, now known as Medicare Advantage, have grown in popularity in recent years and were first authorized in 1982 and often offer additional benefits to members.

All of this ?? took some of the pressure off ?? lawmakers to expand the program, Oberlander said. And one final reason why vision, hearing, and dental care have not been added to standard health insurance is that they are far from the most critical gaps in health benefits overall. health insurance.

For example, Medicare does not cover long term care ?? the kind of non-nursing personal care that provides assistance with activities of daily living such as bathing, dressing, eating, getting up or getting out of a bed or chair, using the bathroom or prepare food. Child care tends to be both very expensive ($ 50,000 to $ 100,000 per year or more) and necessary for a large number of beneficiaries, especially after age 80. Efforts over the years to create a government long-term care benefit have been largely unsuccessful. A very limited program, the CLASS Act, was part of the Affordable Care Act in 2010 but was repealed before it could go into effect because its funding was deemed insufficient. President Joe Biden has called on Congress to include billions of dollars for caregiving in the infrastructure package Democrats will be working on this fall.

Also, as mentioned earlier, traditional Medicare does not include any limits on patient cost sharing ?? the percentage or amount of a medical bill that a beneficiary must pay. His basic inpatient benefit expires after 90 days and the 20% coinsurance (the percentage for which patients are responsible) on outpatient care runs indefinitely.

So why is dental, vision and hearing coverage in the foreground now as lawmakers consider stepping up the program? Some can be selfish for lawmakers tasked with allocating funds. All three advantages are cheaper than [adding] Rest house?? blanket, Oberlander said.

But much of it is political. On the campaign trail, Biden pledged to lower the Medicare eligibility age from 65 to 60. Medicare for All advocates like Senate Budget Committee chairman Bernie Sanders (I-Vt.) have pledged to try to do the same, and lowering the eligibility age is included in the plan that Schumer shared with Senate Democrats optional.

But lowering the eligibility age is fiercely opposed by hospitals and other health providers, who fear losing money if people currently covered by higher-paying private insurance are instead covered by Medicare. This makes expansion of benefits the much easier choice for Congress.

That doesn’t mean it will happen. The Congressional Budget Office said the vision, hearing and dental benefits included in a bill passed by the House in 2019 would have cost around $ 358 billion over 10 years. But this is what comes closest to benefits since the inception of Medicare.

HealthBent, a regular feature of Kaiser Health News, offers insight and analysis of policies and politics from KHN Washington Chief Correspondent Julie Rovner, who has covered healthcare for more than 30 years.

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