Can Medicare Still Support the Health Care Needs of U.S. Seniors?

According to the National Committee to Preserve Social Security and Medicare, at least 45 million senior citizens are enrolled in the Medicare. The 50-year-old health care program designed for citizens 65 and older is one reason why seniors, the poorest age group before the New Deal era, who continued to struggle financially through the 1960s, are generally now the country’s most financially comfortable demographic. While there are often complaints about bureaucracy and gaps in coverage, the reality for seniors before the mid-1960s is that they often confronted the highest risk of illness, yet often did not have the means to afford decent medical insurance and care.

But based on senior citizens’ overall quality life now compared to the mid-20th century, the evidence suggests Medicare is working well at a macroeconomic level. The program provides free health screenings that would otherwise be expensive; its costs are rising at a much slower rate than those of private insurance companies; the program’s overhead is much lower than privately run health plans; and now, prescription drugs are more affordable.

Critics often say the program needs long term adjustments in order to remain financially viable as the U.S. population continues to age. Some analysts say Medicare is paying medical coverage for more affluent seniors who could otherwise afford it. Finding decent coverage and even medical professionals who accept Medicare patients can be difficult in less populated and more rural counties. Privacy, of course, will always be an issue, as demonstrated in the recent lawsuit AARP filed to stall the growth of wellness programs, which the organization says risks making private health information publicly available. And there is always the risk that at any moment, costs can spike dramatically.

So is the coverage that seniors receive from Medicare sufficient and affordable enough? What can be done to improve coverage? And is this important program financially resilient enough so that it can continue to provide vital health care insurance for the elderly in the long run?

On those points, TriplePundit interviewed Lina Walker, Vice President of Health Security of the AARP Public Policy Institute, to learn about what this organization believes is needed to bolster seniors’ access to affordable and quality health care.

“Medicare beneficiaries should take the time to educate themselves about what the program covers and plan accordingly," said Dr. Walker. “Their health can suffer if they delay or avoid necessary health care, as well as lead to higher health care costs down the road. “

It is important to remember that, contrary to popular belief, Medicare does not cover all health care services, including most dental care, eye examinations and hearing aids. The program also does not pay expenses for long-term care options such as assisted living or skilled nursing facilities. Medicare coverage can also be limited in certain circumstances. For example, beneficiaries could end up paying for what would have otherwise been a free colonoscopy if their doctor discovers, and then removes, a polyp during the procedure.

But according to Dr. Walker, feedback from AARP members indicates that most Medicare recipients have adequate access to physician sources. The organization has also cited survey data revealing 82 percent of Medicare patients who needed to see a doctor due to an acute illness or injury said they never had to wait longer than they felt was fair; 72 percent said they felt the same about times when they needed routine care, which in reality is on par with younger citizens who need medical services.

Nevertheless, such research has also demonstrated that among Medicare patients who were looking for a new primary care provider, about 14 percent reported that they had a difficult time finding one. A sampling of the 9 million Medicare beneficiaries who are also eligible for Medicaid (the federal health insurance program for low-income American citizens) report that they had more challenges accessing services than other Medicare beneficiaries. In addition, AARP has heard reports of access problems in certain geographic areas, which in fairness, could reflect overall provider shortages in those regions. In some other cases, beneficiaries have to travel long distances for certain types of specialized health care.

Then there is the one coverage gap that is a huge concern to senior citizens, the “doughnut hole” that frequently occurs due to how the Medicare Part D prescription drug benefit is structured. This gap, which can often pose a financial burden, comprise the out-of-pocket expenses between the point at which when a Medicare recipient exhausts their initial drug coverage benefits and the level at which catastrophic coverage begins. This will change, but not for the next four years. “Fortunately, the coverage gap is slowly closing as part of the Affordable Care Act,” explained Dr. Walker. Unfortunately, the Affordable Care Act's future is no longer certain due to political leadership that would prefer to repeal it entirely. Time will tell how these cut-backs effect seniors.

The shoring up of the prescription drug benefit program, however, will not be complete until 2020, so in the meantime, citizens enrolled in Medicare should be aware that their prescription drug costs will most likely increase while they are in the doughnut hole. While Congress and the president-elect consider how much to cut, AARP nonetheless is keeping the pressure on Washington, D.C., as health care expenses can easily surpass 20 percent of a senior citizen’s income. “Congress should help ensure that people on Medicare do not face burdensome out-of-pocket health care costs,” insisted Dr. Walker, “and that all eligible low-income beneficiaries receive help with their Medicare premiums and cost sharing through the Medicare Savings Programs.”

So for seniors concerned about rising health costs, along with younger Americans wondering if the program will still exist for them upon their reaching of retirement age – not to mention the budget hawks who fret about entitlement spending - how can this valuable program be sustained for the next several decades?

In Dr. Walker’s view, the Centers for Medicare & Medicaid Services (CMS), which administers Medicare programs, should regularly, rigorously and in a timely manner monitor and evaluate Medicare beneficiaries’ access to quality care, including physician services and other Part B-covered services, in all Medicare settings, both regionally and nationally. CMS should pay also pay closer attention to access problems of special populations, including beneficiaries who live in rural areas, U.S. territories and commonwealths; people with disabilities; low-income individuals; and finally, minorities and other demographic subgroups.

Furthermore, technology promises to guarantee Medicare’s affordability and solvency while continuing to deliver quality care. “Services provided by Telehealth have great potential to help consumers more easily connect with various health care clinicians, maintain their quality of life, and remain in their communities longer,” said Dr. Walker.

Other technologies, such as smartphone apps or even something simple like email reminders, offer opportunities for people to manage their care by scheduling, and remembering, health-related appointments, prescriptions refills, and reminders to take medications. The use of technology can also serve as a vital link to healthcare providers when time, distance or local access present barriers. In addition, Telehealth can also help provide support to families and caregivers as they become more involved with the care of their loved ones.

“This is an important hour for the Nation, for those of our citizens who have completed their tour of duty and have moved to the sidelines,” said the 33rd U.S. President, Harry Truman, about senior citizens when he made remarks during the July 1965 ceremony at which President Lyndon B. Johnson signed the Medicare bill into law. “These are the days that we are trying to celebrate for them. These people are our prideful responsibility and they are entitled, among other benefits, to the best medical protection available.”

Today, many seniors, thanks to advances in medical technology and better health care, hardly feel as if they are on the “sidelines” of society. But it is largely because of Medicare that they are able to enjoy a much more vibrant life now than they had in generations past. It is up to American society – and taxpayers - to find that balance between shouldering Medicare’s cost and the benefits our countries gain by having an elderly population healthy enough to contribute and enrich our way of life.

Image credit: U.S. National Archives/Flickr