Medicare is a federal health insurance plan for people who are 65 years old and older. It is also offered to people under 65 years old who have consecutively received disability for at least 24 months, have Lou Gehrig's disease, and have end stage of renal disease (Jackson, 2016). Within Medicare there are 4 different parts; Part A, Part B, Part C, and Part D. Part A and B are both known as Original Medicare. Part A is hospital insurance which covers hospital stays, nursing facilities, hospice and home health care. Part B is medical insurance which covers doctors services, outpatient care, screenings and surgical fees, and occupational and physical therapy (WellCare, n.d.). Part D covers prescription drug costs, while also helping to lower the cost of medications. Lastly, Part C is a combination of Parts A, B, and D. Part C is known as Medicare Advantage (WellCare, n.d.). Medicare is responsible for consuming over ⅕ of the national health expenditures (Shi & Singh, 2015). In the United States, some individuals believe the Medicare age should be opened to those between 55 and 65 years of age with higher premiums but no pre-existing exclusions or upcharge for these conditions, while others think this could have several negative outcomes.
People who need insurance when they reach 65 years old or older are the majority of the beneficiaries that Medicare serves, but some of these people choose private insurances. There has been many proven reasons as to why Medicare is better than private insurance. People who receive medicare are more likely to report being satisfied with their care compared to those with private insurance (Doty, Schoen, & Davis, 2001). By having Medicare, you have a wider range of choices when it comes to picking physicians and less restrictions on care. Many care plans, such as those in private insurance, require prior approval before having specialty services done. According to Doty et al. (2001), 22% of privately insured people found that their plan did not pay for care that they thought was included in their package. The 22% thought they were paying for something that they truly were not and, therefore, had to pay out of pocket for specific care. Also, 9% of privately insured people have a hard time getting a referral to a specialist compared to only 2% of Medicare beneficiaries (Doty et al., 2001). People under Medicare are more likely to feel confident with their care. People from 55-65 years old should be able to receive Medicare because is publicly accountable, unlike private insurance plans (Archer, 2011). Medicare is more reliable and has controlled their costs better than private insurances. Medicare spending only rose by an average of 4.3 each year between 1997-2009 compared to private insurance which grew 6.5 every year (Archer, 2011). If private insurance is not giving people between this age group the care they need, then Medicare should be given to them at a price.
There are even more reasons why Medicare should be opened for those between 55 and 65. People in this age range have very limited options for health insurance, if they don’t have it through their job. It is likely that there are many people in this group that are ready to retire, but the fear of not being able to afford or find quality health insurance is keeping them from doing so. If Medicare were available to them, it would reduce their anxiety and tensions tenfold. It may also be a cheaper option for them, as private insurance companies are allowed to charge them three times more than their younger counterparts (HealthCare.gov, n.d.). As long as the higher premiums they would pay for Medicare do not exceed that amount, they would be saving money. Furthermore, if this age group was granted access to Medicare, they would be removed from the private health insurance sector. In turn, this could reduce the premiums and costs for those less than 55 years old (Bodenheimer, 2017). This is due to the fact that this age group is the most expensive group to insure for private insurances, since they are the oldest and are the most likely to need the most care (Bodenheimer, 2017). Finally, research has shown that people in this age group who don’t have insurance are usually sicker than those who do once they reach 65 years of age (Smolka & Thomas, 2009). Following this line of thinking, allowing everyone to join Medicare at 55 could reduce the health expenses for people later on down the road. This is due to the fact that people would have access to preventative care earlier in their lives, which could improve their overall health before their illnesses become life threatening.
Preventative care model’s are booming in the insurance industry, in hopes that by taking proper action, patients can prevent diseases before they become serious. Things such as preventative screenings, health education, and vaccinations all contribute to preventative care (CDC, 2017). Medicare has participated in some of these incentives in some states. The Center for Disease Control has even published research regarding the benefits of preventative health for adults aged 50 to 64 (CDC, 2017). There is a focus specifically on the changes of life that come with aging from midlife adults becoming seniors. Those in this age group who have low incomes are at an even higher risk for chronic disease and other health issues due to a lack of access to preventative care (CDC, 2017). Making Medicare available to this age group could greatly benefit those who cannot afford care, while simultaneously providing preventative care to those most at risk. While preventative measure are important, implementing education services for self-management of chronic conditions could also be beneficial to reducing costs. The Self-Resource Management Center offers programs to those suffering from chronic conditions as well as their caregivers (Self Management Resource Center, 2018). Programs in this sense could address issues that could potentially prevent visits to the emergency room or even reduce the need for other care. This could be extremely beneficial with those who would become covered with pre-existing conditions by possibly addressing any concern of costs of their care.
Even though there could be many positive outcomes from decreasing the Medicare age to 55, there are also some important negative effects to take into consideration. Certain parts of Medicare are funded by payroll taxes, which means a certain amount of every citizen’s paycheck would go towards funding the Medicare program. If the government lowered the Medicare age to 55 with higher premiums, they would still have to implement higher payroll taxes in order to fund the new population of Medicare users. Another huge downfall to Medicare is how much the government spends on the program each year. According to an article, the United States government spent approximately $588 billion on Medicare spending in 2016 alone (Health Markets, 2017). If the age of Medicare decreases to age 55, the government would have to spend more money on top of this already huge cost. As a result, other government-funded programs would suffer such as reducing poverty, education, and other extremely valuable programs.
The government will incur extremely high expenses by lowering the eligibility age for Medicare. For the past year, members of our federal government have supported actions to decrease the budget for spending on Medicare (Itkowitz, 2018). The government does not want to spend as much money as it currently does on Medicare and Medicaid, but these programs are valued by the citizens that take advantage of them. Some of the changes that are being made to the current system will benefit the Medicare recipients, however the cost will be placed on the government and the taxpayers. One of the most major changes in Medicare that we have seen in the past year is the changes to Medicare’s Part D. These changes were made to reduce the cost of Part D, along with the costs of medication. “Consumers who have spent a lot on drugs and have entered the so-called catastrophic phase of Part D plans will pay no more than a few dollars for each prescription or, for costly drugs, no more than 5 percent of the cost of the drug” (Moeller, 2018). This is extremely beneficial for all recipients, however 95% of the cost for these expensive drugs will be placed on the government. Congress has also created a Medicare Advantage plan in which creates payment plans for long term care expenses (Moeller, 2018). By lowering the age of eligibility for Medicare, the government will have to put more money into the program, money, which comes from the taxpayers.
The debate of whether the 55-64 year old population should be considered for full coverage of Medicare or not is an ongoing conversation that leading health care professionals need to be having. After the research our group has collected, it is apparent that the care of this age population is an issue that must be addressed. Health care professionals must continue to work along with government officials with a common goal of providing the citizens of the United States with the best solution that is both economically and ethically sound.