How Medicare-for-All Would Work

One topic which nearly all of us have heard about over the past few years has been Medicare for All.  Opinions about it vary widely, with some people believing it would be the simplest, lowest cost, and most efficient way to provide healthcare to everyone in our country; other people fear that it will cost too much and take away benefits from the senior citizens who have paid into the system during decades of working. 

Both the enthusiasm about potential cost savings and the concern about potential risks are valid.  Because of the confusion around this topic, I asked our Medicare expert, Danielle Roberts, to explain to our readers how Medicare currently works, how a Medicare for All plan might potentially work, and why some people have legitimate concerns about the plan.


It is important to remember that NO final decision has been made about whether our federal government will consider such a program, let alone how the final plan might actually work.  Although the currently proposed plan, as described in the guest post below, calls for zero co-pays, premiums and deductibles, I personally feel this is unlikely to be the final decision, should some version of Medicare-for-All be implemented.  Under our current Medicare program, the government has been trending towards Medicare supplement plans which combine private insurance, co-pays and deductibles with the government backed medical isurance program. They want patients to "have some skin in the game" so they do not run to the doctor for every splinter or sore throat.  As a result, it is likely the final Medicare-for-All plan would require at least some private insurance company involvement, premiums, minimal co-pays, and possible other costs to the consumers.

I also wanted to mention that a recent study, paid for by conservative Republican donors, the Koch brothers, estimated that even without consumers paying deductibles and co-pays, the state, local and federal governments together would save trillions of dollars with Medicare-for-All.  This does not mean that the plan will be cheap for the government to administer; but it does mean it would be much less costly than the current system in which various government agencies reimburse hospitals and other providers for some of the costs they incur when sick people cannot pay.  In addition, other studies have indicated that hospitals are more likely to remain open in poor and rural communities when virtually everyone in those communities has some insurance coverage.

Change is hard and rarely goes smoothly.  Even positive changes, such as a new baby, job or home, can create stress, confusion and fear.  We can expect the same to be true with any major change to our medical care system, whether it is Medicare-for-All or something else.  

Keeping those thoughts in mind, below is the fair and balanced report by Danielle Roberts, explaining both the pros and cons of the Medicare for All plan which is currently proposed ... the one in which patients would have no co-pays or deductibles. She does an excellent job of covering the details and issues more thoroughly than I have, since she is a Medicare expert, licensed to practice in nearly every state in the U.S.

Medicare for All 

 

The Medicare for All movement may have been on the back burner for a bit, but it is certainly not forgotten. The idea and terminology became popular during presidential candidate Bernie Sanders' campaign and his subsequent legislative bill which was filed in September of 2017. 

You can expect it to be a particularly hot topic in the upcoming November elections. Democrats recently launched a Medicare for All congressional caucus made up of 70 founding members.

But what does it mean really? And is there a chance it is actually going to be in our future?

Universal Health Coverage

Many Americans may not realize it, but we already have a form of national health insurance in place here in America and that’s Medicare. It is a health insurance program financed and overseen by the federal government. So, the term Medicare-for-all began with the idea of expanding our current Medicare system to all Americans.

Medicare-for-All is another term, albeit more positive-sounding, for national health insurance or a single-payer health care system. Proponents of Medicare for All point out that most other free-market countries, like Canada and Britain, all have some sort of universal health care system in place.

In these countries, citizens have access to healthcare regardless of their age. Supporters say that such a system would be more efficient and result in lower costs for health care and prescriptions for all Americans. They believe that better healthcare would be the result and therefore it would improve life-expectancy. In its purest form, it would eliminate the role of private insurance carriers in health coverage, although some versions call for both private and public insurance to be an option.

The Medicare for All movement calls for coverage of all medically necessary services as a basic right, instead of as a privilege. Medically necessary services would include preventive care, physician’s services, inpatient care, outpatient care, emergency care, prescription drugs, durable medical equipment, palliative care, mental health services, substance abuse services and approved dietary and nutritional therapies.

It would also extend beyond our current healthcare system to cover long-term care, dental, vision, hearing, and chiropractic care. The government would also be able to negotiate with drug manufacturers to lower prices on the nation’s behalf, and this is certainly important to many people as costs of prescriptions in the United States are some of the highest in the world.

All U.S. residents would be able to access at least all of these services with no cost-sharing. This means that at the time of service there would be no deductibles, co-pays or coinsurance of any kind due by the patient.

Supporters envision a world where there would be no major medical bills, no medical bankruptcies and a simpler healthcare system with less bureaucracy. People could get their healthcare without fear of creditors or bills which later show up in their mailbox.

Medicare as it is Now

It is important to note that our current form of Medicare does NOT offer this feature. Medicare beneficiaries pay monthly premiums for their Part B and D coverage, and they also are responsible for paying considerable cost-sharing in the form of deductibles and coinsurance. 

Even in this format, with Medicare collecting premiums and cost-sharing, trustees this year warned in their annual report that the current Medicare fund will begin to fall short in 2026. This outlook is even worse than it was last year when the fund was projected to fall short in 2029. If Medicare is already unsustainable, how could it bear the burden of all Americans joining Medicare and paying no premiums, deductibles, co-pays, or coinsurance?

There are Different Potential Versions of Medicare-for-All

While the idea of Medicare-for-All is noble, Congressional members may have a long way to go in structuring the type of program that would be sustainable and affordable for our nation. The National Review reported recently a study which projected that Sanders’ version of Medicare-for-All would cost the nation $32.6 trillion over the next 10 years. Medicare-for-All caucus members must look at how other countries finance their single-payer systems and how the United States might do the same.

In Bernie Sanders’ version of Medicare-for-All, health insurance would be permanently separated from employment. Americans’ eligibility for Medicare would initially drop from age 65 down to age 55 and also cover children up to age 18. Over the following four years, the age of Medicare eligibility would continue to drop until all Americans became eligible for Medicare. Out-of-pocket costs would be eliminated, and benefits would be expanded. 

The plan would be financed by employers, an income-based premium paid by households, and progressive income tax rates. Under Sanders' plan, capital gains and dividends would be taxed as ordinary income, there would be limited tax deductions for wealthy people, as well as an increase in estate taxes for the wealthiest Americans.

Opponents of the program, however, say that Medicare for All would be so expensive that it would quickly become Medicare for None. They claim it would also divert the focus of Medicare from seniors, ultimately hurting them and moving them to the back of the line for care behind younger persons. Cuts to pay for doctors and hospitals might, they say, make it harder for seniors to find doctors who accept their coverage. They have also argued that if millions of new beneficiaries are brought into the program, there would be fewer doctor appointments to go around because Medicare already faces shortages of primary care physicians.

Supporters have responded that while the program would surely be costly, Medicare-for-All would make that up by streamlining operations to reduce high administrative costs and to lower prescription drug costs. Would the savings from new efficiencies in care be enough to take on the extra expense? This remains to be seen, but it’s a step in the right direction that Congress is still talking about health care solutions and recognizes that what we have done thus far is not enough.

The key may lie in finding the happy medium between private and public-sector insurance. There are varying iterations of how a Medicare for All program might ultimately look. Some versions of Medicare for All call for a mixture of private and public insurance rather than a single-payer plan, and this might be very important if they hope to eventually gain the support of insurers and insurance industry lobbyists.

We can only hope that both parties will come together to find one solution that works for the good of all Americans.

About this Guest Post Author:  This guest post was written by our Medicare expert, Danielle Roberts, one of the co-founders of Boomer Benefits and a frequent contributor to this blog.  As always, we greatly appreciate her willingness to share her expertise and her ability to calmly explain difficult to understand issues in plain English.

You are reading from this blog:  http://www.baby-boomer-retirement.com

Photo credit:  Google images - healthmarkets.com

What Medicare Does Not Cover

Most adults in the United States over the age of 65 are covered by Medicare.  American workers paid premiums in advance into the program during our working years.  We did this so our premiums for basic Medicare insurance coverage after retirement would be affordable.

Once we sign up for our basic Medicare insurance, we can also add a supplement, sometimes called a Medigap policy, through a private insurance carrier; or, we can choose a private Medicare Advantage plan, like Kaiser Permanente or SCAN, to handle our Medicare insurance for us.  Adding a private insurance supplement or using a Medicare Advantage plan will assure us that our out-of-pocket costs will be reduced.  However, many people assume all their future medical expenses will be completely covered after they reach the age of 65.  Unfortunately, they are often shocked to discover they will still have to pay out-of-pocket for some important expenses, including premiums, co-pays, deductibles and a number of health needs which are NOT covered by Medicare.

You Should be Prepared for Uncovered Medical Bills

It is important for everyone to realize that basic Medicare does not cover a number of important conditions which could affect almost everyone during the last few decades of life.  By knowing what is not usually covered, you can search for policies which will help fill in some of the gaps or you may want to put aside extra money for your future medical costs.

Hearing Aids Are Usually Not Covered

Basic Medicare and most Medigap plans do not cover normal hearing tests or hearing aids.

Solutions:  Look for a Medicare Advantage plan which includes hearing care, sometimes for an additional premium.  You might be able to sign up for a discount plan for hearing aids.  There are also some special discounts for low income people.  Within a few years, it may be possible to buy certain types of hearing aids without a prescription, due to new legislation recently passed by Congress.  This could bring down their cost.  However, be prepared for the fact that hearing aids can cost thousands of dollars.

You May Want a Dental Care Supplement

Basic Medicare and most Medigap plans do not cover either routine check-ups or major dental work such as root canals or dentures.  If you lose teeth as you age and need dentures or dental implants, these items are not covered, either, and they can be quite expensive.

Solutions:  You may find a Medicare Advantage plan which offers reduced cost dental care, either as part of their basic plan or for an extra premium.  It is also possible to purchase an individual dental insurance plan or private dental discount plan.  You may also be able to get low-cost dental care from a local dental school.  It is important that you NOT wait until you actually have an abscessed tooth or other serious dental problem before you look for dental insurance.  Find a policy as soon as you start Medicare and expect to have out-of-pocket expenses, even with the dental insurance.

You Will Need a Vision Care Supplement

Medicare, combined with most Medigap plans, will cover certain types of eye diseases or damage such as cataracts.  However, those plans do not cover the cost of routine eye exams or corrective lenses such as glasses and contact lenses.  In addition, they often only cover the least expensive type of replacement lens after cataract surgery.  If you want the more advanced lenses, you could be expected to pay thousands of dollars out-of-pocket.

Solutions:  Some Medicare Advantage plans do cover a portion of your vision care costs, usually for an extra premium.  If you need your vision corrected or anticipate vision problems, it may be worth it to purchase a vision insurance policy to help control your out-of-pocket costs.  However, no matter what plan you have, you should still expect to pay out-of-pocket for certain expenses, such as contact lenses, eyeglasses, co-pays and deductibles.

Ask About Podiatry Coverage under Your Supplement or Advantage Plan

Medicare does not cover routine medical care for feet, such as having a callus removed. However, it will cover more serious foot problems.

Solutions:  If you have foot problems and need the care of a podiatrist, try to find a Medigap or Medicare Advantage policy which will cover your costs.  Otherwise, put aside extra money to cover your care.

Plastic Surgery for Cosmetic Reasons is Not Covered

Are you hoping to get a tummy tuck or facelift as you age?  Medicare will not generally cover those expenses.  However, if your eyelids sag so much that it affects your vision, Medicare may cover an eyelid lift.

Solutions:  If you believe you are going to want cosmetic surgery as you age, you will need to put aside the money to cover the cost.  You may also want to consider getting the treatments you want at a local medical school.  They will still charge you, but less than an established board certified plastic surgeon in private practice.

Emergency Medical Care Outside the U.S. is Generally Not Covered by Medicare

Basic Medicare and most Medicare Advantage plans do not offer coverage for beneficiaries when they are outside the U.S.

Solutions:  If you plan to retire outside the United States, as hundreds of thousands of other Americans have done, your best bet is to buy a health insurance plan in the country where you will be living.  If you travel back and forth between the U.S. and other countries, you may consider one of two options.  First, you could look for a Medigap policy which will cover you whether you are in the U.S. or outside the country.  The other option is to have a Medicare plan which will cover you while you are in the U.S. and a health insurance plan in the country where you spend the most time.  If you can afford it, this would give you the widest range of choices for care.

If you live in the United States and only need coverage when you travel on vacation, some Medigap plans cover overseas medical costs.  However, many frequent travelers purchase travel insurance policies which cover basic healthcare expenses while you are traveling.  You may also want to consider "medevac" insurance which will cover either the cost of transportation to a medical facility overseas or a return trip home in the event of a medical emergency.

Long-term Assisted Living and Nursing Home Care is Not Covered

Neither Medicare, Medicare Advantage plans, nor Medigap plans will cover the cost of permanently living in an assisted living facility or nursing home.  However, Medicare will cover the cost of a temporary stay in a rehab facility while you recover from surgery or a serious illness.

Solutions:  Everyone needs to have a plan for how they will be cared for, should they become seriously ill, too frail to live on their own, or develop dementia.  You may have an adult child who is willing and able to care for you during the final years of your life.  You may also want to purchase long-term care insurance to cover the cost of assisted living or the expense of having a home healthcare aide take care of you in your home.  If you have a large retirement income, you may be able to cover these expenses without insurance.  On the other hand, if you have a low income and few assets, Medicaid (a separate program from Medicare) often pays the cost of long-term care.  For veterans and their spouses, there are also benefits available to pay a portion of their long-term care.  However you decide to handle this issue, it is important you have a plan in place long before you need it.  The younger you are when you purchase long-term care insurance, the less expensive it will be.  In addition, once you have a serious health problem, you may not be qualified to purchase long-term care insurance at any price.

The bottom line is that everyone needs to know what will be covered by Medicare and they should either have a Medigap or Medicare Advantage plan to maximize their insurance coverage.  Once you know which uncovered needs you have, you should decide how those expenses will be handled as you age.  Your medical expenses could become quite high, even if you have Medicare and a supplement.  The more money you can save to cover these expenses, the better prepared you will be when you have large medical bills.

If you are interested in learning more about Medicare, Social Security, financial planning, common medical issues as you age, where to retire and more, use the tabs or pull down menu at the top of the page to find links to hundreds of additional articles.

You are reading from the blog:  http://www.baby-boomer-retirement.com

ASR Search Engine
 
Photo:  Morguefile images

Medicare Expert Will Answer Your Questions

As a new service to my readers, we now have an official Medicare expert who will answer your questions.  The expert is Danielle Kunkle Roberts, a recognized Medicare insurance expert and Forbes Finance Council member.  Some of you may have already read the helpful guest posts which she has written for this blog over the past few months.  Expect to see more of her posts in the coming years. Medicare is an important consideration as Baby Boomers plan their retirement. You will find  Danielle's contact information listed permanently in the sidebar of this blog, so you can reach out to her with your questions whenever you wish.

Recent Blog Posts by our Medicare Expert

Below is a list of recent posts which have been written by Danielle Kunkle Roberts.  You will find helpful information in each of them:

Medicare, Substance Abuse, Addiction and Alcoholism - This article explains what your Medicare treatment benefits would be for substance abuse problems.  Whether you or someone you love needs help getting off opioids or has a problem with other addictions, this article will give you the information you need.

Medicare Coverage of Heart Disease - Another concern for retirees is how Medicare covers heart attacks and other heart disease issues.  Find out what coverage you will get through Medicare and how to supplement Medicare to optimize your benefits.

Medicare and Cancer Benefits - Prevention, Diagnosis and Treatment - A cancer diagnosis is terrifying and the last thing you want to worry about is your health insurance coverage.  This article explains what is covered by basic Medicare and how to supplement those benefits.

More Information About Danielle Kunkle Roberts

Although I have been approached by other people who have been interested in covering Medicare on this blog, I have found Danielle to be especially helpful and highly qualified to help my readers.  She is one of the founders of Boomer Benefits.

Her company is uniquely prepared to assist my readers with the many questions they have about Medicare.  Here is more information about the company from their website:

"Founded in 2005 in Fort Worth, TX, Boomer Benefits is an award-winning insurance agency for national insurance carriers such as Blue Cross Blue Shield, Aetna, Cigna, Mutual of Omaha and many other A-rated carriers. We are licensed in 47 states. Over the years, we’ve learned just about everything there is to know about Medicare, and we’ve become known as the baby boomers insurance agency. We pass that knowledge on to you – absolutely free. There is never a charge for our services. Boomer Benefits Consulting is free."

It is my sincere hope that my readers will take advantage of the services of Danielle Kunkle Roberts and the other agents at Boomer Benefits.  I will be interested in getting your feedback about this service.  You can use the contact section on the sidebar, under my picture, to leave your comments.

If you are interested in learning more about other retirement topics, including Social Security, financial planning, where to retire in the US and abroad, common medical problems and more, use the tabs or pull down menu at the top of the page to find links to hundreds of additional articles on a wide variety of topics.

You are reading from the blog:  http://www.baby-boomer-retirement.com

ASR Search Engine Photo credit:  Boomer Benefits 

Dementia is Linked to Depression and Anxiety

In a number of recent posts, this blog has covered how senior citizens can postpone or even eliminate their dementia risk by making lifestyle changes such as following the MIND diet, getting enough exercise, socializing more, playing brain games, learning new skills, and sleeping well.  People who want to protect their cognitive ability will want to know that untreated depression and anxiety are also linked to a higher dementia risk.

If you are interested in doing everything possible to avoid or postpone dementia, including Alzheimer's Disease, then it is important to take a multi-faceted approach to keeping your brain as healthy as possible.   If you have elderly parents or other relatives, you may want to apply some of this research to their care, too.  They will be happier, healthier and easier to care for if their brain is functioning optimally, which will make life easier for you, as well.

Symptoms of Depression in Senior Citizens

Younger adults show signs of depression when they appear to be sad, exhibit a loss of interest in their favorite activities, are agitated easily, or have angry outbursts.  While seniors can have the same symptoms of depression, they may also have symptoms which are not always identified as indicators of depression.   

Watch for the symptoms of depression and anxiety listed below:

Memory difficulties
Slower thinking
Trouble concentrating
Personality changes
Physical aches and pains which are unexplained
Fatigue
Either the loss of appetite or overeating
Sleep problems
Isolation ... a desire to stay home most of the time
Suicidal thoughts, especially in older men
Dwelling on thoughts of death

Medical Treatments for Depression and Anxiety

If you or a family member is experiencing the above symptoms, you should report the symptoms to a doctor right away.  The sooner depression is treated, the less damage it will do.

A doctor can make sure there is not an underlying medical issue causing the symptoms.
A doctor can prescribe an antidepressant or anti-anxiety medication.
A doctor may also recommend a therapist; talk therapy usually does help, especially when combined with medications.

How to Help Yourself with Depression and Anxiety

There are also actions you can take on your own to lessen the depth of your depression and anxiety, but you should do these things in addition to seeking medical help, not instead of it.  Remember, not only do you want to improve your mood, but you also want to reduce your risk of Alzheimer's Disease and other types of dementia.

How to Reduce Your Symptoms of Depression and Anxiety

Learn relaxation techniques such as deep breathing.
Get plenty of exercise and spend time in the sunshine and fresh air, when possible.
Take classes in yoga, Tai Chi or similar relaxing forms of exercise.
Practice mindful meditation.
Try journaling; writing about your problems can reduce depression.

Depression is closely linked to dementia, although it is not the only factor.  Maintaining a generally healthy lifestyle will also reduce your risk.  Check out other the articles in the Medical Concerns section of this blog explaining all the ways you can lower your Alzheimers and dementia risk.  No one wants to lose their memory at the end of their life, if they can avoid it.

If you want to learn more about common medical problems as we age, retirement planning, where to retire, Social Security, Medicare and more, use the tabs or pull-down menu at the top of the page for links to hundreds of additional articles.

You are reading from the blog:  http://www.baby-boomer-retirement.com

Photo credit: morguefile.com

Prediabetes and Diabetes Prevention

According to the American Diabetes Association, approximately 30.3 million Americans have diabetes and 84.1 million Americans have prediabetes.  For Baby Boomers, the statistics are even worse.  Roughly one in four adults over the age of 65 have diabetes, and significantly more have prediabetes.  A large percentage of people with these conditions are NOT aware of it.  However, this is not a disease which you want to ignore.  Diabetes is the 7th leading cause of death in the U.S.  As a result, it is important we understand how to avoid it and how to minimize the damage it can cause.

Monitor your A1C Blood Sugar Levels

A1C measures how much sugar has become attached to your red blood cells over the previous 90 days.  Because of this, it is not a test you can "cheat" by being good for a day or two before having your blood tested.  Here is how it is scored:

Normal A1C:  4.8 - 5.6
Prediabetes A1C:  5.7 - 6.4
Diabetes A1C:  6.5 or more

If your A1C is high, your doctor may order more diagnostic tests including a Fasting Blood Sugar Test (FBS), a Random Blood Sugar Test (RBS) or a 2-hour glucose tolerance test.

How Dangerous is High Blood Sugar?

If you become diabetic, it can contribute to heart disease, strokes, kidney disease or cause blindness.  Sometimes your circulation becomes so poor that you need to have a portion of your legs amputated.  As mentioned above, diabetes often leads to death.

Lifestyle Changes to Prevent Diabetes and Prediabetes

If your A1C levels are at the high end of the normal range or in the prediabetes range, it is not too late to avoid developing diabetes.  There are lifestyle changes you can make which may lower your blood sugar numbers before they reach dangerous levels and begin to damage the organs in your body.  Below are a list of changes which are recommended by AARP, the American Diabetes Association, and my healthcare provider, Kaiser Permanente.  The good news is that the tips below are the basis of a healthy lifestyle, whether you are in danger of developing diabetes or not.

For additional help, you may want to order a book from Amazon such as: "The Type 2 Diabetes Cookbook and Action Plan."

1.  Lose Weight - If you are overweight, losing 5 to 10 percent of your current body weight can reduce your risk of developing Type 2 Diabetes.

2.  Exercise - At least 30 minutes of moderate physical activity, 5 days a week, can also reduce your risk.  Include a mixture of aerobic exercises such as brisk walking or swimming, along with strength training to increase muscle strength, and stretching exercises to increase flexibility.  Try not to spend too much of your day sitting.  The longer you spend in a chair each day without getting up and moving around, the greater your risk.

3.  Eat a healthy diet with plenty of colorful vegetables - For a healthy dinner, half your plate should be filled with vegetables such as dark green leafy veggies, broccoli, cauliflower, carrots and similar foods.  One-fourth of your plate can be a protein such as red meat, chicken, turkey, fish, soy or beans. Your serving of protein should be about the size of a deck of card. One-fourth of your plate should be carbohydrates including potatoes, corn, peas or whole grains.  Avoid refined breads and try to get between 25 and 30 grams of fiber a day.

4.  Limit fruit - While fruit can be part of a healthy diet, limit yourself to three small servings a day and avoid juices completely.  It is much healthier to eat whole fruit rather than drink juices.  Even "healthy" vegetable juices often include fruit juice as their base.  These juices can cause a sudden spike in blood sugar levels.

5.  Avoid sweetened beverages - Minimize your consumption of sodas, energy drinks, sweetened coffee drinks, sweet tea, mixed drinks and other high calorie, sweet beverages.

6. Limit unhealthy foods - Cut back on sweets, sugar, honey, desserts, chips, fast food and other high calorie snacks.

7.  Eat three meals spaced out during the day - Space out your meals so you do not go longer than 4 to 5 hours during the day without eating.  This will help you avoid eating too much during one meal, causing your blood sugar levels to spike.

8.  Practice relaxation - Whether you take up meditation, yoga or other spiritual programs, learning to relax has been shown to be an effective way to reduce your risk of diabetes.

What If You Cannot Reduce Your Blood Sugar Levels?

If you try the above suggestions for a few months and find you are unable to lose weight or lower your blood sugar levels on your own, consult your healthcare provider.  They may recommend that you attend classes, try a more intense weight loss program, take medications or even consider weight loss surgery.

Whatever you decide to do, your goal is to prevent your prediabetes from turning into diabetes and, if you already have diabetes, minimize the damage.  This is not a health problem you want to ignore.

For more information, check out the website of the American Diabetes Association.

If you are interested in learning more about common health problems in senior citizens, retirement planning, Social Security, Medicare, where to retire and more, use the tabs or pull down menu at the top of the page to find links to hundreds of additional articles.


You are reading from the blog:  http://www.baby-boomer-retirement.com

Photo credit:  morguefile.com

ASR Search Engine