Medicare Facts and New Proposed Options

Medicare provides health insurance for seniors and has a sister service called Medicaid, for low-income seniors.  As the politicians jockey for position for the upcoming November elections, Caregiverlist provides a list of the facts regarding Medicare and Medicaid and the proposals on the table.  

Medicare fraud has accounted for more than $60 billion in losses to the program each year - we'll just throw this out there as perhaps the first step in making sure this health care program will continue to be financially solvent as the American senior population grows.  

How many seniors are insured by Medicare or Medicaid?  50 million

At what age does a senior qualify for Medicare or Medicaid?  Age 65

What is the difference between Medicare and Medicaid?  Medicaid is a program which is jointly operated by the federal government and each state which means the benefits and financial qualifications are slightly different in each state.  Seniors must have a very low income and nearly no assets to qualify for Medicaid health insurance which will pay for an on-going stay in a nursing home.  Medicare does NOT pay for long-term senior care.

Does Medicare pay 100% for all medical care needs for seniors?  No. There are some deductibles required and not all medications are fully covered.

Here are the proposals on the table by both Democrats and Republicans (and those in between) to modify Medicare in order to account for ability to finance this benefit for the soon-to-be 77 million seniors.

• Raise the Medicare Eligibility Age
• Raise Medicare Premiums for Higher-Income Beneficiaries
• Change Medicare to a Premium Support Plan
• Require Drug Companies to Give Rebates or Discounts to Medicare members
• Increase Medicare Cost-Sharing for Home Health Care, Skilled Nursing Facility Care (nursing home) and Laboratory Services
• Generate New Revenue by Increasing the Payroll Tax Rate
• Increase Supplemental Plan Costs and Reduce Coverage
• Raise Medicare Premiums for Everyone
• Strengthen the Independent Payment Advisory Board
• Redesign Medicare's Co-payments and Deductibles
• Address the Sustainable Growth Rate Formula (Physician Payments)
• Increase Penalties for Health Care Fraud
• Allow Faster Market Access to Generic Versions of Biological Drugs
• Enroll All Beneficiaries Covered by both Medicaid and Medicare Managed Care
• Prohibit Pay-for-Delay Agreements

You can reach out to your local Congressman and Senator to let them know your thoughts on how the Medicare and Medicaid programs should continue to be structured.  Right now, senior care options include privately paying for senior home care, assisted living communities or a nursing home stay but only seniors who qualify for the low-income Medicaid program receive on-going long-term care in a nursing home.  Review the nursing home costs in your area along with the nursing home ratings for each state. 

Nursing homes can cost from $150 to $400 per day, easily, and there may be additional fees for special services.  As nursing home care is a benefit for the low-income seniors who qualify for Medicaid, these costs are a concern for funding the Medicaid program in each state.  For instance, the Lexington of Wheeling, Illinois, a suburb of Chicago, charges $294 per day for a single private room in their nursing home and $259 for a double room.  The state average is $196 per day.  Review nursing home costs and Medicare and Medicaid benefits on Caregiverlist.