This article was updated on October 13, 2020.
Are you spending crazy money on your prescription medications? Are you going cross-eyed from the number of medical bills you have? Joe Biden’s healthcare plan might be a good thing for you and your family. Biden wants to make some huge moves in the healthcare of this country. Biden’s Medicare proposal is part of his campaign’s pledge to build on the Affordable Care Act. Let’s break it down.
‘Medicare at 60’
Biden wants to lower the eligibility age for Medicare to 60 from 65, with optional enrollment in that five-year period. Under the current law, people generally become eligible for Medicare on their 65th birthday.
Public health insurance option
Biden wants to create a public health insurance option and expand access to coverage through the health-care exchanges.
Lower prescription drug costs
The plan is to reduce what Medicare beneficiaries pay for prescription drugs. This would require changing the current law that does not allow the government to negotiate prescription prices.
The Congressional Budget Office has estimated such a move would save $456 billion from 2023 through 2029.
Biden also would prohibit most drug prices from rising faster than inflation. This would mean placing a cap on out-of-pocket spending in Medicare Part D prescription drug coverage and allowing consumers to import prescriptions from countries such as Canada.
Biden also wants Medicare to extend the coverage of dental, vision, and hearing. These are all currently excluded from Medicare but can be obtained by a Medicare Advantage Plan. Biden would like to see it all be encompassed in one place.
Healthcare insurers prepare for change
Insurers released their expansions in new regions ahead of the annual open enrollment period when seniors eligible for Medicare can choose new benefits or stay with their existing plans. These changes can be made during Medicare’s open enrollment, which runs Oct. 15 through Dec. 7.
Every state in the U.S. offers Medicare Advantage and choices of plans are soaring with practically every major plan offering options that include “$0 Medicare Advantage 2021 premiums.”
Among those that have already announced their Medicare Advantage expansions include Cigna, Humana, UnitedHealth Group, and newer companies like Alignment Healthcare, which said last week it is offering 36 Medicare Advantage options in three states.
These established health plans and startups are looking to take advantage of new rules that allow Medicare Advantage plans to offer more benefits to seniors. Insurers are adding broader coverage of telehealth and ways to address social determinants of health that provide low cost and $0 coverage of several different benefits.
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What does Kamala Harris bring to the Medicare table?
After Biden announced his VP, Kamala Harris, people wondered about the thought process behind his decision. In picking Harris, who is 55 years old, Biden has been intentional by choosing a woman who can speak to the target market of the Medicare proposal, which are men and women and minorities in particular. In addition, other groups who have suffered greatly during this economic crisis, such as those also in their mid to late 50s and early 60s who have lost their jobs during the pandemic of those who have been unable to get subsidies to buy individual coverage under the Affordable Care Act, are audiences for which Harris is able to advocate. And given the pandemic and the particularly harsh impact, the coronavirus strain Covid-19 has had on Black Americans, Harris’ selection could be a bonus for Biden.
Understanding the current Medicare program
Here’s how Medicare currently works.
- Medicare has never been free. You qualify for Medicare as long as you have at least a 10-year work history of paying into the program.
- Part A (hospital coverage) has no premiums.
- Part B (outpatient care) does have premiums. Note: Higher earners pay more.
- Part D (prescription drug) has premiums as well.
- Medicare’s Part B and Part D are heavily funded by premiums and general revenue (not the current struggling Medicare trust fund).
- There are additional costs, such as deductibles and copays.
- Many beneficiaries use private insurance companies for Medicare Advantage Plans, or Medigap, policies for personalized coverage.
The election outcome will dictate U.S.’s healthcare
The Medicare trust fund’s solvency is the main concern of experts today, in regards to who takes office in November.
“If they are going to do something with health care, I’d start with saving Medicare Part A,” said Marc Goldwein, senior vice president of policy at the Committee for a Responsible Federal Budget.
“It’s not entirely clear how a full dismantling of the ACA would impact Medicare,” said Tricia Neuman, executive director of the Medicare policy program at the Kaiser Family Foundation. “But there’s a real risk that it would increase costs for seniors, be highly disruptive for health-care providers and exacerbate solvency challenges facing the Medicare Part A trust fund.”
“That will require Congress and the next president to step in and make sure Medicare is able to meet its future obligations,” said Neuman.
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