The Impact of Medicare on the Healthcare System
- Financial Benefit to the Elderly. While experts have speculated that Medicare has decreased elder mortality, there is...
- The Introduction of Prospective Payment Systems. In 1980, Medicare developed the diagnosis-related group (DRG), the...
- The Transformation of the American Hospital System. As expected, the...
Does Medicare increase mortality in the elderly?
Moreover, given the evidence that the introduction of Medicare was associated with more rapid adoption of new cardiac technologies, in the long run Medicare's impact on elderly mortality may be much larger than the ten-year impact they examine.
How does Medicare help the elderly?
Medicare has a program called Extra Help for those with limited income and resources. The program helps pay for costs associated with prescription drugs, such as premiums, deductibles, and coinsurance. Programs of All-Inclusive Care for the Elderly (PACE) programs are available through both Medicare and Medicaid.
Why do low-income elderly people rely more on Medicare?
Low-income elderly people have been particularly reliant on Medicare coverage because they are in poorer health than high-income elderly, and therefore, are more likely to use health services.
How many elderly Americans rely on Medicare?
INTRODUCTION One out of every five elderly Americans faces each day on a limited income with little flexibility for extra or unexpected medical expenses. When medical care is needed, these 6 million poor and near-poor elderly Americans depend on Medicare for assistance with their medical bills.
How did Medicare help the elderly?
Medicaid and Medicare help seniors pay for medical and healthcare costs. Medicare has several options to help pay for hospital stays, doctor visits, and prescription medication. Medicaid is a state-run, income-based program that can help seniors pay for medical costs.
How do seniors feel about Medicare?
Older Medicare recipients are happiest with their coverage. Nearly nine out of 10 people who are 80 years old or older say they're satisfied or very satisfied with Medicare. That's compared to 79% of people age 71 to 79, 71% of people 65-70 and 69% of those under 65.
How does Medicare impact healthcare?
Providing nearly universal health insurance to the elderly as well as many disabled, Medicare accounts for about 17 percent of U.S. health expenditures, one-eighth of the federal budget, and 2 percent of gross domestic production.
Who does Medicare impact?
Medicare is the federal health insurance program created in 1965 for people ages 65 and over, regardless of income, medical history, or health status. The program was expanded in 1972 to cover certain people under age 65 who have a long-term disability.
At what age does Medicare generally take effect for older adults?
This is called your Initial Enrollment Period. It lasts for 7 months, starting 3 months before you turn 65, and ending 3 months after the month you turn 65. My birthday is on the first of the month.
Do all older adults use Medicare?
Nearly every American 65 or older is eligible for Medicare, and almost all of them are eligible for Medicare Part A (hospital insurance) with no premiums. Although about three-quarters of Medicare beneficiaries are satisfied with their coverage,1 not everyone in this age group wants to receive Medicare.
What is Medicare and why is it important?
Medicare provides health insurance coverage to individuals who are age 65 and over, under age 65 with certain disabilities, and individuals of all ages with ESRD. Medicaid provides medical benefits to groups of low-income people, some who may have no medical insurance or inadequate medical insurance.
What is the goal of Medicare?
Medicare's purpose is to provide national health coverage to the following: Older adults, age 65 and over. This has been a traditional retirement age, when health insurance coverage through an employer might typically end.
What would happen without Medicare?
Payroll taxes would fall 10 percent, wages would go up 11 percent and output per capita would jump 14.5 percent. Capital per capita would soar nearly 38 percent as consumers accumulated more assets, an almost ninefold increase compared to eliminating Medicare alone.
How does Medicare benefit the economy?
Increased availability of 'good jobs' Medicare for All could increase job quality substantially by making all jobs “good” jobs in terms of health insurance coverage and by increasing the potential for higher wages.
Does Medicare save lives?
We estimate a nearly 1 percentage point drop in 7-day mortality for patients at age 65, implying that Medicare eligibility reduces the death rate of this severely ill patient group by 20 percent. The mortality gap persists for at least two years following the initial hospital admission.
What impact do you think did the establishment of Medicare and Medicaid have had on beneficiaries?
Medicaid increased access to care and health care use, and improved self-reported health. One year out from the lottery, the adults who gained Medicaid were 70% more likely to have a regular place of care and 55% more likely to have a regular doctor than the adults who did not gain coverage.
How did Medicare benefit the elderly?
Even absent measurable health benefits, Medicare's introduction of Medicare may still may have benefited the elderly by reducing their risk of large out-of-pocket medical expenditures. The authors document that prior to the introduction of Medicare, the elderly faced a risk of very large out- of- pocket medical expenditures. Tthe introduction of Medicare was associated with a substantial (about 40 percent) reduction in out-of-pocket spending for those who had been in the top quarter of the out- of- pocket spending distribution, the authors estimate.
What happened after Medicare was introduced?
The period after Medicare's introduction, for example, was one of declining elderly mortality. However, using several different empirical strategies, the authors estimate that the introduction of Medicare had no discernible impact on elderly mortality in its first ten years in operation. They present evidence suggesting instead that, prior to Medicare, elderly individuals with life- threatening, treatable health conditions (such as pneumonia) sought care even if they lacked insurance, as long as they had legal access to hospitals.
What is the evidence that the introduction of Medicare was associated with faster adoption of then-new cardiac technologies?
Consistent with this, Finkelstein presents suggestive evidence that the introduction of Medicare was associated with faster adoption of then-new cardiac technologies. Such evidence of the considerable impact of Medicare on the health care sector naturally raises the question of what benefits Medicare produced for health care consumers.
Why is there a discrepancy in health insurance?
Finkelstein suggests that the reason for the apparent discrepancy is that market-wide changes in health insurance - such as the introduction of Medicare - may alter the nature and practice of medical care in ways that experiments affecting the health insurance of isolated individuals will not. As a result, the impact on health spending ...
How much does Medicare cost?
At an annual cost of $260 billion, Medicare is one of the largest health insurance programs in the world. Providing nearly universal health insurance to the elderly as well as many disabled, Medicare accounts for about 17 percent of U.S. health expenditures, one-eighth of the federal budget, and 2 percent of gross domestic production.
What was the spread of health insurance between 1950 and 1990?
Extrapolating from these estimates, Finkelstein speculates that the overall spread of health insurance between 1950 and 1990 may be able to explain at least 40 percent of that period's dramatic rise in real per capita health spending. This conclusion differs markedly from the conventional thinking among economists that the spread ...
When did Medicare start?
Medicare's introduction in 1965 was, and remains to date, the single largest change in health insurance coverage in U.S. history. Finkelstein estimates that the introduction of Medicare was associated with a 23 percent increase in total hospital expenditures (for all ages) between 1965 and 1970, with even larger effects if her analysis is extended ...
What is Medicaid for seniors?
Medicaid is a state-run, income-based program that can help seniors pay for medical costs. A person must qualify under their state program rules. Older adults may qualify for SSI, Extra Help, or PACE to help pay for medical costs.
What is Medicare Part A?
Medicare Part A is hospital insurance. It covers a percentage of charges for inpatient hospital admissions, hospice, some home health care, and skilled nursing facility care.
What happens if you don't enroll in Medicare Part D?
Medicare Part D is an optional benefit. If a person decides not to enroll when they are first eligible, a late enrollment penalty may occur.
What is Medicare and Medicaid?
Medicare and Medicaid are government-run programs that help pay healthcare costs for older adults and younger people who qualify. This article discusses the different Medicare and Medicaid options, when a person is eligible, how to enroll, and what is covered.
What is the program for all inclusive care for the elderly?
Programs of All-Inclusive Care for the Elderly (PACE) programs are available through both Medicare and Medicaid. They help people pay for health care within the community. For people who qualify for PACE, healthcare professionals work as a team to coordinate care.
What are the criteria for Medicaid?
Other criteria include a person’s citizenship, state of residency, and immigration status.
Does Medicare Advantage cover dental?
Medicare Advantage must cover all Medicare-approved services, and some companies may offer additional benefits, like vision, hearing, and dental options.
What are the health problems of the elderly?
people are more likely to have chronic health problems than non-poor elderly people (Figure 5). Nearly two-thirds (65 percent) of poor elderly people suffer from arthritis that can impair mobility and result in the need for medication for treatment and pain relief. Similarly, the prevalence of diabetes and hypertension, both illnesses requiring substantial medication costs and ongoing physician supervision, is highest in the low-income cohorts of the elderly population. Functional disabilities contributing to the need for LTC assistance further com- pound the medical problems of elderly people (Rowland, 1989). Among non-insti- tutionalized elderly Medicare beneficiaries; 7.8 percent report needing help to perform one or more activities of daily living (ADLs), such as dressing, eating, and toileting, and many more report difficulty in carrying out these activities due to health problems. The rates are higher for the poor and near-poor elderly, with 12.9 percent of the poor and 10.5 percent of the near-poor reporting such limitations (Fig- ure 6). Low-income elderly people are also more likely to have three or more ADLs and increased dependency because of mul- tiple limitations than those with higher in- comes. Elderly people with functional limi- tations are often financially strained by non-medical needs and expenses as well as by the need for additional services and spe- cial transportation arrangements to obtain medical care. In sum, poor and near-poor elderly people are more likely to be experiencing health problems for which they require medical services than elderly people who are economically better off, but they are less able to afford needed care because of their lower incomes. For those who need medical care and incur large out-of-pocket expenditures, medical expenses can lead to
What is low income Medicare?
NOTES: Includes non-institutional continuously enrolled beneficiaries. Low-income beneficiaries are those with incomes below 125 percent of the Federal poverty level. SOURCE: Estimates prepared by the authors based on analysis of the 1992 Medicare Current Beneficiary Survey.
Is Medicare a barrier to low income people?
Affordability of private insurance poli- cies to supplement Medicare is a major barrier to coverage for many low-income elderly beneficiaries. Higher income eld- erly beneficiaries are much more likely to have retiree benefits that provide health in- surance coverage to supplement Medicare. Low-income people are less likely to have had the types of jobs during their working years that offer private health insurance af- ter retirement as a benefit. As a result, higher income elderly are more likely to have employer-sponsored coverage, while low-income elderly are more reliant on medigap coverage. An individually purchased medigap plan in 1992 averaged over $1,000 (Chulis, Eppig, and Poisal, 1995). The high cost of medigap coverage results in a greater fi- nancial burden on low-income beneficia- ries compared with more economically advantaged elderly people. For a poor eld- erly individual living on an annual income of less than about $7,000, spending $1,000 on a medigap policy can substantially strain resources. In recent years, Medicaid has helped to fill this gap by providing assis- tance with Medicare's financial obligations to low-income elderly Medicare beneficia- ries, but the large share of both poor and near-poor elderly people relying solely on Medicare for coverage underscores the limits of Medicaid's reach. ROLE OF MEDICAID Medicaid makes Medicare coverage af- fordable for over 4 million low-income eld- erly Medicare beneficiaries by serving as their medigap policy. For those who qualify for assistance from the means-tested Med- icaid program, Medicaid coverage is an
Do elderly people get medicaid?
reflects both their limited financial ability to pay substantial amounts and the likeli- hood that some of the low-income elderly are assisted with their medical expenses and premiums by Medicaid. Although the poor elderly spend a lower dollar amount on out-of-pocket medical expenses than higher income elderly, that spending con- stitutes a much larger share of the overall income of the poor. Health expenditures for acute care services and premiums by the elderly represent one-third of the family income of poor elderly people com- pared with 16 percent for non-poor elderly families (Figure 8). To provide assistance with cost sharing and additional protection, most elderly people have private insurance and/or Med- icaid coverage to supplement their Medi- care coverage (Figure 9). In 1992, 81 per- cent of Medicare's elderly beneficiaries had private supplemental insurance, often called medigap insurance, in addition to Medicare. An additional 9 percent of eld- erly beneficiaries received assistance from Medicaid because of their low incomes. However, 10 percent of Medicare beneficia- ries had neither Medicaid nor private in- surance to supplement Medicare. For these Medicare-only beneficiaries, any ex- penses uncovered by Medicare are out-of- pocket liabilities. The pattern of insurance coverage varies significantly by income. Private insurance to complement Medicare is most common among the elderly non-poor population and less extensive as a form of financing for those with lower incomes (Figure 10). Among the elderly poor, over one-third (36 percent) have Medicaid supplementary coverage, 46 percent have private medigap policies, and 18 percent rely solely on Medicare. For the near-poor elderly, pri- vate insurance coverage is more extensive, with 64 percent privately insured. Among the near-poor elderly, 15 percent have
Does Medicare cover home health?
The hospital in- surance (Part A) component provides fairly extensive coverage of short-term hos- pital care and some coverage of post acute skilled nursing facility and home health services. The supplementary medical in- surance (Part B) component of Medicare covers physician care and related ambula- tory services and home health visits. Medi- care requires beneficiaries to pay a pre- mium for coverage under Part B, a deductible for hospital care under Part A, and a deductible and 20 percent coinsur- ance for most physician and ambulatory care services under Part B (Table 1). For many elderly people, Medicare thus provides essential, but incomplete, protec- tion against medical expenses. In addition to the required premiums and cost shar- ing, Medicare's benefit package does not cover the full range of health services needed by many elderly people. Particu- larly absent from the Medicare benefit package is coverage of outpatient prescrip- tion drugs, vision care, and dental serv- ices. In addition, Medicare does not cover chronic LTC needs, most notably nursing home care for the disabled elderly (Feder and Lambrew, 1996). Out-of-pocket spending on acute care medical services and insurance premiums for both Medicare and private supplemen- tal policies are significant expenses in the budgets of elderly Americans (Moon and Mulvey, 1996). The average dollar amount of out-of-pocket spending increases with in- come, averaging $1495 in 1994 for non- poor elderly and $913 for poor elderly people (Figure 7). The lower level of spending by low-income elderly people
Does medicaid cover elderly?
important source of health care financing. Medicaid will pay the Medicare Part B pre- mium for Medicare beneficiaries with in- comes below 120 percent of FPL plus the Medicare cost sharing for those with in- comes below FPL. Elderly cash assistance recipients and others covered at State op- tion can also receive additional benefits from Medicaid to supplement Medicare, including prescription drugs and LTC coverage. In recent years, Medicaid coverage of the elderly has been expanded consider- ably to assist low-income Medicare benefi- ciaries with the growing cost of Medicare premiums and cost-sharing. Most notably, as part of the Medicare Catastrophic Cov- erage Act of 1988, States were required by July 1992 to provide Medicaid assistance with the Part B premium and Medicare cost-sharing to all elderly individuals and couples with incomes below FPL and as- sets of less than $4,000 for individuals and $6,000 for couples. The individuals covered under this provision are referred to as Qualified Medicare Beneficiaries (QMBs). The act also required States to phase in by 1995 assistance with Medicare's Part B premium to individuals with incomes be- tween 100 and 120 percent of FPL. For this group, known as Specified Low-Income Medicare Beneficiaries (SLMBs), assis- tance is limited to the premium payments. States are not required to provide either group with wrap-around benefits to supplement Medicare. The over 4 million low-income elderly people on Medicaid qualify for assistance by various routes, as shown in Figure 11. Over one-half of the elderly with Medicaid coverage obtain eligibility as "categorically needy" because they are recipients of cash assistance or eligible for assistance under the Supplemental Security Income pro- gram. Other individuals are covered at the option of the State as "medically needy"
What is the average age for a person on Medicare?
According to research by the Kaiser Family Foundation, the typical Medicare enrollee is likely to be white (78% of the covered population), female (56% due to longevity), and between the ages of 75 and 84. A typical Medicare household, according to the last comprehensive study of Medicare recipients in 2006, had an income less than one-half of the average American household ($22,600 versus $48,201) and savings of $66,900, less than half of their expected costs of healthcare ($124,000 for a man; $152,000 for a woman).
How did Medicare help offset declining hospital revenues?
One of the impetuses for Medicare was to offset declining hospital revenues by “transforming the elderly into paying consumers of hospital services.” As expected, the demographics of the average patient changed; prior to 1965, more than two-thirds of hospital patients were under the age of 65, but by 2010, more than one-half of patients were aged 65 or older.
What is Medicare akin to?
Medicare is akin to a home insurance program wherein a large portion of the insureds need repairs during the year; as people age, their bodies and minds wear out, immune systems are compromised, and organs need replacements. Continuing the analogy, the Medicare population is a group of homeowners whose houses will burn down each year.
Why did Medicare drop in 2009?
According to a Kaiser Family foundation study, the number of firms offering retirement health benefits (including supplements to Medicare) dropped from a high of 66% in 1988 to 21% in 2009 as healthcare costs have increased . In addition, those companies offering benefits are much more restrictive regarding eligibility, often requiring a combination of age and long tenure with the company before benefits are available. In addition, retirees who have coverage may lose benefits in the event of a corporate restructuring or bankruptcy, as healthcare benefits do not enjoy a similar status to pension plans.
What were the new treatments and technologies that Medicare provided?
The development and expansion of radical new treatments and technologies, such as the open heart surgery facility and the cardiac intensive care unit, were directly attributable to Medicare and the new ability of seniors to pay for treatment.
How many elderly people are without health insurance?
Today, as a result of the amendment of Social Security in 1965 to create Medicare, less than 1% of elderly Americans are without health insurance or access to medical treatment in their declining years.
How many hospital beds have fallen since 1965?
As a consequence, the number of hospital beds across the nation has fallen by 33% from 1965.
How many people are covered by medicaid?
Medicaid also provides coverage to 4.8 million people with disabilities who are enrolled in Medicare.
What is Part B in Medicare?
Part B: Pays for physician services, lab and x-ray services, durable medical equipment, and outpatient and other services
Can you be covered by Medicare and Medicaid?
Individuals who are enrolled in both Medicaid and Medicare, by federal statute, can be covered for both optional and mandatory categories.
Can Medicare help with out of pocket medical expenses?
Medicare enrollees who have limited income and resources may get help paying for their premiums and out-of-pocket medical expenses from Medicaid (e.g. MSPs, QMBs, SLBs, and QIs).
How did Medicare impact the health system?
There were several conclusions drawn from the review. In its first decade, Medicare had succeeded in accomplishing its primary goal of paying the major portion of large hospital and medical bills for the enrolled population. Yet the data showed that Medicare enrollees still faced substantial out-of-pocket liability for their total health care bill, a potential burden for lower income beneficiaries. In its short history, Medicare had a significant impact on the Nation's entire health care system. It is well known now that the price of medical care services spiraled when Medicare was implemented and continued to rise for many years to come. In response, a number of activities were begun, including research and experiments in new payment mechanisms, and the testing of second-opinion programs for elective surgeries.
What were the most significant changes in Medicare in the first two decades?
Among the most notable utilization patterns during the first two decades were those relating to hospital admissions and home health agency (HHA) services. Hospital admission rates continued to increase yearly for both the aged and disabled (but this trend would be dramatically altered when the Medicare hospital prospective payment system went into effect), and HHA service use increased sharply. Treatment patterns for persons with ESRD changed substantially with Medicare entitlement. Before Medicare, about 40 percent were dialyzing at home, but this figure fell to 9 percent by 1979. The development of immunosuppressant drugs increased the success of kidney transplantation, and the number of transplants paid for by Medicare in 1984 was more than double the number in 1974. During the first two decades, the rate of growth of benefit payments for Part A and Part B far exceeded inflation in the general economy.
What is the second group of Medicare beneficiaries?
The second group made eligible for Medicare by the 1972 amendments was persons suffering from ESRD who were receiving kidney dialysis for 3 months or who required immediate kidney transplantation. ESRD enrollees are not required to meet the same coverage criteria as the disabled group; however, eligibility as an ESRD patient requires meeting the basic Social Security coverage criteria, that is, being in the current or fully insured status. Persons with ESRD were seen as having a life-threatening illness that entailed catastrophically high costs for survival.
How many people were on Medicare in 1984?
Our accounting of 20 years of Medicare concentrated on the experience of the aged, the disabled, and ESRD enrollees. HI enrollment had risen from 19.1 million elderly in 1966 to nearly 30 million persons by 1984—more than 27 million elderly and nearly 3 million disabled persons. In 1984 those entering Medicare at age 65 could expect to live an additional 16.8 years, compared with 14.6 additional years for their counterparts in 1965. The ESRD enrolled population increased from 16,000 persons in 1974 to nearly 82,000 persons in 1983. The economic status of the elderly had improved substantially since Medicare began. In 1966, 29 percent of the elderly had incomes at or below the poverty level, while in 1984 the figure had fallen to 12 percent.
What was the Medicare charge system in 1989?
The charge-based system for paying physicians was replaced by a Medicare fee schedule, a resource-based relative value system . Moreover, limits were established on the amount that physicians' charges could exceed the fee schedule amount OBRA 1989 also instituted target rates of growth in expenditures for physician services.
What was the second decade of Medicare?
During Medicare's second decade, numerous activities were underway to stem the excess growth in health care spending, including the implementation of the professional standards review organization (PSRO) program, later to be replaced by the peer review organization (PRO) program, the institution of a network of health system agencies (HSAs) to oversee areawide health planning, and the encouragement of the growth of health maintenance organizations (HMOs). Some of these approaches were judged to be ineffective or inconclusive in controlling the escalation in health care spending. Noteworthy among all these efforts was the establishment in the 1983 amendment to the Social Security Act of the Medicare hospital prospective payment system (PPS). There was general agreement that Medicare's physician payment method also needed to be changed, and a number of possible reform alternatives were studied. The solvency of the Part A trust fund was becoming a growing concern. By the end of Medicare's second decade, the ratio of workers to Social Security aged and disabled cash beneficiaries had declined from 4.0 to 1 in 1965 to 3.3 to 1 in 1985, and the trend in this ratio would continue downward.
What was the first year of Medicare?
In 1967, the first full year of Medicare, employees and employers each contributed a payroll tax of 0.5 percent to the HI trust fund, on a maximum taxable wage base of $6,600. Over time the HI tax rate and wage base were increased to keep the Medicare program solvent; beginning in 1994 the Medicare tax was required on total wages. For 1996 employees and employers each paid a 1.45-percent tax on wages; self-employed people paid 2.9 percent. The taxes contributed by current workers and employers are earmarked for the HI trust fund and are used to pay for services received by current Medicare beneficiaries—a system known as “pay as you go.” The HI trust fund maintains a balance that is drawn upon when expenditures exceed revenues. The principal and earned interest in conjunction with estimates of future contributions and outlays are the factors used in projecting the solvency of the HI trust fund.
How does the Affordable Care Act help seniors?
The Affordable Care Act (ACA), signed into law on March 23, 2010, aims to provide greater access to health care coverage, improve the quality of services delivered and reduce the rate of increase in health spending. The ACA provides new ways to help hospitals, doctors and other health care providers ...
How many seniors have ACA preventive services?
Seniors can also get an annual wellness visit so they can talk to their doctor about any health concerns. Because of the ACA, over 39 million seniors have received at least one of these preventive services with no out-of-pocket costs.
How much has Medicare saved on prescription drugs?
Since passage of the ACA, more than 10.7 million people with Medicare saved over $20.8 billion on prescription drugs. The ACA reduces prescription drug prices for seniors and closes the coverage gap, known as the “donut hole.” Medicare beneficiaries who fall into the coverage gap, known as the “donut hole,” automatically receive a discount on prescription drugs. Each year, beneficiaries pay a reduced cost for brand name and generic drugs in the coverage gap. The law closes the coverage gap in 2020.
What is the Medicare donut hole?
Medicare beneficiaries who fall into the coverage gap, known as the “donut hole,” automatically receive a discount on prescription drugs. Each year, beneficiaries pay a reduced cost for brand name and generic drugs in the coverage gap. The law closes the coverage gap in 2020. In 2016, Medicare beneficiaries in the donut hole receive ...
What is the ACA?
Medicare Fraud, Waste and Abuse. The ACA includes new resources and tools to protect taxpayer dollars by preventing fraud in Medicare and Medicaid by building on the efforts of the Department of Health and Human Services and the Justice Department.
How much has the government recovered from Medicare fraud?
Over the past three years, the government recovered over $10.7 billion from individuals and companies seeking fraudulent payments. There are also tougher penalties for people who steal from Medicare and more law enforcement to identify criminals abusing the law and beneficiaries.
What was the Medicare premium in 2016?
In 2016, the Medicare Part B premium is $104.90 and the Part B annual deductible is $166. The premium is $121.80 (or higher depending on your income) for individuals who enroll in Part B for the first time in 2016, don’t get Social Security benefits or are directly billed for Part B premiums.