Health Care Reform: What It Currently Means for You and Your Aging Parents
Are you a baby boomer caring for one or both of your parents? Is one parent requiring more support than the other? Are you concerned about how they will pay for their continued health care? Are you wondering what health care reform is doing for them? You may want to take a look at our health care reform Q & A as it applies to older Americans.
Health Care Reform Q & A: Older Americans
Updated 12-17-09
Are you caring for a parent even though their spouse is healthy? Are you concerned about how they will continue to pay for their care?
Currently, levels of Medicaid protection fluctuate for spouses depending on their health status. Under both the House and Senate versions of health care reform, there are protections against “spousal impoverishment” for those with spouses entering nursing facilities.
What about the $500 billion dollars in “cuts” or “savings” to Medicare?
There has been a great deal of information and misinformation about the billions to be saved from Medicare that many fear are just cuts. The honest answer is that there are a few cuts – these are primarily focused on Medicare home and community based services.
Can older Americans receive care in their own homes? Even if they don’t have any money and are eligible for nursing facility care?
For Medicare eligible seniors who qualify for nursing home care, there are services for those who wish to remain in their homes and at outpatient care facilities. The new reform measures will require better follow-up from doctors to reduce hospitalizations and infections.
For Medicaid eligible seniors that qualify for nursing home care, there are a great many programs that would allow you to stay at home. These include programs that would help states pay for more home and community based care, providing more opportunities for both seniors and disabled to have more choice and maintain their independence.
Is there insurance to cover long-term care costs for older Americans?
If passed into law, there will be a five-year vesting period (much like a pension) during which premiums of about $50 a month are paid into an public insurance plan. Once vested and assesses with two activities of daily living (ADLs) for which assistance is needed, individuals qualify for payment of $50 to $75 a day to direct care and help offset the great cost of long-term care.
What about supplemental or Medicare Advantage Plans?
Senior citizens get a good deal from Medicare, the government's health insurance program for senior citizens. The average senior gets far more in benefits out of this government program than he or she ever pays in. Someone retiring in 2008 would have paid, on average, $30,650 in Medicare taxes during his or her working years; yet, will most likely receive on average $85,360 in hospitalization benefits.
Medicare Advantage Plans provide service through a set group of doctors, just as some traditional insurer plans do. In addition, the U.S. Government Accountability Office has noted that many Advantage seniors quite often pay higher co-payments when hospitalized. Simply put, taxpayers are giving an extra $1,166 a year for each Medicare Advantage enrollee’s health care. The new health care reform would scale back the subsidies, using a funding formula to put Medicare Advantage Plans equal to traditional Medicare.
What about prescription drug plans?
Currently, Medicare beneficiaries only receive coverage for up to $2,700 worth of prescription drugs. Once this limit is reached, beneficiaries are expected to pay for prescribed drug expenses until the sum of $6,154 is reached. At that time, Medicare prescription coverage begins again. This gap is often referred to as the “doughnut hole.”
The health care reform bill passed last month in the House of Representatives fully closes the “doughnut hole,” but the Senate, worried about the cost of its health care bill, only partially filled the gap in its bill. Should the Senate and the House merge their two bills, this gap will be filled and the current burden for seniors using prescription drugs will be eased.